Clinical and Research Perspectives on the Therapeutic Conversation: The Case of MS. M.

Abstract

This paper presents a collaboration between a clinician (C.M.J.) and a research team (W.B., B.M., and S.M.) to address the question: At an operational level, what happens in the special form of conversation that is psychotherapy? How can we study, beyond a priori lenses of psychoanalytic models, what we are actually doing when we engage in this process? How can we capture from the linear flow of conversation, the simultaneous, complex, active, interwoven, dimensional emotion schemas that words can only point toward? To address the question, we first present the need for new approaches in the current climate within the clinical and research communities. Next, we address the challenges for clinicians and researchers by using multiple code theory and derived linguistic measures that offer an objective view of the processes of subjectivity. We then apply the research methods to the clinical data to illustrate the yield of the collaborative effort-a yield that captures the connection between the linear flow of words and the arousal, verbal expression, and reflection/integration of emotion schemas without the usual filters of psychoanalytic models of process and change. The project illustrates the critical value of clinicians' perspectives to guide researchers and encourages clinicians to participate in research to advance our field. For researchers, this project represents a "fourth generation" of process research that includes the criteria of video-recorded, transcribed data; the clinician's report of their experience; a theory of how emotion-laden meaning and motivations (emotion schemas) are expressed in the therapeutic conversation; and reliable, valid measures to capture and represent those processes; and that encourages researchers to access the rich contributions of clinicians' understanding. The implication for clinical practice is a new way to look beyond the lens of psychoanalytic models into what is actually unfolding in real time.