Understanding Alliance Ruptures During the Assessment of Client Preferences

: An Applied Conversation Analysis​ 

Abstract

Introduction: Healthcare in the UK is aspiring to actively involve people in decisions relating to their care (NHS, 2019). Counselling and psychotherapy research is attending to the involvement of clients in decisions relating to their talking therapy. This involvement includes clients sharing their perspectives on what may be effective during treatment. Pluralistic Therapy for Depression is one protocol to talking therapy that places people’s preferences and choice-making at the heart of the therapeutic process. A recent trial has shown good treatment outcomes including client satisfaction (Cooper et al., 2015).
Objective: The methodology of Conversation Analysis examined problems in interaction within 14 episodes of client preference assessment (segmented into 18 extracts) from 6 sessions involving 5 dyads.
Findings: The analysis illuminated common problems including how therapists constructed “what would be helpful” questions, and clients’ deference towards professional expertise and care planning. Clients may not always explicitly know what they want, or know how to verbally articulate their wants, in part due to the differences in knowledges between trained therapists and lay people regarding what might be feasible in talking therapy.
Conclusion: These findings can contribute to psychotherapy practice by highlighting helpful and less helpful contributions by therapists and clients during shared decision making.

Date of Award	6 Dec 2022
Original language	English
Awarding Institution	University of Roehampton
Supervisor	John Rae (Director of Studies) & Mick Cooper (Co-Supervisor)