Client Talk Research Articles

Children as Linguistic Rights Holders in the Swedish Welfare System

This paper investigates an encounter in a multilingual welfare setting where a child with migration experiences is the rights holder. The empirical basis is a story told by the interpreter Nour, about an encounter at a youth clinic. The analysis is guided by the concept of linguistic (in)justice. Findings show that linguistic injustices are a result of the reproduction of monolingual mindsets and linguistic paternalism in the intersection of layers of power asymmetries when welfare professionals do not let the child client talk, when adults talk on the child’s behalf, and the speakers give priority to the majority language on behalf of the language that the child speak. These findings suggest that professionals and policymakers must recognise the special conditions of a multilingual setting and children as a particular group of language rights holders.

A sequential analysis of motivational interviewing technical skills and client responses

BackgroundThe technical hypothesis of Motivational Interviewing (MI) proposes that: (a) client talk favoring behavior change, or Change Talk (CT) is associated with better behavior change outcomes, whereas client talk against change, or Sustain Talk (ST) is associated with less favorable outcomes, and (b) specific therapist verbal behaviors influence whether client CT or ST occurs. MI consistent (MICO) therapist behaviors are hypothesized to be positively associated with more client CT and MI inconsistent (MIIN) behaviors with more ST. Previous studies typically examine session-level frequency counts or immediate lag sequential associations between these variables. However, research has found that the strongest determinant of CT or ST is the client's previous CT or ST statement. Therefore, the objective of this paper was to examine the association between therapist MI skills and subsequent client talk, while accounting for prior client talk. MethodsWe analyzed data from a manualized MI intervention targeting both alcohol misuse and sexual risk behavior in 132 adults seen in two hospital emergency departments. Transcripts of encounters were coded using the Motivational Interviewing Skills Code (MISC 2.5) and an additional measure, the Generalized Behavioral Intervention Analysis System (GBIAS). Using these measures, we analyzed the association between client talk following specific classifications of MICO skills, with the client's prior statement as a potential confounder or effect modifier. ResultsWith closed questions as the reference category, therapist simple reflections and paraphrasing reflections were associated with significantly greater odds of maintaining client talk as CT or ST. Open questions and complex reflections were associated with significantly greater odds of CT following ST, were not associated significantly with more ST following ST, and were associated with more ST following CT (i.e., through an association with less Follow Neutral). ConclusionsSimple and paraphrasing reflections appear to maintain client CT but are not associated with transitioning client ST to CT. By contrast, complex reflections and open questions appeared to be more strongly associated with clients moving from ST to CT than other techniques. These results suggest that counselors may differentially employ certain MICO technical skills to elicit continued CT and move participants toward ST within the MI dialogue.

Embedded instruction: Proxy voicing in couples therapy

This paper takes up the issue of how instruction can be accomplished in circumstances in which an instructional orientation during interaction is considered to be or is treated as problematic. In couple therapy, as with other interactional settings, talk about an actor's experience, especially when participants have different access to that experience, can be a delicate matter. Therapist's formulations can make a client's talk or conduct accountable as a lapse of competence or conduct, leading to client opposition in therapy. One procedure used to avoid the possibility of such opposition is to embed a formulation of a client's talk in an understanding check using a form of reported speech called proxy voicing (Seedall and Butler, 2006) in which the therapist speaks to a client as that client. In this paper, I show the way that proxy voicing is produced to serve as a form of embedded instruction in a Jeffersonian sense. As the basis for a therapeutic enactment, the therapist's candidate understanding, is not simply a form of repair or correction, it is a form of embedded instruction in the form of a demonstration. I show that embedded instruction provides both opportunities and resources for clients as learners to engage in learning's work (Zemel, 2014) under the supervision of the therapist while relieving the client of the requirement that he or she account for what the therapist considers a therapeutic problem of competence or conduct.

Derived relations moderate the association between changes in the strength of commitment language and cocaine treatment response.

The psycholinguistic analysis of client-counselor interactions indicates that how individuals talk about their substance use is associated with treatment outcome. However, the processes by which client speech influences out-of-session behaviors have not been clearly delineated. This study investigated the relationships between deriving relations-a key behavioral process by which language and cognition may come to influence behavior, shifts in the strength of client talk in favor of change, and treatment outcome among 75 cocaine-dependent participants (23% Female). Participants were trained to relate cocaine words, nonsense syllables, and negative-consequence words and were then assessed for a derived relation of equivalence before starting treatment. The DARN-C coding system was used to quantify the strength of participant speech during an early cognitive behavior therapy counseling session. Cocaine use during treatment was the outcome of interest. The analyses (a) characterized the process of deriving relations among individuals seeking help for their misuse of cocaine, (b) tested the relationships between shifts in the strength of participants' speech in favor of change and treatment outcome, and (c) tested if deriving equivalence relations moderated the relationship between shifts in the strength of in-session speech and treatment response. Results indicated that a minority of participants derived equivalence relations, however increases in the strength of commitment language predicted less cocaine use during treatment only among those who did. The findings suggest deriving relations may be an important process by which changes in the strength of commitment language comes to influence substance use.

