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Conversational
Ethics in Psychological Dialogues: Discursive and Collaborative
Considerations
Abstract
With the linguistic turn in the social sciences have come increased sensitivities to language use. In this paper, we examine such sensitivities as they relate to the conversational practices of psychologists seeking collaborative relationships with clients. In particular, we link ethical practice with developments in discourse theory and research, presenting arguments and evidence for enhanced forms of collaboration and client-centred practice. We conclude with considerations for what we consider "conversational ethics" in psychological practice.
The social constructionist movement in psychology is now a generation old.
Premised primarily on developments in linguistic theory, the key insight
spurring on this movement has been the notion that language is incapable of
correctly representing experience in any absolute sense. For some, the movement
seemed to invite linguistic anarchy; for others, it ushered in a new era of
critical reflection and potentials for reauthoring understanding. Regardless,
there has been a recent proliferation of research methods, therapeutic
practices, pedagogies, and critically inspired reflections within psychology
derived from ideas and practices associated with social constructionism.
Attempts to reconcile these developments within mainstream psychology have been
occurring for over 30 years now (Gergen, 1985; Shotter, 1975).
For us, a
social constructionist epistemology refers to a view of meaning as the product
of human interaction in relational and broader cultural circumstances; that is,
meaning owes something to its use in social contexts. The Canadian Code of
Ethics for Psychologists (the Code hereafter; Canadian Psychological Association
[CPA], 2000) offers one such example of socially constructed meaning. It also
shows a function of meaning we feel merits particular consideration: how meaning
is consequentially interpreted and put to use. With social constructionist
practice in psychology has come a concern for meanings and practices used
without critical reflection (i.e., taken for granted; e.g., Parker, 1999).
Psychological practice itself can be seen as a socially constructive activity
(McNamee & Gergen, 1992), shaped and reshaped over time. Our focus here is
on how social constructionist perspective can further inform ethical practice,
particularly in discussions psychologists want to see as collaborative with
clients.
Recent developments in social constructionist practice (e.g.,
Gubrium & Holstein, in press; Strong & Paré, 2004) emphasize a premise
highly compatible with some aspects of ethical practice, as promoted by the Code
(CPA, 2000): respect for the dignity and preferences of clients. This respect
can be shown in how client-psychologist interactions occur in a collaborative
manner when that is the aim of the psychologist. Specifically, the ethics to
which we refer focus on how conversational differences are worked out between
clients and psychologists. They also refer to how issues of power and dominance
are collaboratively resolved in the manner by which such psychological dialogues
are conducted. That clients consult psychologists for their expert knowledge, of
course, does not extend to psychologists' expertise overriding the
understandings or preferences of clients. Instead, the first principle of the
Code (CPA, 2000), particularly the first ethical standard, asks psychologists to
demonstrate respect for the knowledge, experience, and expertise of others. For
social constructionists, since there is no correct meaning made possible by
language, a primary issue is the fit or appropriateness of meanings for those
with whom psychologists interact. Meanings not taken up by clients serve neither
client nor psychologist in addressing concerns that clients present.
Arguably, psychologists have developed a more refined discourse than
others from which to discuss clients' concerns and what can be done about them
(Danziger, 1997). At worst, this thinking privileges psychologists' discourse,
forcing clients to converse in ways that do not adequately reflect their lived
meaning or sense of what is useful to them. A growing critical psychology
literature suggests that psychologists (usually unknowingly) hold clients to
normative understandings and ways of being - through exercising their expert
knowledge (e.g., House, 2003; Rose, 1990; Parker, 1999). Such normative
understandings and ways of being thus reflect a dominant social order some
psychologists are therefore seen as upholding. The social constructionist
approaches to psychotherapy have focused on client knowledge, preferences,
theories of change, and resources (e.g., Duncan & Miller, 2000), and on the
discourses or ways of talking and understanding used by clients (Freedman &
Combs, 1996). Thus a corresponding focus is on how psychologists use their
knowledge to incorporate the knowledge and preferences of clients. Clients'
meanings and preferences for mutual work could be important assessment
dimensions in working with clients but our concern does not stop with
considering these client particulars, it extends to how psychologists engage
with them collaboratively.
