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Comprehensive discourse analysis of symbolic externalization Wiebe, Katharine 1993

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COMPREHENSIVE DISCOURSE ANALYSISOF SYMBOLIC EXTERNALIZATIONbyKATHARINE WIEBEB.A., Simon Fraser University, 1984A THESIS SUBMITTED IN PARTIAL FULFILMENT OFTHE REQUIREMENTS FOR THE DEGREE OFMASTER OF ARTSinTHE FACULTY OF GRADUATE STUDIESDepartment of Counselling PsychologyWe accept this thesis as conformingto the required standardTHE UNIVERSITY OF BRITISH COLUMBIAApril, 1993© Katharine Wiebe, 1993In presenting this thesis in partial fulfilment of the requirements for an advanceddegree at the University of British Columbia, I agree that the Library shall make itfreely available for reference and study. I further agree that permission for extensivecopying of this thesis for scholarly purposes may be granted by the head of mydepartment or by his or her representatives. It is understood that copying orpublication of this thesis for financial gain shall not be allowed without my writtenpermission.(Signature) Department of Cou n //, n rt p. 4.)„,„Jorjy The University of British ColumbiaVancouver, CanadaDate Ar.-,Ai JG / 1?93DE-6 (2/88)iiABSTRACTThe purpose of this study was to discover how therapistand clients co-create relational novelty using symbolicexternalization intervention in successful ExperientialSystemic Therapy (ExST) for marital treatment of alcoholdependence through a single case study design. Acomprehensive discourse analysis method was used to studythe therapeutic conversation within a 15 minute therapyepisode in which therapist and clients externalized theproblem of alcohol. The therapy episode was video-taped,audio-taped, transcribed and then analyzed according to theprocedures of comprehensive discourse analysis. Theanalysis of the clients' and therapist's discourse revealedeight themes that contributed to co-creating relationalnovelty at the intrapersonal, interpersonal and symptomaticsystem levels. The themes co-constructed by the therapistand clients to attain relational novelty included: (a)creating and maintaining a collaborative atmosphere; (b)challenging propositions and competence; (c) refrainingalcohol as a seducer; (d) moving from an individual to arelational understanding of the role of alcohol in thecouple's relationship; (e) re-defining and accenting thecouple's commonalities; (f) diffusing tension anddefensiveness; (g) regulating the intensity of experiences;and (h) deepening contrasting experiences. The therapeuticprocess involved movement away from the old, restrictivestory or meaning of the alcohol dependence toward a newiiiperspective while simultaneously moderating the atmosphereand character of the therapy. The outcome, the proximal in-session relational novelty, that the therapist and clientsco-created using the symbolic externalization interventiondemonstrated that therapeutic change is a dynamic,interactive, and context dependent process.ivTABLE OF CONTENTSABSTRACT ^  iiLIST OF FIGURES ^  viACKNOWLEDGEMENTS  viiChapter I. INTRODUCTION  ^1Origin of the Thesis Topic  ^1Process Research  ^5Comprehensive Discourse Analysis  ^7Research Question ^  8The Significance of this Study ^  9Limitations of the Study ^  10Organization of the Thesis  11Chapter II. A REVIEW OF RELEVANT LITERATURE ^ 13Review of Externalization Literature  14Overview of Experiential Systemic Therapy ^ 21Phases of Therapy ^  22Transactional Classes  23Symbolic Externalization Intervention ^ 25Process Research ^  29Review of Family Therapy Process Research ^ 29Gaps in Family Therapy Process Research ^ 42Discourse Analysis as a Method for AnalyzingTherapy ^  44Filling the Gap of Family Therapy ProcessResearch  59Chapter III. METHODOLOGY AND PROCEDURES ^ 62Research design ^  62Criteria for Judging the Quality of ResearchDesigns  64Procedures  66Participant Selection ^  66Therapist Selection  68The Origin of the Data Record ^ 68Unit of Analysis  69Method of Analysis ^  72Comprehensive Discourse Analysis ^ 72Cross Sectional Analysis  72Measuring Instruments  82Alcohol Dependency Measures  83Intrapersonal Measures ^  84Marital Measure ^  86Therapy Measures  86Summary ^  88VChapter IV. RESULTS AND DATA ANALYSIS ^  89Preliminary Analysis and Findings  89Screening Measures ^  89Alcohol Measures  89Intrapersonal Measures ^  91Marital Measure  91Outcome Measures ^  92Alcohol Measure  92Intrapersonal Measures ^  92Marital Measure  95Therapy Measures ^  98Data Analysis ^  102The Therapy Case  102Context  103Arrangement of the Analysis ^ 105Analysis of Therapy Episode  106Summary of Therapy Episode  256Creating a Collaborative Atmosphere 258Challenging Propositions ^ 263Reframing Alcohol ^  266Relational Understanding of the Roleof Alcohol ^  270Re-defining Commonalities ^ 273Diffusing Tension and Defensiveness 275Regulating the Intensity ofExperiences ^  278Deepening Contrasting Experiences ^ 282Chapter V. DISCUSSION ^  288Major Findings  289Social Constructivism ^  290Contextualization  296Contributions to Understanding SymbolicExternalization ^  303Attending to the Therapeutic Process ^ 309Contributions to Understanding RelationalNovelty ^  320Contribution to Marital and Family Therapy ProcessResearch  325Limitations of the Case Study ^  327Direction for Future Research  329REFERENCES ^  332APPENDIX A: Transcript Notation ^  337APPENDIX B: Propositions ^  338APPENDIX C: Discourse Rules  341viLIST OF FIGURESFigure 1. Alcohol Dependency Data Questionnaire Scores^93Figure 2. Global Severity Index Scores on the SCL-90R^94Figure 3. Beck Depression Inventory Total Scores^96Figure 4. Dyadic Adjustment Scale Scores^ 97viiACKNOWLEDGEMENTSThere are a number of people I am grateful to for theircontribution to the process and completion of this research.I would like to express my appreciation to the members of mycommittee: Dr. John Friesen, for fostering my interest anddevelopment in experiential therapy, and Dr. Larry Cochranand Dr. John Allan for their encouraging suggestions andcommitment to process research. I would like to thank thetherapist and clients who were willing to make availabletheir therapy sessions for research purposes. Without them,this study would not have been possible.I am especially grateful to Jennifer Newman, not onlyfor her enthusiasm and knowledge, but also for theinvaluable guidance and support she provided during eachstage of the project. A thank you is extended to othermembers of the Alcohol Recovery Project who providedassistance. I greatly appreciate the time and effort givenby my friends, Delyse Ledgard and Corrinne Murray, whoassisted in the editing of the data analysis. Delyse wasalways available for stimulating discussion and support.It is with gratitude and pleasure that I thank mysister, Angie Wiebe, and two friends, Marita Gustaysson andVal Wilkins for their continual support, encouragement andbelief in my capability to complete the project.Finally, I wish to express my deepest appreciation toEvangeline Carr whose patience, caring, and sense of humoursustained me through much of this project.1CHAPTER IINTRODUCTIONOrigin of the Thesis TopicClient changes within the therapeutic process aregenerally considered to be facilitated by the therapist'stalk and use of particular interventions. It is, however,uncertain how this change actually occurs within thetherapeutic context.In the last decade there has been an influx of researchexamining the factors within the counselling process thatlead to change. Gelso and Fassinger (1990), in theirliterature review, discuss studies that have examinedcounsellor techniques and constructs that are helpful incounselling. The studies cited examined client andcounsellor responses, reactions, and variables, andconstructs such as symmetry and complementarity to determinewho controls whom in the counselling interaction (Gelso &Fassinger, 1990). Lambert, Shapiro, and Bergin (1986), inreviewing psychotherapy outcome research, indicated that thecommon factors across therapies associated with clientimprovement during therapy are interpersonal, social, andaffective factors. They also stress the importance of thetherapeutic relationship being characterized by trust,warmth, acceptance and wisdom. Pinsof (1991) reviewedstudies that used family therapy process research designsand developed instruments to measure some aspect of the2therapeutic process. The empirically unsubstantiatedfindings failed to provide a clear and consistent body ofknowledge about process-outcome links (Pinsof, 1991).Although there has been a great influx of research studyingthe mechanisms of change in therapy, understanding whatactually occurs in therapy to create change is still at anearly developmental stage (Gelso & Fassinger, 1990; Pinsof,1991).Considering the numerous variables affecting the changeprocess in therapy it is necessary to limit the scope of thepresent study and empirically examine a manageable aspect ofthe change process. Orlinsky and Howard (1986) identifiedfive interrelated conceptual elements of a generic model ofpsychotherapeutic process which contribute to theeffectiveness of therapy. These include; the therapeuticcontract, therapeutic interventions, therapeutic bond,client self-relatedness, and therapeutic realizations. Dueto the complexity of studying all five elementssimultaneously the present study will focus only on one, thetherapeutic interventions.Therapeutic interventions constitute the most apparentsubstantive component in psychotherapy. Interventions areintentional in that the therapist must present specifictasks and procedures in response to clients' problems thatwill facilitate therapeutic growth. The diversity acrosspsychotherapeutic theoretical orientations is often due to3use of different therapeutic interventions as well as howdifferent client problems are perceived. "Yet no matterwhat the theory, therapeutic interventions presumably occupythe greater part of the time that [client] and therapistspend together" (Orlinsky & Howard, 1986, p. 313). Thetherapeutic interventions reviewed by Orlinsky and Howard(1986) were more generic across therapies and included thetherapist using interpretation, confrontation or givingfeedback, exploration and questioning, giving support,giving advice, reflection and self-disclosure. Theseauthors also examined aspects of client participation intherapeutic interventions such as client self-exploration,affective arousal, discussion of problems, and here and nowfocus. Overall, the findings showed inconsistentassociation between client outcome and therapeuticinterventions. The authors suggest that therapeuticinterventions do not directly influence outcome becausethere must be "an 'open' state of [client] self-relatednessfor this influence to become effective" (Orlinsky & Howard,1986, p. 369). In other words, a strong therapeutic bondwould provide a safe and supportive environment which wouldincrease the client's willingness to participate ininterventions. Again, it becomes apparent that there islittle understanding about the impact of therapeuticinterventions on the change process in therapy. Moreimportantly, researchers have difficulty studying and4determining what is actually occurring within therapysessions and identifying the mechanisms that facilitatetherapeutic change.A trend in the counselling profession has been toidentify and outline therapeutic interventions andprocedures for particular client problems. The treatmentstrategies for sexual abuse, for example, have been widelydiscussed and delineated in the literature with moreemphasis currently placed on using a combination ofindividual and family therapy (Faller, 1988; Friedrich,1990; Sgroi, 1989). However, considering the highprevalence of alcohol and drug problems, empirical studiesinvestigating the efficacy of marital and family therapy intreatment of alcoholism and drug abuse are few in number(Gurman, Kniskern, & Pinsof, 1986). In their review theseauthors found that studies suggested the preferred treatmentfor couples with alcohol problems was group conjoint couplestherapy. This format was more effective than individualtherapy with the alcoholic spouse.However, there has not been much mention or research inthe literature as to what actually occurs in the context ofa therapy session when the underlying principles of anintervention, which are based within an established theory,are implemented. This is largely due to the employment ofconventional outcome research designs in marital and familytherapy which focus on what occurs outside the confines of5the therapy session, particularly after termination oftherapy (Gurman, Kniskern, & Pinsof, 1986). Movement fromthese traditional research strategies toward utilizingprocess research designs to study what occurs within thecontext of the therapy sessions has been recommended (Gurmanet al., 1986; Pinsof, 1991; Wynne, 1988).The intent of this present study is to comprehensivelyanalyze the actual discourse that occurs within the contextof a therapy session when a particular intervention isimplemented by the therapist. The underlying principles ofsymbolic externalization intervention, derived fromExperiential Systemic Therapy (ExST) model (Friesen, Grigg,Peel, & Newman, 1989), will be presented and analyzedthrough the use of a particular process researchmethodology. The study will examine how therapist andclients co-create relational novelty (change) using thesymbolic externalization intervention in successful outcomemarital therapy with a couple in which one partner isalcohol dependent.Process ResearchTo understand how change occurs in the therapeuticprocess the emphasis in research must be primarily processresearch. Much of the research to date has evaluated theoutcome of therapy without illuminating the process andtheory of change. Outcome research is generally engrossedin studying the efficacy of a particular treatment as6compared to no treatment or an alternate treatment and failsto explore how therapy may be used to facilitate change inpeople or families. Comparative studies that examineoutcome differences between different treatment approacheshave little impact on clinical practice (Gurman, 1988).Clinicians and therapy trainers require information that canhave an impact on their own behavior. Providing "detailedspecifications and observations of the actual [therapeutic]processes" (Orlinsky & Howard, 1978, p. 310) and knowingwhat processes were associated with the success ordeterioration of the treatment would be more relevant andmeaningful to the clinician.The process of testing clinical theory must then beginby investigating the actual events that occur in thetherapeutic process. Otherwise, psychotherapy researchwould be thwarted as would be the specificity question -"What are the specific effects of specific interventions byspecified therapists upon specific symptoms or [client]types?" (Bergin, cited in Pinsof, 1991, p. 700)Family therapy process research is still at an earlydevelopmental stage and has generally been clouded byindividually-oriented approaches that do not take intoaccount concepts specific to marital and family therapy(Pinsof, 1991). Research methods and designs to be used byfamily therapy process researchers are continuing to emerge(Gurman et al., 1986).7Comprehensive Discourse Analysis The present investigation is concerned with proposingan alternate methodology to assist in understanding thechange process in marital and family therapy. This methodis the comprehensive discourse analysis, developed by Labovand Fanshel (1977), which has been employed by these authorsas well as Todtman (1990) to discover what occurs within atherapy setting. This comprehensive methodology allowsresearchers to analyze contextual interactions which iscongruent with the systemic perspective of family andmarital therapy. In general, this micro-analytical approachlends itself to discovering what occurs between therapistand client as well as how the therapist conducts thetherapy. In addition, it also addresses the "relationbetween what is said and what is meant, and how things getsocially accomplished with talk" (Grimshaw, 1979, p. 171).The present study will use comprehensive discourseanalysis to examine a therapy case in which the therapistimplements a symbolic externalization intervention of theExST model with a marital couple. This therapy case isconsidered to be appropriate for this type of comprehensiveanalysis for several reasons. First, ExST and its symbolicexternalizing transactional class is a theoretically definedmodel of therapy. Second, the ExST therapist used thistherapy model as well as the symbolic externalizationintervention during the course of the therapy. Third, the8case was successful which was determined by both thetherapist and the clients self-reports and the measurementsof instruments used. Lastly, the therapy case was video-taped and thus providing the entire therapeutic context.The therapy segment of interest could then be contextualizedwithin the therapeutic practice of the ExST model. Thepresent study will provide the transcript of the segment inwhich the symbolic externalization intervention is used aswell as a comprehensive analysis of how the therapeuticinteractive talk is co-constructed.Research QuestionExternalization approaches have been used in variousways but there has not been any analysis determining whetherit does what it purports to do. That is, does it createchange and if so, how? The purpose of this study is todevelop an understanding of the process of change thatoccurs through the implementation of a symbolicexternalization intervention within the therapeutic contextof successful therapy, with a couple where alcoholdependency is a problem. The question to be addressed is:How do therapist and clients co-create relational noveltywith using symbolical externalization intervention in a caseof successful Experiential Systemic Therapy for maritaltreatment of the husband's alcohol dependence? Thisresearch study is descriptive in nature with the centralpurpose of understanding the mechanisms used by both9therapist and clients to facilitate the co-creation oftherapeutic change. It will also be possible to explore howthe ExST therapist and the clients co-constructed thetherapeutic conversation toward attaining change in thetherapy.The Significance of this StudyThe symbolic externalization intervention of ExST wasselected for this study because of its significance in theearly stages of treatment of alcohol dependency. Davis,Berenson, Steinglass, and Davis (1974) state that there areadaptive consequences that maintain the alcohol problemwithin the family which need to be identified before therapycan be structured to learn effective alternate behaviors.Through using the intervention of symbolically externalizingthe alcohol dependency and making it a separate entity, thecouple will be able to discuss and directly relate to thealcohol and thereby create some change within the maritalsystem of how they relate to each other and the alcohol. Anexploration of what maintains and reinforces the use ofalcohol by the husband can also occur.It is anticipated that analyzing how this interventiondoes what it purports to do, that is, create relationalnovelty, will aid in understanding the mechanisms thatfacilitate therapeutic change when using the ExST symbolicexternalization intervention. This will then lead toexpanding and refining the theory underlying the ExST10symbolic externalization intervention. Clinicians andtherapy trainees will also acquire relevant and meaningfulinformation on how therapist and clients co-created proximalin-session therapeutic change when implementing thisintervention. The how-to-do analysis of co-creatingtherapeutic change when using a symbolic representation ofthe alcohol dependency problem can provide valuableinformation for clinicians in all settings. Clinicians willbe able to understand the actual proximal outcome thatresulted in the therapeutic context when this particularintervention was used at that moment.Additionally, the introduction of an alternatemethodology, comprehensive discourse analysis, to family andmarital therapy process research will enhance thedevelopment of the family and marital psychotherapy field.We will be able to more fully understand what actuallyoccurs within the context of therapy to create change andhow both therapist and client accomplish this task throughuse of language.Limitations of the StudyThis study does not propose that the implementation ofsymbolic externalization intervention will result insuccessful outcome in therapy. Applying this interventionis only one aspect of the treatment process. The ExST modelis comprised of seven transactional classes that aid infacilitating therapeutic change. However, due to the11laborious nature of the methodological research approachemployed in this study, the investigation of other elementsthat are integral to the process of change is beyond thescope and feasibility of this study.The intent of this research is to study an episode ofsymbolic externalization that is grounded in the entirecontext of ExST and to carefully examine what actuallyoccurred within the therapy. This careful examination willalso need to occur with other transactional classes andtheir respective interventions. This change model ofsymbolic externalization will at best be only partialbecause it is unlikely that it alone accounts for all ormost of the change in the course of marital and familytherapy. Furthermore, other processes that may be equallyor even more important for change are not included.Organization of the ThesisChapter two will present a review of the literature onthe process of externalization interventions and a review ofboth family therapy process research and discourse analysisresearch. The gaps found in family therapy process researchwill be identified and an alternate methodology,comprehensive discourse analysis, will be introduced to fillgaps in research design and method. Chapter three willdelineate the methods of comprehensive discourse analysisused to analyze the segment of the marital therapy in whichthe symbolic externalization intervention is implemented.12Other methodological issues to be presented in this chapterinclude; the research design, procedures, and measuringinstruments used to determine the successful outcome of thetherapy.Chapter four will present first the preliminaryfindings of the outcome of the ExST treatment and then theanalysis of the therapeutic discourse in the maritaltherapy. Data for the analysis will be drawn from thetranscripts of the conversation between clients andtherapist during the symbolic externalization episode whichwill be included in chapter four. The final chaptersynthesizes the results of the comprehensive discourseanalysis and discusses the implications for understandingthe therapeutic work of ExST as well as recommendations andconclusions for family therapy.13CHAPTER IIA REVIEW OF RELEVANT RESEARCHIn reviewing the literature on the use of theexternalization interventions it became apparent that therehas not been any research to date determining whether theintervention does what it purports to do. Theexternalization intervention used by both White and Epston(1990) and Perls, (1969) describe what the intervention is,when to use it, general procedures for implementation of theintervention, but they fail to put their interventions totest. This failure to test whether the interventionpurports to do what it sets out to do may in part be relatedto difficulties in selecting research methodologies that canadequately assess the use of this intervention. That is,outcome research designs, often used in psychotherapyresearch (Gurman et al., 1986), do not lend themselves toilluminate the therapeutic process of change.The first section of this chapter will present a reviewof the literature reflecting the use of externalizationinterventions used by both individual and systemic orientedpsychotherapy approaches. An overview of ExperientialSystemic Therapy will be presented to contextualize thetherapeutic process of utilizing the symbolicexternalization intervention. The next section will presenta review of the methodologies used by family therapy processresearchers and the strengths and limitations of process14research will be discussed. An overview of comprehensivediscourse analysis will also be presented as a methodologyto utilize in addressing gaps in the existing family therapyprocess research.Review of Externalization LiteratureExternalizing interventions have been used by variouspsychotherapy orientations. The introduction of the emptychair and two-chair technique was originally made by Gestalttherapy to resolve polarities and splits within individuals(Perls, 1969). The goal of this Gestalt experiment is forthe client to identify and sense the opposing forces of theintrapsychic split and to integrate the conflict between thetwo parts through placing each side of the conflict in aseparate chair and then proceeding to have a directencounter between them (Greenberg, 1979).Apart from experientially oriented therapy,externalizing has also been used by family systemic orientedtherapies. White and Epston (1990) describe externalizingasan approach to therapy that encourages persons toobjectify, and at times, to personify, the problemsthat they experience as oppressive. In this process,the problem then becomes a separate entity and thusexternal to the person or relationship that wasascribed the problem. Those problems that areconsidered to be inherent, as well as those relativelyfixed qualities that are attributed to persons and torelationships, are rendered less fixed and lessrestricting. (p. 38)The method of externalizing used by White and Epston15(1990) involves first defining the problem and then asking"relative influencing questions" designed to assist inmapping the influence of the problem in the persons' livesand relationships, as well as mapping their own influence inrelation to the problem. This is based on the premise thatwhen persons describe their relationship to the problem;they can separate from the problem and review theirrelationship to it, which allows for unique outcomes toemerge.Based on experience with using this approach, White andEpston (1990) conclude that externalization of thepresenting problem assists family members to decreaseunproductive interpersonal conflict, reduce a sense offailure for not resolving the problem, provide anopportunity for members to cooperate in resolving theinfluence of the problem on their lives, permit newpossibilities for members to regain their lives andrelationships from the problem, allow members to be moreeffective and less stressed when dealing with the problem,and to present opportunities for dialogue about the problem.Externalizing has been used with such problems asencopresis, schizophrenia, temper tantrums, communicationproblems, and other similar related problems (White &Epston, 1990). To date, these authors have not mentionedusing this approach to address alcohol dependent problems.More importantly, there has not been research that analyzes16the effectiveness of externalizing interventions. White andEpston have not put their principles of this intervention totest and demonstrated how this process actually occurs inthe context of a therapy session.The externalizing approach used by White and Epston(1990) remains focused on a cognitive, verbal, anddiscursive level. Thus, this approach would not necessarilybe as effective with clients who are more non-verbal andtend not to function predominately on a cognitive level.A variation of the Gestalt empty chair intervention wasused by Friesen and Goranson-Coleman (1987) in addressingalcohol dependency in families. The empty chair was used torepresent the role of alcohol in the family. Thisseparation of the dependent person from the alcohol allowsthe family members to confront and challenge the symptomrather than the drinker. In this externalizing approach thefamily bands together to aid the alcohol dependent person tolet go of the alcohol. ExST adopted and modified thislatter externalizing approach by Friesen and Goranson-Coleman.ExST provides several reasons for extending both Whiteand Epston's (1990) and Gestalt therapy's (Perls, 1969;Greenberg, 1979) approaches to include use of symbols inexternalization. First, ExST proposes that it is possibleto extend the externalizing process to access both digitaland analogical information through the use of symbols17(Friesen et al., 1991). This is based on Bateson's (citedin Friesen et al., 1991) claim that "linguistic thought isstructured in a digital code and perceptual experiences inan analogic code is communicated in the form of models,metaphors, analogies, stories and rituals" (p. 5). Twobasic functions of symbols are abstraction andrepresentation of meaning (Lusebrink, 1990). When themeaning of a situation or experience is unknown due to adirect expression not yet being available, the symbol isconsidered to be the best and most descriptive way torepresent this meaning (Jung, 1964). "This symbolicapproach can mediate an experience of something indefinable,intuitive or imaginative, or a feeling sense of somethingthat can be known or conveyed in no other way, sinceabstract terms do not suffice everywhere" (Whitmont, 1973,p.16). According to Jung (1964), symbols had a life-sustaining function that expressed and transformed life."Thus the function of symbols may be to reveal, to disguise,to mediate" (Lusebrink, 1990, p. 56).In ExST, actual symbolic objects are used as a means toexplore the client's inner world, to describe interpersonalrelationships, and to represent symptoms such as alcoholdependency. Through the use of symbols, ideas are presentedindirectly and experientially that results in them beingmore easily accepted and used. ExST considers what occursin therapy as being symbolic of what occurs in other areas18of the client's life. Relational changes experienced withinthe therapeutic setting result in changes outside of thetherapy room (Friesen et al., 1991).The second reason for utilizing the symbolicexternalization intervention, developed by ExST, is that itextends the use of Gestalt therapy's empty chair and twochair technique (Perls, 1969; Greenberg, 1979) to includenot only enacting and interacting with various aspects ofself, but to externalizing aspects of self that are inrelationship to symptoms, problems, relational themes orrelationship patterns (Friesen et al., 1989). ExST operatesfrom a systemic perspective and is concerned with bothintrapsychic and interpersonal dynamics which is in contrastto Perls (1969) who focused only on the individual'sintrapsychic process of increasing awareness and contact.In ExST, internalized relational aspects of the clients'lives are externalized so that they may explore and changeboth their substantive relational themes and relationshippatterns. By directly experiencing and intensifying aspectsof self in relationship, there may be an increased awarenessof self and understanding of alternative ways of being. Theintent of this intervention is to give clients anopportunity to engage in relational novelty, which is thetransformation of relationship patterns in the here and now(Friesen et al., 1989).Relational novelty, a term coined by ExST (Friesen et19al., 1989), results from the enactment of alternate ways ofbeing in therapy and includes a change in the substantiverelational themes and relational patterns within intra-psychic and interpersonal domains. Relational noveltyoccurs not only on these two levels, but also occurs inrelation to problems presented by clients in therapy.Clients have a relationship with the problem presented intherapy which requires the ExST therapist to bring thisrelationship with the problem into the clients' awareness(Friesen et al., 1989). For example, the clients'intensified experience of interacting with a concrete symbolrepresenting the alcohol can create relational novelty. Theproblem is presented as alcohol creating distance betweenthe couple and hence, it is possible to explore and changethe relationship. When the couple experiences theirrespective relationship to the alcohol at the physiological,emotional, behavioral, and cognitive levels, they are ableto broaden their perspective of the problem and one another.Relational novelty occurs in regards to the clients'presenting problem when they experience their relationshipto the problem by interacting with it and exploring boththeir own and their partner's experience with the problem.Relational novelty occurs at the intrapsychic levelwhen clients experience aspects of themselves which werepreviously unacknowledged or avoided. Relational noveltymay result in therapy when clients experience both unlovable20and newly discovered loving aspects of self.Relational novelty occurs at the interpersonal levelwhen a family or couple, through intensifying theirrelational patterns and interactions, experiences analternate way of being with one another. They mayexperience being vulnerable and loving with each otherrather than engage in their typical pattern of being angryand defensive. In short, relational novelty may occurwithin one or more of these domains.ExST model strives to integrate various perspectives ofalcohol related problems and thus, a multi-faceted,interactive model of alcohol dependence is proposed.Physiological, biogenetic, psychological, and socio-culturalprocesses are all interacting with one another (Friesen etal., 1989). The alcohol dependence model is relationallybased and examines the patterned relationship that hasdeveloped, rather than emphasizing the disease entity of thebehavior. From this perspective, the problem is not thealcohol or the alcoholic, but rather the relationshipbetween the bottle and drinker.The adaptive consequence model of alcohol dependency aspresented by Davis, Berenson, Steinglass, and Davis (1974)examines the adaptive consequences of alcohol dependency andtheir reinforcing value. Davis et al. (1974) state thatthese adaptive consequences are sufficientlyreinforcing to serve as the primary factors maintaininga habit of drinking, regardless of what underlyingcausation there may be. The primary factors for each21individual differ and may be operating at anintrapsychic, intra-couple, or at the level ofmaintenance of homeostasis in a family or wider socialsystem (p. 210).Once the adaptive function of the alcohol dependence isdetermined, the emphasis in therapy is to assist the clientsto manifest the adaptive behavior while sober and to learneffective alternative behaviors and relationship patterns.The goal is to make explicit the implicit role of alcohol toself and family relations. It is not only the once alcoholdependent person who must make changes and deal withredefining self, resolving unfinished issues from the past,and expanding to include alternate behavior, but otherfamily members must also reorganize themselves and establishnew patterns of relationship (Friesen et al., 1989).The therapeutic setting provides a context fordeveloping new behaviors and for both clients and therapistto co-create alternate ways of experiencing themselves. Thetherapeutic process of experiencing relational noveltyimplies that alcohol dependent clients and their family candirectly experience and create non-dependent ways ofrelating to alcohol as well as reorganizing themselves inother significant contexts.Overview of Experiential Systemic TherapyTo understand the rationale for employing the symbolicexternalization intervention it is important to provide thetheoretical framework and context in which the intervention22is embedded. That is, this intervention is not used inisolation from other processes occurring in the therapy. Abrief discussion will ensue describing the process of ExSTand how the transactional classes coincide with thetherapeutic process, particularly symbolic externalizingtransactions.Phases of TherapyThe process of therapy in the ExST approach consists offour phases which include: (a) forming the therapeuticsystem and establishing a context for change; (b) perturbingpatterns and sequences and expanding alternatives; (c)integrating experiences of change; and (d) disbanding thetherapeutic system. These phases do not occur in a linearfashion from start to end of therapy instead, there is oftena looping back and forth of phases over the course oftherapy. These four phases also structure the processoccurring within each session. That is, in each sessionthere will be a forming and joining of the therapeuticrelationship, perturbing patterns, integrating the changes,and ending of the therapy session. The first phase requiresthat the therapist and clients establish a bond and trustwith each other. The therapeutic mandate is developed byassessing the nature of the clients' presenting