Participants and Data
The primary data were the first sessions of nine individual psychotherapies, available from the video-archive of a university-based integrative psychotherapy training program in Finland. The length of the therapies varied from 19 to 78 sessions. The clients were aged between 19 and 45, and eight of them were female and one was male. The nine sessions were conducted by five trainee therapists, all clinical psychologists with a minimum of 2 years of clinical experience. In one case the first session was conducted in tandem by an experienced therapist and a trainee. In two sessions there was a psychology student observing. All clients were self-referred, and no inclusion or exclusion criteria were used in this naturalistic setting. The problems the clients had reported when booking the session included fatigue, stress, social anxiety, panic attacks, depression, coping with divorce, and binging and purging. The sessions were conducted in Finnish. Videotaping and the use of the sessions for research purposes took place with the informed consent of the clients, using a protocol reviewed by the Ethics Committee of the university.
The analysis was performed on the original Finnish transcriptions. The clients’ initial problem accounts were first extracted from the verbatim transcriptions of the videotaped sessions. The word counts of the excerpts coded varied between 71 and 1037. The accounts were responses to the therapists’ initial questions and prompts, which varied in terms of what the therapists asked and how explicit was the assumption that the clients should explain why they were in therapy. The therapists’ questions were open-ended, and often not very clear. The questions entailed the therapist asking about the client’s reason for calling the clinic or the client’s views of his/her problems (e.g., “If you would first talk about this problematics and its development, such as how it has been constructed?”). In one case the therapist’s question was an invitation to talk about oneself (“Shall we begin so that you say something about this situation for which you are seeking help and a little bit about yourself?”). In two cases the therapist did not ask an initial question because the client either presented it himself (e.g., “Well it would probably be good if I shortly say who I am and how I actually got here”) or started to cry at the beginning of the session, hence, the reasons given for crying became the client’s problem account.
The clients’ problem accounts formed one longer, fairly uninterrupted talk turn. They ended when the clients either clearly moved away from the problem telling to a different topic, or the therapist asked or commented on something in a way that did not encourage the client to elaborate on his/her original problem account, but led him/her in another direction. Then, the client’s answer was not a clear continuation of the original problem telling. In five sessions, the client replied to the therapist’s intervening question or comment by clarifying something, but still continued the initial depiction of the problematic situation. These types of therapist turns were thus not taken as signifying the end of a client’s problem account. The data analysis did not include the therapists’ responses and comments, generally sparse and short, within the clients’ problem accounts. The extracts presented in this article have been translated into English and in some cases slightly stylized to make them more readable. The clients are named with pseudonyms.
The 10DT Model
The model consists of 10 discursive tools that have two sides each: an agency tool (AT) and a nonagency tool (NAT), with which either an agentic or nonagentic position can be ascribed to speakers or to addressees. Using ATs or NATs, speakers display either a reflective or nonreflective relation to the description of themselves as an actor. Clients can take a position that is simultaneously agentic but nonreflective or nonagentic but reflective (Toivonen et al.
2018a). When presenting their problems, the clients display problematic or lacking agency by using the nonagency tools of the model.
In Table
1, the NATs are given on the left, the equivalent ATs are next to them in parentheses, and the definitions of the NATs are on the right. For the purposes of readability, the definitions of the ATs are not given here.
Table 1
Summary of the discursive tools of nonagency
1. Dismissing (accepting) | The problem is unrelated to oneself, any meaningful personal relationship with a supposed problem is denied or mitigated |
2. Other as actor (free to act) | Some phenomenon/event is functioning as the actor, the client’s position is either unverbalized/hidden or that of a victim, object, or stooge |
3. Exteriorization (interiorization) | Experiences exist as their own entities and are not one’s own creation |
4. Not initiating action (initiating action) | Not being able to initiate action |
5. Not stopping or curbing action (stopping or curbing action) | Not being able to stop what one is doing |
6. Not modifying action (modifying action) | Not being able to make constructive choices |
7. Noncognizance (cognizance) | Not understanding, knowing, noticing, etc. something about one’s experiences |
8. Reflected dysfunction (reflected function) | Having assumed a problematic way of relating to one’s experiences or dealing with problems |
9. Discontinuance (continuance) | The current actions/experiences are not meaningfully related to the past/future |
10. Presumptive positioning of others (perspectival positioning of others) | Not taking into account other person’s perspective and being unable to coordinate meanings in a situation |
The order of the NATs and ATs represents the increasing reflectivity towards one’s experiences and actions as the number of the tool grows. The nonreflective tools (1 to 6) ascribe a position from which the problems are only reported on. With the reflective tools (7 to 10), an observing position is ascribed, from which the client’s thoughts, experiences, or life events are looked at. The NATs run from a total mitigation and denial of any problems whatsoever through displays of problems in launching, stopping, or modifying action to pondering positions towards one’s own understanding, previous ways of acting, life story, or social relations. The tools are identifiable in short excerpts of talk, occasionally involving only a few words.