Conversational Ethics?
Whether one turns to the training literature or the CPA Code of Ethics, there is no shortage of prescriptions about how psychologists ought to relate to their conversational partners. For us, such prescriptions are often premised on metaphors of communication that are less than dialogic (Lakoff & Johnson, 1980; Sampson, 1993). By dialogic we differentiate relationally responsive dialogues regarded as mutual or collaborative by both participants from talk occurring in uncoordinated and sometimes competing monologues (Shotter, 2006). Researchers studying discourse regard the rhetorical and interactive aspects of conversation as obscured in common information transmission models of communication (Maranhâo, 1986). For most social constructionists, communication involves relational (how to proceed together) as well as informational (what) aspects (Watzlawick, Bavelas, & Jackson, 1967). Talk "performs" (Austin, 1962) relational functions that speakers cannot decide for each other and these rhetorical aspects of dialogue are matters to be worked out by speakers as they talk. Therefore, on "conversation's shop floor" (Garfinkel, 2002), psychologists need flexible and responsive discussions with clients. They clearly cannot hold clients to their ways of talking and meaning exclusively. Their respect extends to how they engage with clients' meanings and ways of talking.
Consistent with our focus on the "whats" and "hows" of professional
conversation, we have chosen to narrow our focus to two types of professional
ethics: content ethics and process ethics (Swim, St. George, & Wulff, 2001).
Content ethics include standards outlined in professional ethical codes
specifying what helping professionals should do in accountably working with
clients (e.g., confidentiality, dual relationships, competence). However, their
uniform application presents responsive and collaborative challenges given the
cultural, contextual, and emergent features of specific professional encounters
(e.g., Donovan, 2003; Pedersen, 1997). For this reason, we feel it is important
to consider process ethics - or what we term "conversational ethics" - to refer
to psychologists' practical reasoning and situation-specific ways of talking
with clients (Gergen, 2001; Swim et al., 2001). So, we are proposing ethical
considerations for fostering psychologists' contributions to collaborative
dialogue.
To a varying extent, psychologists practice in improvised
ways, balancing professional knowledge with modifications required to
reflectively and sensitively interact with clients and circumstances (Schön,
1983). Said differently, psychologists practice in relationally and contextually
responsive ways informed by their ethics and knowledge. Conversational ethics
refer in part to these informed improvisations in a way others refer to as
"dialogic" (Sampson, 1993; Shotter, 2006). Psychologists face ethical tensions
in balancing their professional knowledge and intentions with clients'
intentions and preferences in professional interactions. Intentions, for us, are
what Anscombe (2000) has referred to as "action under a description," action
articulated in descriptions one can recognize and act on privately, or share
interpersonally.
Participating inside a dialogue is different from
third-party accounts of such participation. For Goffman (1967), participating in
dialogue is a comanagement task requiring speakers to be intelligible,
understanding, and influential with each other in the immediacies of their
talking together. For some, this co-management task comes down to enacting clear
role definitions: Clients consent to providing professionally relevant
information and assent so that they can be appropriately assessed and directed
by psychologists. However, close examination of professional dialogues shows
that clients are anything but docile in or outside of such narrow depictions of
their role (e.g., Buttny, 1996; Maynard, 2003). Clients shape all aspects of
professional dialogue and our concern in this paper is partly with how their
influence in turn influences the psychologists talking with them.
Underscoring our social constructionist approach to conversational
ethics is a view that outcomes in professional dialogue are accomplished much
the same as are other outcomes between speakers. People work out such matters
between them in negotiated dialogues, and these negotiations serve as their
basis for later mutual actions. Negotiation, in how the term is commonly used,
can seem anything but collaborative, but as we use it here it refers to the
notion that any meaning or action needs to be understood as the product of
interactions with social or physical reality. The added dialogic piece is that
these interactions occur in ways that adequately reflect the intentions and
preferences of psychologists and clients as each deems "adequacy."
