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

Abstract

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.

Acknowledgments

Many thanks to Elizabeth Couper-Kuhlen for listening to the data and commenting on an early version of this article. Thanks also to Melisa Stevanovic, Mikko Kahri, Liisa Voutilainen, Mika Simonen, Timo Kaukoma, Pentti Henttonen, and Sanni Tiitinen for their comments on an earlier version of the manuscript; to Maari Kivioja and other transcribers of the data; and to participants of the sociology data sessions at University of Helsinki during 2011–2012.

Notes

¹This kind of therapeutic task has many similarities to the actions that Bercelli et al. (2008, p. 48) have identified as reinterpretations. In our data, besides the formulations discussed in this section, there were also reinterpretations exhibiting the characteristics pointed out by Bercelli et al. We do not discuss reinterpretations in this article.

² Clift (2001, p. 286) has found that in English actually occurs in situations where “the actually-speaker's” turn is in potential conflict or contrast with that of another speaker's prior turn. Actually also occurs as a marker of the topic shifts or changes. Here it seems that there might be some similarities with the use of itseasiassa in Finnish. At least in this extract, it seems to mark the “therapist directedness” of the formulation by contrasting it with the client's previous turn. It could also be that the formulation introduces a topic shift to direct the client's attention to his emotion.