Paper presented at the annual meetings of the
American Psychological Association, Washington, D.C., August 2000.
One of the challenges in psychotherapy research has been finding ways to investigate not just the outcomes of therapy, but the process whereby those outcomes are achieved. In this paper we will illustrate a hermeneutic approach to the study of therapeutic process, applied to an interaction between psychiatrist R.D. Laing and a volunteer named Leila. The interaction provides an example of Laing's particular existential psychotherapy; however the tools of analysis could be used to illuminate what is happening in any therapeutic process. These tools build upon conversation analysis, where language is understood as social action, and we seek to understand how talk can change people. Our analysis attends to the pragmatics of discourse, to conversational turns and moves, and to the power of an utterance to index referents and invoke context. In these ways it can illuminate the 'talking cure.'
In 1985, at a conference on the Evolution of Psychotherapy, Laing gave a demonstration of his approach, talking with a woman diagnosed as paranoid schizophrenic. Afterwards a member of the audience asked Laing: "I was wondering what you thought went on therapeutically in that interview." And Laing replied: "What do you think went on therapeutically?" "I'm mystified, to tell you the truth," the questioner responded. "So maybe you can explain it to me." "If you're mystified," Laing said, "I can't explain it to you."
This might seem to confirm the worst suspicions about existential psychotherapy, that it is unscientific, opaque, and elusive. We believe that the process, even Laing's, can be explained. But, as Laing suggests, we'll remain mystified until we attend to the phenomena of talk, the things that typically go unnoticed. In this paper we'll focus on one of these phenomena: that of context.
Our analysis will show how Laing enriches the here-and-now of the interview setting to build what he will later call a "transpersonal field." Through the conversation, this contextual ground is progressively enriched, and that enables a therapeutic "short-cut" that accomplishes repositioning and ontological change.
The conversation begins with Leila in an ontological muddle, in confusion over who she is. Is she paranoid? Is she a Christian? Is she an unfaithful daughter? Our analysis maps how Laing helps her to clarify the basis of this confusion, and open up an alternative.
Laing and Leila are meeting for the first time. They talk about many things, but our focus is on points in their conversation where two important contexts are invoked: that of Christianity, and that of the family. We shall show that it is through a sensitive response to the interweaving of these two contexts that Laing accomplishes therapeutic change.
1. Invoking the Christian context
The first reference to an element of Christianity occurs almost in passing, when Laing responds to a fatalistic comment made by Leila by saying:
214 L: Oh.
215 T: It's only capable of doing what we do. I mean, as far as (.) we're concerned.
219 T: Well, that depends who I'm talking to [laughs]=
220 L: Well, just tell me that=
221 T: If I'm talking to you? Well, ah I'm not sure what I
222 should say about that eh, it ja ah ah I'm a Christian in
223 the sense that Jesus Christ wasn't eh crucified isn't
224 wasn't crucified between two candlesticks in a
225 cathedral, he was crucified in the town garbage heap
226 between two thieves, in that sense I'm a Christian....
230 ...But, I mean in
231 another in another sense I mean I I wouldn't admit to being eh a
232 Christian in most Christian company. Why, are you a
234 L: Hell no!
235 T: Eah eah?
236 L: I don't think so ah I think, I think God doesn't know what he's doing, so
237 um, [sighs] who knows maybe Jesus maybe Jesus had a mental problem.
238 You know.
When we learn something later about Leila's family, we'll see how this shared context can be an important vehicle for a change in her stance towards her parents. As Robert Nofsinger says in his introduction to conversation analysis, through alignment "participants can then achieve intersubjective understandings rather than separate understandings; they can interact rather than merely act" (p. 112).
2. Invoking the context of family
The context of family is invoked in a rather more conventional manner, as Laing asks:
286 em mom and dad an that sort of thing, what sort of (.)
287 are they alive, eh?
288 L: Who my parents?
289 T: Yeah.
290 L: Yeah.
291 T: What sort of chap was your father, is your father?
292 L: Oh, well ah eh he's a Christian preacher. Yes.
293 T: Oh, I ought to have known. [laughs]
294 L: Yeah, my parents are very religious. At least, they say
295 they are.