To
examine our concern with negotiated dialogues in reverse, an ample literature on
clients' nonadherence with treatment recommendations shows when such
negotiations have gone awry (Leahy, 1993; Meichenbaum & Turk, 1987).
Expertise in conveying professional diagnoses or prescriptions seems to have
been eroded by an Internet and self-help book savvy clientele (Starker, 2002).
More likely, psychologists are now seen as consultants offering contestable
knowledge and less so as ultimate authorities on clients' lives (e.g., Bergmann,
1992; Heritage & Sefi, 1992). Paralleling such shifts in clients' ways of
thinking and relating has been a rise in approaches to psychotherapy informed by
client preferences, not only on treatment goals but on the shared processes by
which these might be attained (e.g., Duncan & Miller, 2000; Freedman &
Combs, 1996; Madsen, 1999). Such psychologists are to a varied extent
"resistance-informed" in how they converse with clients to arrive at shared and
"adequate" outcomes (Strong & Zeman, in press). Client refusals of
therapist's interventions thus constitute feedback the therapist can use in
adapting interventions to client preferences and circumstances (Selekman, 2005).
There are striking examples where what we have been raising is relevant, if not disconcerting, for psychologists. How clients' concerns are named offers one such example. While a DSM-IVTR diagnosis may help to translate clients' concerns into symptomatic shorthand useful to the psychologist, it offers but one representation of clients' concerns and aspirations. Our concern is with the exclusory use of professional discourse for both naming clients' concerns and for avoiding other ways clients might want to talk and be understood. Feminist and social constructionist writer, Kaethe Weingarten (1992), spoke of "intimate interactions" in therapy, which, for us, can extend to referring to collaborative interactions. For Weingarten, conversational violence occurs when meanings are imposed, ignored, or misconstrued purposefully in noncollaborative interactions with clients. She was not suggesting, for example, that therapists could not disagree with clients; at issue is how their differences in meaning and talking are reconciled. In psychological interactions, careful responsiveness to clients' descriptive language is a key aspect of the conversational ethics we are articulating. Ferrara (1994) suggests that collaborative interactions in psychotherapy are best conducted and reflected in a descriptive language shared by client and therapist. Where this matters most is in shared efforts to describe intentions for therapy's goals and proceedings. Putting language to intentions is a conversational and descriptive challenge (Anscombe, 2000) but without such discussions people can fail to coordinate their intentions. Articulating shared goals is common ethical practice, but how such goals are accomplished in the back and forth of dialogue is less considered, particularly in psychology.
Conversational Ethics Up Close
The micro-interactions of professional dialogue show how speakers' intentions
are worked out as they take turns in dialogue (e.g., Pomerantz, 1984; Sacks,
Schegloff, & Jefferson, 1974; ten Have, 1999). Those words which come to be
spoken as shared, for the discourse analyst, "ground" (Clark, 1996) speakers in
a language of common intention and articulation. Getting to a language of shared
intention requires conversational work and it is in this sense that dialogue can
be seen as negotiated across turns taken in speaking. Such negotiations are
highly evident when micro-analyzing any passage of therapeutic interaction - in
junctures such as problem-description (Buttny, 2006), understanding (Strong,
2005), identity implicating diagnoses (Antaki, 2001), client narrative
constructions (Ferrara, 1994), advice-giving (Couture & Sutherland, 2006),
and even confronting (Strong & Zeman, in press). The ethic we wish to
underscore relates to Weingarten's (1992) concern that psychologists see their
conversational interactions with clients as the means to work out meanings, in
words acceptable to both parties.
