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Evrinomy Avdi Aristotle University of Thessaloniki, Greece

Analysing talk in the talking cure: Conversation, discourse, and narrative analysis of psychoanalytic psychotherapy
ABSTRACT
This paper reviews research that examines the process of adult psychoanalytic psychotherapy from a qualitative social constructionist perspective and employs conversation, discourse and narrative analysis. It is argued that language-based analysis is coextensive with psychoanalytic psychotherapy, as they both focus on the process of meaning-making, aim to interpret language use in the context of the analytic encounter and assume that the human subject is multiple and fragmented. The main contribution of language-based studies that have been published to date is that they build bridges between the macrolevel of therapeutic description, i.e. psychoanalytic theory and technique, and the microlevel of linguistic phenomena. In this way, they provide descriptions of therapy process in linguistic and narrative terms and this allows for the systematic and detailed study of psychoanalytic process from a discursive and narrative perspective. They examine talk as it unfolds in interaction and can, therefore, further our understanding of the relationship dynamics, the joint construction of new meanings and other interactional processes that underlie psychoanalytic therapy. Moreover, they highlight the active and constructive role of the therapist, generating descriptions which can be useful with regards to training and continuing professional development as well as with regards to theoretical debates around the therapists participation in the analytic process. In sum, it is argued that the systematic, rigorous, meticulous and reflexive way of studying talk provided by language-based analysis constitutes a very useful, yet largely unexplored and underutilised, resource for practitioners and researchers of psychoanalysis.

In recent years, in the cultural context of postmodernism and given the increasing proliferation of qualitative approaches in the study of psychotherapy (e.g. A NGUS & MCLEOD, 2004; F ROMMER, L ANGENBACH & STREECK, 2004; F ROMMER & R ENNIE, 2001; MCLEOD, 2000; TOUKMANIAN & R ENNIE, 1992), the relationship between qualitative research and psychoanalysis1 is being
1 The terms psychoanalysis, psychoanalytic psychotherapy and psychodynamic psychotherapy are treated as equivalent in this paper and are used interchangeably.

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revisited. This paper reviews research that examines the process of adult psychoanalytic psychotherapy2 from a qualitative social constructionist perspective and in particular from the viewpoint of language-based analyses; these include conversation, discourse and narrative analysis (MCLEOD, 2000). Conversation, discourse and narrative analysis all share a focus on meaning and on the constructive function of language, but they differ considerably in terms of underlying theory, analytic focus and methodology. A detailed discussion of these differences is a considerable task beyond the scope of this paper; I briefly describe the distinctive features of each approach and in particular in the way each has been applied to the study of therapy process. Narrative analysis is a widely used term that includes several approaches to the study of language, all of which centre on the notion of narratives, i.e. stories that link events over time and provide a sense of temporal continuity and coherence in ones life-story (e.g. B RUNER, 1990). Narration is considered to be intimately linked with identity, in the sense that identity is continuously re-constructed through the stories we tell about our life. These stories are shaped by previous experience, current circumstances and the powerful presuppositions regarding selfhood and the good life provided by our culture (e.g. M C ADAMS & JANIS, 2004). In addition, narratives are acts of interpretation, as they provide explanations of why things happen and what they may mean, and, in this way, they function as vehicles through which moral issues are negotiated. In this framework, psychotherapy is conceptualised as a linguistic practice of narrative articulation and reconstruction, a process of story repair, where self-narratives are reconstructed to become more coherent, more complex and more inclusive. Although, the view that narrative constitutes a fundamental aspect of therapy is most clearly theorised in narrative therapy, diverse schools of psychotherapy increasingly converge on this premise, including psychodynamic therapy (e.g. SCHAFFER, 1992; SPENCE, 1982). In the field of therapy process research, narrative studies tend to draw from constructivism, generally focus on aspects of the clients narrative, treat narrative as a reflection of individual psychological processes and often focus on narrative coherence as a marker of psychological well-being (AVDI & GEORGACA, 2007a). Discourse analysis is also a diverse field with continuing debates regarding its boundaries with other language-analytic approaches. Many studies reviewed in this paper rely on a notion of discourse drawing from linguistics; discourse is approached as speech beyond the sentence and the analysis takes into account the linguistic, interactional and wider social context of utterances. In therapy process research, such studies examine the linguistic forms through which therapy takes place. Other studies draw upon the notion of discourse as is commonly