problem andcollaboratively creating the goals of the therapy. Thesecond phase focuses on disrupting rigid and dysfunctionalpatterns and sequences in order that new patterns and2 3behaviors of relating to self and others can emerge. Thethird phase then strives to integrate and generalize thechanges that have taken place in the therapeutic setting tothe clients' life outside of therapy. The fourth phase isthe termination of therapy and involves evaluating thetherapeutic process and celebrating the changes made.Transactional Classes ExST developed seven transactional classes whichdescribe the activities of the therapy and are related toand concur with the four phases of the therapeutic processjust described. The following section will briefly describethe seven transactional classes.Therapist-Client Relationship Enabling Class The emphasis is on creating and maintaining thetherapeutic alliance throughout the duration of therapy.Some of the transactions used are empathy, self disclosure,immediacy, and tracking.Process Facilitation Transactional Class The therapist observes the clients' relational patternsby having the clients directly engage with one another inthe session. The therapist then uses particular techniquessuch as blocking, coaching, marking, role reversal,repetition, and expressing underlying feelings to shift therigid and repetitive relational patterns.Expressive Transactional Class The focus is on assisting clients to make their24experiences public through exploring, naming and owningtheir experiences and by accessing both verbal and nonverbalexpression. The use of such transactions as metaphor,sculpting, art, dance, and storytelling can provide anavenue of symbolic expression and move beyond just verbalexpression.Symbolic Externalizing Transactional Class A symbolic representation of a central and problematicfeature in the clients' life is created and brought into thetherapy session. The interventions include empty chairwork, two chair work, and symbolic representations.Meaning Shift Transactional Class The emphasis is on the therapist aiding clients indeveloping and expanding alternate views of the problem.The transactions include using reframing, normalizing,circular questioning, and regressions.Invitational Transactional Class The transactions are used to orient the clients toautonomous functioning outside of the therapeutic system andto enhance the work being done inside sessions. Some of theinterventions used are prescribing symptoms, homework,journal writing, and self monitoring.Ceremonial Transactional Class To acknowledge the progress and change within clientsceremonies are created to demarcate endings, shifts instatus, and changes in roles. The transactions may include25closing ceremonies, burials, confessions, and handshakes.Due to the complexity and laborious task of intensivelyanalyzing all seven transactional classes, the present studywill only focus on examining the symbolic externalizingtransactional class.Symbolic Externalization InterventionWhen working with clients who are suffering fromalcohol dependency, symbolically externalizing the problemis often one of the first steps in understanding therelationship to the alcohol. Symbolic externalizinginterventions offer clients an opportunity to gain distancefrom the problem of alcohol by creating a symbolic ormetaphoric representation of this problem so that it is nolonger perceived as a characterological trait residingwithin the client. For example, an alcohol dependentclient's relationship to alcohol can be externalized byplacing a beer bottle, which represents the alcohol problem,on a chair and having the client relate to it from adistance. Both the alcohol dependent client and his or herspouse can explore and discuss their relationships to thebottle.Symbolic externalizing transactions can be used toaddress any problem, symptom, or relationship difficulty.When the symptom or problem is external and tangible and notfused with the person's identity, it allows clients toexamine the many aspects and dimensions of this concrete26representation of their problem. Through this process ashift in the client's identity or relationship to theproblem may occur and possibly alternate ways of dealingwith it may emerge.The symbolic representation of the problem or symptommay evolve in several ways. It may emerge directly from anexpressive transaction (e.g. a metaphor) or attaineddirectly from the therapeutic discourse. Anotherpossibility is that the therapist introduces the symbolbecause it seems to fit with the client's experience. Howthe symbolic objects evolved is less important than theappeal of the symbols to the analogic mind (Friesen et al.,1989). If this does not occur than the work in relation tothe symbols will not be useful to the client.Beliefs and assumptions of symbolic externalizationintervention. The beliefs and assumptions underlying thesymbolic externalizing transactional class are many. First,ExST postulates that the client's presenting problem orsymptom provides the source and often the solution to theproblem. That is, the problem or symptom is perceived as acommunicative act of existing relational difficulties. Theproblems and symptoms are messengers that something isamiss. For example, the alcohol dependent client who wantsto stop unresolved pain and to detach from reality seeks theanswer through drinking alcohol.Second, intensifying the client's therapeutic27experience is important in facilitating change in therapy."The deepest and the most profound form of knowing resultsfrom experience rather than dialogue or didacticinstruction" (Friesen et al., 1991, p. 6). Therapeuticexperiencing represents an integration of the holisticperson which includes cognition, behavior, affect,perception, and expectation. Therapeutic change involves adeepening, enhancing and broadening of the client'sexperience through the use of action oriented interventionssuch as empty chair work, two chair work, enactment, andsculpting.Third, communicating through metaphoric or symbolicmeans has the potential to move beyond usual defensemechanisms. The indirect and playful nature of the languageused may result in the client not taking it seriously andthus immediately establishing defenses.Fourth, due to symbols and metaphors tapping intoanalogic processes of the mind they are not easily forgottenor ignored. Andolfi, Angelo, and Nichilo (1989) found intheir long term follow-up studies that images created andsymbolic representations "have a remarkable capacity topersist and reverberate that is clearly superior to thoseproduced by verbal exchanges and interpretations" (p. 74).Process of utilizing symbolic externalizing transactions. The following steps demonstrate the processof this transactional class:281. A therapeutic relationship of trust is firstestablished. That is, a collaborative therapeutic allianceis created and maintained.2. Through the client's discussion of his or herconcerns, a metaphoric image becomes apparent to either theclient or the therapist.3. The therapist then helps the client to create ametaphor and then an external symbol which reflects theconcern or symptom. The client's own words are used.4. The client is asked to describe his or herrelationship to the symbol and what he or she might like tosay to it.5. The client then engages directly in the relationshipdialogue with the symbol or with each other about thesymbol.6. The experience of rigidity of the relationship isheightened or intensified.7. Possible changes in the relationship to the symbolare explored.8. Direct experience of relational novelty occurs withthe symbol.9. The therapist and client jointly decide what to dowith the externalized symbol.The function of the therapist while involved in thistransactional class is to assist the client in clarifyingthe quality of the specific problematic relationship, to29explore the significance of the problem and to perturbrelational novelty between the client and the symbol.Process ResearchTo understand what occurs within the therapeuticcontext when implementing the symbolic externalizationintervention, a comprehensive method of analysis thatdescribes and analyzes the process must be utilized.Relying solely on outcome research strategies could notadequately address the research question of this study. Thenature of outcome research is to evaluate the effectivenessof a therapy by comparing outcome differences betweendifferent treatment approaches or no treatment.Consequently, it is unable to reliably describe whatactually occurs in the course of therapy. Outcome researchis not amenable to testing clinical theories about theprocess and effects of various interventions and treatmentstrategies. Instead, these tasks are best addressed withinthe field of process research. The process of testingclinical theory must then begin by investigating the actualevents that occur in the therapeutic process.Review of Family Therapy Process ResearchIn reviewing the family therapy process research todate, Pinsof (1991) stated that research has largely focusedon evaluating the outcome of family therapy "but little hasbeen devoted to systematically describing and evaluating theprocess of family therapy or attempting to relate process to30outcome" (p. 699). Pinsof (1991) claims the three factorsresponsible for the dearth of family process research are;the difficulty of the task, lack of adequate micro-therapytheory, and the individual orientation of researchers.Pinsof (1991) stated thatthis scientific isolation has retarded the speed withwhich the knowledge and skills offered by the field ofpsychotherapy research have infused the family therapyfield. Simultaneously, it has permitted generalpsychotherapy researchers to remain enmeshed within apredominantly individual psychotherapy researchparadigm (p. 701).Other reviews of family therapy process research havealso identified similar limitations (Gurman, et al., 1986;Newman, 1991; Wynne, 1988). There appears to be agreementamong these reviewers that the areas that need to beaddressed in family therapy process research are; use ofadequate methods and measures, establishing clinicalrelevancy, incorporating a systemic perspective on thetherapeutic process, and explicating the theoreticalorientation employed. In the next section each of thesefour areas will be discussed as well as recommendations madefor enhancing the quality of family therapy processresearch.First, much of the earlier process research failed toutilize adequate methods and measures. Pinsof's (1991)review of family therapy process research identifiedresearch that focused on developing instruments to measureaspects of family therapy process. The emphasis of this31review was on enhancing the quality of family processresearch methodology.The family therapy process research, reviewed by Pinsof(1991), focused on either self-report measures or directobservation measures of either the therapist or client'sbehavior using coding systems that describe and analyzebehavior. These coding systems focused primarily on verbalbehavior, disregarding paralinguistic, kinesics or proxemicbehavior. In general, the findings obtained in thesestudies were often unclear or inconsistent.Additionally, a major gap in the family therapy fieldnoted by Gurman et al. (1986) was the lack of attention paidto nonverbal behaviors. They stated that "no one in thefield has developed and implemented an empirical andquantitative methodology for studying paralinguistic... andkinesic... behaviors" (p. 598).Most of the research studies reviewed by Pinsof (1991)focused on employing a complementary position in which thepsychotherapy coding systems had different systems and/orcategories for the therapist and/or family members. Anexception was the study by Scheflen (cited in Pinsof, 1991)that adopted a symmetrical position that applied the samesystems and categories to the behavior of the therapist andfamily members. This study used a context analytic approachaddressing both the issue of cybernetics and communicationtheory (Bateson, 1972).32Scheflen's methodology is ethnographic and involves "anintensive, detailed description of every discernible (to theparticipants) behavior (verbal and kinesic) of everyindividual within a group during a transaction" (Pinsof,1991, p. 721). This method of analysis derives specificcodes and categories at various levels of a transaction.The advantage of this process analytical approach is that itis "the least reductionistic... [and] does minimal violenceto the integrity and uniqueness of a given transaction"(Pinsof, 1991, p. 722). The limitations, however, includeits complex methodology, the difficulty in applying itacross different psychotherapeutic contexts as well as notbeing able to generate context specific therapeutic tenets(Pinsof, 1991).In their review of family therapy process research,Gurman et al. (1986) state that the initial work done byScheflen (cited in Pinsof, 1991) in this area has not beenpursued or developed by others in the family therapy field.Overall, Pinsof (1991) considers the family therapyprocess research to be exploratory. He found that theprocess analysis systems developed were tested in either oneor several studies which did not utilize high qualitymethodologies. "A coherent body of findings has not yetemerged... Researchers need to follow through with morestudies of their own and each other's coding systems"(Pinsof, 1991, p. 724).33Newman (1991), in reviewing family and marital therapyprocess research, agreed that at times the coding systemsused by researchers were "too crude to capture the importantnuances of interpersonal interaction and, as a result, theconclusions were clinically redundant" (p. 6).The overreliance on extensive analysis methodologies byearly marital and family process researchers to understandthe therapeutic change process has contributed to inadequateuse of methods and measures (Newman, 1991). Theappropriateness of using extensive analysis research andconfirmatory paradigms for investigating the therapeuticprocess was previously not challenged due to funding beinggiven for studies that incorporated this methodology(Stanton, 1988). Exploratory research that includeintensive analysis research designs such as small n, singleand multiple case studies, are not regarded or funded in thesame way as conventional research paradigms (Stanton, 1988).The preferential bias toward extensive analysismethodologies has contributed to early researchers notutilizing more exploratory research paradigms.The two research strategies often used in conventionalprocess-outcome studies also contribute to the utilizationof inadequate methods and measures (Gurman et al., 1986).The first strategy focuses on the entire course of therapyand attempts to relate the final outcome measured attermination to some client and/or therapist variable or34experience measured at a particular point in the therapy.The second strategy consists of first obtaining averages ofspecific variable measurements over the entire therapy andto then compare these averages to client outcome at theconclusion of treatment. This emphasis on long-termprocess-outcome links has resulted in a failure to identifyany consistent process-outcome patterns. Long-term linksmay surface at some future point but "they must evolve outof the accumulation of knowledge about the smaller, short-term links" (Gurman et al., 1986, p. 600). It would thusseem that researchers have been too ambitious, at this stageof development in family therapy process research, in tryingto find process-outcome links. It is not likely that astatistically significant relationship will be found"between either an aspect of process at some point intreatment or an aspect of process that spans the wholecourse of treatment and the final outcome (at termination orfollow-up)" (Pinsof, 1988, p. 167). For instance, thelikelihood of what occurs in the first few sessions beingdirectly related to the outcome after 20 sessions is notgreat. There may be a variety of intervening variablesaffecting the outcome. A fundamental problem with these twoconventional research strategies is that the outcome isviewed as a "simple, static phenomenon that is best measuredin some definitive sense at the conclusion of treatmentand/or at some follow-up point after treatment" (Gurman et35al., 1986, p. 599).Rice and Greenberg (1984) suggest adopting more of aprocess orientation in which outcome is perceived as anongoing change process with a series of "small-o" outcomemeasures. This would result in the outcome not beingmeasured at one best point.However, it is essential that researchers identify thesignificant relationship that links the process beingobserved to the outcome when attempting to understand theclient change process. Pinsof (1988) claims that:Substantive (content-oriented) process is meaninglesswithout an immediate or remote link to outcome.Linking process to outcome makes process research thestudy of the process of therapy. Its primary task iselucidating the mechanisms and processes of change.Process research ultimately attempts to reveal howtherapy works (or fails) (p. 161).Previous psychotherapy research has failed to consistentlyfind links between process and outcome variables (Orlinskyand Howard, 1978) which has resulted in clinicians notgaining understanding of the interactions of therapy thatcan have useful impact on clinical practice.The solution to the problem of long-term process-outcome links is to focus on smaller units of analysis ofthe therapy (Pinsof, 1988; Rice & Greenberg, 1984; Wynne,1988). The purpose of using the episode or small-chunkstrategy is to explicate the connection between process andoutcome variables that are closely linked in time. Theintent is to link the particular therapy moment or unit36studied to client change. This would allow forinvestigation of the outcome of specific interventionswithin a session, after a session, and within a series ofsessions. The emphasis being on "proximal" outcome ratherthan "distal" outcome (Pinsof, 1991). The two assumptionsunderlying this method are that "process-outcome linkagesare best discovered in smaller units that do not obscure thephases or vicissitudes of therapy... and that such small-chunk results are meaningful and valuable" (Pinsof, 1988, p.168). This strategy can be utilized to replace the methodof randomly or arbitrarily sampling therapy sessions(Pinsof, 1988).Newman (1991) challenges the strategy of separatingtherapy into clinically meaningful units because thisprocess "removes these change moments from the context inwhich they occurred and the clinical problem of summing andcomparing de-contextualized therapy chunks remains" (p. 12).Although the problem of de-contextualizing therapyunits currently exists, this may be rectified by adhering tothe recommendation made by Wynne (1988) to use smaller,within-model, intensive single and multiple case researchdesigns. This shift in examining smaller units of therapywill require that researchers do not narrow the focus toomuch resulting in the essence of the therapeutic processbeing lost. It is important that researchers ensure theprocess-outcome link is still present. Newman (1991) found37that some researchers were narrowing the scope of thestudies, as recommended, and shifting from examining broadtheoretical orientations and arbitrarily categorizing andcoding therapy units to investigating specific constructsand change moments in therapy. However, these researchstudies cited by Newman (1991) continued to employ"traditional research paradigm that reduces therapy to amechanical act [and] inevitably generates methodologies thatwarp the process being studied until it is unrecognizable topractitioners" (Newman, 1991, p. 11).A comprehensive process analysis requires that theparticipants' (including both therapist and client)experience of therapy, their thoughts and feelings as wellas their observable behaviors are included. Themethodological implication is that the combination of bothself-report methods and naturalistic observational methodsis legitimate and valuable (Gurman, 1988; Pinsof, 1988).This permits the researcher to acquire information aboutboth the client and therapist's perspectives and the actualprocess of the therapy.Clinical relevancy, the second criteria pertinent inprocess research, is considered to be of central importancein efficacy research (Gurman, 1988). Gurman (1988) suggeststhat priority be given to conducting research that will havedirect meaningful relevant impact on clinical practice.This requires identifying the specific and important3 8elements and mechanisms of change in effective familytherapies as well as identifying the elements that do notresult in clinical effectiveness (Gurman, 1988). The resultof such studies would allow for examination of specificinterventions and provide information about how theseinterventions interact with such variables as therapist andfamily characteristics and treatment settingcharacteristics. Understanding how specific family therapymethods work with specific clinical populations isinvaluable for clinicians. This information can also beused for refining or abandoning specific methods withspecific clinical populations.An influx of clinically irrelevant family therapyprocess research studies has emerged from utilizingextensive analysis research designs to examine thetherapeutic change process (Gurman, et al., 1986; Newman,1991; Pinsof, 1991; Wynne, 1988). The result has been themarginalization of the significance of the therapeuticcontext and providing support for the myth of homogeneity(Newman, 1991). Early process research studies describedthe therapist and/or client behavior and/or experience inisolation from their context (Gurman et al., 1986). Thesearch for a representative sample of the variable beingstudied resulted in sampling within and across sessionswithout regard for the role of the context in which thevariable occurred.39Much of the earlier process research was based on theunderlying assumption of homogeneity of process (Rice &Greenberg, 1984). The approach involved selecting andrating samples from one or more sessions and then averagingthe ratings across samples or across sessions. "Aggregatingprocess though all process during therapy is the sameinvolves a uniformity myth from which psychotherapy researchhas been suffering" (Rice & Greenberg, 1984, p. 10). Theassumption is that all therapeutic process is the same andthus can be sampled. This contradicts the premise thattherapy is a change process. Rice and Greenberg (1984)state that:Different processes occur at different times in therapyand have different meanings in different contexts. Itis more the pattern of variables than their simpleoccurrence that indicates the therapeutic significanceof what is happening in therapy (p. 10).Randomly selecting therapy segments and disregardingtheir context fails to provide little information on theprocess of change in therapy. The essence of thetherapeutic process is misconstrued when there is rigidadherence to utilizing conventional or extensive analysisresearch designs.The third criteria for improving the quality of familytherapy process research is to adopt a systemic perspectiveof the therapeutic process. Historically, psychotherapyprocess research has been individually-oriented and failedto include dimensions of family systemic therapy (Pinsof,401991). One factor contributing to the lack of familytherapy research paradigms is the added difficulty instudying the therapeutic process when there are more thantwo participants in therapy (Gurman et al., 1986).Investigating the therapeutic process in individual therapyis a complex task in itself. Family therapy researchmethodologies have to account for the various subsystems inthe therapy setting and how each family member is impactedby an intervention, for example. In reviewing familytherapy research studies, Newman (1991) found that therecontinues to be an emphasis on studying only one client'sbehavior in therapy rather than focusing on the familyinteractions.Therapy is regarded as an interaction between clientand therapist which implies a reciprocal influencingrelationship between therapist and client subsystems(Pinsof, 1988). Thus, it is important to investigate howtherapist and client interactions create client change.This requires developing methodologies for family therapyprocess research that accommodate the theoretical conceptsof circular causality and cybernetics (Gurman et al., 1986;Pinsof, 1988).Gurman et al. (1986) encourage research that isdiscovery-oriented and is of the new 'process perspective'that is derived "from family therapy theory and represents asignificant contribution from the family therapy field to41the general field of psychotherapy research" (p. 596).Progress in the process research field is slow as a resultof researchers needing to "deal with all the problemsinvolved with individual therapy process research as well asthose unique to the family therapy context" (Gurman et al.,1986, p. 597).The fourth criteria of family therapy process researchis to develop a clear theoretical approach of the changeprocess. The theoretical orientation of the therapist isoften not stated in process research studies or in any ofthe reviews mentioned earlier. Developing theories ofchange that can be tested allows for the emergence ofclinically meaningful research questions, designs, andmethodologies (Wynne, 1988). Explicating a theory of changethat is clinically relevant will result in conductingprocess research that is also clinically relevant. Reiss(1988) noted that the many highly abstract and unarticulatedfamily system theories are inadequate for generatingspecific hypothesis and for applying to research methodsthat would inform us about the change process.The testing of clinical theories is important becauseit can result in clinicians refining and modifying theirpractice. Both Gurman (1988) and Epstein (1988) recommendthat at this stage of family therapy research it would bemore fruitful to delineate and study family therapyinterventions within specific approaches since we are not42yet able to investigate common elements across approaches.Dismantling the components of interventions of specificfamily therapy models aids in the refinement of practices ofspecific models by identifying the clinically meaningfulcomponents as well as minimizing or avoiding neutral orharmful variables (Gurman, 1988). The study of commoneffective elements and change mechanisms across familytherapy models can be examined more prolifically afterspecific therapeutic approaches have been delineated (Wynne,1988).Gaps in Family Therapy Process ResearchIn reviewing the literature on the family therapyprocess research conducted to date, it is apparent that thisfield is at an early developmental stage and is strugglingbetween which research method and design to use to capturethe essence of the therapeutic change process. Utilizationof conventional and extensive analysis research paradigmsresults in acquiring information that does not have directimpact on clinical practice, a distortion of the therapeuticprocess, and instruments that produce clinically irrelevantresults. Prematurely categorizing and classifying thetherapeutic discourse into nominal scales tends to result inthe meaning of the therapeutic process being lost. Inaddition, studies that do not clearly articulate the theoryof change and fail to take into account the accumulativeeffect of small outcomes of the therapy limit our43understanding of the change process in therapy. Ourunderstanding of this process is further reduced whenresearchers fail to contextualize the therapeutic changemoments and do not study the multiple levels of interactionsoccurring between both therapist and clients and betweenfamily members. Intensive analysis research strategies thatinvolve using single and multiple case study researchdesigns have generally been ignored by family therapyprocess researchers.The shifting emphasis towards exploratory, discovery-oriented, hypothesis-generating research (Gurman et al.,1988; Rice & Greenberg, 1984; Wynne, 1988) and the notionthat "family therapy research should be theory-based andtheory-driven" (Wynne, 1988, p. 250) will likely result inmore clinically meaningful and relevant contributions of thetherapeutic change process. The discovery-oriented approachis compatible with the intensive analysis procedures whichentails measuring or analyzing a phenomena so that the shiftcan be "from description to explanation of phenomena, modelbuilding, and finally prediction" (Greenberg, 1986, p. 712).Since process research is not yet at the stage ofpredictability we need to begin the process by investigatingwhat was really said and done in therapy. When the goal ofthe research is to understand what and how change occurredin therapy, it is premature to categorize the phenomenaobserved. The intensive analysis of a phenomena begins with44the laborious task of generating hypotheses from the micro-analysis of individual cases and thus calling for theemployment of single and multiple case study researchdesigns (Wynne, 1988).Further investigation by family therapy processresearchers is needed to explore the therapist and clientinteractions and to study both verbal and non-verbalbehaviors of the therapist and clients using a combinationof naturalistic observations and appropriate questionnairesand self-reports. Clearly articulating the theoreticalframework may elucidate the therapeutic change processwithin the specific therapy model. Priority should be givento efficacy research that is clinically relevant andmeaningful to practitioners and to research strategies thatcan reflect the change process.Based on the limitation of previous research methods,such as coding mechanisms, it is important to broaden thefamily therapy process research perspective and examine whatactually occurs in therapy by using a discourse analysismethodology.Discourse Analysis as a Method for Analyzing TherapyDiscourse analysis provides an alternate methodologyfor studying the change process in therapy. This newmethodological perspective has implications for studyingmany socio-psychological topics and social texts as well aschallenging conventional research. Typically, a single case45research design is used to analyze the contextualizeddiscourse occurring in a naturalistic setting. In usingthis approach to study the change process in therapy thefocus would be on understanding what is actually occurringin therapy, what are both the clients and therapist doing,and how is change accomplished. Discourse analysis allowsresearchers to move beyond the constraints of coding systemresearch and instead, to examine the actual interactionsbetween therapist and client. This approach, as will bedemonstrated, fits with the earlier recommendations of usinga discovery-oriented intensive analysis, single case studydesign and it also addresses the concerns of incorporating asystemic perspective in the therapeutic process, clinicalrelevancy, articulation of theoretical perspective andadequate methods and designs.To aid in understanding the purpose and implications ofusing a discourse analysis method the following section willinclude; a rationale for studying discourse, theoreticalroots of discourse analysis, and a review of differentmethods of discourse analysis.Integral to psychology and to the understanding ofhuman communication is the study of language because it isthe most fundamental, influential, and widespread type ofinteraction that occurs between people. Activities aregenerally performed via language; "our talk and writing donot live in some purely conceptual realm, but are mediums46for action" (Potter & Wetherell, 1987, p. 9). Discourseanalysis is concerned with how language is used inorganizing people's perceptions and making events, things,and experiences happen. The premise is that language isused to construct social interaction and varying socialrealities. Discourse analysis, as defined by Potter andWetherell (1987), is the analysis of any type of discoursesuch as spoken interaction, formal and informal, and writtentexts with the emphasis on understanding the nature ofsocial interaction through studying social texts.The study of how people actually use language with eachother in different types of interactions has its roots inseveral theoretical traditions with the first one developedwithin speech act theory. The underlying premise of thistheory "is that all utterances state things and do things.That is, all utterances have a meaning and a force... Peopleuse language, like a tool, to get things done" (Potter &Wetherell, 1987, p. 18). Speech act theory identified thata particular sentence or group of words can be used invarious ways to give an order, a question, or a request.This theory also stresses gaining awareness of how aspectsof the social context are associated with language use.However, the limitation with this theory is that itfails to provide methods for applying it to the vicissitudesof everyday talk in naturalistic settings. It is able todeal with simulated sentences or actual exchanges that are47ritualized as in wedding ceremonies. In everyday talkinteractants' speech acts are often more implicit ratherthan explicit. For instance, we may indirectly request aride by asking "Are you going downtown?" Although therequest is framed as wanting information, the action desiredis a ride. Speech act theory is problematic when it is usedto categorize discrete speech acts of a conversation throughsequencing rules because utterances may perform more thanone act (Cicourel, 1980; Corsaro, 1985; Labov & Fanshel,1977; Potter & Wetherell, 1987). That is, there may bemultiple messages associated with the utterance. Anotherproblem is that the act being performed is often determinedby the response, not aspects of the utterance itself (Potter& Wetherell, 1987). Focusing on only rule-governed featuresof speech acts provides little understanding of the methodsused by interactants to interpret their experience.In contrast, ethnomethodological research, the secondtheoretical tradition of discourse analysis, studies themethods used by ordinary people to understand everydaysituations and how they then produce appropriate responses.Ethnomethodologists identified the reflexive features oftalk. That is, talk is not only a description of a ruleabout particular actions, events, or situations but "it isalso a potent and constitutive part of those actions, eventsand situations" (Potter & Wetherell, 1987, p. 21). The talkformulates both the nature of the action and the48relationship between the interactants as well as having manyconsequences within that situation. Another premiseunderlying ethnomethodology is that many utterances areindexical (Potter & Wetherell, 1987). The meaning of theutterances is attained through acquiring knowledge of theircontext.The problem with using ethnomethodological research isthat the empirical basis is unclear. The data consists offield notes made by the researcher and thus the data isbased primarily on the researcher's interpretation andanalysis. Another difficulty in evaluating the researchresults is that the assumptions underlying the investigationare not clearly delineated. To alleviate these problem,some ethnomethodologists have incorporated an alternativeanalytic method known as conversation analysis (Potter &Wetherell, 1987). The empirical data consists of theverbatim transcripts of interactions.Both speech act theory and ethnomethodology claim thattalking involves action which suggests the study of languagealso be viewed from a social perspective, not justtraditional psycholinguistics. Potter and Wetherell (1987)state:When language is conceptualized as a form of actionperformed in discourse between individuals withdifferent goals we are forced to take the socialcontext into account, likewise, with the notion that aweb of felicity conditions or a system of distinctionsis required for language to be used meaningfully (p.28).49Considering that the predominant feature of therapy is thetalk between therapist and client and that the therapeuticinterview is a social occurrence, it is only appropriatethat the study of language should be considered whenattempting to understand what actually occurs within theprocess of therapy. At present there are a few studies thathave employed the study of language as the basis in maritaland family therapy process research (Gale, 1989; Todtman,1991). To know how language is actually operating it isimportant that researchers not just focus on traditionalpsycholinguistics but begin to include examination of socialpsychological issues.In essence, both speech act theory and ethnomethodologyargue that people use language to perform an action such asordering, persuading, accusing, and requesting. Thisemphasis on language