We do not wish to restrict our considerations here to the role words play in conversational interaction. Often conversation involves not only a negotiation of descriptive terms, but a negotiation of styles of discourse. Discourse, as we are using the term, refers to not only the activities of talking but to culturally systematized understandings and ways of talking prevalent in society. Critical discourse analysts, for example, see the discourses used by clients and therapists requiring some reconciling, otherwise the psychologist's discourse can be privileged in ways clients might not take up, or take up unhelpfully (e.g., Guilfoyle, 2003; Kogan, 1998). Such differences in discourse are not simply about semantics, they comprise significant differences in values, understandings, and cultural affiliations that can dominate social interaction (Fairclough, 1989). Therapists relating to clients in symptom terms, while clients relate to their circumstances in vocational or relational terms, illustrate one example of this point.
There is, however, another stylistic difference we wish to raise here, one pertaining to talk as a performance. Talk as a dialogic performance has also been referred to as talk-in-interaction (ten Have, 1999) to contrast this kind of talking with talk of a more monologic nature. How talk occurs - its speed, gestural accompaniments, vocal inflections, and responsiveness - are also aspects of dialogue to be worked out between speakers in conversational interaction. When, for one speaker, conversation goes too fast, or too slow - while the other speaker will not change speed - such stylistic differences can conversationally matter. Close scrutiny of dialogue shows not only these differences in styles of talking, but how such differences affect speakers as they talk. Our concern extends to how speakers repair junctures in talk where misunderstandings or differences are worked out, not only in words, but in ways of uttering them (Sacks et al., 1974). Alongside negotiating meaning we see conversational ethics extending to how psychologists and clients coordinate differences in their conversational styles.
For us, conversation involves people making practical (i.e., responsive in the moment) evaluations and interpretations of each other. Our social constructionist perspective borrows a micro-interactional sense from ethnomethodology (Garfinkel, 1967) and conversation analysis (Sacks, 1995). seen this way, speakers build on each other's utterances, or depart from them should better fitting utterances be accomplished through dialogues co-managed by clients and psychologists. These efforts have the following ethical dimensions:
* they show psychologists welcoming and engaging with (i.e., taking up) clients' meanings and descriptive language.
* they show clients and psychologists continuously working out a shared language of intentions through negotiating terms acceptable to both parties.
* they show psychologists conversationally working with clients to reconcile and coordinate stylistic differences in the ways of talking used, to find shared ways of talking.
We will now show how this co-management occurs in actual passages of therapeutic dialogue. If psychological practice involves the kind of "conversation shopfloor" Garfmkel (2002) spoke of, one should see evidence of the kinds of interactions we have been describing.
Examining Some Micro-Practices in Psychological Dialogues
In studying how speakers take turns at talk, conversation analysts show what speakers actually do in relation to each other and how their talking shapes their dialogues. Conversation analysts claim that people tend to take such micro-features of communication for granted (Heritage, 1988) and heuristically attend to such micro-features as consequential within dialogue. Slight differences of intonation in a speaker's utterance may convey vast differences of meaning for the recipient. Conversation analysis (CA) transcription enables practitioners to capture these messy, ungrammatical, and seemingly accidental features of talk. Speakers co-manage their rapport while and through making utterances to each other, something evident in transcripts painstaking detailing how they respectively contribute to and influence their dialogues.
Conversational ethics, as we envision them, should be evident in these mostly taken-for-granted aspects of dialogue, in how speakers take their turns at talk and attend to each other. Microanalyses of talk highlight the choices available to speakers as they take conversational turns and present opportunities to consider alternatives. The ethics at stake in these interactions relate to how intentions are articulated, how meanings are negotiated, and how stylistic differences (ways of talking) are reconciled between client and therapist. Communication researchers (e.g., Ferrara, 1994) note that clients and psychologists observably treat seemingly irrelevant details of talk (e.g., changes in intonation, overlapping talk, pauses) as significant for their next responses, and as evidence of the quality of their developing relationships.
