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How treatment conditions shape therapist formulations

(2018)
Author
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Abstract
This study used Conversation Analysis to examine the way in which psychotherapists reformulate depressive patients’ talk during individual therapy sessions, and whether differences between schools of psychotherapy manifest in the practices that accomplish these (re-)formulations. As previous research has shown, formulations can do fixative work in larger conversational undertakings, demonstrate understanding and render conversations preservable and reportable (Heritage & Watson, 1979). Prior talk is reproduced and thereby undergoes some degree of transformation (Antaki, 2008). The reformulated version may also propose a different or selective focus on the aforementioned (Deppermann, 2011). Formulations extract and make relevant aspects of preceding talk, explicate implicit or missing elements and therefore allow therapists to explore their therapeutic meaning or implication (Weiste & Peräkylä, 2013). As the results show, therapists from different schools of psychotherapy hereby take varying approaches. To investigate the differential use of formulations by different therapeutic approaches, qualitative data (audiotapes of therapy sessions) of the Ghent Psychotherapy Study (Meganck et al., 2017) were analysed retrospectively. This Randomized Controlled Trial focussed on interactions between depressive patients’ personality types (anaclitic versus introjective) and psychotherapy type (PDT versus CBT). Both types of patients were randomly allocated to receive either supportive-expressive psychodynamic (PDT) or cognitive-behavioural (CBT) therapy treatment. PDT is primarily explorative in nature, uses no pre-structured therapy plan, and stresses the importance of patients gaining insight into unconscious thoughts, motivations and their meaning. CBT, on the contrary, is more directive in nature, follows a rather strict treatment protocol, and focuses more on the symptoms that patients experience in the here and now, and takes a practical and hands-on approach. Formulations find themselves at the intersection between patient talk and therapist interventions, or as Ferrera (1994) states: “If insight is the ability to see inside, then therapists’ formulations are models of insight for clients” (p. 111). Our analysis identified different types of reformulating practices, which we clustered into two more general groups: non-transformative and transformative reconstructions. It was argued that non-transformative and transformative reformulating practices have common features, yet differ in regard to projected response type and alignment with respective treatment style. Non-transformative practices, such as (partial) repetitions and quotative expressions, are in line with a psychoanalytic therapy approach. This form of mirroring highlights and makes relevant a key aspect of patient talk that is worth expanding (Fink, 2007), and serves locally as an indirect request for elaboration (Ferrera, 1994). Quotative expressions are also used as means to topic management, readdressing matters that came up earlier on. In PDT, reconstructions largely consisted of these non-transformative practices and of transformative specifications. CBT reconstructions, on the contrary, predominantly consisted of marked, transformative practices that confront patient with explicit inferences. Finally, this study also reports on differences in the display of affiliation and alignment in the responding actions to therapist reconstructions.

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MLA
Knol, Antje Sien Lisanne, et al. How Treatment Conditions Shape Therapist Formulations. 2018.
APA
Knol, A. S. L., Huiskes, M., Koole, T., & Desmet, M. (2018). How treatment conditions shape therapist formulations. Presented at the AWIA symposium, Nijmegen, Netherlands.
Chicago author-date
Knol, Antje Sien Lisanne, Mike Huiskes, Tom Koole, and Mattias Desmet. 2018. “How Treatment Conditions Shape Therapist Formulations.” In .
Chicago author-date (all authors)
Knol, Antje Sien Lisanne, Mike Huiskes, Tom Koole, and Mattias Desmet. 2018. “How Treatment Conditions Shape Therapist Formulations.” In .
Vancouver
1.
Knol ASL, Huiskes M, Koole T, Desmet M. How treatment conditions shape therapist formulations. In 2018.
IEEE
[1]
A. S. L. Knol, M. Huiskes, T. Koole, and M. Desmet, “How treatment conditions shape therapist formulations,” presented at the AWIA symposium, Nijmegen, Netherlands, 2018.
@inproceedings{8611039,
  abstract     = {This study used Conversation Analysis to examine the way in which psychotherapists reformulate depressive patients’ talk during individual therapy sessions, and whether differences between schools of psychotherapy manifest in the practices that accomplish these (re-)formulations. As previous research has shown, formulations can do fixative work in larger conversational undertakings, demonstrate understanding and render conversations preservable and reportable (Heritage & Watson, 1979). Prior talk is reproduced and thereby undergoes some degree of transformation (Antaki, 2008). The reformulated version may also propose a different or selective focus on the aforementioned (Deppermann, 2011). Formulations extract and make relevant aspects of preceding talk, explicate implicit or missing elements and therefore allow therapists to explore their therapeutic meaning or implication (Weiste & Peräkylä, 2013). As the results show, therapists from different schools of psychotherapy hereby take varying approaches. 

To investigate the differential use of formulations by different therapeutic approaches, qualitative data (audiotapes of therapy sessions) of the Ghent Psychotherapy Study (Meganck et al., 2017) were analysed retrospectively. This Randomized Controlled Trial focussed on interactions between depressive patients’ personality types (anaclitic versus introjective) and psychotherapy type (PDT versus CBT). Both types of patients were randomly allocated to receive either supportive-expressive psychodynamic (PDT) or cognitive-behavioural (CBT) therapy treatment. PDT is primarily explorative in nature, uses no pre-structured therapy plan, and stresses the importance of patients gaining insight into unconscious thoughts, motivations and their meaning. CBT, on the contrary, is more directive in nature, follows a rather strict treatment protocol, and focuses more on the symptoms that patients experience in the here and now, and takes a practical and hands-on approach. 

Formulations find themselves at the intersection between patient talk and therapist interventions, or as Ferrera (1994) states: “If insight is the ability to see inside, then therapists’ formulations are models of insight for clients” (p. 111). Our analysis identified different types of reformulating practices, which we clustered into two more general groups: non-transformative and transformative reconstructions. It was argued that non-transformative and transformative reformulating practices have common features, yet differ in regard to projected response type and alignment with respective treatment style. Non-transformative practices, such as (partial) repetitions and quotative expressions, are in line with a psychoanalytic therapy approach. This form of mirroring highlights and makes relevant a key aspect of patient talk that is worth expanding (Fink, 2007), and serves locally as an indirect request for elaboration (Ferrera, 1994). Quotative expressions are also used as means to topic management, readdressing matters that came up earlier on. In PDT, reconstructions largely consisted of these non-transformative practices and of transformative specifications. CBT reconstructions, on the contrary, predominantly consisted of marked, transformative practices that confront patient with explicit inferences. Finally, this study also reports on differences in the display of affiliation and alignment in the responding actions to therapist reconstructions.},
  author       = {Knol, Antje Sien Lisanne and Huiskes, Mike and Koole, Tom and Desmet, Mattias},
  language     = {und},
  location     = {Nijmegen, Netherlands},
  title        = {How treatment conditions shape therapist formulations},
  url          = {http://anela.nl/en/activiteiten/awia-symposium/},
  year         = {2018},
}