Chapter 8

Discourse Correlates of Therapeutic Methods
and Patient Progress

David G. Butt, Alison R. Moore, and
Caroline K. Henderson-Brooks

THE CHOICES A SPEAKER MAKES in grammar and in lexis accumulate in ways that are not clear or accessible to the speaker in a sustained interaction, for example, in an hour of interaction between a psychotherapist and a patient. Yet this consistency—that is, a regularity beyond the typical threshold of human powers for tracking—is what the psychotherapist and the discourse analyst alike attune to in their respective work. The purpose of this chapter is to describe and illustrate tools that can track consistencies and departures in meaning, and to show how such tools can be used to characterize how patients diagnosed with BPD and their therapists talk to each other in therapy based on CM. Our aim is to enhance the resources that practitioners and students possess for interpreting and tracking significant aspects of their patients’ states of mind. These resources can then help practitioners predict, promote, and explain changes in inner state on the basis of their own analyses of patients’ “outer” language, in conjunction with other forms of meaningful nonverbal behavior, such as gaze.

PARALLELS AND KEY CONCEPTS

Before illustrating useful tools and techniques from linguistics in later sections, we point out some relevant parallels in the history and foci of CM and functional linguistics and outline a selection of crucial theoretical concepts from functional linguistics that will be drawn on below. These concepts and concerns include the notion of intersubjectivity, now important across a wide range of disciplines. Concepts brought in from linguistics include the notions of motivated selection, and the notion of meaning potential as a relation between each specific instance of language use and what might have been selected from the shared language system of the speaker and addressee. These concepts are less well known outside linguistics but have been shown to be useful in interdisciplinary studies where meaning needs to be tracked, gauged, compared, and explained. The familiar concept of topic is also presented, and contrasted with other ways in which consistency of meaning can be either maintained or interrupted.

Similarities in the Psychotherapeutic and Linguistic “Gaze”

In studying the conversation between therapists and their patients, it emerged that the semantic “drift” of unconscious patterns of meaning making is something that an experienced therapist “reads” from their interactions with patients. Furthermore, it seems probable that it is in responding to a bandwidth of latent patterns of meaning in the structure of discourse that psychotherapists find the motivation for the semiotic techniques their practice propounds as theory. The practitioners of CM, in particular, address these semantic responsibilities explicitly. The motivations of CM are not linguistic, per se, but rather organized around the critical psychic values of intersubjectivity, the quality of relatedness, and the centrality of the self as elucidated by William James (e.g., see Hobson 1985; James, 1890; Meares, 2005). Given these core concepts, it should not be surprising that both the leading practitioner and theorist of CM, Russell Meares, and the linguist who developed Systemic Functional Linguistics (SFL), M.A.K. Halliday, have had a collaboration in common—namely, with the psychologist and neuroscientist Colwyn Trevarthen (e.g., 1987). Trevarthen’s work on intersubjectivity between neonates and mothers has been congruent with, and supportive of, both CM and SFL. In parallel forms of inquiry, Halliday, Trevarthen, and Meares have explored the intricacy of mindfulness as it is created between two people in a profound relationship of reciprocation (e.g., child to mother, patient to therapist).

Meares and his research team (see the other contributors to this volume, as well as the brain-imaging collaborations, e.g. Felmingham et al., 2008; Felmingham, 2011) have specialized in treating the difficult condition of borderline personality disorder (BPD). Such patients present with what might be called an “inert core,” as if their commitment to lived experience has been extinguished or severely compromised (e.g., through trauma). A challenge to psychotherapists is the restoration of animus or aliveness by creating an empathic relationship within which the analogical connections between aspects of living can be created. Crucial to this undertaking is a form of narrative in which memory, reverie, and a new form of meaning potential come together. Such “coming together” is the aim of the therapist’s discourse, producing a new level of insight about the past and an inclination to the possibilities of the future. Discourse in the therapist–patient relationship must be the catalyst of change, since it is the resource in which the reciprocation can be created semiotically.

Motivated Selection

By identifying linguistic consistencies and departures in a speaker’s choices, a case can be made for their relevance to the speaker’s states of mind and also to intersubjectivity between patient and therapist and the relative success of therapist responses. In other words, although speakers do not typically select specific choices in words and grammar with full consciousness of all the other relevant possible expressions that could work at that moment, or with a view to how this choice now echoes a choice made the turn before, or the session before, it is possible to demonstrate that speakers engage in a kind of “motivated selection” of language options. This case depends on the implausibility of semantic consistencies being a merely random phenomenon. The possible combinations in words and grammar in a language, even while talking about the same topic, are so great that the chance of accidental semantic consistencies becomes implausible as more linguistic variables are included and more analyzed data are brought to bear.

