Describing therapeutic projects across sequences: Balancing between supportive and disagreeing interventions

Abstract

Based on the conversation analysis of 70 audio-recorded psychotherapy sessions, this article analyzes sequences of talk in which therapists disagree with clients’ descriptions of their personal experiences. These disagreements are an essential part of therapists’ overall project, continued across sequences of their talk, to increase clients’ awareness of their distorted perceptions and challenge their dysfunctional patterns. The therapists in this study challenged their clients with strong oppositional statements which prompted them to defend their views. In supportive disagreement, the therapists worked at finding congruence between their perspectives and that of the clients, validated the clients’ emotional experience and respected their epistemic primacy, prompting the clients to confirm and elaborate their experience. Conversely, in unsupportive disagreement the therapists maintained their divergent perspectives, discounted the client's claim as unrealistic and claimed privileged access to the client's domain of knowledge. These interactional moves promoted irritation and anger in the client, and the therapeutic relationship eventually became the focus of the conversation. The therapeutic use of different types of disagreements is discussed in relation to resolving relational stress.