Professional non-neutrality: criticising the third party in psychotherapy

Using audio-recorded data from cognitive-constructivist psychotherapy, the article shows a particular institutional context in which successful professional action does not adhere to the pattern of affective neutrality which Parsons saw as an inherent component of medicine and psychotherapy. In our data, the professional’s non-neutrality functions as a tool for achieving institutional goals. The analysis focuses on the psychotherapist’s actions that convey a critical stance towards a third party with whom the patient has experienced problems. The data analysis revealed two practices of this kind of critique: (1) the therapist can confirm the critique that the patient has expressed or (2) return to the critique from which the patient has focused away. These actions are shown to build grounds for the therapist’s further actions that challenge the patient’s dysfunctional beliefs. The article suggests that in the case of psychotherapy, actions that as such might be seen as apparent lapses from the neutral professional role can in their specific context perform the task of the institution at hand.

Emotional experience in psychotherapeutic interaction : Conversation analytical study on cognitive psychotherapy

The dissertation examines how emotional experiences are oriented to in the details of psychotherapeutic interaction. The data (57 audio recorded sessions) come from one therapist-patient dyad in cognitive psychotherapy. Conversation analysis is used as method. The dissertation consists of 4 original articles and a summary. The analyses explicate the therapist s practices of responding to the patient s affective expressions. Different types of affiliating responses are identified. It is shown that the affiliating responses are combined with, or build grounds for, more interpretive and challenging actions. The study also includes a case study of a session with strong misalignment between the therapist s and patient s orientations, showing how this misalignment is managed by the therapist. Moreover, through a longitudinal analysis of the transformation of a sequence type, the study suggests that therapeutic change processes can be located to sequential relations of actions. The practices found in this study are compared to earlier research on everyday talk and on medical encounters. It is suggested that in psychotherapeutic interaction, the generic norms of interaction considering affiliation and epistemic access, are modified for the purposes of therapeutic work. The study also shows that the practices of responding to emotional experience in psychotherapy can deviate from the everyday practices of affiliation. The results of the study are also discussed in terms of concepts arising from clinical theory. These include empathy, validation of emotion, therapeutic alliance, interpretation, challenging beliefs, and therapeutic change. The therapist s approach described in this study involves practical integration of different clinical theories. In general terms, the study suggests that in the details of interaction, psychotherapy recurrently performs a dual task of empathy and challenging in relation to the patient s ways of describing their experiences. Methodologically, the study discusses the problem of identifying actions in conversation analysis of psychotherapy and emotional interaction, and the possibility to apply conversation analysis in the study of therapeutic change.

Therapeutic change in interaction

A process of change within a single case of cognitive-constructivist therapy is analyzed by means of conversation analysis (CA). The focus is on a process of change in the sequences of interaction, which consist of the therapist’s conclusion and the patient’s response to it. In the conclusions, the therapist investigates and challenges the patient’s tendency to transform her feelings of disappointment and anger into self-blame. Over the course of the therapy, the patient’s responses to these conclusions are recast: from the patient first rejecting the conclusion, to then being ambivalent, and finally to agreeing with the therapist. On the basis of this case study, we suggest that an analysis that focuses on sequences of talk that are interactionally similar offers a sensitive method to investigate the manifestation of therapeutic change. It is suggested that this line of research can complement assimilation analysis and other methods of analyzing changes in a client’s talk.

Conversation analysis and second language pedagogy : a guide for ESL-EFL teachers.

Conversación y expresión oral son elementos fundamentales en el aprendizaje de idiomas. Este texto aumenta la conciencia de los profesores sobre el lenguaje hablado y sugiere formas de aplicar esos conocimientos a la enseñanza de habilidades de interacción de un segundo idioma, basado en las percepciones del análisis de la conversación. Presenta reseñas de los conceptos clave de análisis de la conversación y los resultados, conecta directamente los resultados con la pedagogía de la segunda lengua, presenta un modelo de prácticas interactivas basadas en dichos conceptos, incluye transcripciones de conversaciones reales, tareas para consolidar y ampliar su comprensión, actividades prácticas.

Using conversation analysis for understanding children’s talk about traumatic events

This chapter provides a theoretical overview of literature that uses conversation analysis (CA) to explore children’s interactions related to trauma and associated mental health matters. The relatively new approach of using CA to understand trauma reveals the importance of talk in the process of recovery, and also how the participants co-construct talk about traumatic experiences. The chapter will explore literature using a CA approach to investigate children’s trauma talk with professionals as well as literature specifically discussing children’s talk about their traumatic experiences with people who are not qualified therapists or psychiatrists. We conclude by calling for more research using a CA approach for investigating children’s traumatic experiences due to the insight it provides into each child’s personal sense making of traumatic events with a range of people.

Strategies for water pollution control in Dhaka, Bangladesh: an institutional and economic analysis

This paper presents primary data based on research carried out as part of a large World Bank project. Results from our survey show that water pollution in Dhaka watershed has reached alarming levels and is posing significant threats to health and economic activity, particularly among the poor and vulnerable. Rice productivity in the watershed area, for example, has declined by 40% in recent years and vegetable cultivation in the riverbeds has been severely damaged. We also found significant correlation between water pollution and diseases such as jaundice, diarrhoea and skin problems. It was reported that the cost of treatment of skin diseases for one episode could be as high as 29% of the weekly earnings of poor households. Given the magnitude of the contamination problem, a multi-agent stakeholder approach was necessary to analyse the institutional and economic constraints that would need to be addressed in order to improve environmental management. This approach, in turn, enabled core strategies to be developed. The strategies were better understood around three types of actors in industrial pollution, i.e. (1) principal actors, who contribute directly to industrial pollution; (2) stakeholders, who exacerbate the situation by inaction; and (3) the potential actors in mitigation of water contamination. Within a carrot-and-stick framework, nine strategies leading to the strengthening of environmental management were explored. They aim at improving governance and transparency within public agencies and private industry through the setting up of incentive structures to advance compliance and enforcement of environmental standards. Civil society and the population at large are, on the other hand, encouraged to contribute actively to the mitigation of water pollution by improving the management of environmental information and by raising public awareness.

Reflections of professional practice: using electronic discourse analysis networks (EDANs) to examine embedded business emails

Emails have become a central genre in business communication, reflecting both how people communicate and how they go about their professional practices. This chapter examines embedded business emails as reflections of the professional practices of the regulatory and policy department of a multinational based in London, UK. It argues that the nature of online communication in international organisations, with its high levels of intertextuality and interdiscursivity, requires multidimensional analytical approaches that are capable of capturing its complexity and dynamics. To this end, the chapter introduces electronic discourse analysis networks (EDANs) as one example of such approaches. It begins with a brief review of the literature that has informed the study reported on here before it discusses EDANs as its analytical framework. Using a group of embedded emails and a number of networked data sets, the chapter shows how EDANs can be used to further our understanding of professional online communication.

Impact of age and comorbidities on long-term survival of patients with high-risk prostate cancer treated with radical prostatectomy: a multi-institutional competing-risks analysis

Survival after surgical treatment using competing-risk analysis has been previously examined in patients with prostate cancer (PCa). However, the combined effect of age and comorbidities has not been assessed in patients with high-risk PCa who might have heterogeneous rates of competing mortality despite the presence of aggressive disease.