This issue of language choices that are “unintentional” yet clearly motivated is familiar to linguists and literary scholars from discussions of verbal art: It is part of the debate around Jakobson’s (e.g., 1987) claims for “subliminal” patterns, and it underlies the cognate theories of organization in verbal art as enunciated by Mukarovský (1964, 1977) and Hasan (e.g., 1975, 1985a). So too, in Halliday’s (e.g., 1971) concepts of “prominence” and “deautomatization” in relation to verbal art, such accumulating patterns are a recruitment of the habitual resources in existing forms of language to a nonhabitual degree of consistency in their semantic consequences. In verbal art it is only in this orienting of the choices to a thematic consistency that one can then go on to account for innovation of forms, or novelty. In psychotherapy, a similar kind of comparison between the observed utterance and what might be otherwise expected is important, such that departures from what is typical or expected could be considered as signs of a disturbed state of mind or, at other times, of therapeutic progress. Some readers may find a useful analogy here with the epidemiological approach of comparing an observed distribution of features (such as the incidence of certain symptoms in a certain group or time period) against the typical, expected incidence for the population more generally, or over longer periods of time.

Meaning Potential, System, and Instance

The methods of discourse analysis, whether analyzing spoken, written, gestural, or other meanings, share a common task of holding the instance of text against the meaning potential of the system. Note that both the instance and the system are dynamic phenomena, with no linguistic system ever closed off to variability and change.

In this approach, the actual choices of a semantic interaction are viewed against the potential—that is, what might have been said. Establishing the potential, or what is to be selected, to compare it with the actual, is not a simple process. And what is typical will vary for different situations and for different dyads in therapy. Nevertheless, we find that such an approach to text analysis produces immediate opportunities for construing the dominant meanings between therapist and patient. This is possible because an accumulation of analyses of systematic variation changes the depth of the “field” of human interpretation, much as an optical telescope changes human vision by enhancing the process, not by modifying it.

For instance, when a therapist offers an interpretation to his patient, Patricia, that “It’s almost like you’ve been mothering her, as it were,” Patricia replies, “I didn’t see it like that.” Drawing on the notion of meaning potential, it becomes important to consider what the patient might have said instead. One obvious alternative would be “Yes, you’re right”—that is, a change in polarity from negative to positive. But many other alternatives are also possible, such as “No, I don’t see it like that,” or “Well, that’s not really the case.” These latter, unchosen alternatives are negative, like the patient’s actual utterance, but they also incorporate differences in other linguistic systems. The patient’s actual utterance includes the selection of past tense (“didn’t”), and arguably this suggests that there is potential for changing the way she sees things—at least, to a greater extent than would have been suggested by the words “I don’t see it like that,” with the present tense selected. There are many ramifications involved in the apparently small differences between these choices. Indeed, 7 months later Patricia has appropriated the therapist’s interpretation, telling the therapist, “Like I said, she wants me to be the mother and mother her” (see Henderson-Brooks, 2006). Here, however, we use the example to show the need to consider what has been said in therapy against what might have been said but wasn’t, and to show that these choices can be characterized grammatically.

This linguistic approach also offers semantic motifs and threads that can guide the analyst as to what is salient in the text and what might be the appropriate ordering of steps of analysis. By a linguistic approach to analysis, we mean taking the strata of language—context, semantics, lexicogrammar, phonology/phonetics (see Halliday & Matthiessen, 2004)—and asking questions that will elucidate how the construction of meaning is dispersed across systems on different strata, as well as how different resources contribute to the ensemble that we take as the “figure” a person makes.

Overt Topic versus Latent Consistencies

Motivated selections of language choices are particularly significant in that they can compose a semantic “drift” quite distinct from the explicit topic being discussed. They can be an index of an “angle” on the topic, a perspective that is relevant to the affective and ideational judgments a person is making moment by moment, albeit unconsciously. It is always important to consider the play between topical consistency and these other kinds of consistency and departure, and we outline a number of these other kinds below. We pay particular attention here to consistencies in the way speakers convey stance, certainty, responsibility, and time orientation, but there are many other motifs that can be important to track alongside topic.

All language users have a very strong, shared sense of what constitutes “the same topic,” even though we may occasionally dispute what counts as “off topic.” Other aspects of meaning are much more difficult to monitor in real time. Although it might be possible during a session to “listen for” the lexical allocation of actor roles, it is very hard to simultaneously track for differences in how clauses are combined, such as shifts between parataxis/aggregation and hypotaxis/subordination. It is harder still to note what has been left “unchosen”—what might have been taken up in the discourse but which has been grammatically neutralized or occluded.

