Observations on silence in telephone delivered cognitive behavioural therapy (T-CBT)
DOI:
https://doi.org/10.1558/japl.27652Keywords:
Cognitive behavioural therapy CBT, conversation analysis, telephone interaction, silenceAbstract
In psychotherapy and counselling, and many other institutional settings, the occurrence and interactionally derived meaning of pauses and silence have an array of implications over and above those of ‘everyday’ interaction. In this study we utilised conversation analysis to explore aspects of silence in one particular therapeutic setting: telephone delivered cognitive behavioural therapy (T-CBT). We outline how instances of silence which are notionally ‘problematic’ can result in remedial action which we broadly categorise as: ‘Same party prompt’, ‘same party repair’, or ‘synchronous repair’. We observe that ‘therapeutic’ silences that were oriented to by interlocutors as non-problematic generally occur in particular phases of an encounter, and we argue that it is often the issue of how parties switch between and signal orientation towards different modes of silence that can create interactional misalignment, rather than the silence itself.
References
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Bee, P. E., Lovell, K., Lidbetter, N., Easton, K. and Gask, L. (2010) ‘You can’t get anything perfect’: User perspectives on the delivery of cognitive behavioural therapy by telephone. Social Science & Medicine 71 (7): 1308–1315. https://doi.org/10.1016/j.socscimed.2010.06.031
Bordin, E. S. (1979) The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice 16 (3): 252–260. https://doi.org/10.1037/h0085885
Brenes, G. A., Ingram, C. W. and Danhauer, S. C. (2011) Benefits and challenges of conducting psychotherapy by telephone. Professional Psychology: Research and Practice 42 (6): 543–549. https://doi.org/10.1037/a0026135
Byrne, P. S. and Long, B. E. L. (1976) Doctors Talking to Patients. London. HMSO.
Chatwin, J. (2009) Activity transitions in homoeopathic therapeutic encounters. Sociological Review 57 (1): 163–185. https://doi.org/10.1111/j.1467-954X.2008.01809.x
Davies, A. and Newman, S. (2011) Conference abstract: A systematic review to examine the effect of telecare for people with social care needs on outcomes for their informal carers. International Journal of Integrated Care 11. Available online: http://www.ijic.org/articles/ abstract/10.5334/ijic.700/ https://doi.org/10.5334/ijic.700
Drew, P. Chatwin, J. and Collins, S. (2001) Conversation analysis as a method of investigating medical interactions. Health Expectations 4 (1): 58–69. https://doi.org/10.1046/j.13696513.2001.00125.x
Ferrara, K. W. (1994) Therapeutic Ways with Words. New York: Oxford University Press.
Georgaca, E. and Avdi, E. (2009) Evaluating the talking cure: The contribution of narrative, discourse, and conversation analysis to psychotherapy assessment. Qualitative Research in Psychology 6 (3): 233–247. https://doi.org/10.1080/14780880802146896
Glueckauf, R. L., Picket, T. C., Ketterson, T. U., Loomis, J. S. and Rozensky, R. H. (2003) Preparation for the delivery of telehealth services: A self-study framework for expansion of practice. Professional Psychology: Research and Practice 34 (2): 159–163. https://doi.org/10.1037/0735-7028.34.2.159
Goodwin, C. and Goodwin, M. (1987) Concurrent operations on talk: Notes on the interactive organization of assessments. IPrA Papers in Pragmatics 1 (1): 1–54. https://doi.org/10.1075/iprapip.1.1.01goo
Haas, L. J., Benedict, J. G. and Kobos J. C. (1996) Psychotherapy by telephone: Risks and benefits for psychologists and consumers. Professional Psychology: Research and Practice 27 (2): 154–160. https://doi.org/10.1037/0735-7028.27.2.154
Hammond, G. C., Croudace, T. J., Radhakrishnan, M., Lafortune, L. and Watson, A. (2012) Comparative effectiveness of cognitive therapies delivered face-to-face or over the telephone: An observational study using propensity methods. PLoS ONE 7 (9). https://doi.org/10.1371/journal.pone.0042916
Hepburn, A. and Bolden, C. B. (2013) The conversation analytic approach to transcription. In J. Sidnell and T. Stivers (eds) The Handbook of Conversation Analysis, 57–76. Malden, MA: Wiley-Blackwell.
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Heritage, J. and Greatbatch, D. (1991) On the institutional character of institutional talk: The case of news interviews. In D. Boden and D. H. Zimmerman (eds) Talk and Social Structure, 93–137. Berkeley: University of California Press.