2 For child psychotherapy see HUTCHBY (2007).

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used in British psychology. In this framework, discourse analysis includes a range of concepts and analytic practices that share a social constructionist epistemology, an emphasis on language and discourse as constituting external reality and identity, a focus on the function of talk in negotiating reality, agency and accountability, as well as on the importance of reflexivity in the analysis. Language and discourse are seen as constructive, functional and variable (e.g. WETHERELL, TAYLOR & YATES, 2001 a & b). With regards to psychotherapy process research, these analyses tend to focus on the interactional construction of the clients problem and/or its dissolution through the process of therapy as well as on the role of wider discourses in shaping the problems that bring clients to therapy (AVDI & GEORGACA, 2007b). Finally, conversation analysis details the processes through which everyday and institutional practices are interactionally constituted. It involves very detailed reading of brief speech exchanges and the analysis typically focuses on one or more of six overlapping layers of talk organisation: turn-taking, overall structure of the encounter, statement-response sequences, turn design, lexical choice and interactional asymmetries (P ERKYL, 2004). With regards to the study of therapy process, conversation analysis offers fine-grained description of the linguistic interaction and the practices through which the participants accomplish their respective, institutionally-defined tasks. In this paper, language-based analysis is treated as coextensive with psychoanalytic psychotherapy; both focus on the process of meaning-making and both aim to interpret language use in the context of the analytic encounter. However, the relationship between the two is far from simple and several tensions arise with respect to the limits of interpretation, differences between clinical and research settings, issues of authorship and underlying epistemology (e.g. M IDGLEY, 2006; F ROSH & EMERSON, 2005; GEORGACA, 2007). Three broad versions of the relationship between discursive approaches and psychoanalysis can be discerned in the literature. One strand approaches psychoanalysis as a potential resource for enriching language-based analysis both in terms of data collection (e.g. HOLLWAY & J EFFERSON, 2000; KVALE, 1999; SCHORN, 2000) and interpretation (e.g. B JERRUM N IELSEN, 1999; F ROSH, P HOENIX, & PATTMAN, 2003; GOUGH, 2004; HOLLWAY & J EFFERSON, 2000). Psychoanalysis is considered particularly useful in exploring subjectivity and in maintaining a notion of the person in language-focused analysis, although this assertion is at the centre of continuing debates (e.g. F ROSH, 2007; F ROSH & EMERSON, 2005; GEORGACA, 2007; PARKER, 1994, 1997, 2005). A second strand proposes systematic methods to analyse the clients talk, in order to extract information regarding his/her underlying psychodynamics. Examples of such narrative approaches to client assessment are the JAKOB (e.g. BOOTHE & VON W YL, 2004) and a typology of psychopathological narratives suggested by Dimaggio and his colleagues (e.g. DIMAGGIO & SEMERRARI, 2001, 2004). Other well-known systems for the assessment of narratives from a psychodynamic perspective are the Adult Attachment Interview (e.g. H ESSE, 1999) and the Core Conflictual Relationship

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Theme method (e.g. LUBORSKY & CHRITS-CHRISTOPH, 2002). A third strand centres on ways in which discursive/narrative notions and analytic techniques can be used to study texts produced in the psychoanalytic encounter. This literature is in line with the narrative turn in psychoanalysis and the concurrent tendency to develop research methodologies that take into account the centrality of language and meaning-making in the process of therapy. This paper aims to review this last strand of the research literature, that is social constructionist language-based analyses of psychoanalytic psychotherapy, and to discuss the usefulness, the shortcomings and the implications of this type of research for psychoanalytic theory and technique3. Initially, I present studies that examine the interactional, linguistic processes through which psychoanalytic therapy takes place. Then, I discuss studies that focus primarily on the clients talk and study aspects of the clients subjectivity as expressed in his/her unfolding narrative. Finally, issues regarding the implications of this type of research for psychoanalytic process research are discussed.

Studying the discursive processes that constitute psychoanalytic practice

This section includes a group of language-based analyses that focus on the linguistic means that underlie important interactional phenomena in psychoanalytic therapy; issues that have been studied include resistance, the therapeutic relationship and interpretation. These studies build bridges between psychoanalytic theory and linguistic phenomena and therefore provide ways of studying psychoanalytic practice in discursive terms. With regards to the method of analysis employed, these studies adopt linguistic forms of discourse analysis and conversation analysis.