To give an example, when patient “J” talks about forthcoming plans to move house and join a judo class, she says, “Yes, I start Thursday. I’m really excited.” After four short turns directly on the topic of the judo class times and location, the therapist offers “You’re going to become very energetic.” In the patient’s next turn she talks a little more on the topic of the judo, but then turns to talking about another group, a mothers’ group she is thinking of joining, and her turn finishes with “My life could be so good.” One thing happening here is that the therapist’s actual wording combines both a definite future “you are going to” (not “you might”) with two expressions of potentiality, the process “become” and the attribute “energetic.” An effect is produced that sustains the potentiality of “I’m excited” and bridges to the potentiality of “My life could be so good.” Imagine the therapist had chosen an alternative wording, such as “That sounds very energetic” or “You’ll need a lot of energy for all that.” This is unlikely to have produced the semantic consistency of potentiality—which is not a topic in itself but an important motif that the patient and therapist associate here with the future. In Chapter 6, Meares makes a similar distinction when he contrasts consistencies in “aboutness” (i.e., topic) with other kinds of consistencies, such as the consistency in emotional tone, which is called “staying with” (#13).

LINGUISTIC TECHNIQUES

In the following sections, we identify and illustrate some techniques of discourse analysis that we have found salient for the goals and methods of CM. These techniques include: mapping the degree to which patients verbally depict themselves as agentive, prominent or, at least, visible social actors; identifying how therapists and patients exploit the meaning of clausal architecture; mapping the generic shape of therapy sessions; and discriminating different techniques of semantic solidarity. A further technique involves displaying patterns of textual cohesion and cohesive harmony in conversations, and we show the particular relevance of these techniques for therapy with patients who experience dissociative episodes. The final illustration acts as a summary of how the techniques discussed above can work together as a strategy for expanding patients’ meaning potential, and how expanded meaning potential can be seen as a marker of valued change.

Agency, Visibility, and Prominence

Therapists are often concerned with the degree to which a patient makes him- or herself a background (i.e., gives herself low visibility) in her own discourse. Another motivating issue could be the degree to which a patient projects him- or herself as agentive, or as the experiencer of feelings, or as the “victim” of inexorable events (of “happenings,” rather than the actions of others, or of him- or herself). These ways of representing self are related, but not the same, and it is important to keep separate accounts of each phenomenon. Questions of role allocation and of general textual visibility can be informed by tracking a number of simultaneous but independent grammatical choices in a text from clause to clause: for example, by tracking what is grammatical agent (if there is one); what is grammatical subject (that which can be argued over in a clause of English); and what is marked for priority (the feature “theme”) and what for newsworthiness (the feature “new”; see Halliday & Matthiessen [2004] for details on each of these grammatical features; see Moore [2005] for an extended illustration of such textual patterns of patient prominence and agency in the context of HIV medicine).

This “polyphony” of grammatical patterns renders a remarkable display of the moment-to-moment construction of unconscious meaning by a persona in an interaction (it could be the persona of the patient or of the therapist, or additionally the “drift” of the dyad as a unit). The meanings are unconscious because (1) they are realized by choices that few people can consciously report; (2) they accumulate and ramify to degrees that even few linguists could monitor (or censor) in real time; and (3) they accumulate and ramify to amounts that require considerable reflective and statistical processing, since the rates (bunchings and dispersions of a linguistic phenomenon) and quantities (numbers of actual instances of a relevant linguistic choice) can be salient both independently and, even more so, when combined.

If we take just one sentence from a common formulation in English for expressing guilt and responsibility, we can demonstrate the potential for a tension between the ostensible topic (the “aboutness”) and the emotional consistency that the therapist needs to “stay with” when construing a patient’s utterance. There is a tension between the visibility, prominence, and agentivity that a patient can give himself (let us use him for this analysis): “I can’t help but blame myself for what happened.” On the face of it, this statement appears mature, responsible, and unremarkable in any recount. It consists of three clauses each containing selections from several grammatical systems (transitivity, mood, tense, aspect, thematicity, clausal dependency, etc.) and therefore the statement is a combination of numerous choices by the speaker.

In terms of textual visibility, the patient is an overt grammatical participant in at least three ways in the action construed:

1. The participant who can’t help something (“I can’t help x”).

2. The participant who allocates blame (“I blame x”).

3. The participant who is given the blame (“I blame myself”).

In terms of prominence or priority the patient places himself in a thematic role—that is, the subject/actor is himself, the first person, and this is located in theme position at the front of two of the three clauses in the utterance, giving a sense in the discourse that his feelings and experience are working as a departure point for the messages exchanged. Contrast this with other choices that would not create that particular prominence; for instance, in the case of another person or some qualification of circumstance occupying the thematic position (e.g., “Deirdre blames me for what happened,” or “On bad days I blame myself”).

In terms of agency, however, the picture painted by the patient is somewhat different. The message includes an agentive construction “I blame x,” whereby the patient is painting himself as the active participant responsible for the important process of interpreting and evaluating the situation. But undercutting this depiction of agentive responsibility are several other features suggesting that the responsibility is elsewhere, or nowhere. In this expression, the “blame myself” is first person, but with “myself” as grammatical target. This combines the concession of his own guilt with the grammatical role of acted upon or even “victim” (note the traditional terms are the “object,” or even “patient,” in the “accusative” case in Latin).