Hutchby, I. (2007) The Discourse of Child Counselling. Amsterdam: John Benjamins. https://doi.org/10.1075/impact.21
Jefferson, G (1989) Preliminary notes on a possible metric which provides for a ‘standard maximum’ silence of approximately one second in conversation. In D. Roger and P. Bull (eds) Conversation: An Interdisciplinary Perspective, 166–196. Clevedon, UK: Multilingual Matters.
Jefferson, G. (2004) Glossary of transcript symbols with an introduction. In G. Lerner (ed.) Conversation Analysis: Studies from the First Generation, 14–31. Amsterdam: John Benjamins. https://doi.org/10.1075/pbns.125.02jef
Kitzinger, C. B. (2012) Repair. In J. Sidnell and T. Stivers (eds) The Handbook of Conversation Analysis, 229–256. Malden, MA: Wiley-Blackwell.
Kroenke, K., Theobald, D., Wu, J., Norton, K., Morrison, G., Carpenter, J. and Tu, W. (2010) Effect of telecare management on pain and depression in patients with cancer: A randomized trial. The Journal of the American Medical Association 304 (2): 163–171. https://doi.org/10.1001/jama.2010.944
Lehtonen, J. and Sajavaara, K. (1985) The silent Finn. In D. Tannen and M. Saville-Troike (eds) Perspectives on Silence, 193–202. Norwood, NJ: Ablex.
Madill, A., Widdicombe, S. and Barkham, M. (2001) The potential of conversation analysis for psychotherapy research. The Counselling Psychologist 29 (3): 413–434. https://doi.org/10.1177/0011000001293006
McBeth, J., Prescott, G., Scotland, G., Lovell, K., Keeley, P., Hannaford, P., McNamee, P., Symmons, D. P., Woby, S., Gkazinou, C. and Beasley, M. (2012) Cognitive behaviour therapy, exercise, or both for treating chronic widespread pain. Archives of Internal Medicine 172 (1): 48–57. https://doi.org/10.1001/archinternmed.2011.555
Mohr, D. C., Likosky, W., Bertagnolli, A., Goodkin, D. E., Van Der Wende, J., Dwyer, P. and Dick, L. P. (2000) Telephone administered cognitive behavioural therapy for the treatment of depressive symptoms in multiple sclerosis. Journal of Clinical Psychology 68 (2): 56–61.
Mozer, E., Franklin, B. and Rose, J. (2008) Psychotherapeutic intervention by telephone. Clinical Interventions and Aging 3 (2): 391–396. https://doi.org/10.2147/CIA.S950
Muller, I. and Yardley, L. (2011) Telephone-delivered cognitive behavioural therapy: A systematic review and meta-analysis. Journal of Telemedicine and Telecare 17 (4): 177–184. https://doi.org/10.1258/jtt.2010.100709
Muntigl, P. and Zabala, L. H. (2008) Expandable responses: How clients get prompted to say more during psychotherapy. Research on Language and Social Interaction 41 (2): 187–226. https://doi.org/10.1080/08351810802028738
Pawelczyk, J. (2011) Talk as Therapy: Psychotherapy in a Linguistic Perspective. Berlin: Mouton de Gruyter. https://doi.org/10.1515/9781934078679
Paxling, B., Lundgren, S., Norman, A., Almlöv, J., Carlbring, P., Cuijpers, P. and Andersson, G. (2013) Therapist behaviours in internet-delivered cognitive behaviour therapy: Analyses of e-mail correspondence in the treatment of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy 41 (3): 280–289. https://doi.org/10.1017/S1352465812000240
Peräkylä, A., Antaki, C. Vehvilainen, S. and Leudar, I. (eds) (2008) Conversation Analysis and Psychotherapy. Cambridge: Cambridge University Press.
Peräkylä, A. and Weiste, E. (2013a) A comparative conversation analytic study of formulations in psychoanalysis and cognitive therapy. Research on Language and Social Interaction 46 (4): 299–321. https://doi.org/10.1080/08351813.2013.839093
Peräkylä, A. and Weiste, E. (2013b) Prosody and empathic communication in psychotherapy interaction. Psychotherapy Research. 24 (6): 687–701.