Resistance
In contemporary intersubjective theory resistance is conceptualised as an interactive process (e.g. VAN DENBURG & KIESSLER, 2002) embodied in certain linguistic features of the therapistclient conversation. In this framework, G RABHORN, K AUFHOLD, M ICHAL, & OVERBECK (2005) employed a form of linguistic discourse analysis to study resistance in a 12-week inpatient psychodynamic therapy with a woman with a diagnosis of bulimic anorexia. More specifically, talk in the sessions was analysed through Formal Text Analysis, which tracks formal linguistic features of the conversation. Resistance was considered to be displayed through several linguistic features in the conversation, such as low levels of speech activity, many silences, few acknowledgement tokens, few narrative passages and high use of the passive voice. The

3 This paper draws from a larger research project the author has undertaken, in collaboration with E. Georgaca, over the last few years, with the aim to systematically review language-based analyses of psychotherapy.

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analysis shows that strong resistance is evident in the beginning of therapy, followed by diminished resistance and the establishment of the working alliance in the middle phase, and finally by signs of autonomy development in the end phase. This is an example of a study that formally assesses a psychodynamic notion that is implicated in therapy progress from a linguistic perspective. As such, it proposes a systematic and plausible way of studying the development of resistance in interactional terms and to trace shifts in resistance through the process of therapy; moreover, the reliability of this link (between linguistic features and resistance) is supported by the concurrent use of a measure of social interaction. This type of study can help to define important aspects of therapy process in observable linguistic and interactional behaviour and to trace their development through sessions, as well as to link this with outcome.

The therapeutic relationship

Aspects of the client-therapist relationship have been approached analytically through examining the compatibility and the interlocking of their respective utterances. Several studies focus on the inter-mixing of the participants talk, that is the joint construction of meaning that gradually occurs in the process of therapy. For example, LEWIS (1995) used a form of linguistic discourse analysis to examine the participants conversational style in one session of psychodynamic psychotherapy. Conversational style is one aspect of meta-communication and involves different dimensions of talk. The analysis highlights the initial differences in conversational style between client and therapist and shows how the therapist gradually adapts to the clients conversational style. Conversational style is considered important because when it is well-matched between participants this leads to increased conversational involvement and coherence, which are necessary conditions for the achievement of insight and relational connectedness. Therefore, becoming aware of conversational style is important for therapists, as such awareness is closely implicated in consolidating the therapeutic alliance and enhancing the therapeutic process. In a similar vein, F ERRARA (1992) studied the characteristics and the interactional functions of joint productions in therapy. Joint productions are interlocked utterances, where the client initiates a proposition and the therapist completes or extends it in a manner that is semantically and syntactically compatible. The analysis suggests that joint constructions constitute a major linguistic expression of empathy, a significant factor in the process of therapy. The inter-mixing of the therapist and clients language is displayed well through the notion of quasi-direct discourse. Quasi-direct discourse has been used to analyse the interaction in psychoanalytic psychotherapy in an insightful, though relatively unsystematic, study (F INLAY & ROBERTSON, 1990). The term describes utterances that lie between direct (uttering ones own words) and indirect discourse (i.e. quoting the talk of another). It refers to a type of talk

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characterised by a fluidity of subject positions, whereby the different voices of the client and the therapist become thoroughly mixed, in momentary equilibrium, in such a way that neither prevails. In such statements, the authorial position is unclear; it appears as if it is the therapist speaking for him- or her-self, but the word choice and the context produce vagueness. Consequently, there is ambiguity, and meanings are relativised without being resolved. This is considered important as it introduces polyphony and polysemy in the clients world, which in the case of neurosis is assumed to be characterised by polarised, fixed, rigid systems of values and by monological thinking. Moreover, in quasi-direct discourse the referent situation is often left unclear, so that the discourse simultaneously refers to many situations and, in this way, connects them. This form of talk is a common discursive strategy in psychoanalytic therapy and has various functions; it provides evidence that the therapist is listening, it comments on what the client has said while maintaining neutrality, it expresses difficult thoughts and emotions on behalf of the client and it opens up the clients discourse to multiple meanings. Finally, NYE (1998) examines the therapist-client relationship in a long-term psychoanalytic treatment with a particular emphasis on issues of power and authority. The study assumes a rather unidimensional view on power, which centres on authorship regarding the meaning(s) with which the clients narrative is invested. The analysis utilises the notions of heuristic (where the narrator puzzled by his/her experience narrates it in hope to better understand it) vs. negotiative processes (where the listener challenges the meaning the narrator attributes to his/her experience, without the latters invitation to do so) in narrative co-construction. It is argued that concerns about power and authority emerge when therapist and client engage in a process of meaning co-construction, that the nature of these concerns changes with the establishment of a solid therapeutic alliance, and that the client gradually becomes increasingly able to reconstruct her own narratives, facilitated by the therapist sharing narrative power. The studies presented above display how discursive analysis can examine the therapeutic relationship in terms of linguistic interaction and, therefore, provide links between broad theoretical concepts and actual practice; as such they provide ways of studying important aspects of the process of therapy and means to link these with outcome. Moreover, they demonstrate the active role of both participants in constructing the unfolding narrative, and could be used to explore issues of joint authorship and responsibility, i.e. to study who puts what in the analytic space. In addition, such close analyses of each participants contributions can increase therapist awareness regarding the effects of their talk and can, therefore, contribute to therapist training and reflexivity.