In addition, “I can’t help but do x” locates the patient/speaker as under some duress, by way of the modal can’t combined with the main verb can’t help. Comparing the selection in this instance with alternative potential choices, such as “I blame myself” or even “I refuse to blame myself,” we can see that the actual verb selection implies a much more restricted degree of control to the first person.

A further way of downplaying the patient’s own responsibility appears in the last part of the utterance, where he chooses to represent his recent situation as “what happened.” Crucially, he does not select the directly available alternative wording, “what I did.” By choosing neither the active nor the passive but the middle voice (x happened), the personal agency is diminished. The events are placed, latently, in the grammatical domain of weather, storms, disasters, and processes that take their natural (rather than human) course.

In this one common case of expression, we can see already how an instance of explicit avowal of self-criticism can be offset by the implicit meanings of grammatical presentation.

The Meanings in Clause Relations

The principle of comparing the instance (actual) to the system (potential) applies not just to which words and phrases are chosen in a clause, but also to the way that separate clauses are combined to make clause complexes or sentences. In Figure 8.1 we display the sentence about blame, discussed above, in terms of its three separate clauses. Each clause, shown in a separate ellipse, represents a discrete action or state of affairs, which combines with the other clauses to create a more complex account of the goings-on. Arrows show the line of subordination between the clauses, with the first clause being the only independent clause.

Note that the “I” referred to above as a visible participant is placed at two grammatical removes from the “what happened.” This grammatical depth can be seen as one form of grammatical “insulation” between the “I” and whatever “happened.” The insulation provided by this grammatical depth is in step with the further insulation provided by the wording that occurs in that element: the choice of “x happening” over “what I did.” (This third element, i.e., “what happened,” is analyzed here as a separate clause from the verbal process of “blame.”)

 

FIGURE 8.1. Dependency between clauses in “I can’t help but blame. . . .”

Like the differences between speaker visibility, prominence, and agentivity discussed above, these covert, nonconscious choices in how clause dependencies are organized produce a form of textual counterpoint between guilt and the blaming of others. Such counterpoint in the grammar can be a harbinger of meanings that need to emerge in the therapy session—for example, a patient’s shift from self-criticism through to strong claims concerning the role of others in bringing on, or taking advantage of, the patient’s illness.

In the extract in Table 8.1 the importance of “reading” for this subtext is readily demonstrable. The linguistic method assists particularly when the experienced therapist needs to be more explicit about what is happening and how it can be presented, and possibly quantified, as clinical evidence or as a training text. The patient, J, has experienced years of profound suffering and mental illness. Some of the motifs of her relationships with others are evident here. The therapist has asked J to expand on the periods when the contending voices and chaotic feelings were not dominating her life. Elaborating on this invitation, J discusses some periods in her marriage, but the text shows that J consistently presents herself without any agency, any effective impact, or role as an independent actor. She typically takes up stative/relational verbs rather than active/material verbs. Although she has been esteemed (by others?), she casts herself as a collection of attributes, not actions: had (a path)/(hope); was (sore) (tired).

After some actions only in association with her partner (moving house; wanting to marry), her only action is that she “would start to hate herself again” (i.e., she acts out an emotion directed at herself only). Again we see the supervening of outside cause—“something comes . . . then there’s chaos.” To put it crudely, the only independent doing J expresses for herself is a negative action—a failure to be effectual: “and then I felt like || nothing [[I could do]] could make him happy.” She takes on the causal responsibility of another’s state of mind, as if she had the main obligation in this regard. Note again that J, as even a nondoer, is a clause participant only in a clause that is embedded in another clause, as shown by the double square brackets surrounding the clause “[[I could do]]”. This acts as another form of grammatical insulation, locating J’s ineffective action away from the arguable core of the clause: it is as if her ineffectuality is not open for discussion.

Table 8.1. Extract Demonstrating Reading for Grammatical Subtext (Note: || identifies a new clause; << >> indicates a clause that interrupts a clause being spoken; and [[ ]] indicates an embedded clause structure contained within a prior clause.)
37	J	. . . I was esteemed. I had a path. I had hope. You know || what I mean? It seems || when something interrupts the hope, something comes,/mm/ || or interrupts the direction [[I’m going in]] || then there’s chaos.
38	T	You were esteemed || and you had a path.
39	J	Like I meet H, I thought || this time it’s going to work out. And going to move out to country, wanted to get married, we were gonna have, we were gonna have a number of children. But C she was born || and we moved to F || when C was born. He wouldn’t go in and kiss her good night. [[All he wanted to do]] was [[go fishing]]. He was upset || I didn’t have sex [[as often with him as I did]] || because I was tired || and I was sore after the birth. It was like [[give me a few weeks to heal]]. And then the chaos would come || and I would start to hate myself again || and um and different, << it’s hard to say >> different, obviously different people inside would give a different opinion , and it just gets confusing. I was afraid which part, which one to listen to || and um that’s when it . . .
40	T	Those times with H were quite stressful?
41	J	A lot of the time. There were periods when it was really good. We moved, something like six times in 3 years of marriage || and it seemed || after we’d moved || for 2 or 3 months it was wonderful. It was like. I think. Because we had expectations || but then when those expectations weren’t met || he’d get edgy and frustrated || and then I felt like || nothing [[I could do]] could make him happy.
42	T	Right. So can you see the difference there? When things are going well with you and H || you felt contented in yourself || you felt esteemed.
43	J	I felt safe. I felt secure.
44	T	You felt safe and secure.
45	J	And there’s no need for. And they just sort of seem to come up || when there’s chaos || or when there’s. I know || it’s for protection || or to help out, it’s to . . .
46	T	It was, he was causing you a lot of stress /yep/ at times || and it seems || that during those periods of stress you would have all those voices in your head, those noises in your head || and you’d would be trying to sort out one from the other.

