A Critical Methodological Review of Discourse and Conversation Analysis Studies of Family Therapy

Discourse (DA) and conversation (CA) analysis, two qualitative research methods, have been recently suggested as potentially promising for the study of family therapy due to common epistemological adherences and their potential for an in situ study of therapeutic dialog. However, to date, there is no systematic methodological review of the few existing DA and CA studies of family therapy. This study aims at addressing this lack by critically reviewing published DA and CA studies of family therapy on methodological grounds. Twenty‐eight articles in total are reviewed in relation to certain methodological axes identified in the relevant literature. These include choice of method, framing of research question(s), data/sampling, type of analysis, epistemological perspective, content/type of knowledge claims, and attendance to criteria for good quality practice. It is argued that the reviewed studies show “glimpses” of the methods’ potential for family therapy research despite the identification of certain “shortcomings” regarding their methodological rigor. These include unclearly framed research questions and the predominance of case study designs. They also include inconsistencies between choice of method, stated or unstated epistemological orientations and knowledge claims, and limited attendance to criteria for good quality practice. In conclusion, it is argued that DA and CA can add to the existing quantitative and qualitative methods for family therapy research. They can both offer unique ways for a detailed study of the actual therapeutic dialog, provided that future attempts strive for a methodologically rigorous practice and against their uncritical deployment.     

Conversational perspective of therapeutic outcomes: The importance of preference in the development of discourse

Major theme: Evaluation of therapeutic outcome. Logical development of the theme: We suggest a way for practitioners and researchers to assess if they are on track in conversing towards client preferred goals. We offer a critique of more conventional approaches to studying therapeutic progress, suggesting how a discursive (i.e. focused on interaction and language use) lens can address these limitations. Through this lens we examine therapeutic progress evident in ‘preference work’, where clients demonstrably indicate, imply, agree and disagree with where the therapeutic conversation is heading. Such ‘preference work’ offers a form of evidence of within‐session outcomes in a process of reaching larger client preferred outcomes. Authors’ point of view: We present the results of conversation analysis – a qualitative approach to the study of therapy – to illustrate our discursive perspective on therapy progress and change. Implications: we suggest a way for practitioners to assess if they are on track in conversing towards client preferred goals. We propose that our interactional perspective may significantly contribute to bridging practice and research in therapy.     

Assessing ‘good’ qualitative research in the work psychology field: A narrative analysis

This paper considers how work psychologists define ‘good’ qualitative research in the work psychology domain. In addressing the assessment of quality in work psychology research, we draw on 22 in‐depth interviews with work psychologists about their current practices and expectations around qualitative research. Using narrative analysis, the various plots and narratives that constitute how interviewees understand good qualitative research are identified. The implications of the use of these narratives for both how quality is understood and the use of qualitative research in this area are addressed. Drawing on Weick's concept of sensemaking as a theoretical framework, it is argued that the narratives identified enable the construction of a hegemonic understanding of what is good methodological practice within the work psychology discipline. The implications of this for the work psychology field and the methodological practices of work psychologists are considered.     

CONVERSATION ANALYSIS AND PSYCHOANALYTIC PSYCHOTHERAPY RESEARCH: QUESTIONS,ISSUES, PROBLEMS AND CHALLENGES

Understanding the talk of the ‘talking cure’ remains a central goal of researchers in psychoanalytic psychotherapy. Here, we consider whether conversation analysis (CA) can provide techniques to understand better the conduct of the psychoanalytic therapeutic interaction. Following discussion outlining the participant‐oriented nature of this qualitative methodology we consider reasons for the emergence of CA‐informed studies of psychoanalytic psychotherapy. Amongst other aims, CA focuses on uncovering the process and procedures which make the therapy encounter a distinct form of ‘institutional life’. For psychoanalytically‐oriented researchers, CA can refine their skills of attention and engender sensitivity to understanding material in sessions. Using examples from segments of talk between a training therapist and client we highlight both the advantages of, and constraints on, employing CA as an aid to understanding psychotherapeutic sessions by considering contrasting conceptions of temporality in conversation analysis and psychoanalysis. In the former participants are oriented towards the ongoing production of sequential understandings and local ‘context’ in an unfolding present, in the latter participants aim to enhance the emergence of the remote past into the present of the therapeutic interaction. While recognizing the research benefits of CA methodology concluding comments raise questions regarding the potential complementarity between our dispositions towards the close monitoring of the activity and the feelings of fellow humans.     