A Comparison of Natural Language Processing Methods for Automated Coding of Motivational Interviewing

Motivational interviewing (MI) is an efficacious treatment for substance use disorders and other problem behaviors. Studies on MI fidelity and mechanisms of change typically use human raters to code therapy sessions, which requires considerable time, training, and financial costs. Natural language processing techniques have recently been utilized for coding MI sessions using machine learning techniques, rather than human coders, and preliminary results have suggested these methods hold promise. The current study extends this previous work by introducing two natural language processing models for automatically coding MI sessions via computer. The two models differ in the way they semantically represent session content, utilizing either 1) simple discrete sentence features (DSF model) and 2) more complex recursive neural networks (RNN model). Utterance- and session-level predictions from these models were compared to ratings provided by human coders using a large sample of MI sessions (N=341 sessions; 78,977 clinician and client talk turns) from 6 MI studies. Results show that the DSF model generally had slightly better performance compared to the RNN model. The DSF model had “good” or higher utterance-level agreement with human coders (Cohen's kappa>0.60) for open and closed questions, affirm, giving information, and follow/neutral (all therapist codes); considerably higher agreement was obtained for session-level indices, and many estimates were competitive with human-to-human agreement. However, there was poor agreement for client change talk, client sustain talk, and therapist MI-inconsistent behaviors. Natural language processing methods provide accurate representations of human derived behavioral codes and could offer substantial improvements to the efficiency and scale in which MI mechanisms of change research and fidelity monitoring are conducted.

Epistemic asymmetries in psychotherapy interaction: therapists' practices for displaying access to clients' inner experiences.

The relationship between a psychotherapist and a client involves a specific kind of epistemic asymmetry: in therapy sessions the talk mainly concerns the client's experience, which is unavailable, as such, to the therapist. This epistemic asymmetry is understood in different ways within different psychotherapeutic traditions. Drawing on a corpus of 70 audio-recorded sessions of cognitive psychotherapy and psychoanalysis and using the method of conversation analysis, the interactional practices of therapists for dealing with this epistemic asymmetry are investigated. Two types of epistemic practices were found to be employed by therapists while formulating and interpreting the client's inner experience. In the formulations, the therapists and clients co-described the client's experience, demonstrating that the client's inner experience was somewhat similarly available to both participants. In the interpretations, the therapists constructed an evidential foundation for the interpretation by summarising the client's talk and using the same descriptive terms as the client. Clients held therapists accountable for this epistemic work: if they failed to engage in such work, their right to know the client's inner experience was called into question.

Effect of question design on dietary information solicited during veterinarian-client interactions in companion animal practice in Ontario, Canada.

To establish the types of initial questions used by veterinarians in companion animal practice to solicit nutritional history information from owners of dogs and cats, the dietary information elicited, and the relationship between initial question-answer sequences and later nutrition-related questions. Cross-sectional qualitative conversation analytic study. 98 appointments featuring 15 veterinarians drawn from an observational study of 284 videotaped veterinarian-client-patient visits involving 17 veterinarians in companion animal practices in eastern Ontario, Canada. Veterinarian and client talk related to patient nutrition was identified and transcribed; conversation analysis was then used to examine the orderly design and details of talk within and across turns. Nutrition-related discussions occurred in 172 visits, 98 of which contained veterinarian-initiated question-answer sequences about patient nutritional history (99 sequences in total, with 2 sequences in 1 visit). The predominant question format used by veterinarians was a what-prefaced question asking about the current content of the patient's diet (75/99). Overall, 63 appointments involved a single what-prefaced question in the first turn of nutrition talk by the veterinarian (64 sequences in total). Dietary information in client responses was typically restricted to the brand name, the subtype (eg, kitten), or the brand name and subtype of a single food item. When additional diet questions were subsequently posed, they typically sought only clarification about the food item previously mentioned by the client. Results suggested that question design can influence the accuracy and completeness of a nutritional history. These findings can potentially provide important evidence-based guidance for communication training in nutritional assessment techniques.