One could reasonably respond to our summary of the above conversation: “Well, all that is pretty obvious, so why adopt a stance from functional linguistics?” One of many replies is, as mentioned above, the importance of mobilizing evidence and of taking the method of the therapist into more careful discriminations. For instance, this passage gives the impression of marking some change by J, perhaps a new strength of agency: the opening “I was esteemed. I had a path. I had hope” appears to support this reading. But the grammar does not. It gives a more differentiated sense of motivated selection by the patient, and it displays the motivation for the rare situation of the therapist interrupting the patient’s habitual cycle of rationalization (e.g., “something comes . . .”). The patient is still very much the grammatical “patient” (a traditional linguistic term for the one “acted upon”). What is different is the high visibility of her topicality—her position as theme and as subject in the clauses—but the agency is not in evidence (she is not an authentic actor in the human affairs reported).

The experienced therapist recognizes this and makes the issue explicit for their ongoing intersubjectivity. She steers the talk toward “the difference” (in 42), and then cuts off the continuation of talk that is vaguely about cause: “they . . . come up . . . when there’s chaos” (45). The therapist says: “It was, he was causing you a lot of stress /yep/ at times and it seems that during those periods of stress you would have all those voices in your head, those noises in your head. . . . ” Differentiating between prominence of the agentive kind and other means of wording the first person turns out to be crucial in this text and in understanding the therapist’s decision to “step in.”

The Overall Shape of the Interaction: Generic Structure

A review of the generic structure of an exchange is crucial in that it allows one to establish the value of a choice or of a pattern of choices. For example, an initial discussion on the efficacy of medication may be an obligatory step with many of the patients in our data. But, although important, the linguistic patterns of such a segment may not be a relevant inclusion in the linguistic measure of change in the self-evaluation that develops over the 50 minutes of the therapeutic interaction. In some sessions, the openings and closing “coda” to the therapy can be tightly linked to the therapeutic conversation overall: The patient and the therapist appear mindful of the opportunity for “work” of a symbolic kind. But the relevance of each step of the session to the linguistic measurement of change ought to be adjudicated case by case. This involves the comparison of the structure of a session with the typical cycle of therapeutic treatment overall, with its changing priorities and obligatory procedures. The linguist is always looking for marked (contrastive) choices. These are an index of the options that a person has taken up, of the potential. The degree of markedness is a sign of the motivation in that the interaction has to be turned to the purpose implicit in the language (whether such purpose can be regarded as unconscious or conscious). Figure 8.2 graphically depicts the decision that might be made to separate openings and closings from the relation-building discourse in the body of the conversation (which constitutes the criterial technique of psychotherapeutic interactions in CM).

Although the context of psychotherapy allows a very wide range of topics and angles to be encompassed when compared with other registers, it is clear that practitioners and patients share some expectations about how sessions start, continue, and conclude, and how and where variability is likely to occur. Consequently the session can be conceived of as comprising a sequence of moves or phases that probably do not have distinct boundaries but flow into each other and can be dispersed or revisited.

 

FIGURE 8.2.

In tracking and refining one’s sense of how these phase changes are organized, it can be helpful to observe changes in the size of the participants’ turns. Elapsed time and word length have often been used, but an important index that should not be overlooked is clause rate within turns. One reason this statistic is important is because each clause depicts a whole event or state of affairs, and while they can combine to produce complex depictions, each clause independently selects for key features such as speaker visibility, agency, and priority/prominence (through systems of transitivity and theme). And in each clause the speaker can usually select linguistic features that construe different ideas about his or her sense of obligation or inclination, degree of certainty about something (through systems of mood and modality), and other aspects of affect. Patterns in all these features, when examined, can add to the sense provided by changes in length of turns alone regarding the changing texture of the conversation. Large increases or decreases in clause rate per turn can also suggest a good place to spend energy examining transitivity (action/agency), mood (propositional responsibility), and so on.

The two ellipses shown at the beginning and end of the session indicate procedural zones, where the talk concerns issues such as medication (at the outset here) and appointment dates (at the closure). One issue that arises is whether or not qualitative analysis of the texture in the therapeutic session should, or should not, include such procedural segments. As stated above (in relation to markedness), the answer may be “yes,” if and only if they encompass instances that are marked as unusual or contrastive against what is expected as the procedural (or nondiscretionary) use of the potential.