In the following segment (see Appendix A for the transcription notation), the
therapist and client jointly search for mutually fitting descriptions of the
client's experience. The therapist takes great caution in ensuring that language
she introduces meets with the client's approval for its descriptive adequacy.
The therapist seems attuned with the client's emergent discursive preferences
and, recognizing them, uses them to shape her further contributions to dialogue.
Conversation analysts would argue that "being in tune" is a practical,
interactive accomplishment. The therapist displays her "in-tuneness" by
welcoming the client's participation ("Tell me more," "Mmhmm"), completing the
client's utterance (Line 7), mirroring his language (Lines 1, 6, 8, and 9), and
offering possible language to build on the client's original metaphorical
description. The therapist presents her contributions as food for thought
(Anderson, 2001) without having a final say on the client's meanings. Her
collaborative orientation is evident through her openness to being corrected by
the client (end of Line 6) and tentativeness of her interpretation ("kinda").
She responds sensitively to the client's modifications by passing on her
previously stated understanding of the client's utterance (Line 7) in receiving
client feedback that such understanding did not adequately reflect his
experience.
In the exemplar below, the therapist does not insert his professional advice arbitrarily, but negotiates a place in the dialogue into which such advice may be fitted (Maynard, 1991; Vehviläinen, 2001). Without such negotiation, the client may fail to understand the relevance of a particular intervention, or feel it sufficiently adapted to the client's circumstances, which, in turn, may decrease the probability of the client joining the professional in taking up a proposed intervention and thus benefiting from it (Couture & Sutherland, 2006; Heritage and Sefi, 1992).
To maximize the relevance and impact of his intervention, the therapist "aligns" with the client's stated position (Lines 4 and 7-10) and simultaneously transforms or reformulates that position (Lines 11 and 13; Antaki, Barnes, & Leudar, 2005; Davis, 1986; Grossen & Apotheloz, 1996; Hak & de Boer, 1995). Professionals often prefer to first elicit their interlocutors' perspectives on the discussed matter and then fit their ideas or advice into how they offer such information (Maynard, 1991; Vehviläinen, 2001). The therapist's idea (i.e., that the client should heal slowly) is first broached by him with the original material presented by the client ("I don't feel comfortable about it >at all
When inviting clients to talk from potentially problematic experiential and relational understandings, therapists (at least initially) tend to talk tentatively and cautiously (Bergmann, 1992; Lobley, 2001). To accomplish "tentativeness" therapists formulate their utterances by permeating them with pauses, repetition of words, uncertainty markers (e.g., "maybe"), and various particles ("uhm," "eh[four dots above]"). By using tentativeness and uncertainty, therapists are able to be interventive while remaining less authoritarian (Guilfoyle, 2003; Kogan & Gale, 1997; Roy-Chowdhury, 2006). Consequently, clients are offered, via this tentativeness, opportunities to contest therapists' ideas and proposed courses of action. Sometimes therapists openly request clients' feedback on the value of their professional conclusions and interventions (Buttny, 1996), as in the segment below. The therapist tries to elicit the clients' responses to his interpretation (Lines 5-6). Repetition of words and various particles ("uh[four dots above]," "ah[four dots above]") serve to prompt the clients' evaluations of the therapist's interpretation.
Interestingly, even when therapists attempt to collaborate with clients by
presenting their conclusions tentatively and cautiously, clients still may
resist and refuse such offerings. In the following exemplar, both partners
disagree with the therapist's assessment of their experience, in spite of
extensive efforts on the part of the therapist to downgrade his evaluative
authority.
The therapist incorporates, as a part of his formulation,
multiple pauses, repetition of words, rising intonation, and other devices
("ah[four dots above]:." "Yeah?" "if I understand correctly") designed to convey
hesitancy and uncertainty. Instead of reasserting his authority over the
disagreement from both clients, the therapist builds on these clients' responses
to further co-construct an account of this couple's understanding that fits all
parties (Line 24).
