Pragmatik der Veränderung. Группа авторов

(cf. Sarangi 2019).

      Kazdin (2009: 419) states that despite “rather vast literature, there is little empirical research to provide an evidence-based explanation of precisely why treatment works and how the changes come about.” Elliott (2012: 76) underlines that truly evidence-based practice “should be based on multiple lines of CPR evidence” thus, for example, combining various sources of data to arrive at a better understanding of how client change occurs. This seems to be of pivotal importance as the majority of studies still rely on one set of data and consequently neglect other crucial insights in explaining the process of change.

      To sum up, studying client change in psychotherapy poses a methodological and analytical challenge and “certainly not an easy path on which to embark” (Kazdin 2009: 428). The complexity however, needs to be properly addressed by the researcher on every stage of research process (see Sarangi 2019).

      Discourse analysis and analyzing client change

      Elliott (2012: 70) encourages more qualitative work in CPR by emphasizing that discourse analytic approaches have been so far “under-utilized”. Since the CPR’s focus is also on how change occurs, the broad DA perspective should be of particular relevance. After all:

      While clients process internally their experiences and content of mind in and between the sessions, what prompts and maintains this processing is the interaction between the client and the therapist, the therapeutic relationship (Voutilainen and Peräkylä forthcoming).

      CA, as one of the approaches within DA and a method of engaging with data, identifies the sequential organization and interactional functions of certain practices that in the local interactional context enable the client to approach a certain issue in a transformed manner. In the context of psychotherapy, CA helps to examine “what sort of features in the therapist’s turns would guide the patient to respond in a particular way, and vice versa” (Voutilainen et al. 2010a: 300).

      The broad framework of discourse analysis (DA) and in particular conversation analysis (CA) has successfully addressed and identified various interactional phenomena transpiring in the therapeutic interaction as summarized by Peräkylä (2013), e.g., formulations of the client’s prior talk (Antaki 2008; Antaki et al. 2005; Buttny 1996; Davis 1986; Hutchby 2005; Peräkylä 2004; Vehviläinen 2003; Weiste et al. 2016), (re-)interpretations and responses to them (Peräkylä 2004; Bercelli et al. 2008), relational aspects such as resistance (Muntigl 2013), affiliation (Bercelli et al. 2008) and affect/emotion (Voutilainen et al. 2010b; Pawelczyk 2011; Voutilainen 2012; Muntigl et al. 2014).

      The CA-oriented research started addressing the issue of client change, see e.g., Muntigl and Horvath (2005), Voutilainen et al. (2011), Muntigl (2013), Voutilainen et al. (2018). In particular I would like to single out two studies that have employed the methods of conversation analysis in researching client change, i.e., a study by Voutilainen et al. (2011) and by Viklund et al. (2010).

      Voutilainen and colleagues (2011) focused on sequences of talk that were interactionally similar, i.e., clients’ responses to the therapist’s conclusions. The novelty of the analysis lies in adopting the longitudinal perspective in approaching the clients’ responses as evolving over time. Thus the focus fell on how the clients’ talk was transformed over the course of therapy from a) their rejection of the therapist’s conclusions, through b) the ambivalent responses to what the therapist offered to c) the clients’ agreement with the therapist’s conclusions. Voutilainen et al.’s (2011) analysis implies quite a linear progression of client change as evidenced in their interactional handling of therapist’s conclusions, i.e., from rejection to acceptance. As discussed above, this smooth trajectory might offer a rather idealistic conceptualization of client change. Nevertheless the methods of conversation analysis allowed Voutilainen et al. (2011) to track the change in the clients’ understanding of their situations as manifested by the responses to the therapist’s conclusions.

      Another study that used the methods of CA but made a step further by combining it with the client-identified significant events is an analysis made by Viklund et al. (2010). The initially client-identified significant moments of their therapies were then analyzed with CA. More specifically interactional structures and practices of these moments were detailed using CA methods. As Viklund et al. (2010: 152) stress:

      a turn-by-turn study of the therapeutic interaction in events that clients find important will offer an opportunity to explore what takes place between client and therapist and how they make sense of it while it is happening.

      The analysis showed that most of the sequences recognized by the clients as significant contained disagreement between them and the therapist. The CA-oriented analysis exposed three different ways the disagreement was dealt with by the therapist. Furthermore, it identified disagreement as marked at the level of interactional details rather than in what the participants were saying verbally. Importantly, however, as Viklund et al. (2010) stress “just because an interaction is structurally organized as a disagreement, it is not necessarily experienced as such” (2010: 162). This comment indicates the need to use another set of data, e.g., the interviews in which the clients would be given space to voice and elaborate on the significance of the singled out parts of their therapies as – in their view- conducive to change. Importantly, Viklund et al.’s (2010) study proves the usefulness of microanalytic methods in identifying structural similarity in clients’ identified significant moments.

      More studies combining the client-identified significant events approach with the CA microanalytic methods are needed to better understand why certain strategies used by therapists are central to client change (see also Gumz et al. 2015). Fine-grained participant perspective-based CA studies seem to offer much potential in explicating how clients change in the process of psychotherapy.

      In what follows I exemplify two ways in which broadly defined discourse analysis can be of use and complementary to the mainstream psychological research (Elliott 2012) in researching and identifying client change.