function is a fundamental concept indiscourse analysis. The analysis of function cannot beconducted in a linear fashion in which speech acts can bemechanically categorized because language function may varydepending on the context and as well, people often useindirect methods for persuading, for example. "A person'saccount will vary according to its function. That is, itwill vary according to the purpose of the talk" (Potter &Wetherell, 1987, p. 33). This will require the analyst tocontextualize the language function. For instance, twostudents may describe a teacher's formal and structured50lecture in very different ways which are in accordance withtheir own respective preferred style of teaching andlearning. The person who prefers organized, formal, anddidactic teaching may speak about the positive aspects ofthe lecture. Whereas, the other person, who prefersunstructured and informal teaching, may emphasize thenegative aspects. Another example is that the informationpeople choose to discuss with others will vary depending onwhether they are speaking with an acquaintance or anintimate friend. Thus, understanding the meaning ofutterances requires that it is embedded within its context.These examples demonstrate that people, in general, uselanguage to construct their version of the world. Thefundamental premise of "discourse analysis is that functioninvolves construction of versions, and is demonstrated bylanguage variation" (Potter & Wetherell, 1987, p. 33). Theconcept of constructionism is pertinent for several reasons:First it reminds us that accounts of events are builtout of a variety of pre-existing linguistic resources,almost as a house is constructed from bricks, beams andso on. Second, construction implies active selection:some resources are included, some omitted. Finally,the notion of construction emphasizes the potent,consequential nature of accounts. Much of socialinteraction is based around dealings with events andpeople which are experienced only in terms of specificlinguistic versions. In a profound sense, accounts`construct' reality (Potter & Wetherell, 1987, pp. 33 -34).This constructing process is not always intentional. Aperson may not be consciously aware of constructing whilespeaking, but construction occurs through the process of51attempting to understand a particular situation or throughunconsciously entering in accusatory or defensive behavior(Potter & Wetherell, 1987).The emphasis of discourse analysis approach is not onrevealing underlying entities, events, beliefs, andcognitive processes from the discourse rather, it looksanalytically at how discourse or accounts are created. Twokey questions are "How is participants' languageconstructed, and what are the consequences of differenttypes of construction?" (Potter & Wetherell, 1987, p. 55).Although several strands of research have emerged fromthe discourse analysis approach, conversation analysis asfirst developed by Harvey Sacks, Emmanuel Schegloff, andGail Jefferson (cited in Potter & Wetherell, 1987) andcomprehensive discourse analysis (Labov & Fanshel, 1977) areof primary importance for the present study. Conversationanalysis investigates how speakers contribute to producingand managing such actions as blaming, greetings, refusals ineveryday conversation (Potter & Wetherell, 1987). Theprocedure is to study a few occurrences of a phenomenon inits natural occurring context, especially the embeddedsequences of the talk, and to then explicate its systematicproperties. The basic sequential properties include turntaking, adjacency pairing, and preference structure.Turn taking research investigates the principles andrules involved in how speakers alternate between talking and52listening when engaged in a dialogue. These changeovers inconversation operate in an orderly way with speakers knowingwhen the utterances by the other is finished (Potter &Wetherell, 1987). Another structural feature found inconversation is adjacency pairing which includes suchpairings as questions and answers, greetings and returngreetings, and offers and acceptance. Research on adjacencypairs involves investigating the rules that determine howthe second part of the adjacency pair (e.g. acceptance of anoffer) is produced by the first part of the adjacency pair,the offer, and the social context. Preference structureresearch entails understanding whether the second part ofthe adjacency pair is rated as a preferred or dispreferredresponse. A preferred response is acceptance of an offerwhile a dispreferred response is a decline. "The concept ofpreference is used to indicate a normative ranking ofdifferent responses exhibited in the organization of talk"(Potter & Wetherell, 1987, p. 83).The objective of conversation analysis "is to describethe procedures by which speakers produce their own behaviorand understand and deal with the behavior of others"(Heritage, 1988, p.128). In conversation analysis eachspeaker's turn is understood in relation to the sequence inwhich it is embedded (Potter & Wetherell, 1987). Theassumption underlying sequencing rules is that there is arelationship between utterances and the actions performed.53That is, the rules state a possible set of relations betweena question such as "Are you doing the dishes?" and thesubsequent speech acts it suggests such as a request forinformation and a challenge.In reviewing several approaches to discourse analysis,Corsaro (1985) criticizes the conversation analysis approachdeveloped by Sacks, Schegloff, and Jefferson (cited inCorsaro, 1985; Potter & Wetherell, 1987). He claims that"the autonomous nature of the turn-taking system and theinvariance of the rules are not made clear" (Corsaro, 1985,p. 172). The procedure used is to first take segments fromthe data, interpret the meaning of the segments, and then toclassify the utterances into speech acts categories or a setof rules that appear to be operating. The problem is thatthis conversation analysis model cannot account forvariations across cultures, different types ofconversations, and variations of rules in different types ofinformal conversations (Corsaro, 1985). Classifying andquantitatively coding speech acts and sequencing rules is asinterpretative as the coding procedures discussed in theprevious section on process research. At this preliminarystage of analyzing what and how change occurs in thetherapeutic context, it is premature to form a succinctnumber of categorizations.There are real limitations when research focusesprimarily on verbal structuring and organization of a54conversation in its natural setting. For instance, inconversation analysis the emphasis is on identifying thestructural properties of the conversation at any given pointbut is not interested in addressing what is actuallyoccurring in the moment (e.g. a therapeutic change moment).This approach fails to provide reasons for why a particularquestion or response occurred at a particular point. Theconcern is not with such questions as "What is taking placein the therapeutic interview? or, even more to the point,`What should I, as a student, attempt to do in a therapeuticinterview?'" (Labov & Fanshel, 1977, p. 24). Additionally,much of the conversation analysis research has focusedprimarily on the sequencing of individual speech acts andhas not queried about the influence of roles and status onspeakers in conversations (Labov & Fanshel, 1977). Labovand Fanshel (1977) argue that when the contextualinformation in which the discourse is embedded is lacking,researchers imagine it. Consequently,the construction of such imagined context is anuncontrolled variable in the study, so that rules thatappear to be quite general are, in fact, limited bythose conditions that we necessarily constructunconsciously as we imagine how we would interpret theutterances in general (Labov & Fanshel, 1977, p. 73).Research on turn taking and adjacency pairs can beappropriately used when analyzing short strings ofsequential utterances. However, these methods of analysis,due to their narrow focus, cannot be applied to whole orlonger conversations (Bilmes, 1986; Grimshaw, 1979; Labov &55Fanshel, 1977).In contrast, comprehensive discourse analysis,developed by Labov and Fanshel (1977), is capable ofaddressing larger units of conversation. According to Labovand Fanshel (1977) conversation is "a matrix of utterancesand actions bound together by a web of understandings andreactions" (p. 30), not a group of isolated utterances.These authors applied this method to a detailedinvestigation of fifteen minutes of interaction between aclient who suffered from anorexia nervosa and her therapist.The reviews of theoretical discourse models (Cicourel,1980; Corsaro, 1985; Potter & Wetherell, 1987) underscorethe significance of studying discourse in naturallyoccurring settings, contextualizing the discourse, andhaving awareness of the multiple levels of informationprocessing. Cicourel (1980) found that the studies hereviewed "invariably recognize that the surface features oflanguage use are inadequate if we want to address themeaning of the utterances as recorded in context" (p. 111).Thus, utterances are to be expanded to gain a more thoroughunderstanding of language use in social situations. Thisrequires that the cultural basis and context of theinteraction be explicated as well as clearly identifying therelationship between the interactants. Considering thatinteractants often operate under a common knowledge baseresulting in aspects of the conversation not being stated,56this would require making the unsaid explicit. It is alsoimportant to take into account the multiple functions ofcontextualized speech acts which can have either a past,present, or future orientation. Cicourel (1980) stressesthe importance of using an expansion model to analyzediscourse because it isparticularly concerned with the relationship betweenwhat is actually said, including paralinguistic andnonverbal activities, the expansions that are part ofthe researcher's analysis, the attribution ofintentions, and the way the interaction unfolds becauseof locally generated conditions and the broader socio-cultural context in which local talk is embedded. Inall of these activities the participants continuallybenefit from reflexive feedback from their own actionsand the actions of others (p. 111).The expansion model, comprehensive discourse analysis,developed by Labov and Fanshel (1977) is able to accommodatethese recommendations. Their expansion model is able to"synthesize all information that will help in understandingthe production, interpretation, and sequencing of allutterances in discourse materials" (Corsaro, 1985, p. 183).The central goal is to expand what is said in the actualtext to what is meant. This is done by using informationfrom other parts of the therapy sessions and other relevantknowledge acquired by the analyst. This approach permitsmoving beyond actual utterances to explicating underlyingpropositions and to describing how the interaction isaccomplished in therapeutic discourse.The open ended process of comprehensive discourseanalysis has benefits to the study of discourse analysis.57Labov and Fanshel (1977) presented their data andinterpretations in a comprehensive and explicit way whichallows for critical evaluation and challenge from others(Cicourel, 1980; Corsaro, 1985). Challenging theinterpretation of the data "result[s] in the expansion andrefinement of discourse models and lead[s] us toward moreintegrative approaches to discourse analysis" (Corsaro,1985, p. 184)The difficulty of acquiring "correct interpretation"(Labov & Fanshel, 1977, p. 73) cannot be completely resolvedbecause analysts do not have total knowledge about what isshared between interactants. Grimshaw (1979) suggests that:Closer approximations to a solution are possible,however, if we: (1) recognize the seriousness of theproblem and the concomitant necessity to (2) studyconversational interaction in maximally known contextwith speakers well known to the analyst... and (3)subject the conversation to explicit (in the sense that"procedures are stated as plainly as possible so thatanyone else who would like to use them may find itpossible to do so" [p. 354]) and comprehensive (in thesense of making the analyst[s] "accountable to anentire body of conversation, attempting to account forthe interpretations of all utterances and the coherentsequencing between them" [p. 354]) analysis. (p. 171).A criticism of this method of analysis is the manner inwhich Labov & Fanshel (1977) obtained hierarchical levels ofinformation (Corsaro, 1985). The concern is that theresearchers relied on their own interpretations and thetherapist's reactions to playback segments of the sessionwhen they went beyond the immediate text and paralinguisticcues to past and future episodes to aid in contextualizing58the data (Corsaro, 1985). The criticism is that discoursematerial is limited because neither the client nor otherfamily members were consulted to increase the validity ofthe interpretations (Corsaro, 1985). The other concern isthat when these researchers acquired information aboutstatus and roles operating within the client's family, theyrelied only on the client's references to her family in thetherapy sessions rather than also using ethnographicobservations of the family's daily interactions (Corsaro,1985).In the current investigation these two concerns raisedby Corsaro (1985) would not be relevant. The focus of thisstudy is on the therapeutic process of how the therapist andclients use a particular therapeutic intervention to co-create relational novelty which means that the therapysession in which this process occurred would be thenaturalistic setting. For the purpose of this study, it ismore problematic to include both the couple's andtherapist's reaction to playback segments because thetherapy sessions occurred quite some time ago and thus inplayback both the therapist and client would be interpretingwhat they thought had occurred. The problem of makingabstractions about status and role without usingnaturalistic observations of daily interactions is rectifiedin the present study by observing the couple's interactionswithin the counselling setting.59Filling the Gap of Family Therapy Process Research Many theoretical orientations of psychotherapy existbut few studies investigate how social interaction isaccomplished. The early developmental stage of familyprocess therapy research requires a direct investigation ofhow change in therapy is produced. To understand theprocess of change in marital and family therapy severalauthors recommended moving toward intensive, discovery-oriented research (Gurman, et al., 1986; Pinsof, 1988;Wynne, 1988).The method that lends itself to examining the changeprocess in family and marital therapy is comprehensivediscourse analysis which is an intensive micro-analyticalapproach. This methodology could be employed to develop anunderstanding of how abstract interventions and constructssuch as symbolic externalization and relational novelty are"articulated with contextual features of real-lifeinteractive settings" (Corsaro, 1985, p. 185). After thisexpansion method "uncovers propositions (recurrentcommunications), they could then be compared to the generalassumptions and predictions of the various theoreticalperspectives." (Corsaro, p. 185).Comprehensive discourse analysis is able to accommodatethe four criteria of utilizing adequate methods and measure,establishing clinical relevancy, incorporating a systemicperspective, and articulating the theoretical orientation of60the change process. The methods and measures used bycomprehensive discourse analysis are not reductionistic anddo not de-contextualize therapeutic change moments. Theexpansion process of this method attempts to connect theutterances with the background and contextual aspects of theinteraction in which it is embedded. Various parts of thetherapy sessions are used to help clarify specific sequencesof talk and to explicate what is actually intended by theparticipants. This method uses the empirical data(recording and verbatim transcripts) to understand howclients and therapist construct and use their context.Overall, comprehensive discourse analysis is a naturalisticapproach that examines naturally occurring discourse, takesinto account verbal and nonverbal behavior andparalinguistic cues, does not disrupt the discourse beingstudied, and is sensitive to the context explored.Comprehensive discourse analysis is also able toaddress the systemic notions of circular causality andcybernetics that are particular to marital and familytherapy. The reflexive dimension to talk, as identified byethnomethodologists, permits examining the recursive natureof the talk and its connection to the context of theconversation. That is, the reciprocal influencingrelationship between therapist and client subsystems can bestudied to determine how therapist and client interactionsprompt client change.61Due to the comprehensive and intensive analysis of thisapproach clinicians can gain valuable and relevantinformation about the mechanisms of change of thetherapeutic process. Identifying how specific familytherapy methods work with specific clinical populations willallow clinicians to refine their strategies. This approachalso lends itself to studying various psychotherapytheoretical orientations. It can be used to testtheoretical orientations which can aid clinicians inrefining and modifying their practice.62CHAPTER IIIMETHODOLOGY AND PROCEDURESThe present study is concerned with understanding andanalyzing how therapist and clients interact with each otherto co-create relational novelty through using the ExSTsymbolic externalizing intervention in therapy. Thischapter will first delineate the research design and theprocedures used in this study. The next section willpresent salient features of the comprehensive discourseanalysis methodology. The measuring instruments used todetermine a successful case of ExST marital treatment willfollow.Research DesignTo address the present study's research question of howtherapist and clients co-create relational novelty throughimplementing the symbolic externalization intervention, asingle critical case study research design (Yin, 1989) wasemployed. Yin (1989) suggests using a single case "when itrepresents the critical case in testing a well-formulatedtheory" (p. 47). The theory must explicate "a clear set ofpropositions as well as the circumstances within which thepropositions are believed to be true" (Yin, 1989, p. 47).The ExST model concurs with this suggestion in that it hasclearly articulated the theoretical underpinnings of andrationale for using the symbolic externalization63intervention with such problems as alcohol dependency. Whenconditions for testing a theory exist in a single case, thiscase may be studied "to confirm, challenge, or extend thetheory" (Yin, 1989, p. 47). The knowledge attained fromthis particular single case study can contribute to theory-building of ExST and its symbolic externalizingtransactional class.For the purpose of this study, the conditions fortesting the theory underlying the symbolic externalizationintervention of ExST in this critical single case studyrequire that the marital therapy was successful, thesymbolic externalization intervention was used to addressthe problem of alcohol dependency, relational noveltyoccurred after the intervention was used, and that thetherapist operated within the ExST model when working withthis couple.The case selected for this study met these fourconditions. First, successful outcomes based on the resultsof the instrument measures and personal reports by bothclients and therapist were attained. Client goals ofabstention from alcohol intake were maintained at follow-up.Second, the symbolic externalization intervention was usedto address the alcohol dependency and the criteria forimplementation of the intervention was met. Third, thecriteria for experiencing relational novelty was also metwhen using this intervention. Fourth, the therapist64regarded her counselling in this case as being within theExST model. Considering that the selected case meets thesefour conditions of successful outcome and adherence toaspects of ExST theory, it serves as an exemplary criticalsingle case to be studied.The rationale for a single case study design istwofold: First, each case of co-creating relational noveltyusing the symbolic externalization intervention contains itsown unique characteristics and complexity. A comprehensivesingle case study can provide the detail presumed essentialfor a fuller understanding of this phenomena. Second, thisinformation gained can then contribute to future multiplecase study designs on this topic.Criteria for Judging the Duality of Research Designs To determine the quality of a single case study designit must be subjected to four logical tests which includeconstruct validity, internal validity, external validity,and reliability (Yin, 1989).Construct ValidityTo establish construct validity operational measuresmust reflect the concepts studied. Construct validity maybe enhanced through using multiple sources of evidence,establishing a chain of evidence, and having externalresearchers review the analysis (Yin, 1989).The constructs in this study that must beoperationalized and analyzed through appropriate measures65and procedures include; symbolic externalizationintervention, relational novelty, and a successful case ofExST marital treatment of alcohol dependence. The method,Comprehensive Discourse Analysis (Labov & Fanshel, 1977),clearly delineates the procedures to analyze therapeuticdiscourse and thus, it will be used to analyze both symbolicexternalizing intervention and relational novelty. A chainof evidence, used to increase construct validity, isobtained by providing the relevant data in such a way thatan external observer "should be able to trace the steps ineither direction (from conclusion back to initial researchquestions or from questions to conclusions)" (Yin, 1989, p.102). The data to be analyzed in this study is presented inits entirety in chapter four to allow for establishing achain of evidence. A successful case of ExST maritaltreatment of alcohol dependence will be determined throughmultiple sources of evidence such as client and therapistself report measures.Internal ValidityInternal validity requires establishing a causalrelationship wherein particular conditions are inferred asleading to other conditions (Yin, 1989). Internal validitymay be increased by utilizing pattern matching, explanation-building, and time-series analysis (Yin, 1989). However,considering that the present investigation is a descriptivestudy examining how clients and therapist used the66intervention to co-create relational novelty and is notconcerned with causal inferences, establishing internalvalidity is inapplicable (Yin, 1989).External ValidityExternal validity is achieved when the findings of thestudy can be generalized beyond the case studied (Yin,1989). Generalizability occurs through replicating studiesand using the clearly stated research questions, design andmethod of the case study. The present study clearlydelineates both the relevant aspects of the ExST theory aswell as the research question, design, and methods used,which allows for further testing and refinement.ReliabilityReliability is enhanced when it is demonstrated thatthe procedures of a study can be repeated and the sameresults are obtained (Yin, 1989). Increasing reliabilityrequires clearly stating the operations and proceduresutilized. The comprehensive discourse analysis method usedin this study requires that the transcripts of the data andthe analysis are presented to allow other researchers todetermine their own analysis.ProceduresParticipant SelectionParticipants were recruited through newspaper andtelevision advertisements and community and personalreferrals. The requirements to participate in the research67project were that the male, of a hetero-sexual maritalcouple, experienced alcohol problems and was trying torecover from this dependency, the spouse was not analcoholic, and the couple experienced marital problems. Thelevel of alcohol problems was determined by the maleparticipant scoring 5 or higher on the Michigan AlcoholScreening Test (MAST) (Selzer,1971). The male alcoholicalso had to be either sober for 3 months or still currentlydrinking. The Shipley Institute of Living Scale (Zachary,1986) was administered to couples to determine whether theyboth had the verbal and abstract reasoning skills to be ableto complete pretest, midtest, posttest, and follow-upquestionnaires. Participants in the research projectreceived an honorarium for their time in completingquestionnaires of the study.Identifying information about the participants selectedsuch as names, ages, dates, locations, occupations andactivities have been changed to protect theirconfidentiality. The selected participants for this presentstudy were a couple, both in their late thirties, who hadbeen married for over 8 years and had 2 children. Thecouple was of a white racial background and reported amiddle income level. Both spouses identified that thehusband's alcohol dependency was a problem in theirmarriage. This couple who volunteered to participate inmarital therapy with the research project met the screening68criteria.Therapist SelectionThe therapist selected for the present study wasemployed at an alcohol and drug clinic and had completed an8-week ExST training program and received ongoing clinicalsupervision within the ExST model. Identifying informationabout the therapist was changed to ensure anonymity.The Origin of the Data RecordThe data for this investigation were video-tapedrecordings of the 15, one hour per week, therapy sessionswith the selected couple collected from the alcohol and drugprogram that sponsored the research project in which theExST model was used in treatment. Video-taped recordings ofall the therapy sessions were collected, with clientconsent, resulting in the entire therapeutic context beingmade available for study. For the purpose of this presentstudy, audio recordings of the video-taped sessions weremade to aid in transcribing the verbal dialogue. Therecordings in which the symbolic externalizing interventionoccurred were transcribed, and included verbal, non-verbal,and paralinguistic cues, and edited for accuracy. Althoughthere were 15 hours of therapy sessions, only 15 minutesthat were directly related to the intervention being studiedwere transcribed. However, to provide a context for theanalysis of the symbolic externalization intervention thevideo tapes of the entire 15 therapy sessions were viewed69and described in the analysis.The methodology used depends on the analyst beingfamiliar with the theory of ExST and having an ability toderive meaning from the data. Due to the analysis beingaugmented by having familiarity with the data, it isappropriate to have the analyst type and edit thetranscript.Throughout the duration of therapy the couple was alsorequired to complete questionnaires that dealt with personaland marital functioning. The questionnaires were completedby each spouse at pre-treatment, mid-treatment, post-treatment, and follow-up to assess the clients' progress atthese different points of treatment. The follow-upquestionnaires were completed 15 weeks after the 15-sessiontreatment period. In addition, both spouses and thetherapist were asked to complete post-session reviews aftereach session. The couple was also asked to complete 'weeklysituation diary' forms on a weekly basis over the durationof the 15 therapy sessions.Unit of Analysis A case study must delineate the necessary criteria inthe unit of analysis (Yin, 1989). Clearly defining the unitof analysis aids in limiting the data collection andanalysis of the research question. Both the couple and theparticular therapy segment selected for the present studywere based on specific criteria which are as follows:701. The couple met the screening criteria to be includedin the research project.2. The couple selected in this study demonstrated asuccessful case of ExST marital treatment. This wasdetermined by the clients attaining their therapy goals,measurements on instruments indicating success in abstainingfrom alcohol intake as well as measuring a decrease inpersonal and marital difficulties.3. The therapist also perceived her therapeuticapproach in this therapy case as following that of the ExSTmodel and demonstrating good quality work.4. It was important to select a marital therapy case inwhich the alcohol dependency was symbolically externalized.In the selected therapy case, the symbolic externalizationintervention was used with the couple to address theclient's alcohol dependency in the second therapy session.The intervention was viewed as successful by both thetherapist and couple which was based on the couple'sreference to the effectiveness of the intervention in latersessions.The therapy segment transcribed in this study beginswith the discourse leading to the implementation of thesymbolic externalization intervention in relation to thealcohol dependency and ends after the therapist and clientsdebrief the intervention. The total segment to be analyzedis 15 minutes in length and is included within the analysis71in chapter four.The criteria for using the symbolic externalizationintervention was determined by meeting the followingconditions:a. A collaborative therapeutic relationship of trust isestablished and maintained.b. Through the clients discussion of their concerns, ametaphoric image becomes apparent to either the clients orthe therapist.c. The therapist then helps the clients create ametaphor and then an external symbol which reflects theconcern or symptom. The clients own words are used.d. The clients are asked to describe their relationshipto the symbol, and what they might like to say to it.e. The clients then engage directly in the relationshipdialogue with the symbol or with one another about thesymbol.f. The experience of rigidity of relationship isheightened or intensified.g. Possible changes in the relationship to the symbolare explored.h. Direct experience of relational novelty occurs withthe symbol.i. The therapist and clients jointly decide what to dowith the externalized symbol.4. It was also important to select a case in which72relational novelty was achieved through the use of thesymbolic externalization intervention. This required thatthe substantive relational patterns or relational themesassociated with the alcohol dependency problem wereintensified with self, their spouse and/or the presentingproblem. Through the intense encounter with the alcoholdependency problem the clients identified and experiencedsomething new or different about self, their spouse, and/orthe alcohol dependency in the therapy setting.Method of AnalysisComprehensive Discourse AnalysisThe comprehensive discourse analysis of Labov andFanshel (1977) is an approach that analyzes contextualpatterns and has been used by psychologists and linguists tounderstand how interactants produce and interpret their ownand other people's actions. To discover what happens intherapeutic discourse it will be necessary to analyze datathat consists of much detail. Comprehensive discourseanalysis makes it possible to analyze various units ofdiscourse including single words, groups of words, behaviorsexhibited, both short and long episodes of talk, and takesinto account the whole text.Cross-Sectional AnalysisLabov and Fanshel (1977) provide a framework in whichthe conversation studied forms a matrix of utterances,propositions, and actions that indicate two types of73relations. The first relation is "between surfaceutterances and deeper actions which are united by rules ofinterpretation and production" (Labov & Fanshel, 1977, p.37). The second relation is "of sequencing between actionsand utterances which are united by sequencing rules" (Labov& Fanshel, 1977, p. 37). The discourse is analyzed throughcross sections in which elements of small units are studied,identified, and the internal relations delineated. Labovand Fanshel (1977) suggest that the cross sections shouldnot be perceived as ends in themselves because understandingwhat occurs in therapy sessions "necessarily presupposes alongitudinal study of the sequencing of these verbalactions" (p. 37).The components of the cross sectional analysispresented by Labov and Fanshel (1977) include four stages;transcription of the text, text expansion, analysis ofpropositions, and analysis of interaction. The text, non-verbal and paralinguistic cues, the expansion, and thepropositions formulate "what is said" while the interactioncomponent determines "what is done."The text, nonverbal behavior, paralinguistic cues.The first stage is to accurately transcribe therecorded data which involves presenting the words spoken aswell as the false starts, hesitations, interruptions, andnonverbal behavior. The modified notation system used inthe present study is a combination of the systems used by74Labov and Fanshel (1977) and Gale (1989) (see Appendix A).The notation system takes into account the following: speechtempo; inhalations; exhalations; interruptions; loudness andemphasis of words; and timing of pauses. For instance,pauses in speech are demonstrated by using one dot for each1/2 second of pause. An abrupt termination of speech issignified by a dash. The hyphen is used to represent soundsthat are less than a word. Underlined characters are usedto indicate stress. When words are not discernable thesymbol "xxx" is used.Identifying volume, pitch, voice qualifiers (e.g.breathiness, whine), and significant changes in breathingsuch as laughter or suppressed laughter augmentsunderstanding of what is being said and meant by theinteractants. When paralinguistic cues contradict what issaid directly there needs to be a way to interpret theirimplicit meaning. The process and terms used for derivingmeaning from paralinguistic cues is not generally agreedupon (Labov & Fanshel, 1977). These authors restrictedtheir interpretation of paralinguistic cues to limitedmeanings. The cues they identified in their studycommunicated, tension, tension release, exasperation,mitigation, aggravation, sympathy, derogation, neutrality,and reinforcement (Labov & Fanshel, 1977). Attributingmeaning to paralinguistic cues enhances the coherence of thetherapeutic discourse for the interactants as well as for75the analyst.In the present study, the paralinguistic cues and non-verbal behavior are placed within the body of the spokentext. The emphasis is on presenting words spoken as well asnoticeable paralinguistic cues and nonverbal behaviorderived from both the audio and video tape recordings.Examples of these kinesic cues or physical movements by theclients and therapist included in the transcript are headnods, noticeable body gestures, and shifting body positionsobserved from the video-tape recordings.Expansion of the text. After separating the text andparalinguistic cues and non-verbal behaviors, the next stageis synthesis. All the information obtained so far issynthesized to facilitate "in understanding the production,interpretation, and sequencing of the utterance in question"(Labov & Fanshel, 1977, p. 49).The crucial phase of the analysis is the expansion.The process of expansion involves expanding the text to whatis unsaid in the original conversation to describing moreexplicitly what was implied. Various sources of informationderived from the verbal text, paralinguistic cues, materialpresented in earlier or later conversations, and sharedknowledge of participants are synthesized to discover whatis actually being said. Expansion permits going beyondspeech acts to identifying implicit or underlyingpropositions and to describing how an interaction is76accomplished in discourse while taking into account thebackground and contextual elements of the discourse (Labov &Fanshel, 1977).The concept of indexicality identified byethnomethodologists is incorporated into comprehensivediscourse analysis. Thus, it is important that thecontextual information in which the conversation is inembedded be examined.According to Labov and Fanshel (1977) expansion of thetext includes the following process:1. The meaning of the paralinguistic cues and nonverbalbehavior are expanded to communicate their textual terms.2. The referents of pronouns to other situations andtime periods are made explicit.3. Factual material occurring before and after theutterance and from other parts of the therapy sessions areprovided.4. The shared knowledge between the therapist andclients which is obtained from studying the therapeuticprocess in its entirety is made explicit.Expansion of the text is an open-ended process and isunlimited in explanatory facts that could contribute tounderstanding