5. Interpretations
We’ve seen that formulations are a sort of expert editing of the client’s own talk (i.e. “as you were saying”). Interpretations or re-interpretations explicitly provide the therapist’s take on what the client is saying (i.e. “it seems to me”). In other words:
“formulations offer a candidate reading without altering the point, sense or gist of the preceding talk, while reinterpretations include the second speaker’s own perspective (cf. Antaki, 2008). ”
This distinction is useful because it enables us to pay closer attention to what the client does with these two types of turns from therapists: one which aims to capture what the client has said (formulations) —and is therefore open to conformation or rejection from the client — and another (reinterpretations) which layers the therapist’s perspective on the client’s talk (interpretations). It is harder for the client to reject the premise of the therapist’s conceptualisation provided in an interpretation.
In this section, we’ll see (1) how interpretations (or re-interpretations; both terms are used) posit the perspective of the therapist; (2) that this perspective makes some claim to epistemic authority (i.e. knowing more); and (3) how clients respond to interpretations.
5.1 The therapist’s perspective
In interpretations, the therapist proposes additional meaning in what the client has said. These propositions are from the therapist’s perspective: that is, they express “I think that” rather than “what I hear you saying is”. In marking something divergent to the client’s own account, interpretations are often prefaced with phrases like “I imagine”, “I suppose” “it could mean that” to introduce the supposition as subjective and ‘other’ than the account provided by the client.
In the example below, the therapist interprets the client’s (negative) experience at a family gathering as tied to earlier experiences in childhood. This extract from Peräkylä (2008, p. 104), is a translation from Finnish, so the wording is a little awkward…
You’ll notice that the therapist’s interpretation (lines 18-31) opens with an explicit marker that this is the therapist’s interpretation of events, expressed as “I do think that” and “I would indeed connect it”. An interpretation could also be introduced as an independent or impersonal assessment, e.g. “it seems that”.
“The turn design foregrounds the therapist’s own voice, or a voice of ‘anyone’s reasoning’ through the prefaces ‘it’s no wonder that’ and ‘I guess that’. ”
It’s interesting to note that interpretations can be prefaced with a modal verb (e.g. “could”, “would”) which lessens the force of the claim made by the speaker. In the context of psychotherapy, these modal verbs serve to mitigate or soften the authority of the therapist, given that the interpretation remains one of the client’s own experience.
Interpretations sketch the therapist’s claim to understanding the client’s experience, an understanding which can only really be ratified by the client themselves.
5.2 The therapist's (epistemic) authority
Interpretations can be problematic in interaction, because there is an uneven balance in access to knowledge. That is, in making interpretations of another (unconscious) meaning of the client’s talk, the therapist is claiming to know more about the client’s experience than they do themselves. This is typically not the case in everyday conversation where the speaker holds the rights to know their own mind.
The concept of ‘epistemics’ in conversation analysis captures the relative knowledge of speakers, or what my colleague Friederike Kern calls “knowing the mind of another” (see Kern, 2022). (You can read some general definitions here or as specifically related to psychotherapy here). Knowing what the other person might reasonably know is taken into account in every turn at conversation; how much detail to provide, what referents are shared and so on informs the design of each turn. Essentially, speakers use turns at talk to display, claim or assert knowledge. We — as analysts — can see how each turn is designed to take into account the perceived knowledge of speakers.
Epistemic stance is the position the speaker displays in the interaction relative to what they know, taking into account the stance of other speakers.
Epistemic status or epistemic authority describes unequal knowledge states between speakers. Status can be evident in the role speakers have in interaction - e.g. a doctor having higher epistemic status about possible diagnosis. This status is not fixed but rather is continually negotiated in sequences of interaction.
Heritage (2012) describes the speaker as having more or less knowledge ( K+ or K-) than the recipient. Rather than an either/or binary position, epistemic status can be thought of as a cline, a gradient of relative knowledge status. This knowledge status — and the assumed knowledge of the recipient — is always taken into account in the design of turn at talk. Consider the following example you saw earlier in the course:
The speaker in lines 3-4 revises the referent (i.e. replacing “Nonny” with “my granddaughter” which displays as assessment that the recipient probably knows that the speaker has a granddaughter, but perhaps not that the granddaughter’s name is Nonny.
In the next video, Amelia summarises epistemics in interaction.