Couture (2004) provided an example of how a therapist
and client negotiate shared intentions, pertaining to a particular topic under
discussion, that afford participants' joint movement forward in a dialogue. The
therapist attempts to elicit the son's perspective on the "no suicide" contract
established by this client and a nurse upon the son's discharge from the
hospital. The safety contract may be viewed as an "institutional" way of dealing
with clients who are presumed to pose a danger to themselves. Previously in this
session, the parents positioned themselves as certain that their son will follow
the contract. While parents and professionals may join efforts in getting
children to commit to "institutional discourses," children may oppose such
socio-cultural constraints placed upon them and thus assert their social
competence (Silverman, Baker, & Keogh, cited in Couture, 2004).
The
adolescent in this segment of talk may be said to resist an institutional agenda
by providing ambivalent or minimal responses (e.g., "I don't know," "*Mhmm*").
Instead of challenging the client's position in relation to the safety contract,
the therapist acknowledges the client's statement ("Don't know ya (1.2)" and
validates it ("well that is probably an honest statement because you don't know
for sure right?"). The therapist collaborates with the client in co-articulating
this client's position of increased certainty, in relation to the safety
contract, by legitimizing the position initially articulated by the client. The
therapist then tentatively ("I guess") invites the client to join in the
position of honouring the contract. Consequently, the client remains an active
contributor to the dialogue, as demonstrated through his stronger acceptance of
the therapist's statement in Line 11, as compared to his previous responses.
To summarize, the professionals in the provided segments tended to take
a circuitous (dialogical) rather than a straightforward (unilateral) interactive
pathway in their communication with clients (Maynard, 1991). This circuitousness
can be seen as dialogic responsiveness, ways in which psychologists incorporate
the emergent developments in their interactions with clients into what they
would next say. They mostly elicited, acknowledged, and in varied ways
incorporated clients' perspectives in conversationally evident developments
prior to and as part of offering their own professional conclusions and
assessments (Exemplars 2, 3, and 5). Therapists affirmed the status of clients
as competent and credible tellers of their troubles, identities, and experiences
(Exemplars 1 to 5) and downgraded their professional expertise to provide
conversational space for the development of clients' accounts (Exemplars 1 and
3). This does not imply that counsellors withheld their opinions and
suggestions. On the contrary, most segments feature a provision of expertise by
professionals. Such expert knowledge, however, was brought forth and put to use
in ways that conveyed sensitivity to clients' potentially differing preferences
and perspectives (Exemplars 1, 2, 3, and 5). Uncertainty (Hoffman, 1995) and
tentativeness (Anderson, 2001) aided therapists (and was evident) in this
process.
While we do not have the responses of clients participating in
these passages to draw from for their judgments of how collaborative the
passages were for them, a couple of notions inform our reasons for using these
passages. For Clark (1996) and Ferrara (1994), collaboration is evident in the
interweave of common terms and ways of speaking, a phenomenon Clark refers to as
sharing "common ground" in discourse. A further concept from CA, relates to
"uptake" of one speaker's discourse by another (ten Have, 1999). A simple
example relates to a question being responded to with a relevant answer or being
joined with similar language (Clark, 1996). For those who relate to professional
dialogue as critical discourse analysts (e.g., Davis, 1996; Guilfoyle, 2003), an
asymmetric tilt favours the therapist's discourse, however. Collaboration, for
these analysts, is a suspect concept because the stakes of conversation - what
is deemed therapeutically appropriate - are seen as the psychologist's
prerogative, something clients could readily defer to, feign agreement with, and
so on. A full embrace of such a view of professional dialogue, however, can
default psychologists to the very concern being critiqued. Therapists have many
ways of exerting their dominance over the professional dialogue; who most asks
and answers questions is a further aspect of this dominance often taken for
granted (Wang, 2006). A key social constructionist tenet, however, can be
considered relevant to conversational ethics: Professional dialogues can be
where the meaning and talk have some element of contestability or negotiability
(Gergen, 2001). Of course, there are some nonnegotiables in psychologist-client
dialogues. Our concern is with meanings and ways of talking that can be shared.
