The therapeutic relationship in action: How therapists and clients co-manage relational disaffiliation

Abstract

Over the past three decades a great deal of energy has been invested in examining the consequences of relational stresses and their repair. Less work has been done to examine how therapists and clients actually achieve re-affiliation through verbal and non-verbal resources, how such affiliation becomes vulnerable and at risk, and how therapists attempt to re-establish affiliative ties with the client—or fail to do so. We utilize the method of Conversation Analysis (CA) to examine clinical cases that involve extended episodes of disaffiliation. Clients with different styles of disaffiliation—confrontation and withdrawal—are compared. We show how disaffiliation is interactionally realized in different ways and how this is followed by more or less successful attempts at repair.

Negli ultimi tre decenni, una grande quantità di energia è stata investita per esaminare le conseguenze delle rotture relazionali e della loro riparazione. Pochi lavori sono stati effettuati per esaminare come i terapeuti e i pazienti realizzano la riaffiliazione utilizzando risorse verbali e non verbali, come tale affiliazione diventa vulnerabile e a rischio, e come i terapeuti tentano di ristabilire i legami affiliativi con i pazienti o come non riescono a farlo. Noi utilizziamo il metodo dell'Analisi Conversazionale (CA) per esaminare i casi clinici che riguardano ampi episodi di rottura dell'affiliazione. Sono stati confrontati i pazienti con diversi stili di rottura dell'affiliazione, confronto e ritiro. Mostriamo come la rottura dell'affiliazione sia realizzata nell'interazione in modi diversi e come questo è seguito da tentativi più o meno riusciti di riparazione.

Ao longo das últimas três décadas investiu-se uma grande quantidade de energia na análise das consequências das tensões relacionais e da sua reparação. Tem havido menos investimento na análise de como os terapeutas e os clientes alcançam efetivamente a reafiliação através de recursos verbais e não-verbais, como essa afiliação se torna vulnerável e em risco e como os terapeutas tentam reestabelecer os laços de afiliação com o cliente – ou não são capazes de o fazer. Utilizamos o método da Análise Conversacional (CA) para examinar casos clínicos que envolvem episódios extensos de desafiliação. Clientes com diferentes estilos de desafiliação - confrontação e afastamento - são comparados. Mostramos como a desafiliação é alcançada interactivamente de diferentes formas e como é seguida de tentativas mais ou menos bem sucedidas de a reparar.

In den vergangenen drei Dekaden wurde sehr viel Energie aufgebracht, um die Konsequenzen von Beziehungsbelastungen und deren Reparatur zu untersuchen. Weniger Arbeit wurde unternommen, um zu überprüfen, wie Therapeuten und Klienten eigentlich Re-Affiliation mithilfe verbaler und non-verbaler Mittel erreichen, wie solch eine Affiliation anfällig und gefährdet wird und wie Therapeuten versuchen eine affiliative Bindung wiederherzustellen oder daran scheitern. Wir verwenden die Methode der Konversationsanalyse (CA), um klinische Fälle zu untersuchen, welche erweiterte Episoden von Disaffiliation zeigten. Dabei wurden Klienten mit verschiedenen Arten von Disaffiliation *Konfrontation und Rückzug* verglichen. Wir zeigen, wie Disaffiliation interaktionell in unterschiedlichen Weisen realisiert wird und wie sich mehr oder weniger erfolgreiche Reparaturversuche anschließen.

目的：過去三十年諸多學者致力於檢視關係中的緊繃帶來的後果以及如何修復，鮮少研究檢視治療師和當事人如何真正透過口語和非口語的資源達到關係的重新結盟，這樣的結盟關係是如何逐漸變得脆弱與陷入險境，以及治療師是如何嘗試與當事人重新建立結盟的關係。研究者運用對話分析（CA）的方式檢視一群長時間有不滿意結盟關係的臨床當事人，分為面質型的不結盟風格與退縮型的不結盟風格兩類加以比較。本研究顯示這種不結盟的關係在哪些不同面向的雙方互動均可發現，以及這樣的關係在後續有經歷或多或少的企圖修補。

Keywords:

• qualitative research methods
• alliance
• conversation analysis
• disaffiliation
• disalignment
• emotion-focused therapy

Acknowledgements

This research is supported by a standard research grant from the Social Sciences and Humanities Research Council of Canada (410-2009-0549). We also wish to thank Les Greenberg and Lynne Angus for having provided important feedback on a previous version of this paper

Notes

¹ In much of the literature, particularly in relation to the concept of alliance, the term “rupture” is used to identify disturbances in the relationship. We, along with Bordin (1989, 1994) and Safran (2012), find the terminology potentially misleading, as the events in question range in severity from minor disruptions to actual severance of the relation; thus our preferred term in this context is “stress.” However, in this research we examine disturbances in many aspects of the therapy relationship, not only in alliance. Thus we will use the broader concepts of (dis)alignment and (dis)affiliation, as will be defined later.

² For more detailed information on the client and therapist demographics see Greenberg, L.S., & Watson, J. (1998).

³ In this example and the ones to follow, non-verbal information such as “nod,” “smile,” etc. is added within the lines of the transcript in italics below the concurrent verbal text (for more information on how non-verbal information is presented in transcripts, see Muntigl, Knight, & Watkins, 2012, and Muntigl, Knight, Horvath, & Watkins, 2012). We mainly included non-verbal resources that played a role in displaying affiliation.