Abstract
The conversational actions of reformulating and mirroring constitute some of the core intervention techniques of psychotherapy. The purpose of the present study was to investigate the way in which therapists in cognitive-behavioral (CBT) and psychodynamic therapy (PDT) use reformulating and mirroring strategies to return patients’ prior talk and how their differential usage can be viewed in light of the respective manualized recommendations. A mixed methods approach was applied using qualitative data that derived from a RCT. The data collection consisted of 200 excerpts assembled from both treatment conditions. The method of Conversation Analysis was used to determine the practices that accomplished instances of reformulating and mirroring, and to examine their distinct implications for subsequent talk. The quantitative analysis revealed that cognitive-behavioral therapists are significantly more likely to use reformulations, which is in harmony with what is suggested in CBT’s treatment manuals. Psychodynamic therapists’ frequent use of transformative formulations is, by contrast, unexpected in regard to the suggestions of the treatment protocol, as these interventions steer toward topical closure. Compared to the CBT condition, psychodynamic therapists were still significantly more likely to rely on mirroring strategies, which are in line with PDT’s theoretical preference. Our findings raise the question whether alleged differences in treatment styles, as they are imposed by RCT methodology, are actually tangible in manual-guided clinical practice.
Highlights
The use of manual-based therapy treatment implies an orientation toward manual-informed conversational behavior
The aim of the present paper is to examine how, from a conversation-analytic perspective, therapists’ second versions of prior patient talk are deployed differentially across cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) and how this can be interpreted in view of the respective treatment manual
Audio-recorded therapy treatments offered for patients with Major Depressive Disorder (MDD) were selected from a database assembled for the Ghent Psychotherapy Study (GPS; Meganck et al, 2017)
Summary
The use of manual-based therapy treatment implies an orientation toward manual-informed conversational behavior. The aim of the present paper is to examine how, from a conversation-analytic perspective, therapists’ second versions of prior patient talk are deployed differentially across cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) and how this can be interpreted in view of the respective treatment manual. We will discuss two types of conversational second versions, with which therapists return prior utterances to their patient. We will discuss the conversation-analytic notion of reformulating, which refers to second versions of prior talk that entail lexico-syntactic transformation. Our aim is to investigate whether the use of conversational practices that provide second versions of preceding patient talk is guided by therapy style and if so, what sequential consequences these different practices have
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