A Discursive Evaluation of Therapeutic Interactions Between Therapists and Service User During Cognitive Behavioural Therapy Sessions For Depression

Abstract

The aim of the thesis is to discursively examine therapeutic interactions between service users and therapists during Cognitive Behavioural Therapy (CBT) sessions for depression. It is argued that the discursive psychological approach is the most appropriate to explore this aim. The thesis provides a unique perspective regarding the construction of depression because it is the first discursive research to look at how service users and therapists jointly construct depression, how identities are constructed, how CBT principles are constructed in interaction and how cognitive behavioural strategies are implemented and attended to during therapeutic interactions. In total four research questions are addressed in this thesis: (1) How is therapeutic dialogue in CBT constructed and what does it accomplish? (2) How is depression constructed in CBT sessions? (3) What do the constructions of depression accomplish within therapeutic interactions? and (4) How is identity constructed and attended to during therapeutic interactions for depression? Recordings of sixteen, one-­‐ hour CBT sessions were transcribed and analysed using discourse analysis. The analysis of how depression is jointly constructed by service users and therapists in CBT sessions demonstrates that during therapeutic interactions depression is oriented to and talked about but the terms “depressed” and “depression” are often absent from the dialogue. In the unusual cases where the terms are present, it is used by speakers to demonstrate a lack of control, manage accountability and emphasise distress and the seriousness of depression. The analysis shows that the terms “depressed” and “depression” are used differently and were found to have different implications regarding aetiology, prognosis, trajectory and identity. This thesis identified five key discursive strategies that are used to construct the self and identities in CBT sessions for depression. The thesis assessed how CBT strategies work in interaction, and identified the extent to which they ‘work’ by identifying the discursive features of effective and ineffective implementation of CBT strategies. It is shown that while the therapist does accomplish the therapeutic aim, this can be done without displays of understanding and empathy which is incongruent with the ethos of CBT. These findings highlighted inconsistencies in CBT and that therapists are potentially being assessed on how well they can do contradictory things. In addition to adding to the current literature, the thesis identified two new conceptual issues which contribute to wider discussions. The first is that the terms “depressed” and “depression” are largely absent in CBT for depression and the second is the varied meanings of depression. The thesis could aid clinical practice because it provides an insight into how therapeutic dialogue is constructed and what is accomplishes.

Date of Award	2017
Original language	English
Awarding Institution	Coventry University
Supervisor	Simon Goodman (Supervisor)