Interpretation
Interpretation, one of the core distinguishing features of psychoanalytic psychotherapy has been the focus of inquiry in series of conversation analytic studies. More specifically, P ERKYL

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(2004, 2005) and VEHVILINEN (2003) used conversation analysis to study 27 randomly selected psychoanalytic sessions. The papers focus on the interactional practices through which interpretations are accomplished; interpretations are approached as joint constructions between analyst and client through which the clients narrative is invested with new meanings. VEHVILINEN (2003) studied the delivery of interpretations in psychoanalysis taking into account a particular asymmetry that exists between analyst and client, which stems from the notion of the unconscious. Contrary to everyday interactions, where speakers are assumed to own their experience, in the psychoanalytic encounter the analyst is assumed to understand the clients (unconscious) mind better than the client him- or herself. In this context, interpretations refer to analysts statements about the clients (unconscious) mind or about his or her current experience. The analysis describes key features of the interpretation and highlights three conversational devices through which the interpretations are woven into the clients talk and presented as if they are based on what the client has already said. Furthermore, the analysts are shown to actively prepare the ground for an interpretation by constructing some aspect of the clients talk as a puzzle that requires further attention and explanation; thus the interpretation that follows is rendered relevant and expected. Vehvilinen also suggests that this is a continuous process, as interpretations solve the puzzle at hand but often invoke further puzzles that need to be explained. P ERKYL also studies the delivery of interpretations in psychoanalysis (2004) as well as the clients responses to them (2005). His studies support the view that interpretations are effective primarily through their linguistic appeal (narrative truth) rather than their historical validity (SPENCE, 1982). Here, interpretations are defined as statements that make links between different domains of the clients experience (in the past, in current life and in the analytic hour) or statements that describe conflicts between different emotions (MALAN, 1995). P ERKYL (2004) suggests that the analyst actively builds up the plausibility of the links contained in the interpretation and renders the proposed links visible, concrete and plausible. This process is accomplished through two key strategies: lexical choice and sequence organisation. With respect to lexical choice, analysts use identical figures of speech, often drawn from the clients talk, when (re-)describing the different domains of experience they wish to link in the interpretation. With respect to sequence organisation, the study points to two sequential patterns that function to render the interpretation relevant and plausible; in both, the analyst highlights some aspect of the clients narrative, refocusing and elaborating it in a way which allows for it to be linked with another domain of experience in the ensuing interpretation. In a related paper, P ERKYL (2005) examines the clients responses to the interpretations; in more than half of the interpretative sequences examined in this study, the clients elaborated on the interpretation, rather than merely confirming or disconfirming it. This response is actively

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encouraged by the analysts through various linguistic practices, such as the use of silence following the interpretation, explicit requests for the client to reveal what is in his/her mind, formulating the clients minimal response as problematic, and gradually adding new elements to the interpretation, thus creating new opportunities for the client to respond. This interactional pattern is in line with contemporary psychoanalytic theory which views interpretations as actions that are intended to lead to new material and as an opportunity for clients to play with them (e.g. C ASEMENT, 2002). In addition, the clients elaborations sometimes display a discontinuity with the interpretation, expressed through shifts either in the topic discussed or in the stance assumed in the utterance (e.g. from a reflective to a complaining stance). The analysis also shows that, despite these discontinuities, the conversation runs smoothly. It is argued that this is made possible due to the multi-unit organisation of the interpretation; this allows the client to elaborate on one unit usually the one immediately preceding his or her elaboration while disregarding others. Interestingly, the analysis also shows how this selective elaboration which from a clinical perspective can be seen as a sign of avoidance or resistance is also jointly constructed. These studies provide excellent examples of the usefulness of conversation analysis to the study of the process of psychoanalytic therapy; through the detailed analysis of session transcripts, they offer plausible and useful descriptions of how interpretations are realised in practice. Moreover, they assume an interactional perspective, and thus highlight the active and constructive role of the therapist in shaping the unfolding dialogue, and examine the dynamic interplay between the participants in the psychoanalytic encounter. The detailed sequential analysis afforded by conversation analysis could also be used to study the interactional aspects of other important clinical phenomena such as resistance, counter-transference, role-responsiveness, and rapport, and how these are interactionally accomplished. A particularly strong point of these studies is how well they combine conversational analytic assumptions with therapy theory, something which is rare in the relevant conversational analytic literature. These studies manage to firmly locate their findings in fine-grained analysis and to link these findings to psychoanalytic theory. In this way they negotiate successfully the often problematic tension between a competent analysis and its clinical relevance. In the next section we turn to studies that focus on aspects of the clients subjectivity as expressed through their talk.