Understanding and working with existential information in a Norwegian adolescent psychiatry context: a need and a challenge

This is one of several studies on existential information in psychotherapy in Southern Norway. The aim of this study was to explore how therapists' backgrounds and existential information influence their therapeutic practice and philosophy of care, and the use of existential information in psychotherapy. The method used was qualitative, semi-structured interviews. Through emerging themes from the interviews and clinical case illustrations, information relating to therapists' backgrounds and existential orientations strongly influenced: therapeutic practice, philosophy of care, and if as well as how existential information was used in therapy. Professional and continued education/training in this area were insufficient. However, the area itself was considered essential for understanding clients' psychosocial and sociocultural needs in multicultural Norway. Therapists expressed the importance of communication about existential information. Clinical examples were given that focused on this information's usefulness for identifying strategies addressing both salutogenic and pathogenic aspects of adolescent psychosocial functioning. Clinical educational and training insufficiencies related to working with existential information were noted. Although strategic thinking and organisational framework in the working context permitted existential information to be raised in therapy, many expressed the lacking of methodological confidence and training in this area. Education and training were, therefore, priorities. Accessing this type of information with all clients, whatever their existential information, was emphasised for strengthening the therapeutic alliance.     

Practitioners' accounts of religious and spiritual dimensions in bereavement therapy

This study explores religious and spiritual dimensions in bereavement therapy through in-depth qualitative interviews with 12 therapists for whom bereavement work constituted a major part of their therapeutic role. Information was gathered on the conceptualization of religious and spiritual issues, the perceived influence of therapists' beliefs on their practice and the therapeutic processes that occur in work with religious and spiritual issues. Interpretative Phenomenological Analysis was used to analyse the data, examining associations between these areas as well as highlighting the diversity of experiences and viewpoints. The multi-dimensional role of the therapeutic relationship was highlighted by participants as well as the perceived limitations of many theoretical models of therapy and bereavement in working with religious or spiritual issues. Some therapeutic processes were described in terms of the exploration of belief systems that have been challenged by bereavement and the re-creation of personal meaning. Implications for therapeutic practice and further research are discussed.     

Framework analysis: a worked example of a study exploring young people’s experiences of depression

Framework analysis is an approach to qualitative research that is increasingly used across multiple disciplines, including psychology, social policy, and nursing research. The stages of framework analysis have been described in published work, but the literature is lacking in articles describing how to conduct it in practice, particularly in the field of psychology, where researchers may be working as part of a team. Having used framework analysis on a study exploring adolescents’ experiences of depression, we faced various challenges along the way and learned from experience how to use this approach to qualitative analysis. In this reflective article, we describe a worked example of using framework, which we hope will assist other researchers in deciding if this approach is suitable for their own research, and will provide guidance on how one might go about conducting framework analysis when working as part of a research team. We conclude that framework is a valuable contribution to qualitative methods in psychology, offering a pragmatic, flexible and rigorous approach to data analysis.     

Strengthening the Strengths Perspective

Abstract

This article revisits the strengths perspective as conceptualized in social work practice. Although we find this perspective has value and utility for practitioners, we identify areas where the strengths perspective could be enhanced and augmented by integrating the contemporary relational approach exemplified by Paul Wachtel's cyclical psychodynamics. Specifically, we explore his concepts of therapeutic communication and use of language, including interventions that affirm client strengths such as reframing, searching for variations and exceptions, and reconceptualizing how transference impacts the therapeutic action. We illustrate our view with a case vignette, advocating that Wachtel's integrative approach provides a new context for psychodynamics in current social work practice.     

Wie kann man in der Sozialtherapie Therapieerfolg feststellen oder messen?

The tradition of social therapeutic evaluation research in Germany is as old as the institution of social therapy itself. Social therapeutic facilities constitute the royal road to correctional treatment in the German prison system providing an integrated approach for offender treatment by means of psychotherapy (mainly cognitive-behavioral), vocational and job training, social work and leisure time therapy embedded in a therapeutic community. It was generally expected that evaluation research would prove the effectiveness of this method and generate results for the advancement of offender treatment. However, research results have yielded only moderate findings concerning the effects of social therapeutic interventions. This article considers how the outcome of social therapy and offender treatment is measured. Fundamental methodological challenges that evaluation research has to face are identified. In addition, a short overview of recent results from a longitudinal evaluation study is presented to substantiate the dilemmas and solutions of evaluation research in this field. It is discussed why it is so difficult to provide evidence for effectiveness of correctional treatment and concluded that this can by no means lead to a renunciation of the correctional treatment approach.     

Perceptions of health care social workers in Ontario: challenges and facilitators to reflective practice

Background: Reflective practice in health care social work ensures that social workers provide effective and efficient services to clients as well as maintaining their mental and physical health. In this study, we aim to determine how health care social workers engage in and describe reflective practice and challenges related to their reflective practice in their work in the health care system.