296 T: Well, you're very religious.
297 L: You know my, yeah, I guess I am.
3. A Bible passage
Laing gently questions Leila on her relationship with her parents. Her replies are punctuated with frequent sighs and declarations of "I don't know." But she offers a narrative that portrays estrangement: she hasn't visited in years, and even wrote asking permission to send them Christmas presents. She concludes, "…maybe they hate me after all I, after being, an unfaithful daughter." And she extends this turn, unusually cooperative:
337 them either. But, you see, I have my own life to live.
338 Ea, you know, I hope they understand that, but maybe
339 they don't.
340 T: Uhuh. Well, if you're faithful to the Lord Jesus Christ,
341 how can you be unfaithful to your father?
342 L: Yeah.
The duality of the words "faithful" and "unfaithful"--the fact that they function in both contexts--highlights how for Leila the two contexts are interwoven, so that an entity in one context exists at the same time in the other. If one is the daughter of a Christian preacher, how one lives as a daughter is not separate from how one lives as a Christian. Leila is a daughter--some kind of daughter; at the same time she is a Christian--some kind of Christian. But what kind--"faithful" or "unfaithful"?--and how to live this duality?
A consequence of this interweaving is that talk about referents in the context of Christianity can be simultaneously talk about referents in the family context. We see this immediately, as Laing clarifies his reference to a verse from the Gospel of Luke (14:26), a verse that advocates a radical separation from one's family.
344 hate your father and mother and follow me, you can't be
345 eh my disciple.
346 L: Yeahah.
347 T: What does your father make of that?
348 L: Well, probably that um all this, Ch, Christian emphasis
349 on family is a is a is against the teachings of Jesus. You
350 know, the modern the modern Christian emphasis on
352 T: Yeah, I think it is, um....
353 know that passage ea ea where where Je Jesus I I
354 always said thought there was something wrong with
355 that translation that said eh eh said unless you eh the the
356 ah unless you hate your father and mother, brother and
357 sisters also it said said you cannot be my disciple. In
358 the English version though, I think it means unless you
359 prefer me to your father and mother.
360 L: I don't recall that it said hate.
361 T: Hurh.
362 L: It's eh (3) something like deny
363 T: Yeah, ah, I asked a guy eh a Aramaic scholar about that
364 he said he thought it meant unless you are happily
365 indifferent to them.
366 L: Um. That makes a lot of sense.
367 T: Yeah [L laughs] (call his bluff)
Ostensibly they have been talking about religion, but Leila's next utterance makes it clear they have been speaking of the family too.
369 parents, they're going eh be on your case all your life.
371 T: That's right [laughs]…
Discussion of the biblical passage does therapeutic work because, as Laing quickly recognizes, for Leila, born into the family of a "Christian preacher," family and religion are mixed together, imposing contradictory imperatives. Leila's ontological confusion surely has its origin here. The bible passage offers Laing and Leila a way to explore these contradictions, together with a possible resolution. It does some of their interactional work for them, by providing a short cut, by exploiting and explicating the interwoven contexts. The "unfaithful daughter" finds that she could instead be "happily indifferent," a stance that is legitimate within both contexts. A way to be both a daughter and a Christian. Now she knows who she is.
But this work couldn't be done without the shared ground that has been created between Laing and Leila. Speaking to the audience, Laing talks of the importance of a "transpersonal reality"--an unspoken sense of communion that can only be addressed "through language rather than with language." Context is a shared background that can be created through language, but is rarely talked about with language. Taken-for-granted, its effects will indeed mystify those who don't know how to see it.
In conclusion: we have sought to illustrate an alternative approach to the study of psychotherapy, one that maintains talk in its context. We hope we've demonstrated how a hermeneutic methodology can disclose what other analyses do not. It investigates the pragmatics of language, the power of talk to bring about ontological change. Typically, studies of psychotherapeutic process categorize and code talk in order to measure what happens. But that approach necessarily decontextualizes: removing each utterance from its place in the sequential organization of discourse, and stripping it from its contextual background. If, as we are arguing, the power of context is crucial not just to our understanding of the process of psychotherapy, but to the very outcome of psychotherapy itself, this decontextualization is deadly. The baby is thrown out with the bath-water.
We believe an approach such as ours can provide a way of assessing psychotherapy in humanistic terms, remaining sensitive to the power of language; to the difference between what is said and what is accomplished by saying.
Nofsinger, R. E. (1991). Everyday conversation. Newbury Park: Sage.