Studying subjectivity in therapy talk

In social constructionist accounts, subjectivity has been radically reformulated as a discursive accomplishment, jointly constructed in specific interactional contexts and within wider culturally available systems of meaning. In narrative and constructionist conceptualisations, the self is

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described as fluid, dynamic, reflexive, fragmented, multiple, and polyphonous. Some of the notions developed in social constructionist accounts regarding the self (e.g. voices of the self, subject positions, dialogical aspects of the self) as well as well as notions regarding subjectivity that draw from psychoanalytic theory (e.g. self-reflection) have been used in language-based studies of psychoanalytic process. One aspect of subjectivity that has been explored in several studies is the self-analytic function, i.e. the capacity of part of oneself to observe, reflect and analyse ones experience. The distinction between the experiencing and the observing ego is a key feature of psychoanalytic accounts, and a central assertion regarding therapy is that through this process the client comes to internalise the function of the therapist and becomes increasingly self-observing and selfreflective; in line with this, it is suggested that the self-analytic function can provide a linguistic marker for change. Focusing on the self-analytic function, N YE (1994) analysed ten randomly selected sessions from a long-term psychoanalytic psychotherapy employing a form of linguistic discourse analysis; the self-analytic function was examined in relation to referential (i.e. sentences that express facts) and evaluative clauses (i.e. sentences that express meaning) in the clients narrative. In brief, the analysis differentiates three general phases in the therapy. In the beginning phase, the client mainly narrated facts about past experiences using mainly referential clauses, whereas the therapist introduced questions around meaning. In the middle phase, there was a shift in emphasis from past to present, from fact to meaning, from telling stories to talking about the narratives, and from exploring explicit meanings to uncovering multiple hidden meanings. Narrative content was equally divided between referential and evaluative material. In the end phase, there were many narratives about past and present experiences but the clients narratives contained many reflective statements that alternated with factual information. In addition, the client became more active in reformulating the meaning of her narratives, there was more exploration of the transference-related meaning of the narratives and the client seemed more able to explore the multiplicity of meanings and to tolerate ambiguity. Another way of looking at self-reflection in psychodynamic therapy has been through the Narrative Process Coding System (NPCS) (A NGUS, LEVITT, & HARDTKE, 1999). The NPCS is theoretically linked to narrative theory and to process-experiential therapy but has also been applied to psychodynamic therapy. This system differentiates between three distinct narrative modes in the clients talk: external narrative sequences that consist of descriptions of events, internal narrative sequences that involve the description of feelings, sensations and reactions, and reflexive narrative sequences that address issues of meaning. The analysis focuses on shifts both in the content of the talk and in the types of narrative processes involved in a clients narrative. It allows the researcher to trace specific content topics through sessions and to track

