The primary assumption behind conversational analysis is that human interaction follows an organized pattern, one where each participant uses specific methods to communicate meaning, leading to a turn-taking process that achieves a specific goal (Atkinson & Heritage, 1984). The researcher uses audio or video recordings of naturally occurring (non-experimental) interactions to reveal patterns in the sequential features of conversation. Strong, Busch and Couture (2008) advocate for conversational evidence, using methods for evaluation of what therapists do when it works. They distinguish between big ‘O’ outcomes (‘are we there yet?’) and little ‘o’ outcomes (‘are we on the right track?’), a process that implies collaboration based on the therapeutic relationship and the movement towards mutually agreed goals. It is important here to differentiate between conversational analysis and discourse analysis, with the former more concerned with the practical uses of language and the latter more closely aligned with a postmodernist critique of logical positivism (Avdi, 2008). Proponents of discourse analysis are concerned with a fundamental critique of modern psychology and its claims to empirical truths (Parker, 1989, 1992). The field of psychology and the products of research are seen as a series of stories about the human condition, rather than the study of universal truths. Conversational analysis fits more with the apolitical ethos of clinical psychology, concerned with understanding linguistic repertoires. While there is increasing rapprochement between the two disciplines (Woofit, 2005), discourse analysis is concerned more with the deconstruction of talk as rhetoric, exposing societal inequality.
Conversational analysis has been used across the helping professions to explore interactions between professionals and clients. The focus of studies includes the use of psychodynamic interpretations (Perakyla, 2004), how to give advice while maintaining a collaborative therapeutic relationship (Couture, 2006), how to build alliances between family members (Sutherland & Couture, 2007) and how to explain medical illnesses to patients (Heritage & Maynard, 2006).
Perakyla’s (2004) study of psychodynamic interpretations demonstrates the potential contribution that conversational analysis can make to our understanding of therapy. The practice focus of this method is particularly relevant for psychoanalysis, which is sometimes presented as esoteric and idealized in the literature. Interpretations in psychoanalysis are statements made by the therapist to attribute a current phenomenon, such as a symptom, a dream or an event in the therapy room, to some greater meaning, including to the patient’s childhood (Rycroft, 1995). In traditional descriptions the analyst is portrayed as neutral and distant, a reflective and intuitive person whose interpretations are among the few statements made in therapy.
Perakyla’s (2004) analysed 60 sessions conducted by two analysts with three clients, looking specifically at this technique,and discovered that the interpretation resulted from a long series of collaborative conversationsbetween client and therapist, as the end product of a process of drawing parallels between the different domains of the client’s life through language. This is a promising finding, one that supports the demystification of this modality and provides practical guidance to clinicians. Sutherland and Strong (2011) explore how collaboration works in couple therapy. Collaboration between therapist and client, as opposed to advice-giving or an expert position, has long been the hallmark of constructionist couple and family therapies (Anderson, 2001; Hoffmann, 1985; Tomm, 1987). In particular their research explores the question of how the therapist negotiates a participatory relationship with clients while still stimulating change. The micro-analysis reveals a number of specific practices used by the therapist, not to impose new ideas onto the couple regarding their interactions, but to carefully offer them in a way that supports the reciprocal development of new perspectives. New formulations concerning the couple’s interactions are introduced as proposals or ‘candidate answers’ rather than established formulations. This is achieved through a wide variety of techniques including the use of yes/no questions rather than statements, the use of uncertainty markers at the end of statements (‘“I guess’) and the modification or downgrading of new ideas if the clients express hesitancy in their responses.
Close investigation of therapeutic conversations have important clinical applications. They demonstrate how therapeutic techniques are actually applied within the dynamic of interactions with a client, supporting the real-world education of professional psychologists. This knowledge differs significantly from that of the treatment manual, revealing some of the art of therapy, sensitizing clinicians to the subtleties of effective interactions with their clients. They provide a means by which students and clinicians can discover what therapy really looks like, not a didactic phenomenon, but one that requires significant interpersonal skill.