Patient-provider concordance with behavioral change goals drives measures of motivational interviewing consistency

ObjectiveMotivational Interviewing (MI) consistent talk by a counselor is thought to produce “change talk” in clients. However, it is possible that client resistance to behavior change can produce MI inconsistent counselor behavior. MethodsWe applied a coding scheme which identifies all of the behavioral counseling about a given issue during a visit (“episodes”), assesses patient concordance with the behavioral goal, and labels providers’ counseling style as facilitative or directive, to a corpus of routine outpatient visits by people with HIV. Using a different data set of comparable encounters, we applied the concepts of episode and concordance, and coded using the Motivational Interviewing Treatment Integrity system. ResultsPatient concordance/discordance was not observed to change during any episode. Provider directiveness was strongly associated with patient discordance in the first study, and MI inconsistency was strongly associated with discordance in the second. ConclusionObservations that MI-consistent behavior by medical providers is associated with patient change talk or outcomes should be evaluated cautiously, as patient resistance may provoke MI-inconsistency. Practice implicationsCounseling episodes in routine medical visits are typically too brief for client talk to evolve toward change. Providers with limited training may have particular difficulty maintaining MI consistency with resistant clients.

Responding to Client Laughter as Therapeutic Actions in Practice

The widely presumed links between laughter and humour have raised questions about their roles in psychotherapeutic interactions. This study uses conversation analysis to explore client-initiated laughter and different kinds of responses to it. By examining sequences leading up to and following client laughter, we show two distinctive therapeutic actions that are accomplished. When particular lines of therapeutic questioning are being pursued, silence following client laughter functions to prompt further client talk. Client laughter can also build rapport by providing an opportunity for therapists to display that they also find something laughable. Both identified actions support important therapeutic work.

Beyond specification: A study of architect and client interaction

This paper examines a successful architectural design process, taking place over a period of seven years, which resulted in the delivery of a complex building meeting the aspirations of the client. Our analysis focuses on the mechanisms by which expectations about how a building will be experienced are created, shared, and resolved during the process of design. We find differences in the ways designer and client talk to each other about experience and differences in the talk before the construction of the building and after it has been built and occupied. We discuss these differences and why the ‘design concept’ manifests in distinctive ways. We suggest that the phenomena we have noticed are linked intrinsically to expert design performance.

A Comparative Conversation Analytic Study of Formulations in Psychoanalysis and Cognitive Psychotherapy

The uses of formulation in cognitive psychotherapy and psychoanalysis were compared, by means of conversation analysis, using 53 audio-recorded sessions as data. Two formulation types were found in both approaches: highlighting formulations, which recycle the client's descriptions and recognize therapeutically dense material, and rephrasing formulations, which offer the therapist's version of the client's description and focus on subjective experiences. These formulations may be interactional bearers of common factors in psychotherapy. Two other formulation types were exclusive to one or another approach. Relocating formulations, found only in psychoanalysis, propose that the experiences in the client's narratives are connected to experiences at other times or places. Exaggerating formulations, found only in cognitive psychotherapy, exaggerate the client's talk by recasting it as something that is apparently implausible. The contrast between relocating and exaggerating formulations suggests that, despite recent theories in the two approaches being more compatible, interactional differences still exist between cognitive psychotherapy and psychoanalysis.

A Peircean analysis of counselors' interpretations and clients' responses in motivational interviewing sessions

The aim of this study is to apply some ideas from Charles S. Peirce's theory of signs to the analysis of counselor behaviors during motivational interviewing sessions in the probation service by focusing on the counselors' interpretations of their substance-abusing clients' change talk. The results of the study display that making the argument interpretation is the most certain way to make the client talk for the change and to help the client to reach the goal with regard to his/her use of alcohol and drugs. The argument interpretation shows something that the client has not noticed before (deductive argument), captures an anomaly that appears in the client's talk (abductive argument) or makes a conclusion of the client's situation (inductive argument) and presents an assertive inference based on them. The results show that by applying Peirce's theory of signs, we can find the new features of client–counselor interaction that potentially relate to the treatment outcome.

More Than Good Intentions: Advancing Adherence to Therapy Recommendations

More Than Good Intentions: Advancing Adherence to Therapy Recommendations

Therapeutic change in interaction: Conversation analysis of a transforming sequence

A process of change within a single case of cognitive-constructivist therapy is analyzed by means of conversation analysis (CA). The focus is on a process of change in the sequences of interaction, which consist of the therapist's conclusion and the patient's response to it. In the conclusions, the therapist investigates and challenges the patient's tendency to transform her feelings of disappointment and anger into self-blame. Over the course of the therapy, the patient's responses to these conclusions are recast: from the patient first rejecting the conclusion, to then being ambivalent, and finally to agreeing with the therapist. On the basis of this case study, we suggest that an analysis that focuses on sequences of talk that are interactionally similar offers a sensitive method to investigate the manifestation of therapeutic change. It is suggested that this line of research can complement assimilation analysis and other methods of analyzing changes in a client's talk.

Client contribution in negotiations on employability – categories revised?