Methods: We used the Reflective Dialogue Rating Scale (RDRS) developed by Marion Bogo et al. to structure qualitative face-to-face interviews with 23 health care social workers employed in a hospital in a large urban area in Ontario, Canada.

Results: Findings illustrated that all participants regularly engaged in reflective practice in order to carry out everyday social work activities, promote ethical practice, and to enhance the provision of services to their clients. The social worker participants consistently agreed that as a profession they faced challenges maintaining their knowledge of current research due to few opportunities for professional development, workload competing with educational opportunities, and a work climate that is not conducive to gaining professional development, thereby challenging reflective practice. Supportive working environments include: peer supervision, safe and private spaces to talk to colleagues, a supportive supervisor, and an overall positive organizational culture.

Discussion and conclusion: Reflective practice is a key component in health care social work. All 23 social workers stated that they used reflective techniques (such as peer supervision and debriefing) to deal with their own reactions and operated in a purposeful and intentional manner to form therapeutic relationships with clients. As such, participants stated that lifelong learning was paramount in providing quality care to clients.     

Therapists’ experiences of alliance formation in short-term counselling

While therapeutic alliance formation has been widely researched over many sessions of psychotherapy, the question of alliance formation in short-term counselling has been less explored. Given the increasing evidence in the literature for the positive impact of alliances on therapy outcomes, providing counsellors – who may work with clients for a limited number of sessions – with enhanced insight into alliance formation will be of value. This qualitative study investigated the experiences of eight counsellors forming alliances with clients over short periods. Semi-structured interviews were analysed using interpretive phenomenological analysis. Five major themes emerged, that while congruent with the alliance literature, add some details relevant to day-to-day practice. These themes included: the importance of strong alliances; the need for psychologically comfortable environments; the timing of alliance formation; and the impact of counsellor personal qualities – such as being real – in strengthening and maintaining alliances. In addition, an unexpected sixth theme revealed that body language was highly valued as an indicator of strong or weak alliances. Implications for increasing the use of body language to enhance counselling practice and education are discussed.     

The self beyond words: comment on ‘Is there a place for individual subjectivity within a social constructionist epistemology’

Roy‐Chowdhury (2010) is on a quest to reclaim the subject in constructionist practice, specifically therapeutic practice. His argument rests on the claim that there is no subject, no self, no individual outside language in social construction. To be sure, the notion of a self‐contained, privately cognizing individual is dismissed within social construction, noting instead that knowledge of self and world is a byproduct of relational interchange. As Lock and Strong (2010 , p.7) put it, ‘meaning and understanding have their beginnings in social interaction, in shared agreements as to what these symbolic forms are to be taken to be’. The relational self – social construction's version of the self – is very much alive and well. The relational self is very much a person.     

Language and identity among British South Asians: A theoretical review

Given the pervasiveness of language in social life and the implications that language use can have for one’s individual and collective identities, attempts were made to explore the theoretical and empirical advantages in connecting social psychological theories of identity and sociological/sociolinguistic approaches to language use and language choices in order to make sense of language and identity among second-generation British Asians. The current theoretical essay features a brief overview of the sociology of British Asians in the United Kingdom and a detailed consideration of dominant theories of identity in social psychology, namely, Social Identity Theory Tajfel (1982), Self-Aspects Model of Identity (Simon 2004) and Identity Process Theory (Breakwell 1986). It is considered that the latter two theories lend themselves readily to the study of language and identity. The present essay considers the substantive literature on language and identity and deconstructs notions such as ‘mother tongue’ in an attempt to demonstrate the constructedness of such terminology. It is argued that a social psychological approach to questions of language and identity among British South Asians is a valid one and that a qualitative methodological approach is particularly well-suited to the area under investigation.     

Understanding the Role of Everyday Practices of Privilege in the Perpetuation of Inequalities

To explain the interrelated effects of material and psychosocial inequalities, we suggest a move beyond research focused on deprived communities to include their broader social situation. Bourdieu's theory of practice explains how social and material disadvantages are interconnected, and struggles for power are enacted in everyday practice. In this paper, we draw on data from a qualitative study of two neighbourhoods to provide examples of everyday practice as people work to perpetuate or overcome inequalities in one field: education of their children. These examples show that those with more resources are actively working to retain and improve their children's social advantage, which rests on the disadvantage of others. In conclusion, we suggest that many current interventions to improve material and social conditions within disadvantaged communities ignore the damaging effects of social inequalities between social groups. Work towards understanding the nature of power struggles in daily life and the everyday actions of the privileged will help us understand and address the damaging effects of inequalities. Copyright © 2011 John Wiley & Sons, Ltd.     

