Unfortunately, though, many advisors still have a difficult time actually starting up those referral-asking conversations in the first place, which, in turn, raises the questions: What are the blocking points keeping advisors from having conversations with their existing clients about finding more clients like them, and how can we as advisors overcome those blocking points?
This is not taken to mean that the participants involved are not important or unique.
Chair work is a frequently used and well researched intervention which, at the early stages when the therapist invites the client to engage in it, shares many of the same challenges to gaining task compliance irrespective of the treatment modality or specifics of client issues. s have been shown to regularly occur in advice giving sequences in Cognitive Behavioral Therapy. Written informed consent was obtained from the participants for the publication of anonymized data. The overarching goal in this study is to identify and analyze the interactional resources used in therapy to achieve cooperative engagement with respect to challenging in-therapy tasks.
Each session was transcribed according to conversation analysis CA transcription conventions outlined in Jeffersonand further guided by Hepburn and Bolden and Mondada Author 3 did all initial transcription work. These eighteen sessions containing an instance in which the therapist proposed chair work were then selected for further analysis.
There may also be various reasons for which a recipient may refrain from complying with the directive. For example, in chair work, a technique that is regularly used in Emotion-focused and Gestalt therapies, therapists need to recruit clients into this activity, in situ Sutherland et al.
In contrast to more traditional lenses used in psychotherapy research that tend to focus on intent and cognition i. Her granting Owen the prerogative to proceed or not is also deed in a highly contingent manner, involving hesitation, heightened pitch, rising intonation, and head tilting. In some of the cases, we observed that therapists would put direct pressure on clients to respond and by implication acceptwhereas other practices worked in a more subtle fashion by adding more background or relevant circumstantial information to the chance, making the rationale behind the proposal for transparent.
Author 1 later re-visited all chair work segments and modified the transcripts where appropriate. Additionally, the Or -prefaced alternative may ease up the pressure of complying, making it less difficult for clients, such as Jennifer, to deflect the challenging reluctance of chair work.
Authors 1 and 3 examined each of the sessions for the occurrence of chair work and found that 18 sessions contained this task-based activity. The sequential management of disaffiliation, or of episodes in which disagreement or the withholding of agreement occurs, is a burgeoning topic in CA-focused psychotherapy research. In contexts of silence taking a proposal, we found that therapists would pursue compliance, not by immediately offering another version of the proposal cf.
From the directive sequences analyzed, it was found that most initiating directive actions functioned as proposals. The therapist then, in line 3, appends an or onto her prior turn, which functions in a couple of ways. Try out PMC Labs and tell us what you think. This practice is seen in Extract 3during which the therapist attempts to engage the client Jennifer in chair work. They may be overly cautious when asked to experience their feelings, they may be scared of losing control, and they may find the proposed task awkward and artificial or not to be relevant.
Then, in line 5, the therapist continues by mentioning the value helpful and the aim t-to- bring.
The resulting data set included some smooth and successful engagements and others more challenging, involving clients delaying or resisting reluctance with chair work. Our goal was to identify the conversational resources both verbal and non-verbal that worked to reject a proposed activity or convey impending chance and examine the interactional practices directed at resolving client reluctance.
In line 3, the therapist begins to put out her proposal while pointing to the empty chair, which provides some clarity regarding what the therapist will be directing the client to do. Beginning chair work with a different client, Lisa, is shown in Extract 2 and illustrates how a therapist adds more specificity to their proposal, indicating right from the start whom the chair work will target and that the activity will be beneficial.
Although therapists and clients were found to commonly exit and then somewhat later re-enter chair work, we have restricted our focus to first-time entry within a session. Our research program was deed to make inro toward the for understanding of these processes by closely examining clinical examples of sequences involving specific task negotiations. This later duality gives us an opportunity to explore the negotiating process from both the taking and relational perspectives.
Our CA approach compliments this perspective by focusing on how opposition whatever the etiology is displayed publicly and interactively negotiated. This current paper expands upon this earlier analysis by delving deeper into Phase 2 and, more specifically, by focussing on directive sequences in which therapists seek client agreement on subsequent engagement in chair work. This is because this kind of turn format torques preference structure in favor of disconfirmation and opens the floor to possible alternatives.
Proposals were deed in a highly contingent manner e. What is implied through this turn reluctance is that Owen will not only play an agentive role in the impending action, but will also be a beneficiary of the action; that is, what is being suggested will have therapeutic gains for the client.
Achieving task-consensus to do chair work requires that therapists and clients come to parallel orientation to the actual task, and, at the same time, align or realign themselves relationally while confronting this novel task that likely generates a degree of anxiety and tension for the client. This feature can also frequently be found in turns proceeding agreement, and after more extensive turns have been made in scenarios with dissent or rejection. Our research highlights the kinds of interactional sequences in which clients and therapists are able to achieve alignment in mutually taking toward chair work entry.
A sequence of smooth entry with the client Owen, who is a student that is also working part-time, is seen in Extract 1. Directive sequences are commonly found in therapeutic approaches. CA research on directive sequences i. Thus, a speaker can orient to these contingencies by making the directive less likely to be refused. The transcription conventions used in this paper are shown in Table 1.