Pinnock, H., Bawden, R., Proctor, S., Wolfe, S., Scullion, J., Price, D. and Sheikh, A. (2003) Accessibility, acceptability and effectiveness in primary care of routine telephone review of asthma: Pragmatic randomised controlled trial. British Medical Journal 326 (7387): 477–479. https://doi.org/10.1136/bmj.326.7387.477
Roy-Byrne, P. P., Craske, M. G., Stein, M. B., Sullivan, G., Bystritsky, A., Katon, W., Golinelli, D. and Sherbourne, C. D. (2005) A randomized effectiveness trial of cognitivebehavioural therapy and medication for primary care panic disorder. Archives of General Psychiatry 62 (3): 290–298. https://doi.org/10.1001/archpsyc.62.3.290
Sacks, H., Schegloff, E. A. and Jefferson, G. (1974) A simplest systematics for the organization of turn-taking for conversation. Language 50 (4): 696–735. https://doi.org/10.1353/lan.1974.0010
Schegloff, E. (2000) Overlapping talk and the organization of turn-taking for conversation. Language in Society 29 (1): 1–63. https://doi.org/10.1017/S0047404500001019
Scollon, R. and Scollon, S. B. K. (1981) Narrative, Literacy, and Face in Interethnic Communication. Norwood, NJ: Ablex.
Soopramanien, A., Pain, H., Stainthorpe, A., Menarini, M. and Ventura, M. (2013) Using telemedicine to provide post-discharge support for patients with spinal cord injuries. Journal of Telemedicine and Telecare 19 (8): 8–70.
Tannen, D. (2005) Conversational Style: Analysing Talk among Friends. Oxford. Oxford University Press.
Walker, M. B. and Trimboli, C. (1982) Smooth transitions in conversational interactions. Journal of Social Psychology 117 (2): 305–306. https://doi.org/10.1080/00224545.1982.9713444
Weiste, E. and Peräkylä, A (2013) A comparative conversation analytic study of formulations in psychoanalysis and cognitive psychotherapy. Research on Language and Social Interaction 46 (4): 299–321. https://doi.org/10.1080/08351813.2013.839093
Wynn, R. and Wynn, M. (2006) Empathy as an interactionally achieved phenomenon in psychotherapy: Characteristics of some conversational resources. Journal of Pragmatics 38 (9): 1385–1397. https://doi.org/10.1016/j.pragma.2005.09.008
Antonacci, D.J., Bloch, R.M., Saeed, S.A., Yildirim, Y. and Talley, J. (2008) Empirical evidence on the use and effectiveness of telepsychiatry via videoconferencing: Implications for forensic and correctional psychiatry. Behavioral Sciences & the Law 26 (3): 253–269. https://doi.org/10.1002/bsl.812
Back, M. D., Schmukle, S. C. and Egloff, B. (2009) Predicting actual behavior from the explicit and implicit self-concept of personality. Journal of Personality and Social Psychology 97 (3): 533–548. https://doi.org/10.1037/a0016229
Basso, K. (1990) To Give up on Words: Silence in Western Apache. Tuscon: University of Arizona Press.
Bee, P. E., Lovell, K., Lidbetter, N., Easton, K. and Gask, L. (2010) ‘You can’t get anything perfect’: User perspectives on the delivery of cognitive behavioural therapy by telephone. Social Science & Medicine 71 (7): 1308–1315. https://doi.org/10.1016/j.socscimed.2010.06.031
Bordin, E. S. (1979) The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice 16 (3): 252–260. https://doi.org/10.1037/h0085885
Brenes, G. A., Ingram, C. W. and Danhauer, S. C. (2011) Benefits and challenges of conducting psychotherapy by telephone. Professional Psychology: Research and Practice 42 (6): 543–549. https://doi.org/10.1037/a0026135
Byrne, P. S. and Long, B. E. L. (1976) Doctors Talking to Patients. London. HMSO.
Chatwin, J. (2009) Activity transitions in homoeopathic therapeutic encounters. Sociological Review 57 (1): 163–185. https://doi.org/10.1111/j.1467-954X.2008.01809.x
Davies, A. and Newman, S. (2011) Conference abstract: A systematic review to examine the effect of telecare for people with social care needs on outcomes for their informal carers. International Journal of Integrated Care 11. Available online: http://www.ijic.org/articles/ abstract/10.5334/ijic.700/ https://doi.org/10.5334/ijic.700
Drew, P. Chatwin, J. and Collins, S. (2001) Conversation analysis as a method of investigating medical interactions. Health Expectations 4 (1): 58–69. https://doi.org/10.1046/j.13696513.2001.00125.x
Ferrara, K. W. (1994) Therapeutic Ways with Words. New York: Oxford University Press.