Figure 8.3 is a visual representation of the phases that tend to unfold sequentially in most sessions, as represented by the ellipses titled “Bearings, “Something happened,” and so on. The identification of this sequence of phases is based on our combined reading of approximately 30 transcripts of therapy sessions using CM. In the row of boxes below the ellipses, each of these phases is illustrated in terms of the kinds of meanings that occur within them and which, when expressed, usher in and out the phases concerned. The features noted in these boxes attempt to capture the semantic choices available and chosen in a specific session of CM therapy (see Butt et al., 2010).

 

FIGURE 8.3. Generic structure of therapy session shown as a series of moves or “affective cycles,” each with typical semantic profiles and choices available.

The therapist’s interpretation of patient changes and consistencies in forms of speaking, as identified in CM as chronicles, scripts, and narratives, can be refined against the backdrop of the unfolding moves in a conversation. For instance, a chronicle form may be much more likely to occur in moves at the beginning of the conversation, whose semantic and contextual purpose is to update. But if only chronicles and scripts occur in other phases across the session, where the meaning potential includes more complex nonlinear speech, then this may indicate a restricted range of forms of consciousness in the patient.

Figure 8.3 shows the “moves” or elements that form the generic “backbone” of a therapeutic session. These can also be seen as an “affective cycle,” or moves in affective tone and focus.

• Move 1—Bearings: The therapist and patient typically exchange procedural information that brings them quickly up to date on logistical and other matters (e.g., medication).

• Move 2—Something Happened: The general report is extended to “something happened” that disturbed the tenor of recent days.

• Move 3—Sequent Evaluations: There ensues a series of evaluations and reconstruals between the patient and therapists as to what happened and its significance.

• Move 4—Break: A strategic step is taken to break the repetitive construal and reconstrual of the disturbing experience.

• Move 5—Inclination to the Future: Some reorientation to the future and to the management of related experiences is offered.

Techniques of Semantic Solidarity

Additional concrete steps of tracking also contribute to the analyst’s method by offering coordinates in extended discourse. From the theoretical coordinates supplied by the SFL model, organized as it is by strata (levels of sound and grammar), by metafunctions (tendencies of meaning), by constituency, and, ultimately, into systems of choices, we can move into specific zones of meaning making, which functional linguists refer to as registers. For example, a fundamental achievement for a therapist in CM is to establish an empathic solidarity with the patient in which language is selected with a number of principles as guidance. These include:

• Using what is given.

• Using the language of the other (incorporating and cocreating an idiom that the patient can “hear” as reflecting his or her immediate experience).

• Attunement to indices of positive value in tone and various layers of expression in the patient.

• Amplification of the experience and emotional value implicit in the reactions of the patient.

Amplification, as the word suggests, involves an “enlargement” of the patient’s response to encompass a wider world of actual and imaginable possibilities. It is a response to “what is most alive” in the patient’s expression and an attempt to open up the “meaning potential.” Something of these strategies can be captured in a network at the semantic level for empathic solidarity (at least as a first step of broad description). The network, shown in Figure 8.4, is read from left to right; in the zone of a move, a number of options are open to the therapist. The aim of this network is to characterize different ways a respondent might choose to reflect back to a speaker that speaker’s own preoccupations. These could be evident in the wording, the meaning, or in the enlargement of vision—the dynamic spatialization of a semantic motif created by the patient’s discourse.

 

FIGURE 8.4. Techniques of semantic solidarity.

The network can be read as saying that for any interactive move, a speaker must choose from two semantic systems, each of which formalizes a zone of semantic choices. Essentially, the top system characterizes the manner of reciprocation by the therapist. The network for this top system gives more detail as it progresses to the right, in terms of how the reciprocation is shaped. The therapist may agree with the patient’s view. Alternatively, the therapist may provide solidarity by assuring the patient about something relevant to his or her view, such as the clinical feasibility of some symptoms observed and interpreted by the patient. A final group of alternative ways of building solidarity is characterized here as adjudicate, a term used to convey the sense that it may fall to the therapist to check or confirm information or understanding; the act of doing this is not adversarial but part of the solidarity. The lower system offers a stop (the move has been described) or an opportunity to reenter (new turns require further alternative descriptions).

Cohesion and the Mapping of Fusion, Fragmentation, and Dissociation

An important discourse analytic method which bears directly upon difficult domains of psychotherapeutic practice is the technique of mapping the cohesive relations in a text, and their semantic interpretation through the technique of cohesive harmony (Hasan, 1984, 1985b) . As shown below, these techniques are particularly relevant for the interpretation of “dissociative” episodes—cases in which the “fragmentation” of the personality of the patient means that he or she may lose touch with the immediate context and reexperience traumatic events, sometimes with details of other times and events “fused” with the relived trauma. Analyzing cohesion in therapeutic talk is a way of visualizing the connectedness of a patient’s version of experience, and offers some measures of how well a topic is developed, and how well it is tied in with other topics, or not. By displaying connections between lexical tokens (words used and reused, but with some specific conditions) and repetitions of grammatical roles, we can produce a map and a measure of semantic bonding across an extended passage of text.