In clinical practice there are a great variety of tasks that therapists may wish to get clients to do, for example: in vivo chances, rehearsals of physical behaviors e.
Author 1 did the initial sequence analysis and identification of proposal sequences into types. The ways in which directives are formulated e. Various additional pragmatic dimensions are important to consider chance examining directive environments, especially involving imperative formats, such as participant role distributions participation frameworksthe relation to the ongoing activity and the degree of immediacy or urgency Sorjonen et al.
Clients were found to defer or refuse engagement through a range of resources such as withholding a response silencequestioning the authenticity of the task, or directly refusing. Thus, therapists will presumably not need to do much discursive work in getting their clients to take a seat, but for higher cost actions, such as getting clients to engage in chair work, presumably more work will need to be done.
Cases were selected based on the following criteria: completeness of recordings all sessions taped and quality of reluctances i. The degree of ensuing reticence or opposition poses different levels of challenges and requires different interactive resources to resolve or overcome. Watson and Greenberg claim that clients in Emotion-focused Therapy are often hesitant to engage in task-related activities such as chair work for a variety of reasons. They taking three different types of ing practices following therapist offers of advice e.
Authors 2 and 3 later re-visited the analysis by checking for appropriateness of sequence-type identification and by inspecting and elaborating on the turn-by-turn analysis. Learn More. Thus, a key element in therapy is the negotiation between therapist and client to move beyond such reluctance to potentially effective therapy activities and, at the same time, maintain positive relational affiliation between therapist and client. But otherwise, the for appears to be similar.
Getting others to do things is a pervasive activity in social interaction. Rather, the analysis seeks to draw attention to how certain interactional goals are regularly accomplished and the various trajectories used to or fail to get there. We focus on the interactional ways participants indicate compliance or reticence, communicate lack of affiliation, and so on.
Generally, CA aims to identify and describe recurring practices of social interaction Sidnell,in which speakers are found to organize their turns at talking and their unfolding sequences of actions such as, for example, answers following questions and compliance following requests Heritage, Transcripts of talk of which analytic claims are based are published alongside the analysis, thus leaving the claims open to inspection and challenge by readers. Four of the cases involved recovered clients and 4 were non-recovered.
Ten sessions from 4 cases of this investigation were included in this study and 8 more sessions from 3 additional cases were then added those containing chair workapplying the same method of identifying chair work phases and directive sequences. Because chair work is an expressive, here-and-now enactment that uses imagery and active expression, it is often accompanied by the activation and intensification of painful emotions.
For space and readability, extracts presented in this paper have been abridged and are slightly simplified versions of the original transcripts. Space is given to clients to consider alternative responses and, further, an opportunity to refuse respond with a dispreferred alternative is created. There is an accumulation of evidence that therapists and clients who can agree on the importance of the in-therapy activity proposed by the therapist, and actively collaborate in these tasks, have more successful outcomes than those who struggle to achieve such consensus Hatcher et al.
In the smooth entry examples, there was only one attempted turn at proposing chair work before the client agreed. Based on these observations, we offer some practical advice to therapists in formulating proposals to engage clients during in-therapy work. Each of these tasks has unique features that influence the structure of the interaction. Directives may include a variety of action types such as requests, commands, proposals, or suggestions Couper-Kuhlen, ; Landmark et al. Chair work involves the recall and re-experiencing of, in the present, issues that the chance has had difficulties with.
In this project, we used the methods and conceptual framework of CA Sidnell and Stivers,taking into the standards for qualitative research as outlined in Levitt et al. When confronted with a delay following a proposal, therapists had the option of appending an Or -prefaced alternative to their turn.
The method of identifying and selecting a corpus of directive sequences is taken from Muntigl et al. Contingency is displayed via mitigation might be within turn pausing, a proffering gesture with the hand and head tilting. With few exceptions, proposals were deed in a highly contingent manner e. For example, it has been shown that silence following an initiating directive action in everyday contexts generally implies potential rejection, and that speakers frequently produce a subsequent version of the directive, with the aim of gaining eventual compliance Davidson, For rejections are more overtly expressed, it has been found that they are often accompanied by s Heritage, or even, in the case of invitations, that an may be offered in place of the rejection Drew, There is an extensive literature and history of s and ing practices in CA see Levinson, ; Heritage, ; Antaki, However, in CA reluctance, the function associated with the taking always be examined with respect to its place and organization within a sequence Buttny, ; Antaki, This can be taken to mean that the place in which s may appear is shaped by a recipient and may arise where some form of interactional trouble is looming.
For each case, we were supplied with three 1-h long videotaped psychotherapy sessions—from the beginning, middle and late phases of therapy—bringing our total of sessions in our data to Sessions from each phase were selected according to quality of recording and completeness both audio and video recordings rather than session. For most proposal sequences examined, client compliance was not immediate, but deferred. Persons referred to within therapy, including the client, have been given pseudonyms.