the utterances. To demonstrate the expansionprocess an example will be taken from the work of Labov andFanshel (1977):Text:^Client: I don't..know, whether...I--think did--the right thing, jisttalittle..situation77came' I tried to uhm^ welltry to^ use what I--what I'velearned here, see if it worked (p. 119).Cues:^Tension: hesitation, self-interruption;uneven tempo; condensation and longsilences, 3 and 4 seconds (p. 119).Expansion: Client: I am not sure I did the right thing, butI claim that I did what you say is right,or what may actually be right, when Iasked my mother to help me by coming homeafter she had been away from home longerthan she usually is, creating some smallproblems for me, and I tried to use theprinciple that I've learned from you herethat I should express my needs andemotions to relevant others and see ifthis principle worked (p. 119).The next stage is to identify the implicit propositionswhich "build the fabric of conversational interaction"(Labov & Fanshel, 1977, p. 51). The expansion of the text"provides a context for these propositions" (Labov &Fanshel, 1977, p. 51).Propositions. Once the text is expanded, propositionsare extricated. Labov and Fanshel (1977) definepropositions as agreements between interactants of what isbeing talked about or recurrent communications which may belinked to specific social relationships, role definitions,or personal attributes. Propositions may either be local(i.e. specific to events being discussed) or general and mayarise throughout the therapeutic sessions. They may bestated explicitly or referred to indirectly. The specificnature of therapy is that both client and therapist jointogether to make particular propositions explicit.Labov and Fanshel (1977) identified a set of78propositions which include:1. General therapeutic propositions relate tounderlying therapeutic assumptions and processes. Aproposition such as, "Clients should express their needs andemotions to significant others" is central for mosttherapeutic orientations and is often made explicit intherapy.2. Psychological propositions characteristic of therapyinvolve asserting certain emotions. For example, "Katefeels frustrated."3. Status propositions accent the roles andexpectations of the participants' social life. For example,"Kate is in charge of the household." Statuses may carry aset of role obligations and criteria for adequateperformance of the role.4. Performance propositions criticize or support theactivities in the role that a person's plays. For example,"Kate never helps out with the chores."5. Constitutional propositions focus on particularcharacteristics of people. For example, "Kate isthoughtless."The analyst cannot start the process of analyzing thediscourse with an established set of propositions. Therecurrent themes embedded in the particular discourse underinvestigation must be studied. Examining one sentence afteranother will not explicate what the speaker means. It is79only through an intense analysis of what was said before andafter that will provide the external analyst with knowledgeseemingly equivalent to that of the participants.Comprehending the point being made by the speaker requiresthat both the listener and the analyst gain some level ofawareness of the underlying propositions used by thespeaker.The propositions Labov and Fanshel (1977) found in theexample cited on page 77 include:1. The client thinks she did the right thing assuggested by the therapist.2. The therapist's suggestion was that the clientexpress her needs and emotions to significant others.3. The client requests that her mother come home.4. The client questions whether the therapist'ssuggestion was appropriate.Analysis of Interaction. The analysis of theinteraction between speakers attempts to understand the wayin which speakers use utterances to produce responses fromeach other. Labov and Fanshel (1977) define "interaction asaction which affects (alters or maintains) the relations ofthe self and others in face-to-face communication" (p. 59).The goal is to understand what speakers are doing and whatthey mean when they interact in discourse. This analysismay rely on information from previous parts of the text andthe analyst's knowledge of the context.80Labov and Fanshel (1977) consider that "actions aremore important than utterances, since it is actions thathave consequences and affect people's lives" (p. 59).Interaction may also be defined as what is meant by aparticular statement. "The action is what is intended inthat it expresses how the speaker meant to affect thelistener, to move him [or her], to cause him [or her] torespond" (Labov & Fanshel, 1977, p. 59).The interactional statement is a summary of theutterance stating the result of the analysis. Using thesame example as in the previous section, the followingillustration of an interaction is based on the work of Labovand Fanshel (1977):Interaction:^[The client] initiates the session... byreferring to the previous suggestion ofthe therapist and an incident fromeveryday life and asserting that she didright in carrying out [the therapist'ssuggestion]. She simultaneouslyexpresses uncertainty about herassertion, ambiguously questioning thatshe carried out [the therapist'ssuggestion] correctly and questioningthat [the therapist's suggestion] isappropriate, thereby challenging thecompetence of the therapist (p. 126).Rules of discourse. Labov and Fanshel (1977) statethat the rules of discourse "bridge the gap between what issaid and... the actions performed by those words" (p. 71).The rules these authors identified in their study includehow speakers challenge each other, make requests forinformation, present narratives, and dispute assertions.81The discourse rules for the present study will be elucidatedas they appear in the particular text analyzed. Thediscourse rules used in this study and their definitions areoutlined in Appendix C.Synthesis/Episode SummaryThe cross sectional analysis suggested so far presentsa static view of utterances, that is, a still picture ofsocial interactions which allows for understanding andanalyzing each utterance with the inclusion of assumptionsand implications that preceded and followed. Labov andFanshel (1977) state that the "primary interest must be inthe coupling of one utterance with another, in thesuccession of cross sections, in the assembly of stillframes into a moving picture" (p. 69). To accomplish thegoal of connecting the cross sections in a matrix of actionand response, a summary including the observations of theoverall structure of the therapy episode and the generaldirection of the therapy session will be presented in thisstudy. More specifically, the succession of interactionalstatements elucidated in the cross sections of the therapyepisode will be synthesized and summarized. The subsequentstep will be to identify and describe the mechanisms orthemes that contribute to the therapist and clients co-constructing therapeutic change. The emphasis of thesummary will be on describing how the therapeutic discourseflowed throughout the therapy episode and how the therapist82and clients co-created relational novelty using the symbolicexternalization intervention.The data analysis of the present investigation willutilize similar strategies as just presented. The formatwill consist of presenting the text transcription, theexpanded text with the paralinguistic cues, nonverbalbehaviors, and propositions, the interactional statement,and finally the episode summary.Measuring InstrumentsA variety of instruments were used to measure anddescribe both client behavior and change in relation to thealcohol dependency, intrapersonal and marital functioning,and the therapy process. Measures were first used for thepurpose of screening participants to determine theirappropriateness for the study. Other measures were thenused to determine client changes during and after treatment.Client demographic information and the degree of alcoholdependence and marital problems were obtained throughadministering a series of questionnaires.Questionnaires were completed at four differentintervals to determine pretest, midtest, posttest, andfollow-up measures. The results of these measures were usedto determine the success of ExST marital treatment in thiscase study.Alcohol Dependency Measures1. Michigan Alcoholism Screening Test (MAST; Selzer, 1971)83This instrument is used to detect alcoholism and wasused as a screening device in the present study for thepurpose of including alcohol dependent participants.Respondents answer yes or no to the 25-item questionnaireand those who score 5 or more are considered to have alcoholdependent problems. Skinner and Sheu (1982) report test-retest reliability of .84.2. Alcohol Dependency Data Questionnaire (ADDQ; Raistrick,Dunbar & Davidson, 1983)This 39-item measure is used to determine the level ofalcohol dependency, ranging from mild, moderate to severedependence. The frequency of an event or situation isidentified on 4-point Likert-type scale ranging from "Never"occurs to "Nearly Always" occurs. In this study, the ADDQwas used at pretest, posttest, and follow-up.3. Drinking Pattern Assessment Scale (DPAS)This 19-item self-report questionnaire was designedspecifically for the research project. It was administeredonly at the pre-treatment period in this study to assess theparticipants' alcohol consumption pattern and consequencesof alcohol consumption.4. Alcohol Dependence and Treatment History (ADTH)This measure was designed specifically for the researchproject to gather information about the history of thealcohol dependence and subsequent treatment. The 17 itemsof the ADDQ are comprised of questions relating to when the84drinking began, periods of abstinence, alcohol treatmentreceived, goals for treatment of alcohol, and family oforigin alcohol problems. This measure was administered onlyto the male alcoholic.Intrapersonal Measures 1. Shipley Institute of Living Scale (SILS; Zachary, 1986)The SILS is used as a screening devise designed tomeasure the level of intellectual functioning and to assistin discovering cognitive impairment. The revised normativesample of the SILS consists of 290 psychiatric patients,including an even distribution of males and females, with amean age of 34.9 years (Zachary, 1986). The author reportsthat the SILS has construct and criterion-related validityas well as reliabilities ranging from .60 to .82 for theTotal score (test-retest) and .92 (internal consistency)indicate temporal stability and internal consistency. Boththe Vocabulary and Abstraction subtests were administered atscreening to determine whether the participants had theverbal and abstract skills required to complete the pretest,midtest, posttest, and follow-up questionnaires.2. Symptom Checklist-90 Revised (SCL-90-R; Derogatis, 1983)The SCL-90-R is a 90-item self-report symptom inventorydesigned to identify psychological symptom patterns ofpsychiatric and medical patients (Derogatis, 1983). Itemsare rated on a 5-point scale of distress. Reliabilitycoefficients ranging from .77 to .90 (internal consistency)85and .80 to .90 (test-retest) as well as evidence of content,concurrent, and construct validity were reported by theauthor. The SCLS-90-R is able to provide information about9 primary symptoms and indices of distress on three levels;global, dimensional, and discrete symptom. Derogatis (1983)recommends that when a single global measure of distress isneeded the Global Severity Index (GSI) should be usedbecause it represents the best single measure foridentifying the current number of symptoms and the level ofdistress experienced. The GSI was used in this study forthe purpose of identifying psychiatric symptomatology. TheSCL-90-R was administered at screening, posttest, andfollow-up.3. Beck Depression Inventory (BDI; Beck & Steer, 1987)The BDI is a 21 item inventory designed to assess theseverity of depression in adolescents and adults. The itemsare rated on a 4-point scale, ranging from 0 to 3. Beck,Steer, and Garbin (1988) report that the BDI has highinternal consistency ranging from .73 to .92 (coefficientalpha) and test-retest reliability ranging from .60 to .90with 15 nonpsychiatric samples. These authors also foundthat the BDI has high concurrent, construct, anddiscriminant validity. The BDI was used in this study atpretest, posttest, and follow-up periods to assess theparticipants' progress throughout therapy.86Marital Measure 1. Dyadic Adjustment Scale (DAS; Spanier, 1976)This 32-item self-report questionnaire is anextensively used summary measure of marital adjustment.Spanier (1976) reports that the DAS has both highreliability (r=.96, Cronbach's coefficient alpha) andvalidity (content, criterion-related, and constructvalidity). Most items are rated on a 5- or 6-point Likert-type scale indicating the amount of agreement or frequencyof a situation. The norms for married and divorced coupleshave mean total couple scores of 114.8 (S.D. 17.8) and 70.7(S.D. 23.8) respectively (Spanier, 1976). In this study,the total scale score of the DAS was used as a screeningmeasure as well as a measure of outcome at post treatmentand follow-up.Therapy Measures 1. Post Session Review (PSR)The PSR, created for the research project, is comprisedof seven items relating to the process of change in therapyand is completed at the end of each session by both clientand therapist. Respondents rate their agreement ordisagreement, on a 7-point Likert-type scale, to itemspertaining to the following; changes made both within thesession and in personal relationships, and degree ofopenness and awareness with respect to feelings and thoughtsand how they connect to the problem. The last two items of87this instrument require short answers describing the mostsignificant part of the session and giving a title thesession.2. Post Therapy Evaluation Form (PTEF)The PTEF is a 9-item measure designed specifically forthe research project to assess the effectiveness of thetherapy and was completed at the conclusion of therapy byboth clients and therapist.3. Weekly Situation Diary (WSD)The WSD was also designed for the research project andwas completed by both the husband and wife at the end ofeach week. The WSD consists of the following five sections.Part One pertains to changes made, level of satisfaction,and level of closeness in relation to self and others. PartTwo is concerned with specific activities such as alcoholconsumption and attendance of support groups, for example.Part Three, for the alcoholic, is a record of the amount andtype of alcohol consumption. Part Four is also onlycompleted by the alcoholic and the type and quantity ofdrugs taken are recorded. Again the non-alcoholic spousedoes not complete this form. Part Five of the alcoholic'sform is the same as the non-alcoholic spouse's Part Threeform. This section is optional and any additionalinformation can be listed.SummaryThis chapter provided an overview of the approach used88in the present study to analyze the therapeutic discourse.A description of the research design, the proceduresinvolving participant selection, how the transcript data wascollected, and determination of the unit of analysis, thedata analysis strategy, and the measuring instruments usedin this investigation were also provided. The followingchapter will present the results of the screening andoutcome measures and the analysis of the therapy discoursein which the symbolic externalization intervention was used.89CHAPTER IVRESULTS AND DATA ANALYSISIn this chapter both the results of the preliminaryanalyses and the discourse analysis of a therapy episode inwhich the symbolic externalization intervention arepresented. The first section consists of the preliminaryanalyses and results of the screening and outcome measuresthat were used to determine a successful case of ExSTmarital treatment. The analysis of the therapeuticdiscourse will begin with a brief introduction to the case.This is followed by a description of how the analysis ispresented, the analysis of the conversation within thetherapy session and the summary of the analysis.Preliminary Analyses and FindingsScreening MeasuresAlcohol Measures 1. Michigan Alcoholism Screening Test (MAST; Selzer, 1971)The criterion level for identifying respondents withalcohol abuse problems is a score of 5 or more points on theMAST. The female participant in this study scored a totalof 2 points placing her in the non-alcoholic range. Themale participant's score of 21 on this measure placed him inthe alcoholic range.2. Alcohol Dependence and Treatment History (ADTH)This measure was designed specifically for the research90project to gather information about the history of thealcohol dependence and treatment. The male participant inthis study identified himself as being alcohol dependent whothought he could stop drinking with assistance. He hadstopped drinking alcohol several times in the past due tomarital and financial problems and the challenge to overcomehis dependency. Since becoming a regular drinker, a 24-hourperiod has been the longest abstention time. A few monthsprior to participating in this study he had quit drinkingalcohol. The male participant's goal for treatment of hisalcohol problem was to stop drinking completely. He waswilling to undertake both individual and marital therapy.3. Drinking Pattern Assessment Scale (DPAS)This self-report instrument was used to attain adescriptive assessment of the husband's pattern of drinking.The husband identified that drinking alcohol had been aproblem for more than 6 years with him stopping and startingdrinking 4 to 6 times during this time. In the last year,he drank 7-12 beers and a half bottle of wine on a typicaldrinking day. Once the drinking started he frequentlycontinued until intoxicated. He tended to drink in barswith friends, but rarely drank alone or with his spouse.Work related problems due to the drinking were rare. Otherproblems related to his drinking included verbal fightingwith spouse, relatives, and others and driving whileintoxicated. He had not caused physical harm to himself or91others.Intrapersonal Measures 1. Shipley Institute of Living Scale (SILS; Zachary, 1986)Both the Vocabulary and Abstraction subtests of theSILS were administered at the initial screening period todetermine whether the participants had the verbal andabstract skills required to complete the pretest, midtest,posttest, and follow-up questionnaires. The overall summaryscore for the raw scores of both the vocabulary andabstraction subtests were converted to normalized T-scores.The male participant's summary score of 62T placed him inthe above average range. The female participant had a 60T-score which placed her in the high average range. Bothparticipants scored high on the Vocabulary (57T-score) andAbstraction (male 63T-score and female 60T-score) subtestswhich indicates that they had good vocabulary skills andhigh abstract reasoning skills, resulting in them beingincluded in the study.Marital Measure1. Dyadic Adjustment Scale (DAS; Spanier, 1976)The DAS was completed at screening to determine whetherthe couple met the criteria of experiencing maritalproblems. At screening, the DAS total couple score for thehusband was 96 and the wife scored 79. These scores werebelow one S.D. of the mean (114.8) for married couples whichwould indicate marital distress.92Outcome MeasuresAlcohol Measure1. Alcohol Dependency Data Questionnaire (ADDQ; Raistrick,Dunbar & Davidson, 1983)The ADDQ was administered at pre-treatment, post-treatment, and follow-up to assess the severity of alcoholdependency. The findings are graphically displayed inFigure 1. At pretest the husband's score of 62 indicatedsevere alcohol dependency. The posttest score of 5 fellwithin the mild dependency range. However, at follow-up thehusband scored 0 indicating no alcohol dependency. Thesefindings suggest that the marital therapy was successful indecreasing the husband's alcohol dependency. That is, theoutcome of ExST marital treatment was successful.Intrapersonal Measures 1. Symptom Checklist-90 Revised (SCL-90-R; Derogatis, 1983)The Global Severity Index (GSI) raw scores werereferred to gender-appropriate norms (e.g. non-patient) andconverted to standard T-scores. The normative sample iscomprised of 478 non-patient females and 482 non-patientmales. The participants' scores are graphically presentedin Figure 2. The results show that the T-scores for thewife fall consistently within the mean range throughoutscreening, posttest and follow-up periods. This indicates anormal (moderate) level of psychological distress andsymptomatology. However, the husband's T-scores show a93Figure 1. Alcohol Dependency Data Questionnaire Scores94Figure 2. Global Severity Index Scores on the SCL-90R95dramatic decrease in the GSI from the screening period toposttest and follow-up where his scores fall below the meanrange of the normative sample. This finding suggests thatprior to treatment he experienced a high level ofsymptomatic distress which then decreased, revealing littleevidence of psychological distress at the end of treatment.2. Beck Depression Inventory (BDI; Beck & Steer, 1987)The BDI was administered at pretest, posttest andfollow-up to assess the severity of depression throughoutthe course of therapy. The findings are graphicallydisplayed in Figure 3. At pretest the wife's scoreindicated mild-moderate depression and at both posttest andfollow-up she scored within the normal or asymptomaticrange. The husband, on the other hand, indicated moderate-severe depression at pretest but at posttest and follow-uphe also scored within the normal range.Marital Measure 1. Dyadic Adjustment Scale (DAS; Spanier, 1976)The DAS was used as a screening and pre-treatmentmeasure and as a measure of outcome at termination andfollow-up. The findings are graphically displayed in Figure4. As stated earlier, both spouse's scores at screeningindicated marital distress. The total couple scores atposttest for both the husband (114) and wife (112) werewithin one S.D. of the mean (114.8) for married couples.This pattern was continued at follow-up at which time the96Figure 3. Beck Depression Inventory Total Scores97Figure 4. Dyadic Adjustment Scale Scores98husband scored 113 and the wife scored 115. The increase intotal scores at posttest and follow-up intervals suggeststhat there was much less marital distress experienced byboth the husband and wife leading to the conclusion that theoutcome of ExST marital treatment was successful.Therapy Measures 1. Post Session Review (PSR)After each of the 15 therapy sessions both the clientsand therapist completed the PSR to aid in assessingdimensions related to the process of change in therapy. Thefindings for both the wife and husband were generallyconsistent with minor variations in scores. For instance,the wife's scores tended to fall more in the "completelyagree" or "strongly agree" categories while the husband'sscore were generally more in either the "strongly agree" or"agree" categories. The wife indicated that in 12 of the 15sessions she strongly agreed that she had made some valuablechanges in that particular session. The husband agreed thathe had made some valuable change in 12 of the sessions. Inrelation to their level of openness with feelings andthoughts in the sessions, the wife either agreed strongly orcompletely to being open in all 15 sessions. The husbandresponded that he strongly agreed that he was open with hisfeelings and thoughts in all the sessions. The wife alsocompletely or strongly agreed, in all 15 sessions, that shewas more aware of how her usual ways of feeling, thinking,99or behaving were connected to the presenting problem. Thehusband, in turn, agreed that he had become more aware ofhow his usual ways of feeling, thinking, or behaving wereconnected to the presenting problem. Both the wife andhusband agreed that each session helped them to makesignificant changes in their personal relationships as wellas helped them to deal more effectively with the problem intheir everyday life.The therapist's rating of each of the sessions tendedto be slightly lower than both clients' scores. In two-thirds of the sessions (10 out of 15), the therapist agreedthat the husband was making some valuable change in thesession. The therapist, however, agreed that the wife madesome valuable change in 87 percent of the sessions (13 outof 15 sessions). In most of the sessions, the therapistperceived both husband and wife as being open with theirfeelings and thoughts as well as becoming aware of how theirusual patterns of feeling, thinking, or behaving wereconnected to the problem. Additionally, the therapistindicated that most sessions helped both clients makesignificant changes in their personal relationships as wellas helped them to deal more effectively with the problem ineveryday life.These highly consistent findings suggest that the ExSTmarital treatment was perceived as successful by both theclients and the therapist.1 002. Post Therapy Evaluation Form (PTEF)To evaluate the effectiveness of the therapy bothclients and therapist completed the PTEF. The scores weregenerally quite consistent between both the clients and thetherapist.Both the husband and wife were "very satisfied" withthe therapy received and described their present conditionas "excellent". The wife responded that overall she hadchanged somewhat for the better since therapy began andattributed this change to the therapy. The husband'sresponse was stronger; claiming that he was "much better"since therapy began and that this change was "definitelyrelated" to the therapy. Both partners strongly agreed thatthe therapy was particularly helpful to them individually aswell as to their marriage. There was slight to moderateagreement that the therapy was helpful to their family.They both disagreed that aspects of the therapy were harmfulto them. Both were interested in pursuing further therapysessions in the near future.The therapist was also "very satisfied" with thetherapy the clients received. She described the clients'present condition as "very good" and that their overallchange for the better, since beginning therapy, was"definitely related" to the therapy received. She stronglyagreed that the therapy was particularly helpful to themindividually as well as helpful with respect to their101marriage and immediate family. She strongly disagreed thataspects of the therapy were harmful to the clients. Sheindicated that the clients would benefit from furthertherapy sessions in future.These consistent findings indicate that the therapy wasperceived by both the clients and therapist as effective,highly satisfactory, and helpful in creating change.3. Weekly Situation Diary (WSD)On a weekly basis, the clients were requested to ratewhether they experienced change with respect to self,marriage, family, friendships and work as being worse orbetter in the past week. In the first 6 weeks of therapythe wife rated her marriage as changing "somewhat better".In relation to herself, the wife indicated that she"somewhat worsened" in weeks 6, 12, 13, and 15. Apart fromthese scores, the wife generally rated "no change". Thehusband, on the other hand, identified more changes for thebetter in relation to self, family, and to the marriage.The change in his work was "somewhat better", but oftenthere was "no change" in either his work or friendships.In regards to the wife's level of satisfaction ofherself, her marriage, friendships, and work she generallyrated all these categories over the course of therapy asranging from "somewhat satisfied" to "extremely satisfied".In other words, she was generally satisfied with her life.However, the husband's satisfaction scores in these same102categories were lower, ranging typically from "somewhatdissatisfied" to "somewhat satisfied".Each week participants were requested to rate how closetheir marriage, self, family, friendships, and work came totheir ideal on a scale of 0 to 10, with 10 being ideal.During the course of the therapy the wife rated her marriageas ranging from 6 to 9, family ranging from 8 to 10,friendships ranging from 7 to 9, work ranging form 5 to 8,and herself ranging from 5 to 9. Her family ideal scoreremained fairly consistent at score 9 and as well, herfriendships tended to be scored at either 7 or 8. Thehusband's ideal scores were considerably lower, ranging from1 to 6. The work category was the lowest for him and thescores often fell between 3 and 4. Both his family andmarriage scores typically ranged from 4 to 6 while selfscores generally ranged between 4 and 5.Part Two indicated that the husband did not consume anyalcohol during the course of therapy suggesting that thetherapy was successful in decreasing alcohol dependence. Hedid not partake in any support group meeting during thecourse of therapy.Data AnalysisThe Therapy CaseThe therapy case began when Sam Laney made a telephonecall to the research project office. Both Sam and his wife,Jill Laney, were invited to complete screening measures to103determine their appropriateness for the study. Once thiswas assessed, the couple was contacted by the therapist anda therapy session was scheduled for the following week inwhich the clients' goals for therapy were explored.Fifteen therapy sessions were conducted over a 17-weekperiod. The conclusion of the therapy case was successful;Sam had abstained from drinking alcohol, their therapeuticgoals had been achieved, and their marital relationshipimproved.ContextIt is important to contextualize the utterances andactions of all three members of the therapeutic subsystem inthe therapy episode before proceeding with the analysis.The therapist, for instance, was recently trained in theExST model to be used in a large programmatic researchinitiative combining both outcome and process researchmethodologies. In outcome studies there is often a tendencyfor the therapists involved to take a great deal ofresponsibility for efficacious outcome of the research whichmay lead to nervousness and hesitancy (Newman, personalcommunication, 1992). Hesitancy may also be exacerbated bythis being one of the therapist's first ExST cases of thelarger research study. Furthermore, the session studied,was only the second session of this therapy case which mayresult in the therapist exercising clinical judgement inregards to matching the intensity level of the session104number with the clients' comfort level. The expectation ofthe therapist was to also adhere to the principles of theExST model in conducting the therapy. According to the ExSTmodel, the first phase of the therapeutic story is theforming of the therapeutic system which requiresestablishing a bond between the therapist and clients,assessment of the current problem, and to develop and committo the goals, that is, the therapeutic mandate of thetherapy.Sam stated in the first therapy session his goal was toabstain from drinking forever. He had quit drinking morethan 5 times, but each time he resumed. The on-off againpattern of drinking resulted in self-doubt and feelingscared that he could not permanently quit drinking. Samasserted at the outset of the therapy that he should be incharge and in control of quitting drinking and handlingalcohol related concerns in his own way, otherwise, he andothers (Jill and therapist) would perceive him as being weakand a failure for not being competent and effective indealing with his battle with alcohol. He also interpretedattending therapy and seeking help with his alcoholdependence as indicative of him being weak and a failure fornot quitting drinking on his own. Subsequently, Sam's fOcusin the therapy was to attempt to lessen his feeling of beingweak, worthless, and a failure.Jill's agenda for the therapy was also for Sam to quit105drinking and to take responsibility for alcohol relateddecisions. She was concerned and fearful about interferingwith alcohol related issues because Sam could becomedefensive and be mean toward her, which she wanted to avoid.Arrangement of the Analysis The segment of therapeutic discourse analyzed in thisstudy consists of the 15-minute therapy episode in which theproblem of alcohol dependency was symbolically externalized.The intervention was introduced in the beginning of thesecond therapy session after the therapist summarized thecouple's understanding gained in the previous session abouttheir experience with alcohol and how alcohol had affectedtheir marital relationship. She then began the process ofestablishing the therapeutic mandate by reiterating Sam'sgoal of wanting to permanently quit drinking alcohol andstating that alcohol is a relational experience which hasaffected them individually as well as affected their maritalrelationship. The therapy episode analyzed was chosenbecause it was the beginning of a new topic of conversation(Labov & Fanshel, 1977) that led to the implementation ofthe ExST symbolic externalization intervention andsubsequently, co-creating relational novelty.The analysis of the therapy episode is arrangedaccording to the conditions set in the previous chapter.Each speech turn will result in a cross-sectional analysisand will begin with the original text, including non-verbal106behavior and paralinguistic cues, then the expansion andinteraction. After the entire speech turns in this episodehave been analyzed, an episode summary describing howrelational novelty was co-created by the therapist andclients will follow. When not obvious inferences are madein the expansion an explanations will be provided. Thepropositions will be embedded within each of the textexpansions and will only be introduced and explained whenthey first appear in the therapy episode. The propositionsare enclosed in parenthesis in both the text expansion andinteraction sections. A complete list of the propositionsidentified in the episode is in Appendix B. A descriptionand definition of the discourse rules used in theinteractional statements is in Appendix C.Analysis of Therapy Episode: Getting Rid of Alcohol Text1 Th: So it will be interesting to know if-if you want to2 continue that talking that you began last week. ((hand3 gestures)) You shared.. ah some feelings and ah you4 did too. (Sam: Yeah) You also let me know that fear5 was in the room. (hhh) A:nd I appreciate knowing that6 and I know that fear is here (Sam: Yeah xxx) and it-it7 is very important to acknowledge it (hhh) and fear will8 ((hand gestures)) continue to be here from time to time9 and I appreciate that even ((sharp gesturing with10 clenched fist)) when fear is here you can be ((leans11 slightly forward; gestures with fist)) here (Sam: Yeah)12 and that means to me that ah ((Sam rubs neck)) you're13 willing.. to cope ((open hand gesturing)) with change14 while you're here. (Sam: Yeah) That you stay here.15 [xxxExpansionTh: Last week in our therapy session you both began theprocess of disclosing feelings, not previously spoken,107to one another {S-Share}. I am wondering whether youare willing to continue sharing more feelings intoday's therapy session {S-Express}. Jill, last weekyou disclosed some feelings of fear {El-J} and anger{E2-J} in relation to how alcohol has affected you,your family, and your relationship with Sam which youhave never verbally stated to Sam in the past. Sam,you also disclosed feelings such as fear, worry, andapprehension {El-S}. In our last session, Sam, youtalked about feeling fear and apprehension {El-S} thatyou will again fail in your goal to quit drinkingalcohol 1 - 21 and that your commitment to your goal toquit drinking alcohol forever {1} will wane resultingin you resuming your repetitive pattern of quittingdrinking for a while and then starting drinking again.You stated feeling fearful {El-S} that the alcohol willkill you if you continue drinking. You also talkedabout knowing that when you do not drink you are muchmore aware of your feelings and this feels scary to you{El-S} and thus, this is one reason why you like a lotof stimulation, things going on, and challenges. Jill,you also talked last session about feelings of fear{El-J} you have felt in the past regarding Sam'sdrinking getting worse and fear {El-J} of knowing whatlies ahead in the future when Sam drinks. You alsosaid that you are bothered by the patterns repeatingthemselves and cannot endure the repetitive patterncontinuing anymore. I appreciate being informed aboutyour feelings of fear {S-Express} because thisinformation helps me to understand what you arecurrently experiencing which is part of the therapeuticprocess and my task as a therapist. I want you to knowthat I am aware of and understand that you are bothexperiencing fear {Convey} presently in this session.Acknowledging feelings of fear as they emerge withinyou is an important therapeutic process {S-Express}.Part of the therapeutic process is to become aware offeelings such as fear and to then directly express thefeelings {S-Express}. During the course of the therapyyou will feel fear from time to time because there aresome painful issues from your past that you have notaddressed due to your emotional growth being stoppedwhen you started drinking. Considering the disastersyou experienced in relation to alcohol, there will bepainful experiences which may feel scary to talk aboutand this is normal {Convey}. I appreciate and am awarethat even when such a strong emotion as fear is feltwithin yourself Sam {El-S}, you can allow yourself tostay present with this feeling and directly experiencethe feeling in the here and now {A-Feeling}. By beingable to experience the fear, I interpret this to meanthat you are expressing a willingness to cope with and108make changes {3} while in therapy. Your staying herein therapy even when you feel fear informs me of yourcommitment to make change within yourself, yourrelationship with Jill, and with alcohol {3}.Expanding the text. In this particular speech segment,as in most of the other therapist's utterances in thisepisode, the therapist uses gestures to support her verbalmessage. For example, the therapist uses clenched fist toaccent how difficult it is for Sam to stay present when heexperiences intense emotions. When contrastive stress isused, as was done by the therapist, this "forces us tolocate the implicit proposition that is being used as apoint of contrast" (Labov & Fanshel, 1977, p. 117). Forinstance, the stress placed on the words "be here", which isa euphemism for being present in the here and now, can becontrasted with dissociating from what is actually occurringin the here and now.The expansion included referring back to session one tounderstand what feelings and information each spouse haddisclosed to one another and what the therapist had said.The original text in session one was condensed and includedin this segment. The following discussion will delineatethe propositions revealed.Propositions. A recurrent theme of this entire episodeis; {S-Express} In therapy clients should express theirfeelings. This general proposition is considered to be afundamental assumption underlying most individual and familypsychotherapy theories and approaches and is often made109explicit in therapy. Another general proposition pertinentto family systemic therapy is; {S-Share} Spouses shouldshare feelings and needs with one another.An essential theme for the ExST model is that "changeoccurs through increasing the client's awareness of theirpresent condition" (Friesen et al., 1989, p. 3) which thensuggests that clients must develop awareness of theirfeelings, cognitions, physical sensations, and behavior.The proposition reflecting this theme is stated as;{Awareness} Clients should develop awareness of theiremotions, cognitions, bodily sensations, and behavior. Forthe purpose of the present study, this general propositionis broken down into more specific propositions for each ofthe dimensions of emotions, behavior, cognition, and bodilysensations. For instance, the assertion in therapy is thatclients should become aware of feelings they experience.That is, if a client feels angry then he or she should beaware of it. A goal of therapy would then be to developthis awareness. The proposition is stated as; {E} Clientfeels an emotion.The therapy episode revealed that there were specificemotions experienced by both Sam and Jill and they aredelineated as;{El-S} Sam feels fear and/or apprehension. {El-J} Jillfeels fear and/or apprehension.