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changes in the clients narrative within and across sessions; moreover, it can be employed to compare the function of narrative processes between different client groups, between goodoutcome and poor-outcome therapies and between therapies of different orientations (ANGUS, LEVITT, & HARDTKE, 1999). For example, ANGUS & HARDTKE (1994) compared the narrative processes between three good-outcome and three poor-outcome brief psychodynamic therapies. The poor-outcome dyads were shown to have a greater overall percentage of internal and external narrative sequences, whereas the good-outcome dyads displayed a progressively higher percentage of reflexive narrative sequences. These findings are in line with the theoretical assumption that an important goal and outcome of therapy is the development of a reflexive capacity. A related study focused on the importance of emotional disclosure for the development of the therapeutic alliance, based on twelve clients undergoing brief psychodynamic therapy for depression. The findings suggest that clients emotional expression is important and does indeed constitute a pre-requisite for change, that the therapists attunement to this emotional expression facilitates the development of a strong therapeutic alliance, and that good outcome is related to emotional expression being organised within a narrative framework that identifies what is felt, about whom, and in relation to what need or issue (ANGUS, 2005). These findings are in line with the psychoanalytic assertion that successful therapy involves working-through and attributing meaning to (unacknowledged) emotions rather than mere emotional expression. These studies provide good examples of how narrative analysis can offer a clear and systematic description of the processes that take place in therapy, as evidenced in shifts that occur in the clients talk. It is argued that, through such analyses, clinicians can be helped to better understand the processes of change and thus to enhance the quality of their work. In addition, such analyses could complement similar work on tracking developments in the clients reflective functioning or mentalization, a central notion in many contemporary articulations of psychoanalytic treatment, in particular for borderline pathology (e.g. B ATEMAN & FONAGY, 2004). Adopting a constructionist perspective, several studies draw from the notion of the dialogical self in studying shifts in subjectivity through psychoanalytic therapy. This approach proposes that the self resembles a polyphonic novel, containing a multitude of internalised voices engaged in internal dialogue. In this view, psychopathology is considered the result of either fragmentation between the I-positions or the dominance of one position over others. The aim of therapy, accordingly, is to facilitate the flexible and fluid adoption of different positions, as reflected in shifts in the dialogue that takes place between the characters in the narrative. This approach has been employed in several studies of therapy transcripts (e.g. E LLIOTT & GREENBERG, 1997; H ERMANS, 1997, 2001; LEIMAN, 2002) and few of those concern psychodynamic therapy. For example, Lysaker and his colleagues analysed sessions from a long-term psychodynamic-integrative psychotherapy with a man diagnosed with schizophrenia (LYSAKER,

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L ANCASTER & LYSAKER, 2003). In narrative terms, schizophrenia is considered to entail either the collapse of narrative, whereby the present and past are left unstoried leaving the person with a diminished sense of agency and temporality, or serious narrative disturbance, whereby internal conversations take place with no organising structure or are dominated by a singular voice. Consistent with a dialogical perspective, the analysis demonstrates how positive therapeutic change in this case involved a shift towards a more coherent narrative and the development of increasingly complex, diverse and polyphonous internal conversations. In a similar vein, GEORGACA (2001, 2003) produces a very interesting reading of the process of change in subjectivity in a seven-year psychoanalytic treatment. The analysis utilises two central notions from Bakhtins work, namely that all utterances are structured in relation to an addressee and that all utterances have a social history (in this context the various meanings that specific words have relate to the clients history in important relationships, as well as to the culturally-assigned meanings associated with them). Using these concepts, the analysis traces a gradual shift in the clients voices, from a mainly transferential frame in the beginning of therapy, where the client addresses the therapist as if he is the object of his transference, towards the use of a reflexive frame towards the end of therapy, where the client comments on his transferential feelings from a distance and gradually evaluates them and connects them to important relationships in his past. Moreover, the analysis highlights an increasing fluidity in these moves (2001). In other words, therapeutic change is associated not only with the emergence of a reflexive voice but also with an increase in the fluidity and interplay between different voices and frames. The second paper focuses on the therapists interventions and their effects in facilitating shifts in the clients subject positions; these shifts are shown to occur through the joint exploration and mutual appropriation of voices, subject positions and languages by therapist and client (G EORGACA, 2003). Other studies have utilised the notion of subject positioning to examine shifts in subjectivity in the context of psychodynamic therapy. For example, MADILL & DOHERTY (1994) and MADILL & BARKHAM (1997) employed discourse analysis to study a short term psychodynamic-interpersonal psychotherapy with a woman presenting with depression. More specifically, M ADILL & DOHERTY (1994) demonstrate how the client, drawing from dominant discourses regarding ideal femininity, presents her account in terms of obligations to others while the therapist, drawing upon a Western, masculine individualist account, constructs her as a passive recipient of other peoples wishes, which is then presented as problematic. M ADILL & BARKHAM (1997) further this analysis and trace shifts in the way the client constructs herself and her mother employing subject positions of the dutiful daughter, the bad mother and the damaged child and the effects of these constructions. In this therapy, therapeutic progress is shown to involve the therapist working with the clients frame to construct an account of her life which is morally defensible; more specifically the placement of the clients mother into care is