A cohesive chain is built out of similarities. These chains are built, then, from “open system” items (i.e., drawn from those dictionary entries for a language known as head words). These are interrelated by way of similarity (synonymy), oppositeness (antonymy), class membership (hyponymy), or part-to-whole relations (meronymy). For instance, if we hear the lexical token horse in a recount of an event, and then the token pony, we hear these as words that typically keep company with each other. The relation is one of synonymy, and it holds no matter what context the interactants are in, or whether the listener is familiar with the speaker’s idiom or history (see Chain 1 in Figure 8.5). Similarly, if we hear the token real, then hear the token made up (or a different form of the same word, such as making it up), we hear these as antonyms (see Chain 2).

A second form of chain is based on the accumulation of words that “point” to an identical person or thing; for example, “he,” at the bottom of Chain 1, points back to “the horse.” Such words are grammatical items like pronouns and demonstratives, which create threads of identity (known as identity chains). These are specific to the given text, but entail grammatical and social limits: “he” for singular, male, sentient referent; “it” for nonsentient or gender-unknown referents, including abstract or diffuse ones such as “the situation,” etc. Chain 1 in Figure 8.5 is formed using both similarity ties (horse pony) and identity ties (horse/pony he), where the direction of the arrows shows that when pony is heard it refers back to horse, and when he is heard, it too refers back to horse, and also to pony.

 

FIGURE 8.5. Fragments of two lexical chains in a therapeutic session with “Jennifer.”

A third kind of chain can occur that is built from explicit declarations of equivalence in the text, for instance, “the birds, the birds were soldiers . . . ” in a war poem by the poet Wallace Stevens. This kind of relation does not carry beyond the text in question—birds are not typically synonymous with soldiers. Such “instantial ties” often capture metaphorical relations that become significant to the logical skeleton of a text. In therapeutic talk, this can include unusual patterns of text chaining that may indicate dissociative experience or other highly personal aspects of a patient’s experience.

In Figure 8.6 each long box represents a cohesive chain in the session excerpt. The excerpt starts with J beginning to report on a visit to her sister’s place where there are horses, as shown above, using tokens such as horse, pony, and he. Shortly after, she says, “It’s like, it’s really disgusting.” The conversation, until turn 114, is taken up with this thread and the patient is in considerable distress. Clinical evaluation suggests that the patient was possibly in a dissociative episode during this part of the session.

 

FIGURE 8.6. Selected cohesive chains in therapeutic session with Jennifer (turns 79–114).

There is both fragmentation and fusion between the recent horse episode being narrated, earlier experiences the patient has had, and the current moment of speaking (see Butt, Moore, Henderson-Brooks, Haliburn, & Meares, 2010, for extended analysis). What we draw attention to here is the instrumental value of cohesion analysis and of clinical reflection based on the ideas behind such analysis. The figure shows repeated, shifting, and wide bands of gray running across the chains, including the chains for horse, penis, sex, memory, image, feeling, thought, and seeing.

What is the “it” that’s disgusting and later confusing, perverse, and distressing? The horse, the memory, the images previously seen? Their recollection? Toward the bottom of the diagram the gray banners across the chains narrow and disappear. Here the referential chains become easy for the linguist to resolve, and for the patient and therapist there appears to be considerable resolution and mutual agreement about what “it” is. The patient now appears to be out of the possible dissociative episode. (Note that we are not saying that evidence from the wording of the texts is the only index of how the therapist can judge a patient’s language to be dissociative; in fact, quite the opposite: Many forms of gestural and contextual cues form a suite with language, or even provide the signal of a person’s experience in the absence of any “wording.”)

Furthermore, when viewed as an exchange of rhetorical moves, much is achieved: in particular, the dramatic “closure” (with mutually achieved consensus) in the final turns of 110–114 (see Table 8.2). This reestablished equilibrium, albeit with the perturbing episode now fully integrated in the common “archive” of their relationship, attests to the control in the interaction.