{E2 -S} Sam feels anger. {E2-J} Jill feels anger.110{E4-S} or {E4-J} Sam or Jill feel relaxed, calm and easier.{E5-S} Sam feels tentative, anxious and unsure.{E6-S} Sam feels less apprehension.Another underlying assumption of the ExST model is thatthe therapeutic process involves the clients becoming awareof feelings and then experiencing these feelings in the hereand now (Friesen et al., 1989). The proposition relates tothe dimension of therapeutic experiencing and is stated as;{A-Feeling} Therapeutic process involves becoming aware offeelings and experiencing them in the here and now.Another related dimension in ExST is that clients areto become aware of bodily sensations and to directlyexperience them in the here and now. The proposition is;{A-Bodily} Therapeutic process involves becoming aware ofbodily sensations and experiencing them in the here and now.Furthermore, clients are to become aware of theircognitions in ExST and thus, the proposition is; {A-Cognitions} Therapeutic process involves becoming aware ofcognitions and experiencing them in the here and now.The proposition relating to developing awareness tobehaviors reads as; {A-Behavior} Therapeutic processinvolves becoming aware of behaviors and experiencing themin the here and now.Other propositions underlying the ExST model are asfollows:{Here} ExST focuses on the here and now experiences.111{Mandate} A therapeutic mandate must be established in ExST.{Experience} Heightening and intensifying experiences isimportant to aid in gaining awareness of internal processand to create change.{Novelty} Direct experiencing in therapy deepens and expandsalternate ways of being, that is, relational novelty.{Safety} Pacing the therapeutic work is important.{Split} A conflict/contradiction is brought to clients'awareness.Other psychological propositions involve thetherapist's role and her tasks as a therapist. Thetherapist is required by most theoretical orientations toconvey understanding of clients' feelings and experiencesand to normalize the therapeutic process for clients. Theproposition is stated as; {Convey} Therapist conveysunderstanding of clients' feelings and experiences.A method that the therapist uses to aid in establishingsafety and acceptance of the clients' experiences in thetherapeutic relationship is tracking. Tracking can lead toexploration of new ways of being in relationship to oneselfand others. Tracking is utilized by most schools ofpsychotherapy to "discover explicitly and in detail aspecific pattern of behavior, thought, or feeling in itssystemic context" (Sherman & Fredman, 1986, p. 120). Thetherapist follows the clients' experiences by noting andhighlighting their experience, asking clarifying questions,112encouraging further talk, repetition of client's words, andinvoking amplification of a point (Minuchin, 1974). Thismethod is a non-intrusive approach and one in which thetherapist does not challenge what the client has said. Theproposition is stated as; {T-Track} The therapist notes andhighlights clients' experiences.In most therapeutic orientations the therapisthighlights both clients' strengths and difficulties. Theproposition is stated as; {T-Highlight} Therapist highlightsclients' strengths as well as difficulties.The general underlying premise of marital and familysystemic therapy is that the therapist recognizes thecommonalities between the spouses and family members. Forinstance, both spouses may have in common their desire to berid of the alcohol dependence problem and may argue witheach other about it, rather than acknowledging their commongoal. This proposition reads as; {T-Common} Therapistaccents couple commonalities.A proposition, related to the general proposition{Safety}, emerges in this therapy session in regards to therole of the therapist. The therapist is respectful of theclients' therapeutic process and does not intrude when thesubject matter results in intense emotions and experiences.The proposition is stated as; {Non-Intrusive} Therapist doesnot intrude upon clients when intense experiences emerge.The recurrent theme that emerges in the course of this113episode, and in the therapy as a whole, is that Sam's goalis to quit drinking alcohol forever. He explicitly statedthis goal in session one. The proposition reads as; {1}Sam's goal is to quit drinking alcohol forever.A related proposition, which is repeatedly expressed aswell as challenged in this episode, is that Sam deals withhis alcohol dependence in a competent and effective way.The proposition is stated as; {2} Sam is competent andeffective in dealing with alcohol. However, Sam alsoexpresses feeling weak, worthless and a failure in how hedeals with alcohol. He fears he will fail in his goal toquit drinking alcohol forever. The local proposition is;{25} Sam feels weak, worthless, and a failure.Sam stated both in session one and in this episode thathe made the decision to commit to The Alcohol RecoveryProject which signifies to him that he is committed,willing, and motivated to make changes in regards to hisrelationship with alcohol, his marriage and within himself.This local proposition is stated as; {3} Sam is motivated,willing, and committed to make changes.In regards to general propositions related to alcoholdependence a few themes emerged. In ExST, client problemsand symptoms such as alcohol dependence are considered to bea relational experience affecting all family members. Thetherapist introduced this explicit underlying assumption inthe first session and again mentioned it in the beginning of114this session. The proposition reads as; {Relational}Alcohol dependence is a relational experience. A localproposition, related to this general proposition, thatemerges in this therapy case is as follows; {16} Jill is,and should be, a part of Sam's alcohol recovery process.InteractionThe therapist redirects the conversation to the topicof {S-Share} both clients disclosing feelings and needs notpreviously shared before. The therapist then uses the rulefor indirect request, referring to the third precondition ofrule of requests: The couple's willingness to carry out theaction of {S-Express} sharing more feelings with each other(See Appendix C). She also refers to the time referent forindirect request which is, "in today's therapy session."The therapist uses an indirect request to assert {S-Express}both clients should express feelings in therapy. Thetherapist then continues speaking as she summarizes what {E-S;J} feelings both clients shared in the therapy sessionlast week as well as the {Awareness} awareness that theyboth developed about their feelings, cognitions, andbehaviors in relation to the alcohol. After presenting theevents that occurred in last session, the therapist gives anevaluation of the importance of these events by asserting{S-Express} that expressing emotions is an important taskperformed in therapy. She continues speaking and asserts{Convey} her understanding that Sam may experience {E1-S}115feelings of fear. The therapist acknowledges the clients'feelings and normalizes both the feelings and thetherapeutic process for the couple. She then interpretsSam's {A-Feeling} feeling and experiencing of fear {El-S} inthe therapy session as {3} his willingness and commitment tomaking therapeutic change and thereby {Highlight} highlightsthis as a strength. The therapist repeats part of the laststatement which again emphasizes the importance of herinterpretation. That is, by {A-Feeling} Sam feeling {El-S}fear in the therapy session, he is demonstrating {3} hiswillingness to make change. Sam reinforces what thetherapist says. The therapist's words become inaudible andSam interrupts.Text 16 Sam:^[I enjoy challenge ((leans to the right)) so17 itsExpansionSam: Your emphasis on my feelings of fear results in mefeeling uncomfortable and hence, I rub my neck andshift position and interrupt you. I want to shift thefocus from intense experiences and emotions, whichresults in me feeling not in control of my battle withalcohol { - 8} and thus, feeling weak and a failure {25},to feeling in control and strong. I will say that thereason I stay in therapy and experience my feelings offear is because I perceive this to be a challenge forme. I will also tell you that I enjoy challengesbecause I believe that challenges help me to maintainmy sobriety. As I explained to you both last week, Ihave a problem with experiencing dullness and I feelafraid that when I feel dull again I will drink. Inprevious periods of sobriety I have reverted back todrinking alcohol when I felt dull, no stimulation andmy interests were not peaked. Considering that I knowwhat I need to not drink, which is have my interestspeaked, to feel stimulated, and be challenged, I can116save face and say that I am still in control of mybattle with alcohol {8}. Thus, I do not expose myfeelings of being weak and a failure { - 25} as you talkabout my fear and for being in therapy.Expanding the text. Pro-forms which are "anaphoricelements that refer to unstated objects, facts, orpropositions" (Labov & Fanshel, 1977, p. 117) were locatedand expanded. For instance, the reference to "its" clearlyrefers to the fear that Sam feels. This is determined bythe topic of conversation of the previous utterance made bythe therapist as well as the sentence that follows in whichSam says, "you know fear is a big challenge".To understand and explicate what Sam's fear is about,it will be necessary to refer back to the first session. Hestated in session one that his fear is that he will revertback to his repetitive on-off again drinking pattern. Sincehe has not been able to quit drinking permanently and be incontrol of alcohol, he renders himself weak and a failure.Overcoming the fear is a big challenge because he has notever been able to quit drinking permanently. As well, hetalked in session one about how he ended periods of sobrietybecause of feeling dull and lack of stimulation. He fearsthat he will feel bored and dull during this period ofsobriety and resume his repetitive drinking pattern. Thetherapist concluded in session one that when Sam does notdrink, he is much more aware of his feelings which is scaryfor him and hence, is one reason he wants much stimulationand challenges. That is, he feels dullness when he is less117stimulated which then results in him becoming aware ofexperiences he has not resolved.Another recurring theme that exists throughout theduration of this therapy is that Sam thinks he should quitdrinking on his own and that to seek help from either Jillor a therapist means that he is weak and a failure.Propositions. The propositions identified include:{5} Sam is challenged to keep the top on the bottle ofalcohol.{6} Sam's goal is to confront and handle his fear that hewill revert back to his repetitive drinking pattern.{7} Client tends to analyze and explain behavior.{8} Sam is in charge and in control of his battle withalcohol.InteractionSam interrupts the therapist and indirectly expressesfeeling uncomfortable with the therapist's expression ofintense emotions because it results in him feeling { -8} notin control of his battle with alcohol and hence, feeling{25} weak and a failure. Sam indirectly asserts that {8} heshould be in control and in charge of quitting drinking onhis own {17}. Since he feels he is { - 8} not in control, hethen {25} feels weak, worthless, and a failure. Sam thendeflects from the intense emotions expressed by givinginformation as to the reason for staying in therapy andthereby regulates the intensity of his experiences in118therapy. To save face for feeling the fear, which resultsin him { - 8} not feeling in control and in charge of quittingdrinking on his own, and for attending therapy, Sam assertsthat challenging himself, and not feeling dull, helps him tomaintain his sobriety. Having this self-awareness helps him{8} re-gain control and { - 25} not feel weak and a failure.In his next utterance, Sam refers to the previoussession when he says, "you know fear is a big challenge".He is reminding the therapist and Jill that the reason hestays in therapy is because of needing challenges to helphim remain sober and that it was dullness in his life thatwas responsible for him resuming drinking. He asserts that{1} his goal is to quit drinking alcohol forever and whathelps him to achieve this goal is being {5} challenged tokeep the top on the bottle of alcohol.Text 18 Th: Yeah I hear thatInteractionTherapist provides reinforcement.Text 19 Sam: you know fear is a big challenge (hhh)Expansion Since I have been able to save face by not feeling weakand a failure { -25}, this then allows me to concedethat I feel fear {El-S} about being able to keep thetop on the bottle of alcohol {5}. Confronting andovercoming my fear that I will drink again and revertback to my repetitive drinking pattern {6} is a bigchallenge for me.119InteractionSam continues expressing that since he has saved faceby demonstrating he is {8} in control of his battle withalcohol and thus { - 25} does not feel weak and a failure, hecan concede to feeling {E1-S} fear and doubt about notattaining his { - 1} goal to quit drinking alcohol forever,and thereby he regulates the intensity of his experience.He simultaneously asserts another challenging goal, {6}which is to confront and handle his fear that he will revertback to his repetitive drinking pattern.By using the discourse marker of "you know", which"represents an appeal for solidarity or support" (Labov &Fanshel, 1977, p. 185), Sam is reminding the therapist ofand explaining the reason he stays in therapy. He ispossibly recognizing that he is entering in an area ofdisputable statements and thus, wanting support from thetherapist based on what he said last session.Text20 Th: Yeah. So you know something ((outward hand21 gesturing)) about facing the fear that is in-in22 challenge (Sam: hmhm) and you will feel challenged as23 we move through this process (hhh)ExpansionTh: Yes I heard you say last week that you like to bechallenged, stimulated, and to have your interestspeaked. You also said that confronting your fears {6}of not quitting drinking alcohol forever and ofreverting back to your repetitive pattern of drinkingalcohol in a therapeutic setting is a new experience aswell as a scary challenge for you. When you do notdrink alcohol you are more aware of your feelings whichis scary and is one reason you like much stimulation120and challenge. You are wanting me to know that youhave analyzed yourself {7-S} and thus, have gained someawareness {Awareness} about confronting your feelingsof fear {El-S} that are associated with taking on thechallenge of staying sober and keeping the top on thealcohol bottle {5}. As well, I acknowledge that youwant me to know that you have some control over whathappens with you {8} and therefore you are { - 25} notweak and a failure. One way you feel in control, Sam,{8} is by analyzing and telling me about yourawareness. Having awareness of your behavior,thoughts, and emotions is one way you get control.Again, I want you to know that you will feel challengedand not dull as we go through the therapeutic process{Convey}.Interaction The therapist interrupts and acknowledges that sheheard Sam's proposition; {6} that his goal is to confronthis fears of reverting back to his repetitive drinkingpattern. The therapist then interprets Sam's precedingresponse as being {7-S} analytical and acknowledges that hehas performed the proposition {Awareness} of developingawareness of what challenges represent for him. She assertsthat analyzing his experiences also serves to demonstratethat he is {8} in control over what happens to him regardinghis quitting drinking and thereby asserts that he is { - 25}not weak and a failure which simultaneously helps regulatethe intensity of his experience. She then re-assures Samthat he will feel challenged during the therapeutic processand thereby asserting that he will not experience thedullness that he fears will result in him drinking again.Sam reinforces what the therapist says.121Text24 Sam: (hhh) I just wish I could handle it better. (Th:25 ah ((nods yes))) you know that's I mean I:[ ((shakes26 head))ExpansionSam: Since you are allowing me to save face by notchallenging my competence { - ?2}, therapist, I willadmit that I feel weak, worthless, and a failure {25}because of how I handle not being able to quit drinkingalcohol forever { - 2} and because I feel fearful that Icannot succeed in staying sober. I fear that I maypossibly revert back to my repetitive on-off againdrinking pattern making me incompetent in dealing withalcohol { -2}. I just wish that I could take charge andbe in control {8} which would mean that I would handlemy quitting drinking better. If I could better handlemy fear about starting drinking again {6} then I wouldnot feel weak, worthless, and a failure as I presentlydo {25}. I am beginning to feel uncomfortable aboutadmitting what I just said and, so, I am wanting toexplain and analyze what I meant. Analyzing will allowme to feel like I have control {8}.Expanding the text. The pronoun "it" refers to Samquitting drinking which is based on his preceding utteranceas well as the reason why he is in therapy. The expansionincludes information from session one at which time Samdescribed his fear of failing to quit drinking forever andreverting back to his on-off again drinking pattern. Theself-interruption and shaking of his head accent him feelingweak, worthless and a failure for not quitting drinking.Interaction Sam indirectly asserts that the therapist's responsehelped him save face and { - 25} not feel weak and a failure.Hence, he is willing to venture forth and concede to both{25} feeling weak and a failure for not { - 2} being competent122in dealing effectively with his battle with alcohol andfeeling fear about not 1 - 11 achieving his goal topermanently quit drinking. He then gives a self-criticalevaluation of his behavior regarding proposition {1}, whichis his goal to permanently quit drinking alcohol, andthereby asserts he is not { - 2} competent and effective indealing with alcohol and thus, he feels {25} weak,worthless, and a failure. The therapist reinforces andsupports Sam by nodding yes. Sam then expresses wanting {8}to control his quitting drinking and feelings of fear andreduce his 1 - 251 feelings of being weak and a failure. Hethen expresses feeling uncomfortable and begins to gain {8}control by explaining and analyzing.Text27 Th:^ [So28 ((reaches and gets note pad)) that may be something29 that ah xxx xxxExpansionTh: So, based on what you are saying Sam, I identifiedanother goal. This then brings us back to my originalgoal for today's session, which was to establish atherapeutic mandate {Mandate}. One therapy goal foryou Sam may be to learn how to handle your fear of notquitting drinking alcohol forever and resuming yourrepetitive on-off again pattern in a better way {6}.Expanding the text. To understand the meaning of"that" and "something" it is necessary to contextualizethese pro-forms in the preceding and subsequent statementsmade by both Sam and the therapist. The therapist began thetherapy session by saying she would like to establish a123therapeutic mandate (i.e. goals of therapy) in this session.The word "that" refers to Sam's last utterance in which hetalked about wanting to better handle his quitting drinkingas well as better handle his fear. Sam's fear of notquitting drinking is made explicit in this speech turn.InteractionThe therapist interrupts Sam and re-directs the topicof the conversation back to her original task of the sessionwhich is {Mandate} establishing a therapeutic mandate.Focusing on establishing therapy goals rather than Sam'sexperience contributes to regulating the intensity of Sam'sexperience. The therapist asserts that another goal for Samis to {6} handle his fear in a better way. Through the useof mitigating forms such as, "may be" the therapist permitsthe client to either agree or disagree.Text30 Sam: Very rarely have I shied away from things.31 Whether-I usually walk through the situation that I-I32 am aware of what to expect or how to.. you know address33^it.ExpansionSam: In continuing with my last statement, what I meanto say is that I am usually in charge and in control{8} and therefore, I am not { -25} weak, worthless and afailure. I have rarely avoided challenging situations.How I do this is to rehearse in my mind what I mightexpect to occur and what I can do to handle thesituation so that when the situation actually occurs, Iam in control and aware of what to do {8}.InteractionEven though the therapist interrupted, Sam continues124with his explanation and {7-S} analysis regarding handlinghis fear in a way that he would prefer and thereby assertingthat he is not { -25} weak, worthless, and a failure. Hegives information about how he deals with challengingsituations so that he can maintain {8} control of hissurroundings and not { - 25} feel weak, worthless and afailure and thereby, indirectly asserting that {8} havingcontrol will help him achieve his goal of quitting drinkingforever. To feel in control {8}, Sam must have informationabout what is happening otherwise he feels {25} weak and afailure. Throughout this speech turn, Sam also regulatesthe intensity of his experience.Text 34 Th: ((sits back; begins writing on note pad)) *OK* So35 one of the things you want to ah..ah accomplish here36 ((briefly looks up at Sam; then resumes writing)) is..37 learning to handle fear ((looks up at Sam; then writes38 again)) and confront it.ExpansionTh: OK I want to make sure that we are in agreementwith our therapeutic mandate {Mandate}. I have heardyou say Sam that one goal you want to accomplish intherapy is to confront and learn how to handle yourfear {6} of not being able to quit drinking alcoholforever. Is that a correct statement of one of yourtherapeutic goal Sam?InteractionThe therapist does not directly respond to Sam's lastutterance, instead she repeats her earlier assertion{Mandate} of establishing a therapeutic mandate whichconcurrently serves to reduce his intense experience of not125being in control and feeling weak and a failure. She theninterprets and summarizes what she understood Sam to sayabout his goal of therapy {6} and requests confirmation thatshe correctly interpreted his goal.Text39 Sam: Ye:ah. I: (.hhh) like I have I mean I have40 cravings for alcohol all the time (Th: *yes*)41 ((therapist continues writing))) and that scares the42 hell out of me because uh (hhh) I mean we ((gestures43 to the left)) have=we don't have liquor cabinet full44 but there is alcohol in the house. ((therapist looks45 up at Sam then looks at Jill and back at Sam)) (hhh)46 And uh.... to me... ((therapist moves her chair47 back)) once I have ((sharp downward hand gesture; then48 gestures to the left and right)) made that decision49 that I'm not going to do it it's not a problem. (hhh)50 But.. I go through: periods of pondery ((therapist51 nods yes)) where. I wonder ((tilts head to the right))52 we::ll what the hell. ((hand gestures to the right))53 You know I'm having a coffee throw some rum in the54 coffee=I'm ((gesture to the left)) having this=I'm55 having you know (hhh) ((gestures to the right)) I'm56 gonna have a pop or something=we'll throw some rum into57 the pop you know or-or a dozen beer ((rubs his head and58 therapist shifts position)) or something you know.59 ((leans to the right)) Oh what the heck one is not60 going to kill me but (hhh) ((picks lint off his pants61 and drops it)) I-that.. sometimes lasts.. you know62 sometimes ((sharp downward hand gestures)) that is63 two minutes that I think about it ((holds hands open64 and then gestures downward)) and sometimes it's half a65 day I think about it. ((holds hands open)) (hhh)66 And I still have not.. since the first day quit, gone67 done anything about it. You know I have not been68 active. I have not gone and opened anything or had a69 drink. So, (hhh) you know, I'm always c-concerned and70 worried that I might=and ((spreads hands out and then71 drops them on his lap)) it's not a fact like=I mean it72 is in the house but it is more of a direct..73 presentation to me but that's (hhh) I mean=its the pub74 is not far away and uh I know half the people=I know75 all the regulars in there. You know that sort of thing76 and it would be easy. So it is not a [fact its just is77 in the house126ExpansionSam: Yes one of my goals in therapy is to learn how tohandle and confront my fear that I will repeat mydrinking pattern {6}. Considering that my fear is verybig, that is, I have cravings for alcohol all the time{14} which terrifies {E1-S} me, then coming to therapyand admitting that I have a problem controlling alcoholseems more acceptable and does not suggest that I am{ -25} weak and a failure. But if I talk about why Ihave this fear then I might reveal that I am {25} weakand a failure which is not something I want to do.Therefore, I will not talk about my fear and, instead Iwill begin analyzing {7-S} and attempting to understandmy feelings and behavior associated with these alcoholcravings. Actually, I do not know what triggers thealcohol cravings, but I do know that the alcoholcravings are not triggered by the fact that alcohol isin our house or in close proximity such as at the pub.Jill and I have some alcohol in our house {10} and I amnot bothered by having it there {9}. Once I have madethe decision to quit drinking alcohol I do not drink{11} and therefore the presence of alcohol in our house{10} is not a problem that triggers the alcoholcravings {9}. But the problem that concerns me inregards to my goal of how to handle my fear ofreverting back to my drinking pattern {6}, is theperiods of time when I ponder and wonder whether tohave a drink of alcohol {12}. At times I feel afraidthat I might drink which would make me incompetent indealing with alcohol { -2}. I rationalize to myself bysaying, "Well what the hell, since I'm having somecoffee I may as well pour in some rum." Or I might sayto myself, "I'm having this particular beverage whichwould taste good if alcohol was added so I'll pour insome rum. Or I'll drink a dozen beer." I try toconvince myself that drinking alcohol will not harm meby saying to myself "Oh what the heck one drink ofalcohol will not kill me as the doctors threatened"{12}. This rationalizing and convincing myself thatone drink of alcohol will not harm me {12} cansometimes last either two minutes or half a day. Thefrequency of the thoughts makes this a big problem forme and really scares me {E1-S}. However, as I admitthis fear to myself and both of you I begin to feelweak and a failure {25}. So, instead, I will changethe topic and tell you about my success which wouldnegate my weakness and failure { -25}. Even though Ihave these thoughts about drinking alcohol, I stillhave not had a drink {2} since the first day I quitdrinking alcohol. That is, I have not been active inpursuing drinking and have not opened a bottle of127alcohol or had a drink. This illustrates that I amcompetent and effective in how I deal with alcohol {2}.But, as you both are aware, based on my past behavior,I am always concerned and worried {El-S} that I mightbreak my goal to quit drinking alcohol forever and havea drink, resulting in me being { -2} incompetent indealing with alcohol. Again, as I admit my fear Ibegin to feel weak and a failure {25} and thus, I willsay that I am in control {8} of my battle with alcohol.This is verified by the fact that when I see a bottleof alcohol in the house, for instance I perceive thebottle as it is, a direct, actual presentation of abottle of alcohol {9}. Similarly, the pub is a directpresentation of where drinking alcohol occurs, but thepub also does not trigger my alcohol cravings {9}. Thepub that I used to frequent with other regularcustomers is not far away and if I wanted to have adrink of alcohol I could go to the pub and drink {11}.The point that I am making is that alcohol isaccessible in other places besides our home and if Iwanted alcohol I could get it from the pub. Havingalcohol in our home or being in the presence of alcoholis not what creates my problem of having constantalcohol cravings {9}.Expanding the text. The stress placed on the word"hell" is used to emphasize intense feelings of fear. Theeuphemism "scares the hell out of me" is generallyassociated with feeling terrified. Thus, Sam is stressingthat his fear of having frequent alcohol cravings terrifieshim. Throughout this speech turn Sam self-interrupts whichindicates his uneasiness with discussing his alcoholdependency.The decision that Sam speaks about making on line 48 isthe decision to quit drinking alcohol, which is the focus ofthe therapy. When he says on line 49 "its not a problem",it is necessary to refer back to both the preceding andfollowing sentences in which he talks about the alcohol inthe house not being a problem.128A proposition not yet mentioned in this episode readsas; {14} Sam craves alcohol almost on a constant basis. Samdiscusses this proposition throughout the course of therapyand identifies the alcohol cravings as the problem for him,not the alcohol. As stated in his previous speech turn, Samwants to be in charge and in control of his battle withalcohol. Perceiving the alcohol cravings as the problem tocontrol is Sam's way of maintaining control over alcohol.In the alcohol dependency literature (Brown, 1988;Steinglass et al., 1987), alcohol is the central organizingprinciple for the alcohol dependent person. The alcohol anddrinking behavior become the primary focus in the familywhile the denial of this behavior becomes the primarycognitive focus (Brown, 1985). Such defenses of denial,rationalization, and minimization are essential to maintainthe alcohol dependent person's belief in self-control. Eachfamily member develops similar behavioral and thinkingdisorders to the alcohol dependent person. That is, theyare controlled by the reality of alcohol dependency and mustat the same time deny the reality. They then adapt theirthinking and behavior to accommodate the family's story orexplanations that allow the drinking behavior to besimultaneously maintained and denied. The alcohol dependentperson and other family members make adaptations in theirperceptions and logic to maintain the belief that thealcohol dependent person has the ability to control his or129her drinking, often through use of denial andrationalization. Incoming information that challenges thisbelief must either be altered to accommodate the belief,ignored, or denied.In the family environment, the alcohol dependent personis number one, setting the changing rules and tone to whichother family members must adjust and respond. Theorganizing function of alcohol, its denial, and the need fora focus of control are central concepts in working withcouples where one spouse is alcohol dependent. The beliefsthat the dependent person does not have a drinking problemand that he or she has self-control, the ability to controlthe drinking behavior, forms the dependent person's identityand structure, and interpretations of self and others.Furthermore, these beliefs are also central to thedependent's family when denial is present. That is, thereis no alcohol problem and no lack of control. The chaos,inconsistency, and unpredictability in the family are eitherdenied and become part of the family's normal functioning orare projected onto another problem.It is evident in the present study that Sam's belief inself-control, the ability to control alcohol relatedproblems, and the denial and rationalization of alcoholrelated problems are paramount. For instance, in sessionone Sam minimizes the extent of his drinking problem eventhough he had been drinking "heavily" on a daily basis, that130is, 7 to 12 beers on a typical drinking day, according tohis self-report on the DPAS instrument. Each time he beganhis pattern of drinking he would say to himself, "I don'tsee [my drinking] as a problem. I think it is normal and mymindset changes. I focus it and change to either I do[drink] or I don't." Jill states that she recognized thatSam denied the drinking problem to himself and "justifieddrinking through [his work], saying he had to drink withclients." Sam tended to drink during the day and by thenext morning the alcohol problem was forgotten. Jill saidwhen Sam stopped drinking for a while the memory of drinkingslid away and she had more trust for Sam, felt at peace, atrest, and did not doubt him. They both said that neitherone talked about the drinking in either sober or drinkingstates because their motto was to "let sleeping dogs lie".This is in effect a denial and belief in Sam not having analcohol problem and that he can control it.However, it is important to acknowledge that Jill'ssilence about the alcohol problem was not necessarily adenial or minimization. Throughout the course of thetherapy Jill talks about how she stopped raising herconcerns about the alcohol and Sam's alcohol dependencybecause he became either defensive and mean or deflected herconcerns through use of humour. In session four, Jill talksabout feeling intimidated by Sam because he would get angryand aggressive by throwing objects in her direction, for131example. To protect herself from Sam's intimidating andaggressive behavior she withdrew from him. Thus, it isessential to acknowledge that Jill's fear of Sam'sintimidating behavior does not mean she has been denying andminimizing the alcohol problem. It was safer, and in herbest interest, to remain quiet and let him deal with thealcohol as he chose.Based on the preceding discussion, the followingpropositions, not previously mentioned, were identified:{9} Presence of alcohol does not bother Sam, making it moredifficult to abstain from drinking alcohol or triggeringalcohol cravings.