Eskelinen L, Olesen SP, Caswell D. Client contribution in negotiations on employability – categories revised?Int J Soc Welfare 2010: 19: 330–338 © 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and International Journal of Social Welfare.In this article, we explore how the institutional category ‘unemployed’ is specified in everyday practice when implementing an active employment policy. We illustrate the process of categorisation as an aspect of the in situ positioning and self‐representation of the client by examining one social worker–client talk: how the category unemployed is shaped and ‘translated’ when the client negotiates her situation with the social worker. Two types of category revisions are identified. First, the employability of the client, rather than her unemployment situation, is the issue under negotiation. Second, the client introduces new categories that are compatible with the demands of the employment system. She contributes by drawing on discursive resources related to the category of ‘active job seeker’ but does this with an own agenda of looking for a suitable job. The analysis elucidates the client's contribution to institutional practice and discusses constitutive and constituted elements of categorisation.

Exposed and embedded corrections in aphasia therapy: issues of voice and identity

Because communication after the onset of aphasia can be fraught with errors, therapist corrections are pervasive in therapy for aphasia. Although corrections are designed to improve the accuracy of communication, some corrections can have social and emotional consequences during interactions. That is, exposure of errors can potentially silence the 'voice' of a speaker by orienting to an utterance as unacceptable. Although corrections can marginalize speakers with aphasia, the practice has not been widely investigated. A qualitative study of corrections during aphasia therapy was undertaken to describe corrections in therapy, identify patterns of occurrence, and develop hypotheses regarding the potential effects of corrections. Videotapes of six individual and five group aphasia therapy sessions were analysed. Sequences consistent with a definition of a therapist 'correction' were identified. Corrections were defined as instances when the therapist offered a 'fix' for a perceived error in the client's talk even though the intent was apparent. Two categories of correction were identified and were consistent with Jefferson's (1987) descriptions of exposed and embedded corrections. Exposed corrections involved explicit correcting by the therapist, while embedded corrections occurred implicitly within the ongoing talk. Patterns of occurrence appeared consistent with philosophical orientations of therapy sessions. Exposed corrections were more prevalent in sessions focusing on repairing deficits, while embedded corrections were prevalent in sessions focusing on natural communication events (e.g. conversation). In addition, exposed corrections were sometimes used when client offerings were plausible or appropriate, but were inconsistent with therapist expectations. The observation that some instances of exposed corrections effectively silenced the voice or self-expression of the person with aphasia has significant implications for outcomes from aphasia therapy. By focusing on accurate productions versus communicative intents, therapy runs the risk of reducing self-esteem and communicative confidence, as well as reinforcing a sense of 'helplessness' and disempowerment among people with aphasia. The results suggest that clinicians should carefully calibrate the use of exposed and embedded corrections to balance linguistic and psychosocial goals.

An Uncommon Treatment of Obsessive-Compulsive Disorder

This article describes the unorthodox, but successful treatment of a 32-year-old male client suffering from chronic obsessive-compulsive disorder (OCD). The client was first diagnosed with OCD at age 18, and since then had received all of the standard treatments (both therapeutic and pharmacological) for OCD without showing any improvement. The treatment described here focused on alleviating the client's symptoms of depression, forcefully discouraging the client's talk about his OCD symptoms, and behavioral assignments derived from systemic-constructivist theory. Decisions made by the therapist at various stages of treatment were based on several well-known marriage and family therapy techniques.

Diagnostic formulations in psychotherapy

Conversation analysts have noted that, in psychotherapy, formulations of the client's talk can be a vehicle for offering a psychological interpretation of the client's circumstances. But we notice that not all formulations in psychotherapy offer interpretations. We offer an analysis of formulations (both of the gist of the client's words and of their implications) that are diagnostic: that is, used by the professional to sharpen, clarify or refine the client's account and make it better able to provide what the professional needs to know about the client's history and symptoms. In doing so, these formulations also have the effect of shepherding the client's account towards subsequent therapeutic interpretation. In a coda, we notice that sometimes the formulations are designed discreetly. We examine one such discreet formulation in detail, and show how its very ambiguity can lead to its failure as a diagnostic probe.

How Does Motivational Interviewing Work? What Client Talk Reveals

How Does Motivational Interviewing Work? What Client Talk Reveals

How Does Motivational Interviewing Work? What Client Talk Reveals

A psycholinguistic account of motivational interviewing (MI) is proposed. Critical to this view is the assumption that therapists and clients are natural language users engaged in a constructive conversation that reveals and augments relevant information about the status of future change in a client’s substance abuse. The role of client speech acts—most notably, verbal commitments—during MI is highlighted. How commitments can be signaled in client speech or gestures is discussed. How these commitment signals can inform therapeutic process and subsequent behavioral outcome is then put forth. Using natural language as a measure, a MI process model is presented that not only posits a mediational role for client commitment in relating underlying factors of desire, ability (self-efficacy), need, and reasons to behavior, but also a pivotal role as a need-satisfying enabler of a social-cognitive mechanism for personal change.