Epistemic status is particularly relevant to how a therapist frames the client’s experience – in formulations which make very few edits to the client’s own expression, the client retains epistemic authority, but in interpretations where the therapist includes a perspective not expressed by the client, the very structure of the turn makes a claim to knowledge, that the therapist has greater knowledge of the client’s mind than they do themselves.
“In sum, in interpretations that went beyond the clients’ own descriptions of their experiences by suggesting connections, meanings or explanations, the therapists’ claim to epistemic access was mitigated by hypothetical and conditional turn constructing features. By mitigating practices the therapists marked their own lack of direct access to the client’s experience and in that sense treated themselves as highly cautious about claiming to know the things that they were claiming in their interpretations. The therapists worked carefully to justify their access to their clients’ experiences by anchoring their suggestions in the clients’ prior talk, for instance, circulating the words used by the clients and summarising the clients’ talk.”
This delicate balance of epistemic authority is evident in how therapists move between interpretations and formulations (i.e. returning to the client’s own words), and paying close attention to how the clients responds to each interpretation.
5.3 Responses to interpretations
In client responses to a therapist’s interpretations, we see evidence of the fact that interaction is a highly collaborative endeavour. In the very next turn, a client can resist, revise or endorse the therapist’s perspective. Here is the most useful insight from research in conversation analysis: the sequential organisation of talk allows us to see what the recipient made of what was just said. The next turn provides a proof procedure for how the prior turn was received.
(Re)interpretations make relevant very particular next actions: the client agrees, resists, or provides an elaboration which revises some part of the therapist’s turn. It has to be responded to in some way, and – as with other actions in conversation – agreement or acceptance of the interpretation is preferred. Not preferred pysychologically, but linguistically: it is interactionally easier to agree than reject the prior turn. Disagreement requires more interactional work, such as including a reason for rejecting the interpretation.
Rejections of interpretation are not always directed to the proposition of the interpretation, it can be resistance to the therapist's claiming to know more than the client about the client’s own experience. In other words:
“clients may view therapists as having intruded on their epistemic rights (Heritage and Raymond, 2005) concerning personal events and, by implication, that the therapist is displaying specialized or greater insight into the client’s life and experiences. ”
Regardless of how the client views the therapist’s interpretation, there is an interactional obligation to respond. If there is no (i.e. silence) or minimal response from the client, the therapist can expand her interpretation, ‘creating new opportunities for the patient to respond’ (Peräklyä, 2012, p. 562). Consider what the therapist does with the client’s responses in the example provided in the following activity:
We see in sequences of therapy talk that the therapist modifies, downgrades, explains or expands the prior interpretation based on what the client does next. Categorising client responses as either ‘accept’ or ‘reject’ — overlooks the fact that these accounts are achieved collaboratively over a sequence of turns, each building on the prior turn at talk. If we return to the interpretation we saw earlier, where the therapist ties the client’s report of a family reunion to childhood trauma, we see that the client takes up the therapist’s account without delay (see the overlap ‘yeah’ in line 22). This preferred agreement allows the therapist to continue the interpretation to include an attribution of how this made the client feel. The client agrees and collaborates in framing the expectations of how to behave (see lines 28-34).
At every turn, the client has the opportunity to reject, re-frame, accept or endorse the therapist’s interpretation. And subsequently the therapist can then abandon, refine or extend the interpretation. The key point we want to take from studying the design of therapist interpretations of the client’s experience, is that the ratification of the interpretation is jointly constructed. Turn by turn, the client and therapist negotiate meaning and draw inferences from both what the client says and how the therapist frames the client’s experience. That is,
“in the co-describing of experience, neither client nor therapist are the clear agent of the description; rather, agency (essentially belonging to the client) is co-constructed in closely tied, adjacent utterances. The experience of another person is described through creating an intersubjective context in which the inner experience of the other is accessible to mutual observation (Peräkylä, 2008). ”
Summary
Mutual observation is not only on display for the therapist and client; as professional eavesdroppers, conversation analysts can also make sense of how knowledge is co-constructed in therapy.
In this module, we have seen that (re)interpretations bring into play the epistemic stance of speakers, and that this relative knowledge (the client expert of their own experience, the therapist expert of the human experience) is carefully navigated turn-by-turn in therapy talk.
This calibration of epistemic status is central to the work of therapy. Thinking about the content you’ve worked through in this module, respond to the following prompt:
In your experience, what aspect of managing the relative knowledge status is most challenging in interactions with clients?