Georgaca, E. and Avdi, E. (2009) Evaluating the talking cure: The contribution of narrative, discourse, and conversation analysis to psychotherapy assessment. Qualitative Research in Psychology 6 (3): 233–247. https://doi.org/10.1080/14780880802146896
Glueckauf, R. L., Picket, T. C., Ketterson, T. U., Loomis, J. S. and Rozensky, R. H. (2003) Preparation for the delivery of telehealth services: A self-study framework for expansion of practice. Professional Psychology: Research and Practice 34 (2): 159–163. https://doi.org/10.1037/0735-7028.34.2.159
Goodwin, C. and Goodwin, M. (1987) Concurrent operations on talk: Notes on the interactive organization of assessments. IPrA Papers in Pragmatics 1 (1): 1–54. https://doi.org/10.1075/iprapip.1.1.01goo
Haas, L. J., Benedict, J. G. and Kobos J. C. (1996) Psychotherapy by telephone: Risks and benefits for psychologists and consumers. Professional Psychology: Research and Practice 27 (2): 154–160. https://doi.org/10.1037/0735-7028.27.2.154
Hammond, G. C., Croudace, T. J., Radhakrishnan, M., Lafortune, L. and Watson, A. (2012) Comparative effectiveness of cognitive therapies delivered face-to-face or over the telephone: An observational study using propensity methods. PLoS ONE 7 (9). https://doi.org/10.1371/journal.pone.0042916
Hepburn, A. and Bolden, C. B. (2013) The conversation analytic approach to transcription. In J. Sidnell and T. Stivers (eds) The Handbook of Conversation Analysis, 57–76. Malden, MA: Wiley-Blackwell.
Hecker, J. E., Losee, M. C., Roberson-Nay, R. and Maki, K. (2004) Mastery of your anxiety and panic and brief therapist contact in the treatment of panic disorder. Journal of Anxiety Disorder 18 (2): 111–126. https://doi.org/10.1016/S0887-6185(02)00241-4
Heritage, J. and Greatbatch, D. (1991) On the institutional character of institutional talk: The case of news interviews. In D. Boden and D. H. Zimmerman (eds) Talk and Social Structure, 93–137. Berkeley: University of California Press.
Hutchby, I. (2007) The Discourse of Child Counselling. Amsterdam: John Benjamins. https://doi.org/10.1075/impact.21
Jefferson, G (1989) Preliminary notes on a possible metric which provides for a ‘standard maximum’ silence of approximately one second in conversation. In D. Roger and P. Bull (eds) Conversation: An Interdisciplinary Perspective, 166–196. Clevedon, UK: Multilingual Matters.
Jefferson, G. (2004) Glossary of transcript symbols with an introduction. In G. Lerner (ed.) Conversation Analysis: Studies from the First Generation, 14–31. Amsterdam: John Benjamins. https://doi.org/10.1075/pbns.125.02jef
Kitzinger, C. B. (2012) Repair. In J. Sidnell and T. Stivers (eds) The Handbook of Conversation Analysis, 229–256. Malden, MA: Wiley-Blackwell.
Kroenke, K., Theobald, D., Wu, J., Norton, K., Morrison, G., Carpenter, J. and Tu, W. (2010) Effect of telecare management on pain and depression in patients with cancer: A randomized trial. The Journal of the American Medical Association 304 (2): 163–171. https://doi.org/10.1001/jama.2010.944
Lehtonen, J. and Sajavaara, K. (1985) The silent Finn. In D. Tannen and M. Saville-Troike (eds) Perspectives on Silence, 193–202. Norwood, NJ: Ablex.
Madill, A., Widdicombe, S. and Barkham, M. (2001) The potential of conversation analysis for psychotherapy research. The Counselling Psychologist 29 (3): 413–434. https://doi.org/10.1177/0011000001293006
McBeth, J., Prescott, G., Scotland, G., Lovell, K., Keeley, P., Hannaford, P., McNamee, P., Symmons, D. P., Woby, S., Gkazinou, C. and Beasley, M. (2012) Cognitive behaviour therapy, exercise, or both for treating chronic widespread pain. Archives of Internal Medicine 172 (1): 48–57. https://doi.org/10.1001/archinternmed.2011.555
Mohr, D. C., Likosky, W., Bertagnolli, A., Goodkin, D. E., Van Der Wende, J., Dwyer, P. and Dick, L. P. (2000) Telephone administered cognitive behavioural therapy for the treatment of depressive symptoms in multiple sclerosis. Journal of Clinical Psychology 68 (2): 56–61.