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gradually constructed as justifiable and as being good for the clients depression, in an elaboration that at the same time allows the client to maintain the dutiful daughter position. These analyses display how problem formulations and subject positions are interactionally negotiated and how wider discourses are strongly implicated in personal distress. Focusing also on aspects of subjectivity, MADILL, SERMPEZIS & BARKHAM (2005) examine the first session of four brief psychodynamic-interpersonal therapies; they compare between the good (three) and poor outcome (one) therapies with an aim to identify possible early markers of outcome, utilising notions of narrative identity. In the good-outcome therapies there was evidence of agentic positioning, which was almost completely lacking in the poor-outcome therapy. This is in line with constructionist theory and research, whereby it is often assumed that therapeutic change implicates a shift in the clients gradually assuming an agentic position, i.e. constructing their self-narratives in terms of increased agency, which involves the notions of action, intent and responsibility. In addition, although all clients described themselves in negative terms, those in the good-outcome dyads also constructed some aspects of themselves and their relationships in positive terms. With respect to the client-therapist relationship, all clients affirmed the therapists contributions but in the poor-outcome case there were no attempts at rapport-building or at recognising and interpreting transference dynamics. These studies pay attention to the way subjectivity and agency are negotiated in therapy talk. They draw from constructionist accounts relating to identity and selfhood, and therefore provide links between psychodynamic theory and social constructionism; these links could be used to further theoretical debates within psychoanalytic theory. Another contribution of these studies is that they point to the importance of studying therapy talk both in terms of the microprocesses that take place in the psychotherapeutic encounter and in terms of the macroprocesses that involve culturally-preferred ways of constructing selfhood. Such approaches may extend therapist reflexivity towards attending to the sometimes unacknowledged assumptions and values inherent in their theory. However, these studies approach the psychoanalytic dialogue from a framework outside psychoanalytic theory and therefore it is not always easy to assimilate their findings and implications in psychoanalytic theory and in clinical work.

Strengths and limitations of language-based analysis of the psychoanalytic process

One immediate conclusion from this review is that this body of research is still in its infancy and that there is virtually no cross-referencing between studies; this significantly limits the knowledge-base generated with regards to psychoanalytic process. Notwithstanding this limitation, language-based analysis constitutes a largely unexplored and underutilised resource for practitioners and researchers of psychoanalysis. As a qualitative research approach it is open-

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ended, discovery-oriented and aims to produce thick descriptions of what actually takes place in therapy rather than to reduce the therapeutic process to predetermined variables. This is line with a recent tendency towards developing process research that does not rely on the drug metaphor (CHARMAN, 2003). Language-based analyses are idiographic and are therefore limited to the detailed study of a small number of sessions, yet rigorous, systematic and transparent; analyses are open to alternative interpretations in a process reminiscent of psychoanalytic practice, where meaning is considered to be overdetermined and multilayered and where analysis aims to produce further understanding rather than fixed answers. Moreover, discursive research provides ways of examining contradiction and diversity in the ways participants talk, thus allowing for the study of conflicting and fragmented aspects of human subjectivity. These characteristics make language-based analysis compatible with clinical thinking and so these approaches have the potential to generate clinically meaningful knowledge. Arguably postmodern intersubjective strands within psychoanalysis (e.g. M ITCHELL & ARON, 1999) are more readily compatible with these analytic approaches, although the meticulous detail and grounding to actual talk characteristic of this form of research can also enrich understanding in more traditional trends in psychoanalysis. Language-based analysis examines talk as it unfolds in interaction and can, therefore, further our understanding of the process and dynamics of the psychoanalytic process. The main contribution of this body of research to date relates to the definition and study of the linguistic form that various psychoanalytic notions take in practice. In this sense, such analyses demonstrate the linguistic processes that constitute the therapeutic process and can help study in detail how therapy gets done (i.e. what we do, whether we do what we say we do, and how we do it) and to trace shifts in meaning and talk through the process of therapy. These studies are in line with a paradigm of practice-based evidence, which proposes that research that is close to the experience and the concerns that therapists face in actual practice may be more ecologically valid and useful to clinicians (e.g. MARGISON ET AL., 2000). With regards to process-outcome links, narrative analyses are more readily suited to this task, as they spell out more clearly criteria of narrative pathology and narrative health. Findings from conversation and discourse analytic studies, however, can also be related to outcome, for example by comparing the patterning of discursive processes in good- and poor-outcome therapies (GEORGACA & AVDI, 2007). In addition, such analyses can also help compare between different psychoanalytic schools and to examine theoretical and technical differences as evidenced in practice, which in turn can enhance clinical awareness as well as inform theoretical debates (Perkyl & Vehvilinen, 2003). The findings of these discovery-oriented and bottom-up approaches to studying talk, a feature particularly prominent in conversation analysis and discursive psychology, can be used to counteract the criticism that psychoanalysis is often too theory driven (top-down) as an approach to interpreting the clients talk (FROSH & EMERSON, 2005).