Conversational Ethics: Some Training, Supervisory, Research, and Other Implications
We believe discursive research and a social constructionist perspective on psychological practice point to considerable ethical implications for how psychologists' converse with clients. Discursive evidence, the kind we have shown in our previous exemplars, permits a "slowing down" of professional interaction, so that psychologists can witness and evaluate their influence at work (Strong, Busch, & Couture, in press). Recommendations regarding ethical professional practices can be best derived from close empirical examination of the use of such practices (Donovan, 2003; Gergen, 2001; Pedersen, 1997). For Donovan (2003),
Ethics [are] integral to every passing moment of our work rather than
something to be visited on special occasions. Ideas about maximizing the "good"
become ideas about maximizing opportunities for "good" conversations and the
starting point for ethical debate about what might constitute a "good"
conversation, (p. 302)
A CA-informed, constructionist lens on
psychological practice offers a useful means to more finely attune one's
conversational practice to collaborative or other professionally sought outcomes
(Gale, Dotson, Lindsey, & Negireddy, 1993; Strong, 2003). Literally,
videotapes or transcripts of one's practice should show how the psychologist's
contributions to dialogues with clients fare, in terms of how clients respond.
Are clients showing in their responses that they are taking up what
psychologists offer via their suggestions, responses to clients, or
presuppositions in their questions? How are "delicate" discussions, ones that
put possibly client-sensitive meanings to client experiences or considerations
of identity, co-managed as discussions (Silverman, 2004)? What might be getting
passed over as clients and psychologists talk that might be relevant to revisit
as a result of certain topics or ways of talking dominating the interview (Gale
& Lawless, 2004) ? These are examples of the kinds of questions we feel are
brought to the fore by considering the micro-dynamics of psychological dialogue,
and how psychologists contribute to them.
By looking closely at how
psychologists and clients respond to each other as they construct
client-preferred outcomes in their conversational efforts, our microanalyses
point to dialogue as a co-management task in keeping with Principle 1 of the CPA
Code of Ethics. The dialogues clients have with psychologists are conducted for
them. However, psychologists face tensions in bringing their expert knowledge
and ways of practice to these co-management efforts. Good intentions, skillful
and knowledgeable practice, and sound ideas that do not fare well in
psychological dialogues, can occur when our expertise is not collaboratively
transacted with clients. The days when expertise alone should translate to
information or interventions well received by clients seem to be passing. In the
social constructionist approaches to therapy, some have gone so far as to
pronounce the "death of resistance," seeing collaborative conversational
practice as prerequisite to good professional relationships and their outcomes
(de Shazer, 1984).
In the immediacies of psychological dialogues,
psychologists do things with their words and ways of talking that clients
respond to, and that they, in turn, responsively adapt to based on how clients
respond to them. All this is done while drawing on their professional skills,
knowledge, and understandings of ethical practice. Schön's (1983) "reflective
practitioner" responsively acts based on feedback arising in the immediacies of
interactions between professional, client, and circumstance. Hopper (2005)
articulated a distinction related to our conversational ethics. Specifically,
for Hopper there are "pre-strategy" professionals: those who practice from well
and alreadyarticulated strategies that they apply to client circumstances.
Conversely, there are professionals whom he terms "emergent-when" professionals:
Those who can knowledgeably, flexibly, and constructively interact with the
people and circumstances they aim to influence. It is the former professionals
who ethically concern us most, whose fidelity to prescripted dialogue can be
experienced as nonresponsive, if not impositional, by clients. It is the
psychologist's ability to be responsive, to co-develop meanings, ways of
talking, and customized interventions befitting how clients respond to them that
we are promoting. Regardless, our review of discursive research on psychotherapy
suggests both clients and psychologists actively contribute to such
developments. And by this, we are not referring to clients merely cooperating
with psychologists' directives or following closely what they say.