Cohesive Harmony

A further iconic sign of text bonding is the bridging function resulting from what are known as chain interactions (Hasan, 1984, 1985b). These are not items that could go in either chain, such as “it” above. Rather these are occasions in the text where items in one chain interact grammatically with items in another chain. For instance, if more than one token from the “horse” chain (pony, horse, or their stand-ins he or it) recurs in more than one sentence with items from the “real” chain (real, made up, what happens, etc.) applied to them, then this is heard as significant to the drift of the conversation, even if ambiguity or confusion still exists about what the “it” is. Alternatively, does the figure show any chain, or grouping of chains, without a bridge of interaction with other chains? Such “islands” in cohesive chaining suggest a failure of connectedness, or (depending on the genre) such a segment may be indicative of a leap of analogical thinking, a leap that will be interpreted as a parable or excursus. Such leaps may become retroactively relevant if a case can be made for a leap of imagination (i.e., of similarity without explicit identity through a pronominal chain). It should be noted, however, that analogical leaps are important textual phenomena in many registers (e.g., in sciences, in verbal art, in philosophical arguments, and in joking). So too analogical connections in discourse are crucial to CM (as explicated by Meares, 2005); this follows Vygotsky’s (1962) emphasis on the value of nonlinearity in discourses of self-reflection.

Table 8.2. Excerpt of Session: “Horse” Episode Closure with Patient “J”
Turn	Speaker	Text
110	Therapist	You see the pony’s penis well for that matter one can see, you know, pictures and one can see naked bodies in reality. Mmmm.
111	Patient	Yes.
112	Therapist	But does that mean something sexual? But it seems like the association . . .
113	Patient	It doesn’t, it shouldn’t but with me it does.
114	Therapist	Yes.

A Further Example: Meaning Potential, Intervention, and Change

We have suggested that in a therapeutic conversation, although the interaction is very open, each “move” is motivated by a distinct dimension of the social process, by steps in the “business to hand” (Greek: pragma). In the session excerpted in Table 8.3, which comes from later in the session between Marguerite and her therapist discussed in Chapter 6, an overarching or long-term purpose appears to be a fresh inclination to a future freer of the sense of a deadened core that is the chief behavioral sign of BPD. This inclination is to a future with an extended value, an extended potential to mean.

Table 8.3. Excerpt Demonstrating Overarching Purpose
Clause	Speaker	Text
1	Therapist	Ha! . . . does that mean
2		If you stopped
3		him doing that to you
4		you would do it less to the children?
5		Is that it?
6	Patient	Well I might feel better about myself
7		Yeah. I might, mm . . .
8		cause he stopped for a few days—
9		I think
10		it was last week
11		or, I don’t know
12		I think
13		there was some abatement
14		and then it just . . .
15		just for a couple of days
16		as if it was—
17		I don’t know
18		maybe it’s sort of delusional, escape
19		it was just living and breathing
20		which was just a little bit easier, y’know . . . er . . .

Session Excerpt: “If you stopped him doing that to you.”

Such a breakout into a “freer,” more alive space is realized only when the interaction finds a way out of an aporia—the conundrum that has entrapped the patient in a loop of hopelessness (Greek: aporia, lack or resources; an impasse of material or semantic impoverishment). Such impasses in our data include the logistical and personal constraints of breaking away from abusive relationships. The domestic and emotional reasons “to stay” can appear overwhelming, but the reasons lead to a cascade of problems. For example, in the following extract a mother considers her treatment of her own children as the result of the abuse she experiences from her partner (described earlier as like “acid eating away”).

The therapist draws attention to the patient’s own agency (“if you stopped him doing that to you,” not “if he stopped doing it to you”). This creates a pathway into a meditation—carefully balanced as it is uttered—in which the patient can envisage a different existence, modalized (via maybe, just, I don’t know etc.) and in small increments though it may be. The mother’s realistic review of her own situation has its own discourse correlates. Here, the modalization of her memory and judgments and the balanced clausal architecture are part of a grammatical ensemble, a therapeutic music that realizes the feeling that has emerged: Change can be envisaged. Therefore, change has already occurred.

One can ask: Why should language be given such a central role in the interpretation of a psyche and, particularly, in the characterization of any form of mental disorder? There are many points to consider on this issue and many of those have been taken up by Meares and others in the development of CM. One point we would emphasize here is that language “cuts to the quick” (quick is archaic for the core of our living being) in that it is taken up preconsciously in our formative, earliest relationships with carers. Our taking on of personhood and the personalization of our brains (Greenfield, 2008, Chapter 1) are continuous with the meanings we take in and with the meanings by which our intersubjectivities are sustained. In this there is a common theory of intersubjectivity across the work of Trevarthen (e.g., 1974, 1987; see also Bullowa, 1979), Meares (2005), and the functional linguistics of Halliday (1975, 2003). We trust that debate around the status of linguistic evidence will be encouraged by the exemplification in this chapter and related publications by ourselves and others with a similar approach (e.g., Butt et al., 2010; Fine, 2006; Muntigl, 2004).

Future investigations into the discourse correlates of CM are likely to elucidate both the shared and distinctive techniques of psychotherapists, information that should assist in the process of mentoring. Beyond this professional goal, many more global issues are appearing on the horizon: for example, the grammatical construction of the “duplex self,” the profound insight by William James that appears to have latent reactances in the most habitual areas of linguistic practices. There is much work to take up, but the linguistic bases of CM and the psychotherapeutic relevance of functional linguistics are well established.