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A particularly useful aspect of these methods, as compared to other qualitative approaches, is that they approach therapy as a collaborative process of meaning-making and highlight the joint construction of new meanings in the analytic encounter. Conversation and discourse analysis, in particular, focus almost exclusively on interaction and thus bring to the fore the constructive role of the therapist, in line with intersubjective approaches to psychoanalysis. By studying in detail conversational features such as sequence organisation, one can study who introduces what in the conversation and what participants do with each others interventions; this is very useful for studying the dynamics as they unfold. Moreover, the close attention to language and the meticulous level of detail regarding interaction that language-based analysis provides can help sharpen the therapists skills of attention and increase sensitivity to understanding material. The distancing generated through the processes of transcription and analysis may promote the generation of further interpretations and new insights regarding clinical material (FORRESTER & R EASON, 2006). Therapists can become aware of the effects of their interventions on the clients narrative and can also monitor the extent of correspondence between the therapeutic assumptions they adhere to and their implementation in practice. In this way, language-based analyses can generate knowledge that is useful for training and continuing professional development. Finally, it is worth noting that the majority of studies reviewed in this paper either approach psychoanalytic talk from within the psychoanalytic frame i.e. adopt psychoanalytic assumptions or assume a neutral stance towards psychoanalysis as, for example, in conversation analytical studies that aim to describe how psychoanalysis gets done, without evaluating its practices or the effects these may have. This means that the potential of language-based analysis for developing critique has not been fully exploited yet. The more critical approaches to studying talk, such as poststructuralist discourse analysis, can help therapists become more attentive to issues of power and authority in their interactions with clients. This can promote a form of reflexivity that relates to the recognition, on the part of therapists, of the discourses, the values and the practices they employ and the effects these may have on the clients lives; such reflexivity would hopefully contribute to the development of more ethical practice. On the other hand, language-based analyses are very time-consuming and necessarily limited to the in-depth examination of a few sessions, a fact that limits the generalisability of the resulting claims and findings. In addition, language-based analyses, by definition, rely on the study of language and may be argued to sidestep important non-verbal aspects of the clinical interaction. It is worth noting, however, that the study of the structure, organisation and form of accounts can provide information regarding relational dynamics, as evidenced by some of the studies reviewed. Moreover, the findings and methods of research on the non-verbal aspects of the therapeutic encounter, e.g. research on affective communication as expressed in facial

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expressions (e.g. DREHER, M ENGELE & KRAUSE, 2001; KRAUSE & M ERTEN, 1999; M ERTEN, 2005), could be used to inform language-based analyses of psychoanalytic therapy. In addition, findings from other fields of narrative research could be usefully employed in broadening the scope of language-based analyses, such as narrative analyses of the unsayable (R OGERS ET AL., 1999). A final point that is worth mentioning here is that in contemporary intersubjective and relational approaches to psychoanalysis, the distinction between action and speech is considered to be, at best, hazy (e.g. STREECK, 1999). In sum, studying the process of psychoanalysis from a qualitative social constructionist perspective is not a straightforward task; one finds oneself facing several points of tension, the most salient of which relate to clinical relevance and epistemology. As already mentioned, the balance between analytically competent studies and clinically relevant analyses is not easy to achieve; as a result some studies are analytically competent but difficult to relate to clinicians concerns, whilst others make intuitive sense to clinicians but are analytically limited. A second point of tension relates to differences between the social constructionist assumptions regarding subjectivity and the inner self assumptions of much of conventional psychoanalytic theorising. This tension means that it is not easy to maintain an awareness of the interactional nature of psychoanalytic practice and of the importance of context in the production of the clinical dialogue (both micro- context i.e. institutional and the macro-context i.e. sociocultural) without losing the subject. These are tensions that have not been resolved. Perhaps this is inevitable given the nature of social constructionist research; perhaps as soon as we decide to abandon the certainty, clarity and orderliness promised by quantitative research, we need to be prepared to tolerate tensions and uncertainty as indeed in psychoanalysis and to accept that these tensions may be resolved only partially and only with respect to specific research contexts. Without wishing to sidestep these thorny issues, I hope this review has shown that the systematic, rigorous, meticulous and reflexive way of studying talk provided by language-based analysis can be fruitfully used in furthering our understanding of the many nuances and complexities that characterise clinical psychoanalysis.

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Correspondence address:
Evrinomy Avdi Department of Psychology Aristotle University of Thessaloniki 54124 Thessaloniki, Greece Phone ++30 / 2310 / 997363 Fax ++30 / 2310 / 997384 e-mail: avdie@psy.auth.gr

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