With
respect to training and supervision of psychologist trainees, we see great
advantage in adding microanalytic examinations of videotaped passages of the
trainees' professional dialogues. To foster a sense of the responsive nature of
dialogue, we see the focus as much on the psychologist trainee's communication
as on how clients respond to their communications (Strong, 2003). As trainees
recognize that clients do things with their talk that they in turn must respond
to - while trying to attain client goals - a more responsive trainee often
emerges than one focused on her or his communication skills alone. This can be
especially recognized when reviewing videotapes as a means of self-supervision
(Gale et al., 1993). There one can attend to how outcomes are dialogically
accomplished in the back and forth of client-psychologist dialogue. An example
might be: how do client and psychologist start then complete a passage where the
psychologist proposes an intervention that a client willingly takes up? But,
trainees can observe also how their use of language dominates or collaboratively
features in the professional dialogue, and to note the effect this has on
clients and what develops from their contributions. We feel that psychologists
track conversational evidence for such developments or accomplishments, in how
clients respond to them, and in how the psychologist sometimes does a
"mid-course correction" in customizing an intervention to make it more likely to
be taken up by clients (Strong et al., in press). We see such activities as
useful sensitizing tools for trainees who are often insufficiently attentive to
clients' contributions to the dialogue because of a preoccupation with their own
communications.
Conclusion
Discursive inquiry offers a unique perspective on professional conversations as a two-way interactional process. For language-focused psychologists, clients are active participants in the constitution, maintenance and negotiation of therapeutic understandings and relationships (Anderson, 1997; Buttny, 1996; de Shazer, 1994; Huffman, 1995). Psychologists routinely encounter situations in which clients display commitment to certain meanings and perspectives. A frequent ethical dilemma faced by professionals relates to how to engage with, and respond to, meanings asserted by clients - how to invite clients into alternative understandings without undermining their competence or infringing on their autonomy. The artful conversational work that goes into delicately negotiating shared meaning is frequently overlooked by both psychologists and researchers interested in professional interaction. Yet, our ethics are clear (CPA, 2000; e.g., Ethical Standards 1.3,1.16,1.17, II. 21, III.10) that we are to use respectful, culturally appropriate, and engaging language to promote consensual relationships with clients.
By exposing the "seen but unnoticed" (Garfinkel, 1967) details of professional communication, we aim to highlight the interactional context that shapes psychologists' knowledge and that is simultaneously shaped by this knowledge. Those who practice from a social constructionist perspective claim that they cannot influence clients but only influence the context of their interaction with clients through their own contributions to such interactions (Hoffman, 1995; Lipchik, 2002). Such discursively informed psychologists locate their knowledge and interventions in a particular time and place, and present them as relative and contestable rather than objective and undisputable. While this does not negate their well-informed suggestions or opinions, they also invite clients to modify or contest their meanings for life events, as part of opening up new options for action and self-understanding (Anderson, 1997; Goldner, 1993; Walter & Peller, 1992). They invite clients to be "active mediators, negotiators, and representatives of their own lives" (White, 2004, p. 20), a stance we see as being in keeping with the CPA's (2000) ethical principles and standards. The Code encourages psychologists to be reflective of their contributions to interactions with clients and to guard against imposition on clients, whether intentional or unintentional, of these professionals' knowledge and values.
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Please address all correspondence to Dr. Tom Strong, Associate Professor,
Registered Psychologist, Division of Applied Psychology & the Campus Alberta
Applied Psychology: Counselling Initiative, Faculty of Education - University of
Calgary, 2500 University Drive NW, Calgary, Alberta, Canada T2N 1N4 (Phone:
403-220-7770; Fax: 403-282-9244; E-mail: strongt@ucalgary.ca).
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Canadian Psychological Association May 2007
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