Analytic Procedure
The analysis focused on the previously defined first problem accounts and started by identifying problem formulations, understood as semantically independent reasons given for attending therapy, within them. The formulations were often separated from each other in the clients’ talk by short expressions such as “and well then” or “but well.” Each problem formulation usually consisted of one utterance, in some instances of two or three, that concerned the same situation or phenomenon constructed as a problem. First, the utterance forming the main statement or central point of the formulation was identified, and the tool with which the client’s nonagentic position was constructed, was coded as the main tool. Next, the other utterance(s) including complementary information and statements supporting the main point were identified and the nonagentic expressions in them were coded as side tools.
Every problem formulation included at least one nonagentic tool, thus identified as the main NAT. There was not a side tool in all formulations of a certain category. If the same NAT was used in several successive utterances within the same problem formulation, they were counted as one instance of the tool in question. Below is an example of how the main tool and the side tool can look like in the constitution of one formulation:
And then somehow the summer went so that not a single day went by without me thinking about the return to work (NAT5) (but then somehow it went) and it kind of like increased all the time like soon it’s getting closer (NAT2).
The client first describes how she could not stop worrying about returning to work, coded with NAT5 (not stopping or curbing action), a tool with which the speaker takes the position of not being able to stop a specific action. The part within brackets was read as a short agentic expression, as the summer is displayed to have passed in some way despite the client’s nervousness. The last expression provides complementary information on her worrying about the return and shows the nervousness as the actor that increases on its own, coded with NAT2 (other as actor). Often, the expression coded to include the main tool was underlined by the speaker with verbalizations such as “above all” and/or came first in the utterance, followed by the extra information provided by expression/expressions where the nonagentic tool was classified as a side tool. The first author made the first suggestions of what was the main position and which were the less important positions, constructed with which NATs, and the coding was subsequently refined by all three authors together.
Occasionally, there was also neutral talk within the utterance (i.e., talk that did not concern the clients’ problems in any way). In addition, there were in the clients’ talk, both between the problem formulations and in some cases also within them, agency ascriptions, that is, expressions where the clients constructed themselves as agents using agency tools. As the focus of this analysis was on nonagency construction, and because the agency ascriptions were few and did not differentiate the problem formulations, they were not coded or included in the final analysis.
As a second step in the analysis, the problem formulations were categorized.
In their problem accounts, the clients hardly ever presented only one single, clearly defined problem. Hence, each client’s account included several problem formulations and a large variety of nonagentic positions. The categorization of the formulations was done bottom-up from the data, as formulation categories, differing in terms of how the client’s failing agency became displayed, started to evolve from the data. The categorization of the problem formulations was not based on the psychological content of the problems, nor on details of vocabulary, but on how the discursive construction of nonagency was performed using different NATs. In all of the formulations of the same category, the main NAT was the same. Also, it was noticed that the same NAT could be used in different ways to create the impression of failing agency. The difference was recognized for instance in grammatical details such as what/who was the subject of the sentence. As such linguistic nuances created slightly different versions of the nonagentic position associated with the particular NAT in use, it became evident that categorically different kinds of formulations could be constructed with the same NAT. The categories emerging from the analysis were named according to the particular quality of the problem, as produced with the respective NATs constructing the client’s nonagentic position.
Credibility Check
The close reading of the data, the coding of the verbatim transcriptions with the 10DT model, and the preliminary categorization of the problem formulations was done by the first author. The coding and the categorization were reviewed and modified in consensus meetings by all three authors, with full access to the data. The final decision on the coding of the data and the categorization of the formulations was usually achieved in full agreement by all three authors, but in more difficult questions, the agreement of the first author and one of the other authors was considered sufficient.