{12} Client rationalizes, minimizes and justifies behavior.{17} Sam is responsible for quitting drinking and dealingwith alcohol related concerns on his own.{10} Alcohol is in the clients' home.{11} Sam's decisions are final and absolute.{15} Sam gets defensive when alcohol concerns are raised.{4} Jill feels afraid and intimidated by Sam's aggressivebehavior.Other general propositions are beginning to emergewhich relate to the obligations and status of each spouse.Labov and Fanshel (1977) suggest that much of what occurs inthe therapy discourse is concerned with the social life,particulary the statuses of each person and theiraccompanying set of role obligations and requirement for132competent role performance. To maintain a particular statusrequires the person to act in competent and appropriate waysin accordance to the social norms of the family. Minuchin(1974), as well, emphasizes that the family structureconsists of both universal rules governing familyorganization (e.g. the family may have power hierarchy withdifferent levels of authority for each family member) andidiosyncratic mutual expectations of family members, whichinvolves implicit and explicit negotiations among familymembers in regards to small daily events.Throughout the course of the therapy, Sam often, eitherexplicitly or implicitly, states that males, the husbands,are the head of the household. For instance, in sessionthree Sam refers to males as, "we're strong, we're tall,we're the breadwinner, the ones to stand alone". In sessioneight Sam discusses how he has 51% and Jill has 49% of thedecision-making power because he is the man of thehousehold. Jill does not dispute this split. He alsostates in the first three sessions that his decisions arefinal and that when it comes to alcohol related decisions hedoes not involve Jill in the decision making process. Forinstance, in session one Sam says, "When it comes to alcoholI deal with it the way that I wish to deal with it, andfrankly it has always been if I wanted a drink I would haveone." Considering that both Sam and Jill have accepted thathusbands are the head of the household, the husband's status133carries certain implications such as, the duty and roleobligation of the husband to have authority, be responsiblefor making decisions, act responsibly in his decision-making, and reserve the right of final decision.When the husband is head of the household this meansthat he must be competent to perform the obligations andduties of that status. The general proposition is statedas; {H-Head} Husband is a competent head of the household.The local propositions, {11} and {17} are related to {H-Head}.In session one Jill clearly asserts that she supportsand respects Sam's decisions and does not interfere becausewhen Sam makes a decision it is final and her input does notinfluence him. Moreover, she is afraid of his defensivenessbecause he acts mean and aggressive toward her resulting inher feeling intimidated. For instance, in session five Jillstates, "Arguing with Sam is not easy. You don't get yoursay with Sam. Lots of things I didn't say because I'mafraid of him leaving". She continues to say that since shedid not get her say in arguments she gradually gave upletting Sam know what she felt. She also felt frustrated atnot getting her say and feared him either leaving orexploding. She also realizes in session five that sheleaves the initiative to Sam which stems from childhoodexperiences of being told her opinions were not worthy. Shesays, "When you are silenced a lot you end up being silent."134The general proposition, which is either implicitly orexplicitly negotiated, for the wife's role is stated as; {W-Supports} Wife is a competent support to husband.This last proposition requires that the wife supportsher husband's decisions and performs the necessary taskswhich support him. It also requires that she not challengehim and not do anything that may result in him becomingdefensive. Related local proposition include; {23} Jill iscaring and attentive to Sam. {20} Jill does not interferewith alcohol related concerns.InteractionSam confirms that the therapist has correctly stated{6} one of his goals for therapy. He then gives informationabout his feelings of {El-S} fear, the intensity of hisproblem {14}, which he identifies as the constant alcoholcravings, and as well he expresses the intensity of his {El-S} fear associated with (61 his goal of handling the fearand thereby asserting that he is not { -25} weak and afailure for attending therapy to deal with his alcoholdependence. That is, he asserts that his problem is big,requiring outside help and thereby not rendering him { - 25}weak and a failure for not { - 8} being in control of hisbattle with alcohol. The therapist acknowledges what Samsaid about having the frequent cravings by nodding her headyes. As Sam is about to give an interpretation orexplanation for having {14} the constant alcohol cravings,135he begins to {25} feel weak and a failure. Consequently, here-directs the topic of conversation and asserts that {9}the presence of alcohol does not bother him and therebyindirectly asserting {8} he is in control of his battle withalcohol and simultaneously reducing { -25} his feeling ofbeing weak, worthless and a failure. In other words, toresume his position of {8} being in control, Sam deflects by{7-S} analyzing and explaining what he knows does nottrigger the alcohol cravings. He then proceeds to assertthat {9} the presence of alcohol in or near their home isnot what triggers the alcohol cravings. By asserting thisproposition {9}, Sam presents a disputable event (D-event)which is an event that both speaker and listener know thatthe truth of the proposition cannot necessarily be assumed(See Appendix C). Sam acts in such a way that indicates heis aware that disagreement may occur. Before either Jill orthe therapist speaks, Sam supports his assertion withsubsequent evidence and argument. That is, Sam asserts thathe knows he is not affected by the presence of alcohol {9}because he has proven this by not being bothered by thealcohol that already exists in their house. To ward offpossible criticism for having alcohol in the home he alsodefensively asserts that there is not a large quantity ofalcohol in their home. While continuing to provide supportfor his proposition {9}, Sam asserts another proposition{11}, which is that his decisions are final. Hence, if he136decides to quit drinking, nothing, including the presence ofalcohol, will deter him from his decision. Sam then re-directs the topic and gives information about {6} his goalto handle his fear which is an A-event; information known toA (Sam) and possibly not known to B (either Jill or thetherapist) (See Appendix C). Typically A has privilegedknowledge about these events and can expect to address themas an expert without facing contradiction. Sam hasinformation about the alcohol cravings and thoughts aboutwhether or not to drink which no one else would know unlesshe provides this information. Sam orients the therapist andJill to the behaviors and thoughts he experiences when hequestions whether or not to drink alcohol. The orientationhe presents is about the connection between his fear and histendency to {12} rationalize and justify drinking. As headmits {El-S} feeling fear, he begins to {25} feel weak anda failure. He then re-directs the topic by givinginformation about incidents of success which then rendershim {2} competent and effective in dealing with alcohol andthereby reducing his { - 25} feelings of being weak and afailure. He again admits {El-S} feeling fear and f - 21possibly being incompetent in dealing with alcohol whichresults in him {25} feeling weak and a failure. To preventfeeling {25} weak he re-directs the topic by givinginformation about {9} not being bothered by the presence ofalcohol and thereby indirectly asserting that {8} he is in137charge and control of alcohol battle. He ends his speechturn by re-asserting {9} that the presence of alcohol doesnot bother him.Essentially, what is occurring in this speech turn isthat Sam feels he is weak and a failure for not being incontrol of his alcohol battle and for being in therapy. Hefluctuates between perceiving alcohol as a problem and notperceiving it as a problem. He also fluctuates betweenadmitting he is incompetent in handling his alcoholdependency and consequently feeling weak, worthless, and afailure and being competent and not weak and a failure inhandling the alcohol. To Sam, being competent means that heis in charge and in control of his battle with alcoholwithout the help of anyone else.Sam appears to be functioning in more of a defensivemode and explaining and analyzing much of his behavior andthoughts. This may be a result of denying the effectalcohol has on him. Sam stated at the end of the therapysession that he was defensive during this episode.Text 78 Th:^ [It is within walking79 ((gestures outward)) distance=ExpansionTh: Alcohol is so close to you that alcohol is justwithin walking distance from you...Interaction The therapist interrupts Sam when he begins to repeat138his explanation and rationalization that {9} the physicalpresence of alcohol is not a problem for him. The therapistrepeats part of Sam's preceding utterance, by paraphrasing,that the alcohol is in close proximity to Sam and therebyusing {T-Track} the method of noting and highlighting Sam'sexperience of alcohol. The therapist heightens theproximity of the alcohol which would make it difficult tonot drink.Text 80 Sam: (hhh) Oh yeah! ((nods yes))Expansion Sam: Oh yes I agree, alcohol certainly is in closeproximity.Interaction Sam agrees with the assertion that the alcohol is inclose proximity.Text81 Th: =Alcohol is within reach ((grasping motion)) (Sam:82 yeah) even within your house (Sam: yeah) (hhh) and you83 feel tempted constantly ((back and forth hand84 gestures)) (Sam: Yes. ((nods yes))) many=many times85 (Sam: yeah) throughout the day (Sam: Oh yeah!) you feel86 really drawn [to ((leans forward and uses grasping87 gesture))ExpansionTh: I recognize Sam that you are not weak and a failure{ - 25} because the problem is that alcohol is a verypowerful seducer {13} that tempts you to open it anddrink it. Alcohol is so seductive {13} and by it beingin such close proximity as in your home {10}, itconstantly tempts you to drink it many times throughoutthe day, making you feel compelled to reach and grab it{-9}-139Expanding the text. Through the use of graspingmotions and leaning forward the therapist accents the easein which the alcohol can be reached and how it draws Sam toit. The therapist accents the frequency of the temptationto drink by repeating, "many=many times". The phrase, "feelreally drawn" is defined more precisely to mean that Samfeels compelled to drink alcohol. In session three Samstates, "I feel incredibly compelled to drink" which is howhe thereafter describes his experience with alcohol. Theproposition identified is; {13} Alcohol is seductive intempting Sam to drink.InteractionThe therapist continues speaking after beinginterrupted by Sam. She then gives an interpretation, orreframe, of the function of alcohol as {13} a seducer andthereby, asserting that Sam is not { -25} weak and a failure,but rather, the problem is that {13} alcohol is seductive.She simultaneously asserts that {10} the alcohol in theirhouse aids in increasing the intensity of the {13} seductionand temptation for Sam to drink. The therapist isindirectly challenging proposition {?9} and therebyquestions Sam's assertion of {9}. When the therapist usesthe rule for challenging propositions regarding Sam'sassertion of the proposition {?9} that the presence ofalcohol does not bother him, which is supported by Sam'sstatus {?H-Head} of being a competent and responsible person140to deal with such problems as alcohol dependency, then sheis heard as challenging Sam's competence in his status {?H-Head} (See Appendix C). Sam reinforces what therapist says.Text 88 Sam:^ [(hhh)89 ((holds neck, uncrosses legs, shifts position, folds90 arms over chest, leans to the left)) Well=no I.91 usually go through one sequence... you know ((Jill92 moves hands)).. but.. as I say it can last for like 293 minutes ((lightly claps hands)) or a-a thought will go94 through my mind YEAH I want a drink ((forward hand95 gesture)). (hhh) And I'll sit there and say or96 rationalize we:ll no I shouldn't because I-I've come so97 far I've gone ((Jill scratches face)) three and a half98 weeks or four weeks at this point ((alternates left and99 right hand gestures)) (hhh) um.. and it would j-just100 set me back again so••^ (hhh) I just put it aside101 ((flicks hand to the left)) but some days it's102 stronger.. ((gestures back and forth)) than other days103 and ah for what reason I don't know ((shakes head))104 (hhh) I haven't seen trigger points or anything like105 that that-that prompt me to-to feel that way. (hhh)106 But it's.. you know.. it's something that I have to107 address and deal with.. Al-almost (Th: *yeah*) on a108 constant basis.ExpansionSam: Well, in regard to alcohol being close by me {10}and craving alcohol constantly {14} I do concede. ButI do not feel compelled to want to reach out and grabthe alcohol because then I would be admitting that I amweak and a failure {25} and not in control of battlewith alcohol { -8}. In order for me to be strong and incontrol, I must analyze my experiences {7-S}. I do notwant either one of you to think of me as a failure, soI will tell you about how I am in control {8}. As Ihave said earlier, the problem is my cravings foralcohol, not the alcohol. There is one particularsequence that I usually experience in relation to myalcohol cravings, but what varies is the length of timeof the sequence. For instance, the sequence can lastfor 2 minutes or momentarily like a thought such as"Yeah I want a drink of alcohol." What typicallyhappens next is that I sit and rationalize {12} bysaying the following statement to myself, "Well, Iwant a drink of alcohol, but I shouldn't have a drinkof alcohol because I have made great strides in my141sobriety by having quit drinking alcohol for 3 1/2 or 4weeks. I know that if I have a drink of alcohol Iwould just set myself back again and repeat my patternof quitting drinking and then slowly starting againwhich would eventually lead to drinking alcohol morefrequently." When I say the above-mentioned statementto myself {12} I can put thoughts and cravings ofalcohol out of my mind and be in control {8} of mybattle with alcohol. But some days the thoughts aboutalcohol and the alcohol cravings are stronger and I donot understand the reason for this. I have not beenable to identify what triggers me to feel such strongalcohol cravings. But, as I have said previously toyou both, my alcohol dependency problem is mine toresolve {17} and as you know, based on what you saidearlier, I will have to address and deal with thesethoughts and cravings for alcohol on an almost constantbasis {14}.InteractionSam interrupts and disagrees with the therapist'sinterpretation that the {10} proximity of alcohol { - 13}compels and seduces him to drink the alcohol and thereby,attempting to deflect from his {25} feeling of being weakand a failure for not being in { -8} control of his battlewith alcohol. He indirectly defends against the challengesto the proposition {?9} that the presence of alcohol doesnot bother him and to {?H-Head} him not being competent ashead of the household, by giving information to thetherapist and Jill about his alcohol cravings to help themunderstand what he means and experiences. Sam heard thetherapist's last comment as her not understanding thatalthough he has alcohol cravings, he controls {8} them andis successful {2} and competent in dealing with alcoholwhich then results in him also being competent {H-Head} inhis status. This preceding interpretation made by the142analyst is based on the information that Sam then gives.That is, Sam gives information about his alcohol cravingswhich he describes as lasting briefly and then he evaluatesthe success {2} he experiences in using self-talk tomanage/control {8} the cravings. Considering that he hasbeen successful in controlling his cravings, then he isactually competent in {H-Head} his status as head of thehousehold. Sam then re-directs the conversation back to hisoriginal concern which is not understanding what triggersthe strong alcohol cravings. Simultaneously, Sam evaluatesthat most days he is {2} successful in controlling thecravings but "some days" he is not as f -21 successful. Inother words, most times Sam is competent {H-Head} incarrying out duties and obligation relegated to his statusas head of household, but some times he is not as competent{"H-Head}. Since these latter incidents occur only "sometimes", overall he is still competent {H-Head} in his statusand is {8} in control of his battle with alcohol. Sam againre-directs the conversation back to the proposition of hisstatus {H-Head} and asserts the local proposition {17} ofbeing the one responsible to quit drinking alcohol and todeal with it alone. He asserts that he deals with thecravings on an almost constant basis {14} and therebyasserting this is a big problem and thus he f - 251 is notweak and a failure.143Text109 Th: ((gestures towards self and nods yes)) Yeah: Yeah:110 I think that-that's:. right you'll have to do (Sam:111 yeah) that on a constant basis ((drops hands on lap))112 (hhh) and.. almost on a constant basis. (hhh) And you113 may ask yourselves, "Why do we have alcohol in the114 house when it (Sam: yeah) makes it ((holds and shakes115 pressed fingers in the air)) that much more difficult116 (Sam: hhh) ((Jill looks toward Sam)) =that little=bit117 more difficult for me?" ((briefly looks down at note118 pad))ExpansionTh: Yes, based on my knowledge about alcohol addictionI think that you are correct {Convey}. You will haveto deal with your alcohol cravings and thoughts on aconstant, or rather on an almost constant basis {14}.Considering the frequency of your alcohol cravings {14}I want both of you to ask yourselves, "Why do we havealcohol in the house when the presence of alcoholseduces and tempts {13} you to drink Sam and adds moredifficulty in abstaining from alcohol { - 9}, especiallyadding more stress for me, Sam, in my struggle tomaintain sobriety?"Expanding the text. The therapist's gestures are usedto accent the close proximity and seductiveness of thealcohol in the house and the difficulty this proximity cancreate for Sam in his sobriety. Another proposition arises;{Alcohol} Alcohol should not be in the clients' home.InteractionThe therapist agrees with Sam's assertion {14} that hewill have alcohol cravings on an almost constant basis andthereby acknowledging that he is { -25} not weak and afailure. She then indirectly requests information from bothspouses about the reason for {10} having alcohol in thehouse. This request is based on the premise that {13}alcohol seduces Sam to drink, resulting in Sam having more144difficulty abstaining from alcohol { - 9} and thereby sheindirectly asserts that {Alcohol} alcohol should not be intheir home. The therapist uses a mitigating form whenmaking the indirect request, which is evident by her stating"And you may ask yourselves...", rather than using animperative such as "Ask yourselves..." Simultaneously, thetherapist is denying Sam's assertion { - 9} that the presenceof alcohol does not bother him or trigger alcohol cravings.She is also challenging his competence {?H-Head} in dealingwith alcohol related concerns. That is, she is assertingthat if Sam were competent {H-Head} in dealing with thealcohol, he would abide by the proposition {Alcohol} thatalcohol should not be in their house.By directing the question to both clients, thetherapist is implying and redefining that both spouses areresponsible for the presence of alcohol in their house andfor creating more stress for Sam in his sobriety{Relational}. The therapist leaves the question open-endedby not looking at either client.Text119 Sam: (hhh) Yeah:. ((therapist looks first at Sam and120 then at Jill and writes on a note pad)) I have thought121 of. getting rid of it all like-our-my intention was the122 holiday celebration party it would all be gone because123 we had.. we:11 we didn't have the party we were.124 planning on having because ((therapist looks up from125 note pad toward a plastic alcohol bottle and then looks126 at Sam)) of my injury and whatnot we only had a half127 dozen people in (hhh) but I was hoping that it would128 all be gone that night ((therapist puts head on chin129 and looks at Sam)) so it wouldn't be there. Now.. we130 have.. ((Sam gestures; therapist looks at bottle and145131 then at Sam)) family was over this weekend that sort of132 thing and.. ((back and forth gestures, drops hands on133 lap, shakes head)) we serve it to guests:. (Th: *yes*134 ((nods))) you know (Th: yeah) rather than ((shifts135 position and leans to left)) (hhh) (Th: yeah136 ((therapist looks at Jill))) you know.. I don't137 replenish our stock [ExpansionSam: Yes, I agree with your suggestion that {Alcohol}alcohol should not be in our home and I have at varioustimes thought about getting rid of the alcohol in thehouse {18} in my own way {17}. For instance, our, no Ishould say my intention, because I am responsible fordealing with my alcohol dependence {17}, was that allthe alcohol in our house {10} would be drunk by ourguests at our holiday celebration party. Well this didnot happen because we did not have the large party wehad planned due to problems associated with my recentphysical injury. We only had half a dozen peopleattend our party and they did not drink all the alcoholas I had hoped. I was hoping that all the alcoholwould be consumed that night so that there would not beany alcohol left {19-S}. Another way that I planned toget rid of the alcohol in our house is by serving thealcohol to guests and family members who visit us likethis weekend, for example {18}. Since I am trying toget rid of the alcohol in our home in my own way {17},as is my responsibility, I would say that I am beingboth competent {2} in how I handle the alcohol andresponsible {H-Head}. The reason alcohol is in ourhouse is not because I replenish our alcohol stock,which would be a justifiable reason to criticize me forbeing irresponsible in my duties. But because thealcohol is still left over from the time when I wasdrinking I am being responsible and competent in myduties {H-Head}.Expanding the text. The "getting rid of it" logicallyrefers to getting rid of the alcohol which was the focus ofthe last utterance. The reference to an injury was expandedby referring to the first session in which Sam talked abouta recent physical injury. The vague statement of "we serveit to guests rather than you know I don't replenish ourstock" must be expanded and contextualized within Sam's146complete speech turn. The implication is that they havealcohol in the house because it is leftover from Sam'sdrinking days, not because he is buying alcohol while insobriety.Propositions not previously discussed were identified:{18} Sam has plans to get rid of alcohol from the house.{19} Client wants alcohol to be out of their house.InteractionSam responds to the therapist's indirect request forinformation by initiating a narrative about {19-S} wantingto get rid of the alcohol by providing orientation on time,persons, place, and behavioral setting (See Appendix C). Hegives information about {18} his plans to get rid of thealcohol and thereby asserting that these are his plans, notJill's and as well, minimizing and dismissing Jill's input.He is the {17} one responsible for his alcohol dependenceand dealing with any alcohol related concerns. Samsimultaneously asserts that {19-S1 he does not want thealcohol in their house. He then gives evaluation of thenarrative; he was not successful in getting rid of thealcohol. Sam then initiates another narrative about {18}his plans to get rid of the alcohol by providing orientationto time, persons, place, and behavioral setting. Sam thendefensively supports the proposition {19-S} regarding hisdesire to get rid of the alcohol in their house bysubsequently stating that he is not currently buying any147more alcohol and thereby asserting that he is competent {H-Head} in his role as head of household to deal with alcoholrelated concerns. The essence of the narrative was toassert his competence {H-Head} in dealing with alcohol andto indirectly assert that he has been abiding by theproposition {Alcohol} that alcohol should not be in theirhouse by planning how to get rid of it.Text138 Jill:^ [again I always said139 to you  ((Sam sighs)) to get rid of it.140 ((flicking away gesture)) and you always said that's my141 problem.... [Expansion:Jill: Considering that the therapist is here to help mefeel safe in voicing my opinion, I have some thingsthat I want to say Sam about how you deal with youralcohol problem. Since you might get defensive I willtake my time and choose my words carefully so as to notmake { - 15} you defensive. The therapist is confirmingwhat I have always said to you, Sam, which is that youshould get rid of the alcohol in our house {Alcohol;19-J}. But, your response to me wanting you to get rid ofthe alcohol has been to either deflect my concerns orto get defensive {15} and say, as you have always said,that your alcohol dependency is your problem {17} andthat I should leave the alcohol alone {20} {?H-Head}.Expanding the text. The long pauses may indicateuncertainty or thoughtfulness of words to use, especiallyconsidering that Sam's tendency is to get defensive. Theproblem that Jill is referring to is made explicit insession one. Both Jill and Sam discuss how Sam has decidedthat the alcohol dependency and alcohol related concerns arehis to address and Jill does not interfere. Jill asserts insession one that she felt safer voicing her opinion because148the therapist was present.InteractionJill interrupts Sam and indirectly asserts agreementwith the therapist's assertion {Alcohol} that alcohol shouldnot be in their house and that {17} Sam should get rid ofthe alcohol, especially considering that he is responsiblefor quitting drinking. Subsequently, Jill indirectlyreprimands Sam for not { - 2} competently and effectivelygetting rid of the alcohol. She asserts that she has always{19-J} wanted the alcohol to be gone from their house, butdid not interfere because she {4} felt afraid of Sam'sintimidation. She also asserts that she was competentlycarrying out her role {W-Support} of being a supportive wifewho {20} does not interfere with Sam's decisions. Jill isbeginning to question {?H-Head} whether Sam is competent incarrying out his duties in regards to the alcoholdependency. She has always respected {H-Head} his statusand authority and not interfered even though she has wantedto be rid of the alcohol. In the therapy episode Jill isreceiving the support for her original position {19-J} fromthe therapist.Text142 Sam:^[Yeah. ((shakes head)) I've always143 saidInteractionSam interrupts Jill and confirms that he has told herto leave the alcohol alone {17} and not interfere.149Text 144 Jill:^leave it.Expansion(Part of previous expansion)Text 145 Sam: Yeah. One way or other I mean. It-it because146 it's in the home I-I if I wanted to drink, it wouldn't147 matter if it was in the home or not.. I'd have a148 drink.ExpansionSam: Yes, you are correct Jill, I have always said thatthe alcohol is my personal battle which resides withinme and thus, I have to control my alcohol battle. Thismeans that I will decide how I will deal with thealcohol {17} in our house {10} {H-Head}. Jill, I ambeginning to feel like you are criticizing me andsaying that I am {25} weak and a failure for notgetting rid of the alcohol. To let you know that I amnot { - 25} weak and a failure, I must tell you thatneither the presence nor lack of alcohol in our houseaffects my decision to not drink {9}. I am in control{8} of the alcohol because its presence does not botherme {9}. If I really wanted to drink alcohol I wouldfind a way to get a drink {11}. Ultimately thedecision to drink or not drink is mine {17} and thus, Iam in control of my battle with alcohol {8} and amcompetent {2} {H-Head}.Expanding the text. In session three, Sam says"Alcohol is my personal battle. Again I feel the problem iswithin myself. I have to control it. I alienate myselffrom her [Jill] in this respect and have done so basicallyafter a couple of years." In session one, both Jill and Samtalk about how Sam has decided that he must single-handedlyresolve his alcohol problem. The text is expanded toinclude the statements made in session one and three.150InteractionSam agrees with Jill that he has told her {17} to leavethe alcohol related concerns to him. Sam then defendsagainst the challenge {?H-Head} that he has not beencompetent in fulfilling requirements of his status and notbeen { -2} competent and effective in handling alcoholbecause he did not get rid of the alcohol. He asserts {9}that the presence of alcohol does not bother him and thathis {11} decisions are final and if he wanted to drink hewould. He is indirectly asserting that since {9} thepresence of alcohol does not bother him, he is in fact {8}in control of his battle with alcohol and thus, {2}competent and effective in handling alcohol and competent in{H-Head} handling his status as being a responsible head ofthe household who can deal with his alcohol dependency.Text149 Jill: Yeah but.... accxxx [((unfolds and refolds150 hands))ExpansionJill: I understand what you are saying Sam but I havealso heard what the therapist said earlier in terms ofthe accessibility of alcohol making abstaining fromalcohol more difficult for you { - 9}.InteractionJill agrees with Sam's assertion of proposition {11},which is that if he really wanted to drink he would do so.She then uses mitigation, by making reference to thetherapist's earlier comment, as she repeats her challenge to151Sam about {?9} the presence of alcohol negatively affectinghim in his sobriety. Jill gives her interpretation that the{ -9} accessibility of alcohol does bother Sam. She hasinternalized the therapist's reframe that alcohol seducesSam and the close proximity of alcohol affects Sam'sstruggle to maintain sobriety. She uses this information tochallenge Sam's competence {?H-Head} as head of household in{?2} effectively handling alcohol. By challenging Sam aboutthe presence of alcohol affecting him, Jill is beginning toredefine that {Relational} the alcohol dependence is arelational experience. That is, both spouses are affectedby the alcohol dependence and therefore it is not just Sam'sproblem. In questioning Sam about how he handles decisionsrelated to the alcohol dependence, Jill is { - 20} interferingand getting involved with the alcohol problem. Jill usesmitigation to avoid Sam getting defensive when she raisesconcerns regarding the alcohol dependency. Sam interruptsJill and completes her sentence for her.Text151 Sam:^ [OH access it-it's you152 knowExpansionSam: Oh, I am surprised because I thought you were {"W-Support} criticizing me or getting angry as you usualdo when the alcohol is mentioned. I did not realizethat you are referring to how I am affected by theaccessibility of alcohol!Expanding the text. The word "Oh", which is spokenlouder than the surrounding text, indicates Sam's surprise152and is expanded. In the first and third session, both Samand Jill talk about how Jill would express anger andcriticism toward Sam when the alcohol issue was raised. Insession three, he says he does not talk to Jill about thealcohol because "I assumed because of past experience thatI'll get the same response from her which is `No No No, NoNo - there is no discussion on the matter [regarding myalcohol dependence]."InteractionSam interrupts Jill and finishes the word she isattempting to utter. He deflects from {?9} the challenge tohis earlier proposition, the challenge to both hiscompetency {?2). in handling the alcohol as well as {?H-Head}his status as being responsible for his alcohol dependenceby asserting his surprise at Jill's reference to theaccessibility of alcohol. Sam is indirectly {?23}challenging whether Jill is really caring and attentivetoward him and thereby challenging {?W-Support} whether sheis competent in her supportive role. That is, if she weresupportive and caring toward him then she would notcriticize him about how he handles quitting drinking whichresults in him {25} feeling weak and a failure.Text 153 Jill:^ its-its ((presses finger154 together emphasizing closeness)) so much closer=I mean155 we can get rid of it!153ExpansionJill: I heard what the therapist said about the closeproximity of alcohol affecting you and seducing you todrink {13}. I am concerned about how you are affected,Sam, when alcohol is so much closer to you by being inour home {?9}. I am aware of you getting defensive{15} and therefore, I will soften what I really want tosay to you Sam. I want you to get rid of the alcoholin our house {Alcohol}! That is, I do not mind yougetting rid of the alcohol in our house because I donot want it there {19-J}.InteractionJill continues speaking even though Sam interrupts her.Jill expresses {23} her concern and care for Sam as sheagrees with the therapist's assertion that {13} alcohol is aseducer tempting Sam and thereby {W-Support} supporting Sam.She uses mitigation to diffuse his { - 15} defensiveness whileshe challenges {? 