4. Formulations
Having looked at how repair is managed in conversations – how speakers manage to clear up misunderstandings, mishearings or mistakes – we come to see that making revisions in ongoing talk does not always do the work of repair.
For example, the following extract looks at first like other-initiated other-repair (technically, it is), but the function of the therapist’s turn (line 10) does something more than simply correction:
(Extract 5 in Rae, 2008)
The therapist re-casts the client’s description of their experience (‘a little uncomfortable’ is upgraded to a ‘lot uncomfortable’) which is subsequently endorsed by the client: “It feels a lot uncomfortable actually”, produced with some laughter.
You will have a particular take on the example above from your own professional expertise (i.e. an understanding of the therapist’s intention). But what we’re aiming to do in this course is to pay very close attention to how these goals of therapy are realised through the actions of turns at talk. It is the technical details of how the talk achieves the therapeutic goal that we are concerned with here.
“How does the talk move from clients’ problem tellings and accounts into the therapist’s version? Such conversational movement seems to be one of the most artful practices of therapy: the reframing, redefining, or reconfiguring of “the problem”.”
In the first three modules of the course, we looked at three fundamental features of how we manage conversations, how we use the structural organisation of talk to manage intersubjectivity and how we repair misunderstanding. The same mechanisms of interaction organise therapeutic talk; in other words, professional communication builds on the same rules of everyday conversation.
In the next two modules of the course we will look at interactional practices which are distinctly used by psychologists. Formulations (this module) and interpretations (the next module), are used by therapists to reframe, redesign, or reconfigure clients’ expression of “the problem”.
4.1 Actions in therapy talk
“Actions specific to psychotherapy include formulations and reinterpretations, where the formulations reframe the client’s own account, and the reinterpretations provide the therapist’s own perspective on the client’s account. ”
We have seen that each turn at talk accomplishes some sort of action in the conversation for which there is a relevant next action (eg to accept or decline are the relevant next actions to an invitation). We explored this basic sequence of actions known as an ‘adjacency pair’, where a first pair part sets up a preference for a particular type of second pair part, a particular next action.
(Remember, the preference is linguistic, rather than denoting the wishes of the speaker; although the turn’s preference and the speaker’s preference are most often the same.)
An example of two adjacency pairs in sequence:
The therapist asks a question.
The client responds.
The therapist provides a formulation of the client’s response.
The client then accepts or rejects the formulation.
It is this third turn that we are interested in here: how the therapist might transpose the client’s talk.
Before moving on to consider how the therapists might “reframe the client’s own account”, in the short video below, some further definitions of formulations are provided by CA researchers:
In therapy, paraphrasing — by emphasising elements of the prior talk — serves to provide an unequivocal precis for what the prior turn meant. But formulations do more than simply repeat the prior utterance.
Formulations —where the therapist provides an account of what the client has just said — are used to achieve a number of different actions. As Antaki (2008, p.27) explains, “challenges, corrections, extensions and elaborations form a gradient, descending from a more combative to a more cooperative way of offering the client an alternative view”. Let’s move on to consider how these actions are achieved in interaction.
4.2 How formulations are done
Importantly, in formulations, therapists do something to the client’s prior turn, rather than simply repeating the client’s talk. Exact repetition can be described as mirroring (you can find a helpful definition of mirroring here) as used in psychotherapy and can do the work of highlighting an element of the prior talk as relevant or significant in some way. Formulations, however, refine the client’s own talk in such a way as to introduce a new reading or emphasis on the prior turn(s).
Consider the following example from Antaki (2008, p.20):
Antaki (2008) explains that in the formulation in line 17, the therapist re-phrases the client’s experience of being made redundant as “very difficult”. Furthermore, the therapist transposes the client’s idiomatic “I don’t get on with that” with the more psychologically-salient “adjust”.
Formulations have the character of “so what you’re saying is…” where the therapist uses some of the client’s own words, effectively re-packaging what the client themselves has said. The therapist is not overtly providing their own account. Yet, in making small revisions, deletions, substitutions and so on, they are re-casting the client’s talk in therapeutically-relevant ways.
Elina Weiste and Anssi Peräkylä (2013) have looked at how formulations are done and how they are used in both cognitive psychotherapy and psychoanalysis. The next activity builds on their data and gives you an opportunity to consider the following key question: What is the therapist making relevant in their formulation, and how is this achieved interactionally?
Heritage and Watson (1979) described summative formulations as ‘gists’ (as in ‘the gist of what he said was’) or upshots. While these might be used to display understanding of the client’s account, to demonstrate ‘active listening’, they can also be used to re-direct attention to the immediate therapeutic project (see Antaki, 2014, p.23 for example and explanation). In other words, gists can be deployed by the therapist to sum up but move on.
Clients can choose to resist this move to move on. In fact, as the therapist has re-framed their own stance, clients hold rights to accepting, rejecting, or editing formulations.
4.3 Responses to formulations
The efficacy of formulations is evident in how they are received by clients. Remember, in sequences of action, there is always a relevant and required next action. The design of a formulation means that there are constrained options for the client the next turn. In other words, when a therapist provides the gist of what the client said, the client can either confirm or revise the therapists rendering of what they, the client, said.
“Although formulations are closely connected to clients’ talk, they still transform this talk. Thus, clients may feel that their version of experience has been altered to the point that they may no longer endorse it or even that they have begun to lose ownership of this experience. Second, formulations may function to move talk in a specific therapeutically relevant direction. Clients, however, may choose to disalign with the therapist’s agenda and, also, may prefer to continue with their own agenda instead. ”
Interactionally, in response to formulations as gists — where the therapist provides some selective summary of what has been said in the prior turn(s) — confirmations are ‘massively preferred’ (Heritage & Watson, 1979, p.143)
In other words, endorsing/accepting the therapist’s formulation is by far the most common response.
Disconfirmation requires an account of some kind, to account for why the formulation is being rejected (i.e. has the form of all dispreferred actions)
So even though clients typically confirm (go along) with the therapist’s formulation, they always have the option, in the very next turn, of dismissing the therapist’s re-casting of their own talk.
Let’s return to the data provided by Weiste & Peräkylä (2013), where they identified types of formulations. This time, however, we’re turning our attention to how the client responds to the formulation. In this activity, you’ll be asked to explain what the client does in response to the therapist’s formulation, and how they design their response.
The fact that clients typically endorse the therapist’s account is not surprising. The therapist is not (overtly at least) providing their own perspective, they purposefully use the client’s own words in some way to draw out therapeutically-relevant element of what the client said. As these formulations are close to the client’s own account, evidence in CA research shows us that they are usually confirmed.
If you would like a summary of the types of formulations you have looked at in this module, you can download an excerpt from Weiste & Peräkylä (2013) here.
Summary
“The fact that formulations allow the current speaker to select some parts of the prior speaker’s words, ignore others, add spin, and present the package in a form that projects agreement makes them a powerfully discursive tool. ”
Therapists, in reformulating the clients’ prior talk are focusing in on therapeutically-relevant parts of the client’s prior speech, discarding less productive elements (see Antaki 2008), and retaining the kernel of the key issue – one identified by the client themselves, but shelled by the therapist, polished in the formulation for clarity or insight.
Formulations do more than display that the therapist is listening carefully to their clients. Thinking about the content you’ve worked through in this part of the course, respond to the following prompt:
In your experience, what is the purpose of formulations therapy talk? How are they used, and why?
You can return to the course home page here, or continue by clicking on ‘5. Interpretations’ below right.