Mozer, E., Franklin, B. and Rose, J. (2008) Psychotherapeutic intervention by telephone. Clinical Interventions and Aging 3 (2): 391–396. https://doi.org/10.2147/CIA.S950
Muller, I. and Yardley, L. (2011) Telephone-delivered cognitive behavioural therapy: A systematic review and meta-analysis. Journal of Telemedicine and Telecare 17 (4): 177–184. https://doi.org/10.1258/jtt.2010.100709
Muntigl, P. and Zabala, L. H. (2008) Expandable responses: How clients get prompted to say more during psychotherapy. Research on Language and Social Interaction 41 (2): 187–226. https://doi.org/10.1080/08351810802028738
Pawelczyk, J. (2011) Talk as Therapy: Psychotherapy in a Linguistic Perspective. Berlin: Mouton de Gruyter. https://doi.org/10.1515/9781934078679
Paxling, B., Lundgren, S., Norman, A., Almlöv, J., Carlbring, P., Cuijpers, P. and Andersson, G. (2013) Therapist behaviours in internet-delivered cognitive behaviour therapy: Analyses of e-mail correspondence in the treatment of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy 41 (3): 280–289. https://doi.org/10.1017/S1352465812000240
Peräkylä, A., Antaki, C. Vehvilainen, S. and Leudar, I. (eds) (2008) Conversation Analysis and Psychotherapy. Cambridge: Cambridge University Press.
Peräkylä, A. and Weiste, E. (2013a) A comparative conversation analytic study of formulations in psychoanalysis and cognitive therapy. Research on Language and Social Interaction 46 (4): 299–321. https://doi.org/10.1080/08351813.2013.839093
Peräkylä, A. and Weiste, E. (2013b) Prosody and empathic communication in psychotherapy interaction. Psychotherapy Research. 24 (6): 687–701.
Pinnock, H., Bawden, R., Proctor, S., Wolfe, S., Scullion, J., Price, D. and Sheikh, A. (2003) Accessibility, acceptability and effectiveness in primary care of routine telephone review of asthma: Pragmatic randomised controlled trial. British Medical Journal 326 (7387): 477–479. https://doi.org/10.1136/bmj.326.7387.477
Roy-Byrne, P. P., Craske, M. G., Stein, M. B., Sullivan, G., Bystritsky, A., Katon, W., Golinelli, D. and Sherbourne, C. D. (2005) A randomized effectiveness trial of cognitivebehavioural therapy and medication for primary care panic disorder. Archives of General Psychiatry 62 (3): 290–298. https://doi.org/10.1001/archpsyc.62.3.290
Sacks, H., Schegloff, E. A. and Jefferson, G. (1974) A simplest systematics for the organization of turn-taking for conversation. Language 50 (4): 696–735. https://doi.org/10.1353/lan.1974.0010
Schegloff, E. (2000) Overlapping talk and the organization of turn-taking for conversation. Language in Society 29 (1): 1–63. https://doi.org/10.1017/S0047404500001019
Scollon, R. and Scollon, S. B. K. (1981) Narrative, Literacy, and Face in Interethnic Communication. Norwood, NJ: Ablex.
Soopramanien, A., Pain, H., Stainthorpe, A., Menarini, M. and Ventura, M. (2013) Using telemedicine to provide post-discharge support for patients with spinal cord injuries. Journal of Telemedicine and Telecare 19 (8): 8–70.
Tannen, D. (2005) Conversational Style: Analysing Talk among Friends. Oxford. Oxford University Press.
Walker, M. B. and Trimboli, C. (1982) Smooth transitions in conversational interactions. Journal of Social Psychology 117 (2): 305–306. https://doi.org/10.1080/00224545.1982.9713444
Weiste, E. and Peräkylä, A (2013) A comparative conversation analytic study of formulations in psychoanalysis and cognitive psychotherapy. Research on Language and Social Interaction 46 (4): 299–321. https://doi.org/10.1080/08351813.2013.839093
Wynn, R. and Wynn, M. (2006) Empathy as an interactionally achieved phenomenon in psychotherapy: Characteristics of some conversational resources. Journal of Pragmatics 38 (9): 1385–1397. https://doi.org/10.1016/j.pragma.2005.09.008
Published
2018-04-30
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Articles
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Equinox Publishing Ltd.
How to Cite
Chatwin, J., Bee, P., Macfarlane, G. J., & Lovell, K. (2018). Observations on silence in telephone delivered cognitive behavioural therapy (T-CBT). Journal of Applied Linguistics and Professional Practice, 11(1), 1-22. https://doi.org/10.1558/japl.27652