9} that the presence of alcohol in theirhome bothers him. She agrees and accepts the therapist'sproposition {Alcohol} that alcohol should not be in theirhome and is suggesting indirectly to Sam to agree with thisproposition and to get rid of the alcohol. Jill alsoindirectly asserts that she too believes it is Sam'sresponsibility to get rid of the alcohol {17} and thus, shedoes not suggest getting rid of it herself. She asserts toSam that they do not have to keep alcohol in the house for{19-J} her purposes. Jill uses mitigation to diffuse Sam'sdefensiveness when she asserts {19-J} not wanting thealcohol in the house. She says "we" which is a mitigatingform used to mean Sam.154Text 156 Sam: OH easy enough! oh su:re[ExpansionSam: Oh, of course, getting rid of the alcohol in thehouse is an easy task for me because as I have said {9}the presence of alcohol is not the problem that I amconcerned about. Since I can get rid of the alcohol inour house, this means that I am {8} in control of mybattle with alcohol and thus, { -25} I am not weak and afailure.InteractionSam agrees with Jill that the actual process of gettingrid of alcohol from their house would be an easy taskbecause {9} the presence of alcohol does not bother him andthereby asserting that {8} he is in control of his alcoholdependency and { - 25} is not weak and a failure. Jillinterrupts Sam to complete her preceding speech turn.Text157 Jill:^ [there is no problem with158 tha:tExpansionJill: Sam, I do not have a problem with you getting ridof the alcohol from our home {17} because I do not needor want to have alcohol in our house {19-J}. Iactually do want you to get rid of the alcohol.Interaction:Jill continues with her preceding speech turn and doesnot acknowledge Sam's interruption. She asserts that shedoes not foresee a problem with getting rid of the alcoholwhich is a way of indirectly supporting Sam to accept theproposition of {Alcohol} getting rid of the alcohol. She155also indirectly asserts to Sam that she supports him in {17}getting rid of the alcohol and thereby asserting that she is{23} caring and attentive toward him and thus, {W-Support}competent as a supportive wife. Jill uses mitigation tocircumvent his defensiveness while trying to get her pointacross. By using an impersonal pronoun such as, "there"suggests that she is using indirectness and mitigation whenspeaking to Sam about what she wants.Text159 Sam: give it to Jack^ ((laughs and tilts head to160 the left))ExpansionSam: Since you, Jill and therapist, are both sayingthat the alcohol in our house is a problem { - 9} and Ishould get rid of the alcohol {Alcohol}, then maybe toplacate you both, and to not { - 25} feel weak and afailure for not getting rid of the alcohol, I willjokingly suggest that I give the alcohol to our friendJack who still drinks alcohol {18}.InteractionSam continues with his earlier speech turn and deflectsfrom the challenge to the proposition {? - 9} that thepresence of alcohol does bother him by using humour. Heasserts a disputable event which is to give the alcohol toanother alcohol dependent person. By making this assertion,Sam is indirectly implying that he is prepared to agree withthe proposition {Alcohol} that alcohol should not be in thehouse and thereby, negating the indirect assertion that heis {25} weak and a failure for not getting rid of thealcohol. He introduces {18} a plan of how he could get rid156of the alcohol, but the teasing nature of his assertionsuggests that Sam still believes {9} the presence of alcoholdoes not bother him. Sam recognizes that both Jill and thetherapist are in agreement that {Alcohol} alcohol should notbe in their home and that his way of getting rid of thealcohol has not worked. Hence, he uses humour to deflectfrom this contentious issue and thereby saving face.Text161 Jill: Well No ((looks toward therapist)) we would162 create somebody else a problem ((laughter))ExpansionJill: Well no, Sam I do not agree with your idea ofgiving the alcohol to Jack {?18} because you would justcreate a similar alcohol dependency problem as we arefacing, for Jack and his family {?H-Head}. I am alsofamiliar with your tendency to use humour to change thetopic of conversation when we approach this contentiousissue of you getting rid of the alcohol from the house.You use humour to let me know you want me to stopinterfering {20} and to let you deal with the alcoholin your own way {17}.InteractionJill reluctantly, through mitigation, rejects Sam's{18} plan to give the alcohol to a friend who already hasalcohol dependency problems. She again uses mitigation tochallenge his competence {?2} in effectively dealing withalcohol and to also challenge his competence {?H-Head} asbeing responsible in his status as head of the household.Jill laughs and thereby suggesting her familiarity withSam's tendency to use humour to deflect from the contentiousissue of how he deals with alcohol, to stop her from {20}157interfering and to let him deal with the alcohol in his ownway {17}.Text163 Th: So: ((laughs; back and forth gestures)) th-there is164 a possibility that you could get rid of it from the165 houseExpansionTh: So, since this issue regarding getting rid of thealcohol is contentious, which I recognize by you, Sam,getting defensive and using humour as a deflection andyou, Jill, using mitigation when speaking to Sam aboutthe alcohol. I hear both of you saying that you wantthe same thing, that is, to get rid of the alcohol inthe house {T-Common}. As well, Jill and Sam, you areboth saying that you both could possibly get rid of thealcohol from your home if you chose to do so {21} {T-Common}.Expanding the text. Although the therapist says "you",which is a single form, she is looking at both clients andthereby implying that they are both responsible for gettingrid of the alcohol. She is also suggesting that bothspouses agreed they could get rid of the alcohol if theychose to do so. The proposition identified is stated as;{21} Client is aware of choice in getting rid of alcohol inthe house.InteractionThe therapist gives an interpretation of the assertionsmade by both Jill and Sam thus far, which includes; gettingrid of the alcohol from the house is a contentious issuebetween them, that they both agree they {19-S,J} want thealcohol out of the house, and there is the possibility of{21} getting rid of it and thereby, she asserts the {T-158Common} commonalities between them. Furthermore, theircommonalities support the proposition {Alcohol} that alcoholshould not be in their house. Through the clarification andparaphrasing of their previous assertions, the therapistuses mitigation to bring to both clients' awareness theirpossible {21} choice of getting rid of the alcohol. Thatis, she informs them that they have a choice in what they doabout the alcohol in their house. The therapist joins theclients in their humour by laughing with them.Text 166 Sam: Oh yeah!ExpansionSam: Oh yes, of course, I, {17} who am responsible forthe alcohol concerns, could get rid of the alcohol inour house if I wanted to {21-S} because as I havealready said the alcohol in our house is not a problemfor me {9}. Consequently, I {8} am in control of mybattle with alcohol and therefore, I am not { - 25} weakand a failure.Expanding the text. The "Oh" adds more emphatic stressto his absolute agreement to what the therapist has said.InteractionSam agrees with the therapist's interpretation of {21-S} his choice to get rid of the alcohol if he chose to doso, and thereby asserting that {8} he is in control of thealcohol. Thus, he is { -2} neither incompetent andineffective in how he deals with the alcohol nor { - 25} weakand a failure. He again indirectly asserts {9} the problemfor him is not the presence of alcohol in their house.159Text167 Th: you could give it to Jack (Sam:Oh yeah, yeah) but168 then you might not want to give it to JackExpansionTh: I recognize, Sam, that in order to not feel {25}weak and a failure and to save face, you used humour todeflect from this contentious issue {Convey}. Youindirectly admitted to wanting to get rid of thealcohol in your house {19-S} by suggesting a plan {18}and thereby presenting that you are in control of howyou choose to get rid of the alcohol {8}. Even thoughyour idea of giving the alcohol to a friend would notwork, you still presented that you have a choice {21}in getting rid of the alcohol {T-Highlight}.InteractionThe therapist continues with her previousinterpretation that {21-S} Sam has a choice to get rid ofthe alcohol by providing subsequent evidence of informationSam recently presented, such as giving the alcohol to afriend and thereby asserting {19-S} Sam's desire to also getrid of the alcohol. The therapist, at the same time, {T-Highlight} positively connotes Sam's deflection in order tohelp him save face and re-direct from him his experience of{ - 8} not having control over the alcohol and feeling {25}weak and a failure, to {8} him having control. She doesthis by presenting the {21-S} choice he made of how he mightwant to get rid of the alcohol.Text169 Sam: ((laughing; shakes his head)) No maybe not. He170 has enough of a problem with it already as it is any171 way.160ExpansionSam: Your response to me, therapist, allowed me to saveface and to feel that I {8} am in control of how Ichoose to get rid of the alcohol in the house, andtherefore, I do not feel { -25} weak and a failure. Ican now laugh at my suggestion without being defensive{ - 15} and can agree with you that maybe my choice ofgiving the alcohol in our house to Jack is not such agood idea {?18}.InteractionSam expresses feeling {8} he has control over how todeal with the alcohol because of the {Highlight} therapist'spositive connotation of his deflection. Hence, he { - 25}does not feel weak and a failure or get { - 15} defensive.Sam then agrees with the therapist's interpretation.Text 172 Th: ((laughs; continual rotating hand gesture)) and173 um^ ((tilts head to the left)) I appreciate the174 humour. I wanted to say this to you last time; I175 appreciate the humour that you have the camaraderie you176 have going between you. ((Sam rubs his neck; Jill177 yawns)) (hhh) And: uh... on the one hand .. it makes178 it harder for you SAM.. that alcohol is in the house179 ((Jill looks toward Sam)) (hhh) BUT ON THE (Sam:180 *Yeah*) OTHER HAND you think we::ll if I wanted it, I181 would get it anyway ((singsong)) so (hhh)=part of you182 thinks (Sam: yeah) lets just keep it there. [*keep it183 there*ExpansionTh: Since I am aware of the sensitivity of the subjectmatter so far, I would like to stop for a moment andcomment on the strengths I notice in both of you.Highlighting strengths as well as difficulties in yourelationship is part of my task as a therapist {T-Highlight}. Thus, I would like to say that Iappreciate the humour and camaraderie that you bothexhibit {T-Highlight}. Considering that getting rid ofthe alcohol in your house is a sensitive issue betweenthe two of you, which is evident by you, Sam, usinghumour to deflect from this topic when Jill approachedit, my concern is that this conflict about you, Sam,161getting rid of the alcohol from the house {Alcohol}will circumvent you from further exploring this topicbecause you may get defensive {15}. So, instead offocusing on this conflict which results in yourdefensiveness, I will highlight your strength in beingable to diffuse tension through use of humour {T-Highlight}. Now that the tension seems to havedecreased, which is evident by you yawning, Jill, andyou rubbing your neck, Sam, I will focus on theconflict {Split} within you Sam. Focusing on yourinternal conflict will help to decrease yourdefensiveness { - 15} as well as deter the possibility ofan argument ensuing between you and Jill which willdeflect from our issue at hand, which is for you totake responsibility for the choice of having alcohol inyour house as well as your choice of drinking alcohol.The conflict {Split} I notice Sam, seems to existwithin yourself in relation to having the alcohol inyour house. On the one hand, the presence of alcoholin your home creates more difficulty in you abstainingfrom alcohol { -9} because you are compelled to wantingthe alcohol. But then on the other hand, yourationalize {12} to yourself, "Well if I wanted todrink alcohol I would find some way of getting thealcohol so, ultimately having alcohol in our home isnot going to affect whether or not I drink {9}. So, Icontinue rationalizing by saying to myself,`Considering what this latter part of me said, I may aswell keep the alcohol in our house.' I am convincingmyself to keep the alcohol in our house." {12}Expanding the text. The conflict is expanded toinclude what has been said so far in this episode. That is,that the presence of alcohol in the house makes abstainingfrom alcohol more difficult { - 9} and that Sam usesrationalization to convince himself to leave the alcohol inthe house. The conflict is emphasized by the therapistspeaking louder when she says, "But on the other hand". Thediscourse marker "well" and the following singsong tone ofvoice is used to emphasize the way Sam rationalizes. Thetherapist's paralinguistic cues softens the confrontation ofSam's behavior.162InteractionThe therapist continues re-directing the conversationfrom the contentious issue of {Alcohol} getting rid of thealcohol by using immediacy to positively connote {T-Highlight} both the couple's strengths as well as Sam's useof humour to diffuse tension and thereby, she diffuses { - 15}Sam's defensiveness which then allows them to address {17}Sam taking responsibility for his choice of keeping alcoholin the house. She then re-directs the conversation to Sam'searlier assertion of an A-Event. That is, an event known toSam, but not necessarily know to either therapist or Jilland one in which Sam can expect to address without beingcontradicted. The therapist re-directs the conversationback to the original focus: {Alcohol} alcohol should not bein the house. She gives an interpretation of what Sam hassaid so far about what he experiences internally in regardsto the alcohol being in the house by presenting it as aconflict {Split}. Consequently, she again indirectlychallenges the proposition {?9} that the presence of alcoholdoes not bother Sam. She continues with her interpretation,using mitigation in the form of singsong voice, of how Sam's{12} rationalizing and justifying behavior results in himmaking a {21-S} choice to keep the alcohol in the house.The therapist introduces the conflict to also help Sam gainawareness of this conflict and how he creates this dilemmafor himself. By repeating "keep it there" the therapist163heightens what Sam tends to say to himself and as well,heightens the power of his rationalizing behavior.Text 184 Sam: [WELL its the challenge. ((points toward bottle))185 It-its there its like that sitting there.^((Jill186 looks toward bottle while Sam points)) Like that187 really catches my eye.. (Th: yeah ((scratches face;188 Jill looks toward Sam))) and uh.. (hhh) you189 know..((shrugs shoulders)) it-it's the same sort of190 thing. It-it's benign ((points to bottle and looks191 toward therapist)) as long as the top's on it. (Th: ah192 huh) OK.. but when the top's off it and you're pouring193 it then it's a threat. (hhh) and uh^ ((shakes194 head)) so I feel as long as I can keep the top on it,195 it's benign. ((points toward bottle)) I can see it..196 vi-visually. (hhh) I can reach out and touch it. Yet197 uh.... you know that's the challenge. There's the198 challenge. There's the (hhh) the mountain you've got199 to climb is right there. And that. I can't say200 ((gestures)) it-re IT does reinforce me ((points to201 self)) because I'm saying no to it. (hhh) So it. builds202 inside me again. ((rolling hand gesture)) I mean I-I203 as I-we went through this last time, ((gestures away204 from self)) I quit h-half a dozen eight times through205 the course of my life (hhh) and uh.... things that fuel206 it like-a the first couple of times I quit (hhh)=I207 could not have it in the house (hhh)=and ((rapid hand208 gesture)) I could not walk into a bar.. pub or209 anything.. and have a pop or have a mineral water or210 something like that. I=just=simply=could=not=do=that=I211 =would=not=allow=myself=to=get=into=a=situation (hhh)212 =where I might fe-feel compromised. (hhh) And uh....213 now I've gotten ((holds out open hands)) over that214 step. So.. you know.. I-I-like-I you know it-it does I215 mean=I wouldn't be talking about it if it didn't bother216 me I guess in the house. But uh.. (hhh) it's [sort217 ofExpansionSam: It is important for me to let you both know that Ihave made improvements in regards to my relationshipwith alcohol. That is, I can now be around alcoholwithout opening a bottle and drinking it which informsme that I am succeeding in my challenge and my battleagainst alcohol {8} and therefore, I am { - 25} not weakand a failure. The reason I keep alcohol in our house{10} is because it is a challenge for me to keep thetop on the bottle of alcohol {5} and to not {1} fail in164my goal by repeating my same on-off again pattern ofdrinking. A similarity exists with that large plasticbottle of alcohol sitting on that table and with havingalcohol in our house. Seeing that plastic alcoholbottle in here is very unsettling for me. That plasticalcohol bottle is analogous to my experience of havingalcohol in our house because that plastic bottle is assafe and comforting to me as is a real bottle ofalcohol in our house, with the top on, sealing thebottle {9}. But when the top is off and I pour thealcohol, then the alcohol becomes a threat to me { - 9}in terms of me starting to drink alcohol again. So, Ifeel as long as I can keep the top on the alcohol,alcohol is safe and comforting to me {5} and thus, thepresence of alcohol is not what bothers me {9}. I cansee alcohol and reach out and touch it. Yet, I know Ishould not touch the alcohol because when the top isoff and I pour the alcohol, I will drink it. I amafraid that I will like it and continue drinking andyou know that is the challenge. The challenge is tokeep the top on the alcohol {5}. I do not feel incontrol of alcohol { -8} when the top is off. The closeproximity of an actual bottle of alcohol to mesymbolically represents the challenge, that is, my goalof maintaining my sobriety forever {1} which translatesto me having to keep the top on the alcohol {5}.Keeping the top on alcohol is a hard struggle. I feelthat trying to achieve this goal {5} and continuallyseeing alcohol in my presence does not help me to keepthe top on { - 9; - 5}. I end up feeling like I am not incontrol and losing my battle with alcohol { - 8}.Consequently, I feel weak and a failure {25}. Since Icannot tolerate feeling weak and a failure, I will nottell you that this is what I really feel. Instead, Iwill say that the presence of alcohol does help me toabstain from drinking alcohol {9}. But, as wediscussed last session, I have failed to abstain fromdrinking 6 to 8 times through the course of my life.Considering that I failed and was never able topermanently abstain in the past, and that I amcurrently attempting to quit drinking again, I feelafraid {El-S} I will fail again which would prove thatI am incompetent and ineffective in dealing withalcohol { -2}. I can no longer tolerate feeling that Iam weak and a failure {25} even when the desire todrink builds inside me and is fuelled by being in thepresence of alcohol { -9}. Since I cannot accept myselfas being weak and a failure {25}, I will say that itwas only during my first two times of sobriety that Icould not abstain from drinking alcohol when it was inmy presence { -9}. During those first few times ofquitting drinking, I could not have alcohol in our165house and I could not walk into a bar and drink a non-alcoholic beverage. I would not allow myself to be ina situation where I could not trust myself not to drinkand to possibly compromise my resolve to not drink.But now I have accomplished that step in my sobriety.I can confront alcohol directly {5} and say No todrinking alcohol which then suggests that I amcompetent and effective in dealing with alcohol {2}. Iwant you both to know that my quitting drinking thistime is different from those other two times. Duringthose two times the presence of alcohol did not help meto abstain from drinking alcohol. Therapist and Jill,I have improved and now I can be around alcohol and notdrink {9}. The presence of alcohol now does help me toabstain from drinking alcohol. Hence, I am showingmyself and both of you, that I am not weak or a failure{ -25}. But, as I speak so much about this topic {9}, Iam beginning to have some doubt about what I am saying.I suppose I would not be talking so much about thepresence of alcohol in the house if the presence ofalcohol did not bother me { -9} {A-Behavior}. Also, bybeing in therapy about my problem with alcohol wouldnaturally suggest that alcohol does bother me. I amable to admit that I may have a problem with thepresence of alcohol because you, therapist, respondedto me in such a way that allowed me to save face byreducing my defensiveness. I do not feel weak and afailure { - 25} because I can tell you both that alcoholin the house bothers me { - 9}.Expanding the text. The discourse marker "well" refersback to the topic that was discussed. It also "shows thatwhat will follow is relevant to what preceded, but alsomarks a distinct shift of topic" (Labov and Fanshel, 1977,p. 182). Sam's utterance is based on the therapist'sprevious statement, but he makes a shift by adding anotherelement, which is the challenge to keep the top on thealcohol. To understand what Sam means when he says he keepsalcohol in the house because this provides a challenge, itis necessary to refer to previous utterances as well asother therapy sessions.166Sam's hesitations and self-interruptions indicate hisstruggle with explaining what he means. He uses the objectin the room to give an analogy of how he is affected byalcohol in the house. The euphemism "really catches my eye"is translated to mean that he feels very disturbed andunsettled as he sees the alcohol bottle in the room. Samuses impersonal pronoun when he refers to himself such as"you're pouring it", instead of saying "I am pouring it",particularly when it is apparent he is referring to himself.The indirectness of using impersonal pronouns may suggestlack of taking responsibility for actions in relation toalcohol.The stress placed on the words "threat" and "benign"indicates that the pouring alcohol is threatening to Sam andmay result in him resuming drinking, whereas having a top onalcohol is harmless, non-threatening, safe, and comfortingand not tempting him to drink. For instance, he says, "Ican reach out and touch it" indicating its comfort andsafety. The challenge is to reach out and touch the alcoholand at the same time keep the top on the bottle. Theeuphemism "mountain you've got to climb" is translatedliterally to goals that he has to achieve.InteractionSam interrupts and informs both Jill and therapist ofhis improvements in relation to alcohol and therebyasserting that {8} he is in control of his battle with167alcohol and is { - 25} not weak and a failure. He then givesanother reinterpretation of why he keeps alcohol in theirhouse, which is the {5} challenge to keep the top on thebottle of alcohol and thereby, defending the challenges to{2} his competence in dealing effectively with alcohol, to{?H-Head} his status as a competent head of the household,and to {?8} him not being in charge and in control of hisbattle with alcohol. The essence of the "challenge" is tosave face and to show that {8} he is in charge and controlof alcohol both to himself, Jill and the therapist. Samthen self-interrupts. In his representation of an A-event,which is known to A and possibly not known to B, he givesinformation about how an external symbol such as a plasticbottle of alcohol is symbolically representative of how heexperiences the presence of alcohol. He continues givinginformation about what is and is not a threat to himmaintaining his goal {1} of quitting drinking forever whichalso serves to support {9} that the presence of alcohol doesnot bother him. He then evaluates that the {5} challenge tokeep the top on the alcohol is a struggle for him when inthe presence of alcohol and thereby he indirectly refutes{ - 9} that the presence of alcohol does not bother him aswell as simultaneously admitting { - 8} not being in controlof his battle with alcohol and therefore, {25} being weakand a failure. To gain {8} control and not be perceived as{ - 2} incompetent and ineffective and to not { - 25} feel weak168and a failure, Sam again asserts {9} that the presence ofalcohol does not bother him. He then initiates a narrative,providing orientation to time, place, persons, and behavior,to illustrate that at one time { -9} the presence of alcoholdid bother him, but not anymore {9}. He then gives anevaluation of his current success of {9} the presence ofalcohol no longer bothering him and thereby defending that{ - 2} he is not incompetent and ineffective in dealing withalcohol. Before either Jill or the therapist can respond,Sam contradicts his earlier position {9} as he becomes {A-Behavior} aware that his behavior of talking so much aboutthe presence of alcohol in the house might signify that { - 9}the presence of alcohol does bother him and therebychallenging {?9} this proposition. As well, he indirectlyacknowledges that {T-Highlight;T-Track} the therapist'sresponse allows him to save face and admit { -9} that thepresence of alcohol does bother him.Considering that both Jill and the therapist want himto get rid of the alcohol, Sam knows that he would not beable to keep insisting the alcohol does not bother him.Thus, to save face he must concur with them. At the pointof admitting that he is bothered by the alcohol in the househe becomes much more hesitant and self-interrupting. As hebegins to analyze and explain the reason for being botheredby the presence of alcohol the therapist interrupts.As Sam discusses how he is and is not affected by the169presence of alcohol it becomes apparent to him that themetaphoric image of a plastic bottle of alcohol representshis relationship to alcohol. He talks about how the symbolis analogous to his experience of being in the presence ofalcohol and thus, the symbol has been created.Text 218 Th:^ [it's: part of219 ((rotating hand gestures)) it's part-partly a challenge220 partly its a tea::se: ((holds up clenched hand)) ....221 [xxxExpansionTh: I do not perceive you as weak or a failure 1 - 251Sam. Based on what you have been just saying, thealcohol in your house functions partly as a challengefor you {5} to keep the top on the bottle as well aspartly functions as a tease dangling in front of you,tempting you to drink it {13; -9}. Alcohol is seductive{13} in that it tempts you to become weak and to drinkit. Since alcohol is difficult to resist due to itsenticing nature, you are not weak { -25}. It is thealcohol enticing you to take the top off {13}.Expanding the text. The therapist uses hand gesturesto intensify how alcohol dangles in front of him, teasingand tempting him to drink.InteractionThe therapist interrupts Sam and indirectlyacknowledges that she does not perceive him as { - 25} weakand a failure by refraining the function of alcohol as being{13} a seducer tempting him to become weak and take a drink.She also reinforces Sam's proposition {5} that the presenceof alcohol is a challenge that helps him to keep the top onthe alcohol as well as indirectly challenges {?9} that the170presence of alcohol does not function to tempt him to drink.Both Sam and Jill interrupt.Text222 Sam:^[Yeah:InteractionReinforcementText223 Jill:^[We should get rid of it then. ((Sam224 scratches neck)) I have often thought of getting rid of225 it.... ((outward thumb gesture)) because it's always226 ((holds hand up)) out of the way. It is up in the227 cupboards [way out of the way....ExpansionJill: Sam considering that alcohol is seductive {13} inteasing and tempting you to drink it, you {17} shouldget rid of the alcohol in our house {Alcohol},particularly now that you concede its presence is aproblem { -9}. Furthermore, the therapist is inagreement with me that the alcohol should not be in thehouse {Alcohol} which allows me to feel safer inasserting to you what I think about the alcohol in thehouse. I have often thought of getting rid of thealcohol in our house myself {19-J}, but I was afraid ofyour defensive reaction {4}. You have always deflectedfrom my concerns regarding this topic by either usinghumour or cautioning me that alcohol was your problem{17}. I wanted to get rid of the alcohol and oftenthought of dumping the alcohol that is stored high upin our cupboards, and not easily visible to you, Sam.But, I did not do this because I did not want tointerfere {20} with your responsibility of getting ridof the alcohol {17} and thus render you weak and afailure {25} for not dealing with the alcohol on yourown.InteractionJill interrupts the therapist and responds to thetherapist's interpretation of the alcohol being {13}seductive in tempting Sam to drink by encouraging Sam that171he {Alcohol} should get rid of the alcohol in their house.The pronoun "we" is a mitigation Jill uses to refer to Sam.Jill interprets that the therapist's comments are inaccordance with her position, which is that {Alcohol}alcohol should not be in the house. Jill uses this latterinterpretation as well as the therapist's assertion that{13} alcohol is seductive, to more avidly persuade Sam toget rid of the alcohol. Jill then initiates a narrativeabout often {19-J} wanting to get rid of the alcohol herselfand gives information about why she has not got rid it. Theproposition asserted in the narrative is {19-J} that shewanted to get rid of the alcohol, but was {4} afraid ofSam's defensiveness and intimidation tactics. He also woulddeflect from her concerns. Jill begins repeating herselfand Sam interrupts.Text 228 Sam:^[yeah, don't.. see: it.Expansion Sam: Yes, I agree that the alcohol is out of view and Idon't it.InteractionSam interrupts Jill and reinforces what she said andattempts to finish her sentence.Text 229 Jill:^ and you230 probably wouldn't even know it was gone until I got rid231 ((lowers hand)) of it but then I thought if I did232 that^ ((back and forth gesturing)) [without saying233 anything then I'm interfering with172ExpansionJill: Sam, you do not see the alcohol now because it isstored high up in the cupboards. But, if I were to getrid of the alcohol from our house {19-J} that would bethe time that you would probably notice that thealcohol was gone. But then I thought to myself that ifI got rid of the alcohol in our house without tellingSam, then I would be interfering { - 20} with hispreferred way of handling his battle with alcohol {17}and indicating that I thought he was { -2} incompetentand ineffective in dealing with alcohol. He has alwayshandled his alcohol dependency in his own way (17}. Ihave not ever interfered {20} when he starts and stopsdrinking because with Sam when he has made up his mindI cannot sway him anyway. He is like this withpractically anything he does {11}. When his mind ismade up he does what he wants {11}. I have been afraidto get rid of the alcohol because Sam, you wouldperceive me as interfering { - 20} with your struggle toquit drinking alcohol and thus, admitting your failure{25} with regards to quitting drinking. If I were toperform your task of getting rid of the alcohol thiswould render you weak and a failure {25} which is notmy intent. I know how important it is to you, Sam, tosave face and to not feel weak and a failure { - 25}.Thus, I attempt to refrain from making you defensiveand subsequently feeling weak, worthless, and afailure. I feel intimidated by Sam because he can getvery angry and threatening {4}. He has clearly statedto me that he wants to handle his alcohol dependency inhis own way {17} and I have accepted this decision andnot interfered {20;W-Support}.Expanding the text. The emphasis on the word "that",which is explicated as Jill getting rid of the alcohol, andthe subsequent long pause and rapid back and forth gestureindicate that secretly getting rid of the alcohol would notbe an appropriate behavior on her part. Sam and her haveagreed the alcohol problem is his to resolve. As statedearlier, this issue is discussed more fully in both sessionone and three.The reference made to Jill not interfering with Sam's173decisions about his alcohol dependency is made explicit byusing information from session one. Jill states, "Well Samdoes all of this type of thing [quitting drinking] on hisown and I never interfere with when he starts drinking andwhen he stops drinking because with Sam when he has made uphis mind you can't sway him with anything and that ispractically about anything. So when his mind is made upthat is it... he has always thought he had to conquer it onhis own" (Session one).In session four, Jill talks about arguing with Sam asnot being easy and feeling afraid of him leaving orexploding. She talks about the fights they had and how shecould not voice her thoughts, Sam would not listen to her,and how Sam had thrown objects in her direction. Sam admitsthat he had thrown objects at least three times. Thisbehavior exhibited by Sam is aggressive and has intimidatedand scared Jill and has resulted in her withdrawing fromSam. Withdrawing, she said, is a protective way of handlingsituations with Sam.InteractionJill continues with her narrative even though Saminterrupts. She gives information about why she did not getrid of the alcohol which is based on the proposition {20}that she does not interfere with {17} Sam's alcohol relateddecisions because he gets {15} defensive and {25} feels weakand a failure and thereby, she asserts being competent in174her {W-Support} role of supporting her husband's status {H-Head} by not rendering him { - 25} weak and a failure. Jillexplains that her reason for not getting rid of the alcoholherself is because she did not want to challenge Sam'sauthority {"?H-Head} and wanted to be respectful of Sam'sdesire to handle his own alcohol problem. She also assertsin this narrative that {11} Sam's decisions are final andwithout influence from her which is consistent with Sam'srole {H-Head} of being the head of the household and havingauthority. She then asserts that {15} Sam's defensivebehavior has {4} intimidated and scared her resulting in her{ -20} not interfering. Sam continually interrupts Jill andhelps finish her sentences which may be his way of asserting{H-Head} his authority. It is evident that Jill hasperceived that the alcohol was a problem and, therefore, itwould be inaccurate to say she denies and rationalizes thatSam can control the alcohol.Text234 Sam:^ [you're235 interfering you're interfering with my[ExpansionSam: Jill, you are interfering { -20} with my way ofhandling my battle with alcohol and emphasizing mybelief of myself as weak, worthless, and a failure{25}.InteractionSam interrupts and thereby substantiates Jill'sassessment that she would be { - 20} interfering with his175alcohol battle and rendering him {25} weak, worthless and afailure if she got rid of the alcohol.Text 236 Jill:^ [his wayText 237^Sam:^ [yeah... of238 handling the situationText239 Jill: of handling the situation ((gesturing first to240 self and then back and forth)) which has always been=he241 has always handled it his own way. So that's why I242 have always not touched it. It's because^243 ((holds hands open on lap)) he wants to do it his way.244 So—^  [xxx xxxExpansionJill: The way that Sam handles his battle with alcoholhas always been in his own way {17}. Subsequently, Inever discuss my concerns {20} about Sam's alcoholdependency with him because he has insisted that hewants to quit drinking in his own way {17}. I cannotsway or influence Sam about the alcohol dependencydecisions {11}, nor about other decisions he makes. Ido not discuss my concerns with Sam because myexperiences of how he deals with alcohol is generallynegative and when I express this to Sam, his responseto me is to feel challenged which then leads to himgetting defensive {15} and mean with me. Consequently,I am mindful of how I phrase my thoughts to Sam withthe intention of softening the effect of my words. Imay speak in vague terms and/or repeat his exact wordsbecause I do not want to upset him or make himdefensive, which is ultimately not in my own bestinterest {4}. Sam's approach to quitting drinking,which has been to quit drinking for a while and then tostart up again, has not been an effective way ofhandling his battle with alcohol { - 2}, but I tend notto say this because he will get angry with me. So,instead of him getting angry and intimidating me {15} Ilet him handle his alcohol battle in his way {20} eventhough his way apparently does not work { -2}. I do notfeel safe saying anything else because what I have saidso far has made it apparent that I do not think he iseffective in handling his dependency {-2}.176InteractionJill continues giving information about the reason shehas not {20} interfered with Sam quitting drinking which isdue to Sam insisting he {17} quit drinking alone and in hisown way. She indirectly asserts that { -2} Sam has not dealtwith his alcohol battle very effectively and thus, { - 8} heis not in control of his battle with alcohol. She, however,does not {20} interfere because {15} he gets defensive andmean which results in her {4} feeling afraid andintimidated. Jill asserts that to protect herself from hisintimidation {21 -J} she allows {17} Sam to make alcoholrelated decisions.Text245 Sam:^[which ((therapist gestures))246 apparently has not always worked but ((laughs)))ExpansionSam: Jill, I am aware that you are saying that the wayI have decided to handle my own battle with alcohol{17} has apparently not always been successful { - 2}because I have stopped and started drinking many timesand have not quit drinking permanently as I said Iwould. When you say this to me, I begin to feel weak,worthless and a failure {25}. To avoid feeling like atotal failure { - 25}, I want to tell you that I have hadsome success in abstaining from drinking alcohol {2}which means that my way is effective {2}.Expanding the text. Sam has been closely followingwhat Jill has been saying throughout this episode and oftenfinishes her sentence and thus, it is logical to assume thathe is still doing so when he begins to speak in this speechturn. That is, Sam is completing Jill's last word, "So..."177This then would imply that "which has not always worked" ismade in reference to Jill's preceding statement that Sam hasbeen incompetent in handling his alcohol dependency.InteractionSam interrupts Jill and finishes her sentence whenthere is a long silence and her words are inaudible. Heacknowledges Jill's challenges of his competency {?H-Head}as head of the household and him {?2} effectively handlinghis alcohol battle. As a result of the challenges, Samasserts feeling {25} weak, worthless, and a failure. Hethen defends against Jill's challenges by asserting {2} thathe has been effective and experienced some success inquitting drinking and thereby asserting { - 25} that he is notweak, worthless, and a failure. The therapist gesturesindicating she would like to speak.Text247 Jill:^ [Yeah but it has worked for248 quite a whileExpansionJill: Yes, Sam, you have had some successes {2} in yourrepetitive on-off again pattern, but overall yourfailure to quit drinking permanently has been happeningfor quite a while { - 2}.InteractionJill interrupts Sam and reluctantly agrees with hisassertion {2} that at times he has been effective andexperienced some success