Resetting the rules of the game: Language preferences and social relations of work between Russian immigrants and veteran professionals in an Israeli organization

Workplace is the main site of the cross-cultural encounter between majority and minority groups in multicultural societies, yet there is paucity of research on workplace language practices and their influence on the social relations of work. The current qualitative study focused on the patterns of language use and their links to social identities, inter-group attitudes and work relations between recent immigrants and veteran employees in a white-collar organization in Central Israel. On-site observations and interviews with the workers—Israeli-born, veteran Soviet immigrants of the 1970s, and recent arrivals—were conducted in Hebrew and in Russian. The findings indicate that language use indeed serves as the key marker of social identity and signifier of work status and group boundaries. The common use of Russian by recent immigrants is a trigger of conflict and mutual antagonism, as Hebrew-speakers perceive it as a sign of their separatism and anti-Israeli outlook.     

The interplay between early social interaction,language and executive function development in deaf and hearing infants

In this article, we review the influence of early social interaction on the development of executive function and language in infants. We first define social interaction, executive function and language and show how they are related in infant development. Studies of children born deaf are used to illustrate this connection because they represent cases where there has been a disruption to early social interaction and the development of intersubjectivity. Unlike other groups, the disturbance to development is known to be largely environmental rather than neuro-biological. This enables us to more accurately tease apart those impacts on EF that are associated with social interaction and language, since the potential confounds of disordered cognitive development are largely controlled for. The review offers a unifying model for how social, cognitive and linguistic development work together in early human development.     

Understanding the ‘blind spot’ when children move from foster care into adoption‡

Current social work practice in the UK dictates that when children move from foster care into adoption, the transition takes place within 7 and 14 days, and usually there is no contact between the child and their former carer for several months after the move, if at all. Very little attention or research has been aimed at understanding the rationale for these procedures, or their impact on the children. Joining forces with social work colleagues in a Looked After Children’s team, two child psychotherapists carried out a piece of qualitative research to look at these moves in more detail, and try to tease out how and why these key decisions are made. Analysing data from interviews with foster carers, adopters and social workers, the researchers found that the emotional experience of the child, particularly their experience of losing their foster carer, loses centre stage in people’s minds during this transition, leading to what is described as a ‘blind spot’ across the network. A significant reason for this emerged, in that the children tended to be very compliant both during and after the move and lacking in any obvious distress at losing their former carers, despite having previously been described as passionately attached to them. The research showed that adults across the network, all struggling with intense anxieties of their own, tended to interpret this as evidence that the children were ‘fine’ rather than questioning what might be going on at a deeper level. These research findings are explored in the light of a knowledge base accumulated from a working understanding of attachment and loss in early childhood, and of the psychoanalytical phenomena of individual and organisational defences against loss. Implications for future practice are suggested.     

Addressing social determinants of mental health in therapy: A thematic synthesis

Background

The importance of addressing social determinants of mental health in therapy is well-documented. However, there appears to be limited research on what this actually involves in practice and how best to prepare therapists to work with individuals experiencing adverse social determinants.

Aims

The aim of this review was to draw implications for practice and training from reviewing research on addressing social determinants of mental health in therapy.

Methodology

A qualitative systematic review of the research on addressing social determinants of mental health in therapy was conducted, extracting papers from eight databases: Cochrane Library, ASSIA, CINAHL Plus, PsycInfo, Psychoanalytic Electronic Publishing, Science Direct, Scopus and Web of Science. Out of 127 papers found, five met the eligibility criteria and were quality-assessed and analysed thematically.

Findings

The thematic synthesis generated three main themes: “the therapeutic relationship,” “adapting to client context” and “community as a resource,” with eight subthemes.

Conclusion

This thematic synthesis highlights the importance of the therapeutic relationship and adapting mental health support to client frame of reference and context to address social determinants of mental health in therapy. It emphasises community as a helpful resource for informing training and therapeutic interventions, as well as a significant resource for people experiencing adverse social determinants.     

Systematically reviewing remote e-workers’ well-being at work: a multidimensional approach

The practice of remote e-working, which involves work conducted at anyplace, anytime, using technology, is on the increase. The aim of this systematic literature review is to gain a deeper understanding of the association between remote e-working, within knowledge workers, and the five dimensions of well-being at work: affective, cognitive, social, professional, and psychosomatic. Sixty-three studies employing quantitative, qualitative and mixed-method designs have been included in the review. Findings indicate that we know more about remote e-workers’ affective state and their social and professional life than we know about their cognitive functioning and psychosomatic conditions. Whilst the research indicates a positive focus there are some negative aspects of this way of working which are highlighted within this review; such as social and professional isolation, and perceived threats in professional advancement. This review may be of great importance for academics, to continue the theoretical advancement of research into remote e-working, and practitioners, to implement and manage remote e-working attitudes and policies more effectively.