in dealing with his alcoholdependency. She then asserts that overall Sam { - 2} has not178been effective and competent in quitting drinkingpermanently and thereby she indirectly asserts that Sam is{"H-Head} not competent in his status and C81 not incontrol of his battle with alcohol.Text249 Th:^ [So.. you've left it for him250 to do?ExpansionTh: So what you are saying Jill is that you do notinterfere {20} because you have chosen {21 -J} to leaveSam with the responsibility of deciding {17} what to dowith the alcohol in your house.Expanding the text. The therapist's utterance refersto Jill's preceding utterance in which Jill asserted thereason for not interfering with Sam's decisions.Consequently, the word "it" then refers to leaving thedecision about the alcohol in the house to Sam.In acknowledging Jill's choice and decision to notinterfere, the therapist is elevating Jill's status in therelationship. That is, Jill is capable of making decisions.The proposition reads as; {24} Jill's status is elevated.InteractionThe therapist interrupts Jill and finishes hersentence. She interprets Jill's preceding assertion of {20}not interfering with {17} Sam's alcohol related decisions,due to {15} wanting to avoid his defensiveness andintimidation, as making a {21-J} choice to leave Sam withthe responsibility of getting rid of the alcohol in the179house and thereby asserting {A-Behavior} that Jill becomeaware of and take responsibility of her behavior {21-J}.Moreover, by asserting that Jill has a {21-J} choice to {20}not interfere with Sam's decisions, the therapistsimultaneously {24} elevates Jill's status in therelationship. That is, Jill is, and has been, involved inthe decision making process.The therapist's assertion also serves to not negateSam's desire to want to be responsible for his quittingdrinking and to handle alcohol in his own way and therebyallowing him to save face and fend off { - 25} feelings ofbeing weak, worthless, and a failure. This desire is statedmore fully by Sam on line 254 when he says he wanted toblock Jill from making decisions.Text 251 Sam: YeahExpansionSam: Yes, Jill is blocked out of my decision about whatI do with the alcohol in our house because I deal withthe alcohol in my own way {17}.InteractionSam responds to the therapist's assertion that Jillleft decisions to Sam by providing a reinterpretation. Heasserts that he blocked Jill from his decision about thealcohol {17} as opposed to {21-J} Jill wilfully leaving himwith the decision and thereby asserting {17} alcohol relateddecisions are his to make. He wants to take responsibility180for quitting drinking on his own and to fend off feelings ofbeing {25} weak and a failure.Text252 Th: Alright_ [So ah ((points finger upward, stands up,253 picks up bottle and sits down))ExpansionTh: Alright, considering all that we have said so farin our session about alcohol I would like to change thefocus to another realm.InteractionThe therapist re-directs the conversation from thediscussion about the alcohol in the house and whoseresponsibility for this decision is, by saying "alright" andthen getting the plastic alcohol bottle. Since there hasbeen much talking about and explaining in regards to thealcohol, the therapist decides to change the focus of thediscourse to directly interacting with a symbolicrepresentation of alcohol. Although the symbolicrepresentation of the alcohol dependence has been referredto by Sam in his earlier assertion, the therapist now makesthe symbol explicit.Text254 Sam:^[I have always blocked her out of my255 decision making with it. We went through that [last256 time too.ExpansionSam: I have always blocked Jill out of my decisionmaking process in terms of how I will handle my alcoholdependency {17}. In our last therapy session, Jill andI also talked about how I make decisions about quittingand starting drinking and that I tend to handle my181alcohol dependency concerns in my own way {17}. When Imake a decision I firmly abide to my decision andnothing Jill says or does can sway me from my decision{11}.Expanding the text. The conversation from session oneis included in this expansion.InteractionSam interrupts the therapist and continuesreinterpreting the therapist's previous interpretation thatJill left Sam to make decisions about the alcohol in thehouse. He defends that he had been the one to block Jillfrom {20} interfering and thereby asserting {17} he makesthe alcohol related decisions, not Jill, and that {11} hisdecisions are final. He simultaneously asserts hiscompetence in {H-Head} having the authority in theirhousehold. The therapist gets the symbol and Sam continuesspeaking. As he begins initiating a narrative providingorientation to time, persons, and behavior, he isinterrupted by the therapist.Text257 Th:^ [It's258 very.. very significant that um^ you uh.. want a259 challenge ((sets down bottle and gestures left to260 right)) and.. uh that you've been in agreement that he261 should be_ make these decisions. You've blocked her262 out. She has decided that it is your responsibility so263 together, collaboratively ((hands held together)),264 you've agreed that he's to make these decisions.265^((folds hands))ExpansionTh: I am wanting to introduce this symbol, but before Ido so, I want to acknowledge significant points youhave both raised. First, Sam, being challenged to keep182the top on the bottle of alcohol {5}, to keep alcoholaway from your presence, and to get rid of the alcoholin your home {Alcohol} are very important to youralcohol recovery process. Second, both of you haveeither explicitly or implicitly agreed {Collaborate}that Sam should be responsible for quitting drinkingand to make the decisions about how he deals with hisalcohol dependency {17} such as, whether or not to keepalcohol in your house. The way you agreed to thisdecision was by you, Sam, blocking out Jill from yourdesire to quit drinking and helping you deal with youralcohol dependency and deciding that you must conquerand control your own alcohol dependency {17}. Jill hasalso decided {Collaborate} that it was yourresponsibility to quit drinking as well as the alcoholdependency concerns being your responsibility {17}. Sotogether, collaboratively, you have both agreed{Collaborate} that Sam is to quit drinking and to makealcohol related decisions {17}. Consequently, Sam, itis not only your decision, Jill also wants you to quitdrinking, and so, together, you have decided that thebest plan is for Sam to be responsible for quittingdrinking {17} {T-Common}.Expanding the text. Information from the precedingtext was used to expand the significance of challenges.Furthermore, information from session three which relates toSam believing he must conquer the alcohol problems on hisown is included in the expansion. The decision referred tofollows logically from what has been the focus of theconversation, that is, leaving alcohol in the house. Thetherapist places stress on the word "together" to aid thecouple in understanding that they both are involved in thedecision making process. Another proposition, notpreviously stated, arises in this speech turn: {Collaborate}Clients collaborate on decision making process.InteractionThe therapist sits down, interrupts Sam, and gives an183interpretation and summary of what has transpired so far inthis therapy session which includes: Sam is {5} challengedto keep the top on the alcohol; Sam is not to have alcoholin his presence because { - 9} it bothers him; {Alcohol}alcohol should not be in the house and; that both spouseshave either explicitly or implicitly {Collaborate}collaborated in deciding that {17} Sam is responsible forquitting drinking and dealing with alcohol related concerns,including getting rid of the alcohol in their house. Thetherapist {T-Common} accents both spouse's commonalities,that is, both are saying and wanting the same thing inregards to the alcohol. As the therapist emphasizes thecouple's desire for Sam to quit drinking she indirectlychallenges Sam's individualistic beliefs that {? - 17} he isnot responsible for quitting drinking, {? - 2} incompetent anda failure and {? - 8} not in charge of his battle with alcoholif he includes Jill in his decision making process, andthereby she asserts {16} that Jill is, and should be, a partof Sam's recovery process. She simultaneously asserts theproposition {Relational} that alcohol dependency is arelational experience affecting both spouses. By placingemphasis on {21-J} Jill's choice to {20} decide not tointerfere with the alcohol decisions, due to her {4} fearand intimidation, the therapist indirectly {24} elevatesJill's status and thereby challenges Sam's tendency tonegate Jill in the decision making process. Sam's negation184of Jill's choice is connected with him feeling worthless ifhe is not in charge and feeling {"H-Head} incompetent in hisauthority as head of the household.Through her verbal words and the emphatic stress on"together" the therapist introduces the systemic conceptthat in marital relationships both spouses agree eitherovertly or covertly to how decisions are made.Subsequently, she also introduces the notion that they bothhave a choice and responsibility for how they behave inrelation to making decisions. That is, Sam is not solelyresponsible for the alcohol in the house because Jill hassupported him in keeping it in the house by not interfering.She also reinforces the relational aspect of the alcoholproblem and thus, it is not just Sam's problem.Text266 Sam: hmhmExpansionSam: Yes what you have said is correct.InteractionSam reinforces what the therapist said.Text267 Th: (hhh) Right now.. ((lifts and holds up bottle;268 sets it down and folds hands)) um.. alcohol^ I269 guess is in the room. Fear is in the room. Fear and270 apprehension (hhh) and you mentioned ((rolling hand271 gestures)) a number of things that you.. are feeling272 scared about. (hhh) And um.... where ((looks at273 bottle, taps it and then looks at Sam and Jill)) would274 you put this right now in this room? ((holds up275 bottle))185ExpansionTh: Having decided three key issues: (a) the alcoholproblem lies with alcohol being a seducer {13}, notwith Sam being weak and a failure { - 25}; (b) Jill is,and should be, involved in Sam's recovery from alcohol{16} and; (c) you both {Collaborate} decided thatgetting rid of alcohol is the primary goal {1-S,J} ofour therapeutic work, we can now begin to focus onexploring getting rid of alcohol. At this moment{Here}, as we discuss how alcohol is a part of yourlives {Relational} and the associated feelings of fearand apprehension {El-S;J}, alcohol is metaphoricallypresent in this therapy room. The fear for you {El-S},Sam, is that you may fail and be ineffective in yourgoal to quit drinking alcohol forever { - 2} and repeatyour on-off again pattern of drinking. And you, Jill,expressed feeling fear {E1-J} when Sam drinks alcoholand about knowing that his drinking will worsen.Considering that alcohol dependency is present in yourlives {Relational}, where would you put this symbolicrepresentation of alcohol in relation to yourselvesright now {Here} in this room?Expanding the text. The reference to the alcohol,fear, and apprehension is expanded to include what wasdiscussed in an earlier segment. The discourse marker,"right now" is used to focus the therapy from what hadtranspired earlier to what is happening in the here and now.InteractionThe therapist re-directs the conversation from how thecouple has related to alcohol concerns and decision makingprocesses in the past to focusing on the {Here} present,here and now. She indirectly asserts three key issuesaddressed thus far in this couple's therapy which include:{13} alcohol is a seducer and thus, Sam { -25} is not weakand a failure; {16} Jill is, and should be, involved inSam's alcohol recovery and; {1-S,J} the therapeutic goal is186to get rid of alcohol from their lives. The therapistasserts that the therapeutic subsystem has agreed to thesethree redefinitions which then permits exploring thecouple's relationship with alcohol. She gives aninterpretation of alcohol metaphorically being present inthe therapy session and in the clients' lives. She thenrefers to the associated feelings of {El-S,J} fear to thealcohol which were expressed earlier. She then introducesthe symbolic representation of the alcohol dependence andrequests that the clients metaphorically place the alcoholin relation to themselves. By engaging with the symbol ofalcohol dependence, the therapist emphasizes her desire tochange from "talking about" alcohol concerns to directlyinteracting with the symbol of alcohol which would allowdirect experiencing to occur.Text276 Sam: Outside the door. ((low tone of voice))ExpansionSam: I want the alcohol placed outside the door, awayfrom me, because I want alcohol out of my life forever{1}.InteractionSam's responds directly to the therapist's requestindicating his goal, which is that he wants {1} the alcoholout of his life forever.Text277 Th: You would like it outside the door?187ExpansionTh: Are you saying that you would like the alcoholoutside the door?InteractionThe therapist {T-Track} uses tracking as she repeatsSam's statement. She phrases his statement into a questionwhich clarifies and heightens Sam's goal and desire {1}.Text278 Sam: (hhh) Yeah ((scratches head, smooths hair))ExpansionSam: Yes, I would like alcohol to be outside the door{22-S} because my goal is to be rid of alcohol forever{1}.InteractionSam directly responds to the therapist's question bystating agreement.Text279 Th: Where would you... put this right now Jill?ExpansionTh: Where would you place the symbolic representationof alcohol at this moment {Here} Jill?InteractionThe therapist makes a direct request to Jill. Thetherapist says "right now" indicating reference to the hereand now. When the therapist asks both spouses where thealcohol would be placed in relation to them she isindirectly asserting the proposition that {Relational}alcohol is a relational problem affecting both spouses, not188just the alcohol dependent person. Furthermore, in askingJill to decide where she would place the alcohol, thetherapist is {24} elevating Jill's status to a person whocan make decisions about alcohol.Text 280 Jill: Outside because he wants it outside the door.281 ((Sam laughs)) Outside the door.Expansion Jill: I would place the alcohol outside the doorbecause Sam says he wants the alcohol outside the door.He is responsible for quitting drinking and decidinghow he will deal with his alcohol dependency {17}. Ihave decided not to interfere with whatever Sam wantsto do with the alcohol {20} because he gets defensive{15} when he thinks I am telling him what to do.However, since Sam wants the alcohol outside the doorand out of our lives, as I do {22 -J}, then I will saythat I too want the alcohol outside {22 -J}.InteractionJill directly responds to the therapist's request.Jill mitigates her own desire {22 -J} of wanting the alcoholoutside the door by asserting that this is what Sam wantsand thereby asserting {17} that Sam is responsible forhandling alcohol related problems and that {20} she does notinterfere due to his {15} defensiveness. She is {4} fearfuland hence, careful to {20} not say or do anything that mayresult in Sam thinking she is trying to take charge whichwould result in {15} him getting defensive and intimidating.Thus, Jill asserts that she is in agreement with Sam aboutwhat to do with the alcohol to ensure she gets her desiremet, which is to put the alcohol outside and to also not189have Sam act intimidating toward her. Jill asserts shedecided to agree with what Sam wants in relation to thealcohol because she too wants the alcohol out of theirlives. Jill repeats her assertion and thus accents herdesire to have the alcohol outside the door.Text 282 Th: So: you would put it outside the door. Would you283 put it outside the door please? ((puts bottle on floor284 and looks down))ExpansionTH: So you are both in agreement {Collaborate} that youwould like the alcohol outside the door {22-S,J}.Would you then please put the symbolic representationof alcohol outside the door?InteractionThe therapist gives an interpretation based upon bothspouses' preceding assertions that they would place thealcohol outside the door and thereby asserts {Collaborate}that they have collaborated in making this decision. Shealso Common} accents their commonality in wanting {22-S,J}alcohol out of their lives. She then makes a request foraction (ie. to put alcohol outside the door). After makingthe request, the therapist looks downward so as to notinfluence who performs the task. The purpose of requestingthe task is to heighten and intensify the experience ofalcohol being out of their lives.Text 285 Sam: *sure* ((picks up bottle and puts it outside the286 door. Therapist smooths her hair and puts notepad on287 table and leans forward)) ((Sam sits down and folds190288 arms over his chest))ExpansionSam: Sure, I will be the one to perform the task ofputting the alcohol outside the door and away from Jilland I, because I am the one responsible for handling myalcohol dependency {17}. I have to be the one toperform the necessary tasks in relation to alcohol {17}{20} {H-Head}.InteractionSam responds to the request for action by performingthe requested action and thus, behaving in accordance withthe proposition {17} that he will be the one responsible fordealing with alcohol related concerns. In performing theaction, he thereby asserts his {H-Head} competence as headof household. Jill also gives support for both proposition{17} and {20} by not performing the task herself.Text289 Th: Now it's gone. At the moment....((back and forth290 gesturing)) [you want it outside the door.ExpansionTh: Now {Here} the alcohol is gone from this therapyroom and from your lives. At this very moment {Here},you both want the alcohol outside the door and awayfrom your lives {22-S,J} {T-Common}.Expanding the text. The discourse marker "now"indicates a shift in topic of conversation to the present,here and now, and away from their discussions about what thecouple has done in the past with alcohol. The therapist issaying that symbolically the alcohol is gone from thetherapy room and from their lives. She again emphasizesthat she is referring to the here and now by saying, "at191this moment."InteractionThe therapist re-directs the focus of the conversationto what is happening in the here and now. She gives aninterpretation about what both spouse want {22-S,J} in the{Here} present moment and thereby accenting {T-Common} theircommonalities. Sam interrupts after the long pause.Text 291 Sam:^[hm It's interestingExpansionSam: After putting the alcohol outside the door I amaware that my internal bodily experience {A-Bodily}changed to feeling less apprehensive {E6-S}. Thischange in bodily response really surprises and shocksme.Expanding the text. The "hm" suggests Sam's reflectionon his new awareness of something happening internally whichhe describes more fully in his next speech turn. In readingahead to line 303, Sam states that he experiences a bodilychange of feeling less apprehension which surprises andinterests him.InteractionSam interrupts the therapist and begins to express hisinternal experience {A-Bodily} of performing the task.Text292 Sam: *Yeah*ExpansionSam: Yes, in response to your earlierinterpretation, therapist, I do want the alcohol192gone from my life and from this room {22-S}.InteractionSam's reinforcement is in response to the therapist'spreceding statement that both spouses want to have alcoholout of the room.Text 293 Th: And that's.... that's really important ((folds294 hand)). Now that it is not here.... ((gestures toward295 the door)) um.. I'm=I ((outward hand gesturing)) want296 to ask you.. to uh.... to=let me know what's=that like297 for you. ((looks from Jill to Sam and Jill looks at298 Sam))ExpansionTh: Wanting the alcohol outside the room and not inyour lives {22-S,J} is really an important goal for youboth {T-Common}. Considering that you both now haveaccomplished this task and the alcohol is not here inthis room and not in your lives, I am wanting toventure into exploring your experience of performingthis task. However, I am hesitating about introducinga more intense way of exploring your feelings inrelation to the alcohol because I am cognizant thatthis is only our second therapy session, that I am alsorecently new to using this therapy model, and thattypically both of you tend to be more comfortable indealing with your problems in a cognitive domain. I amuncertain whether to introduce my next plan because Ido not want to be intrusive {Non-intrusive}.Nevertheless, I will continue with following throughwith applying the intervention I had begun, and ask youboth to tell me your experience of not having alcoholpresent {S-Express}.Expanding the text. The discourse marker "now"suggests a change in topic of the conversation. Thetherapist wants to introduce the exploration of intensefeelings that is particular to the ExST model. Thetherapist's hesitation, pauses, and self-interruptionsreflect her uncertainty in implementing the intervention at193this point without intruding upon the clients' intenseexperiences. The hesitancy of the therapist may be due toher being new to this therapy model, wanting to be competentand effective in applying the model, this therapy case beingone of her first ExST cases, and the clinical judgement thatin a second session a therapist does not intrude uponclients by encouraging expression of intense experiences.InteractionThe therapist continues asserting her precedinginterpretation which is that {22-S,J} both spouses want thealcohol out of their lives and thereby accenting {T-Common}the commonalities between them. The therapist is not onlyspeaking about the actual goal, to have alcohol outside thedoor, but also metaphorically being rid of alcohol forever.The therapist then hesitates and uses mitigation as sheindirectly asserts not wanting {Non-intrusive} to beintrusive with this couple by having them express intenseexperiences and thereby regulating the intensity of theirexperiences. The therapist indirectly requests the coupleto express what they experience and thereby requesting thatthey gain {Awareness} awareness and {S-Express} expressionof their internal experience. This request is for an actionto be performed (See Appendix C), not just a request forinformation, because the therapist is wanting them todevelop awareness and to then experience this awareness inthe here and now. By looking at both Jill and Sam, the194therapist indicates non-verbally that she wants a responsefrom both spouses.299^((four seconds of silence))Text 300 Sam: I feel less apprehensive to be frank with you uh301 .. that's interesting that is why I said OH THAT'S302 INTERESTING because I noticed it went down in me.303^(hhh) Uh when I first walked in and saw it.. ....304 something triggered inside me and.. uh-uh you know it305 really.. caught my attention. Really caught my306 attention. And uh.. ((hand on face)) I thought it was307 a little unusual to have it in here (hhh) ((gestures308 away from self)) but=I=mean p-part of the therapy and309 everything else it is to see the reaction granted.310 (hhh) But uh.... apprehension levels have gone down.311 ((holds out open hands))ExpansionSam: To be honest with you, I feel less apprehensive{E6-S} since putting the alcohol outside the door andout of my presence { -9}. I am surprised at my reactionof feeling less apprehensive {E6-S} because I did notexpect to be affected by having alcohol absent. Thatis why I said "Oh that's interesting" when I came backinto the therapy room after putting alcohol outside.When I first walked into this room today and saw thatlarge plastic alcohol bottle on the table I becameaware of feeling very anxious {E5-S}. I questioned theappropriateness of having a plastic alcohol bottle in atherapy room when dealing with alcohol recovery. Butthen I suppose you, therapist, would say that part ofthe therapeutic process is to test how I would react toalcohol being present. I consider that to bechallenging me, not supporting me {?Convey}, andpossibly rendering me { - 8} not in control and thus,weak and a failure {25} if I do not respond correctly.Although I felt very anxious {E5-S}, I am {8} still incontrol and still aware that my apprehension level hasdecreased {E6-S}.Expanding the text. In saying, "to be frank with you",Sam indicates his directness and honesty in expressing hisexperience. Sam is surprised by the decrease inapprehension and indicates this by using a mitigating195phrase, "that's interesting" and then repeating it in alouder voice. The phrase, "something triggered inside me"is expanded to include his earlier assertion on line 187when he talked about feeling anxious when he saw the bottlein the therapy room. The discourse marker "but" is used toshift the topic back to what he spoke about earlier, whichis feeling less apprehension.InteractionSam directly responds to the therapist's indirectrequest for action by expressing that he feels {E6-S} lessapprehension as well as surprise because he did not expectto be affected by the absence of alcohol. That is, he didnot perceive the problem to be the alcohol. Sam theninitiates a narrative providing orientation to time, person,place, and behavioral setting. The narrative was about hisexperience of entering the therapy room in the beginning ofthe session and feeling {E5-S} anxious due to the bottlebeing present. He then interprets that the presence of thebottle is inappropriate in a therapy room and that it mightbe used to test whether or not he {?8} is in control ofalcohol. The result of testing him in that way may possiblyrender {25} weak and a failure, depending on how heresponded, and thereby he challenges {?Convey} thetherapist's support and understanding. He concludes that heis {8} in control of alcohol. Sam then re-directs theconversation to his feeling of {E6-S} less apprehension.196Sam's internal process entails the following pattern:he begins this speech utterance by expressing how his bodyfeels; he thinks about how interesting he finds the shift inhis internal state; he explains his analysis of why hethought the bottle should not be present in the therapy roomand; then he shifts back to expressing his feeling of lessapprehension. This internal process described, suggeststhat when the feelings become intense for Sam, he shifts toa cognitive realm which is a safer and less vulnerable wayof being for him. When he feels safe again he shifts backto experiencing intense feelings. This process wasexplicated and discussed in session one by the therapist.Sam's process of going in and out of feelings is alsoconsistent with the therapist's desire to not intrude uponthe clients when intense experiences arise. Thus, thetherapist and client co-create how they interact with oneanother to regulate the intensity of experiences. When theexperiences or emotions become intense for Sam, both he andthe therapist shift the intensity to him gaining control ofhis experience and thereby decrease his feeling of beingweak, worthless, and a failure. For instance, when Sambegins to express feelings of fear he begins to feel not incontrol which leads to feelings of being weak, worthless anda failure. To prevent these feelings from emerging he thenmust gain control of his experience.197Text312 Th: So ((gesturing)) what's it like Sam^to have313 apprehension levels gone down a bit? *What's that314 like?*ExpansionTh: As I said earlier, I am wanting to be careful tonot intrude upon you, Sam, when you experience intenseemotions {Non-intrusive}. So given that you have saidyour apprehension level has decreased {E6-S}, which Irecognize is a surprise to you, what is your experiencelike of having your apprehension level decrease a bitSam? {Awareness} What is this experience like for you?{Experience}Expanding the text. The therapist uses a mitigatingphrase, "a bit" in reference to Sam saying he experienced"less" apprehension. Using mitigating forms is consistentwith the therapist's desire to not intrude upon clients whenintense experiences emerge.InteractionThe therapist asserts her desire {Non-intrusive} to notbe intrusive and thus, regulates the intensity ofexperiences. She then acknowledges Sam's feeling of {E6-S}less apprehension and directly requests that Sam {Awareness}develop awareness of his internal state in the here and now.Simultaneously, she indirectly requests an action; that Samfocus on his experience of feeling less apprehension. Bydoing so, the therapist asserts that through {Experience}heightening and intensifying Sam's experience of lessapprehension new awareness of his internal process as wellas change may be created.The therapist asks a question designed to keep Sam198focused on feeling less apprehension as well as deepen hisexperience of this feeling. She softly repeats the questionto heighten his awareness and experience of his lessapprehensive state. Repeating the request in a soft voicealso provides more empathy which may possibly allow Sam tomore fully experience the feeling.Text315 Sam: um.. I relax a little bit more.. you know (Th:316 *yeah* ((nods))) um^ I'm not as tentative I-I317 ((gestures)) already I feel like it=something has318 changed.ExpansionSam: When I feel less apprehensive {E6-S}, I feel alittle bit more relaxed {E4-S}. I no longer feel astentative {"E5-S}, unsure, or cautious as I did when Ifirst entered the therapy room today. However, I amuncertain what has changed, except I do know that I nowfeel more relaxed and less cautious {Novelty}.InteractionSam responds directly to the therapist's request aboutwhat he experiences internally (Sam's representation of anA-event). He hesitates, stammers and pauses as he expressesfeeling {E4-S} more relaxed when he experiences (E6-S} lessapprehension. The therapist provides reinforcement for himto continue expressing his emotions. Sam then expressesfeeling { -E5-S} less tentative {Here} at this moment andthereby, indirectly asserting the contrast in feelings fromwhen he first entered the therapy room. He gives anevaluation of these current feelings as indication of thechange he experiences {Novelty}.199Text319 Th: ((gesturing outward and then up and down)) So feel320 a little more relaxed.. (Sam: yeah, yeah) ah not quite321 as tentative.. and.. a=little easier (Sam: hmhm322^((nods))) in yourself. (Sam: yup) OK. ((lowers head323 and gestures to her body)) Where do you feel that in324 your-your body?ExpansionTh: To ensure safety {Safety} in therapy, pacing isimportant. I do not want to work too fast with you,Sam, because I am aware that experiencing intensefeelings is uncomfortable for you and that you may feelout of control which we know leads to you feeling weak,worthless and a failure {25}. I will then slow us downa little and help you to not feel weak and a failure{ -25}. So, Sam, what I have heard you say is that youfeel a little more relaxed {E4-S}, not quite astentative, unsure, or cautious { -E5-S}, and a littleeasier {E4-S} within yourself now that alcohol is notwithin your presence { -9}. Ok, now that we both knowwhat feelings you experience {A-Feeling} and you arestill feeling in control and not feeling weak and afailure { - 25}, will you focus internally and becomeaware of where you actually feel the relaxed, lesstentative, and easier feeling in your body? {A-Feeling;Bodily}InteractionThe therapist, through gesturing, pausing and matchingSam's style of speech, indirectly expresses concern aboutthe possibility of { -8} Sam feeling out of control if hisemotions become too intense, resulting in him feeling {25}weak and a failure, and thereby she asserts the need for{Safety} pacing the work. The therapist then repeats Sam'spreceding expression of feelings {E-S} (Sam reinforces eachfeeling by nodding or saying yes) and thereby the therapist{Experience} heightens and deepens the contrast betweenfeeling tense and relaxed. The pauses in her speech help to200heighten the feelings for Sam and aid him in {A-Feelings}developing awareness of his feelings when alcohol is notpresent. The therapist matches Sam's speech style andthereby she is {T-Track} noting and highlighting Sam'sexperiences which aids in establishing acceptance and safetyin the therapeutic relationship as well as regulates theintensity of his experience. The therapist also indirectlydenies { - 9} the proposition that alcohol does not botherSam. To aid Sam in gaining awareness of his {A-Bodily}bodily sensations associated with feeling {E4-S} relaxed and{ -E5-S} less tentative when alcohol is not present, thetherapist indirectly requests that Sam perform the action offocusing internally to where he experiences these feelings.This process also results in the therapist graduallyincreasing the intensity of and deepening his experience.The therapist is attempting to integrate bodily, cognitive,and emotional responses.Text325 Sam: Right across here ((back and forth gestures across326 shoulders))ExpansionSam: I feel the relaxed {E4-S}, less tentative, unsure,cautious { -E5-S}, and easier {E4-S} feeling across mychest and shoulders {A-Feeling;Bodily}.InteractionSam responds directly to the therapist's request andexpresses {A-Feeling; Bodily} awareness of feeling therelaxation {E4-S} in his shoulder and chest area and thereby201{Experience} deepening the contrast between {El-S}apprehension and tension and {E4-S} relaxation.Text 327 Th: Right across there ((back and forth gestures across328 shoulders))Expansion Th: Sam, you are saying you feel the relaxed {E4-S},less tentative { -E5-S}, and easier {E4-S} feelingacross your chest and shoulder {A-Feeling; Bodily} {T-Track}.InteractionThe therapist responds by {T-Track} reflecting, notingand highlighting, through use of verbal words and gestures,Sam's experience. The intent is to gradually intensify anddeepen this feeling of relaxation in his body when alcoholis not present, and thereby bringing this information {A-Feeling, Bodily; Experience} into his awareness.Text 329 Sam: Yeah right across thereExpansionSam: Yes, you are correct, I feel the relaxed {E4-S},less tentative { -E5-S}, and easier feeling {E4-S} rightacross my chest and shoulders {A-Feeling, Bodily}.Interaction Sam agrees with the therapist's empathic statement. Herepeats where he feels the relaxation in his body,indicating he has {A-Feeling, Bodily} developed awareness ofand experiences both feelings and bodily sensations, andthereby he further {Experience} deepens the contrasting202experience as well as intensifies his experience.Text330 Th: you feel easier (hhh)and ah.. ((looks downward and331 continues gesturing across shoulders)) right across332 there ah.. what is it like ((moves head forward))333 inside there *right across there*?ExpansionTh: Sam, you are experiencing feeling easier {E4-S}right across your chest and shoulders. What do youexperience inside your chest and shoulder area as youfeel this easier feeling? {A-Feeling, Bodily}InteractionThe therapist repeats Sam's expression of feeling {E4-S} easier in his chest and shoulder area and thereby{Experience} deepening the contrast between feeling tenseand relaxed, easier, and calm. She continues to {T-Track}track his experience by matching his style of speech as shegradually aids in intensifying and deepening his experience.She also indirectly suggests that he develop and experiencethis {A-Feeling, Bodily} awareness. To continue heighteningand intensifying his {A-Feeling, Bodily} contrastingexperience, the therapist then indirectly requests that Samfocus internally and thereby develop {A-Feeling; Bodily}awareness of what he experiences in his body when he hasthis {E4-S} easier feeling.Now that he knows what feelings he has, where he hasthe feelings, the therapist is helping Sam to become awareof what the feeling is like by requesting that he expand onwhat the easier feeling is like in that particular area of203his body. The intent of this intervention is to intensifyand deepen the relaxed feeling in the chest and shoulderarea and to have the client experience this feeling on adeeper level.Text334 Sam: It feels calm right now. (Th: *ah*) And that's335 where it seems to have welled up into. ((continues336 with shoulder gesture)) Th-The apprehension was right337 through there ((drops hands on lap)).ExpansionSam: I feel calm {E4-S} inside my shoulder area at thismoment {A-Feeling; Bodily}. However, as I continuefocusing on this calm feeling in my shoulders, I amaware that in this calm area is where I previously feltmy apprehension {El-S}. That is, my feeling ofapprehension {El-S} was located right in my chest andshoulder area {A-Feeling; Bodily}.Expanding the text. When Sam refers to "that's whereit seems to have welled up into" he is no longer referringto the calmness, but is talking about the apprehensionwelling up in his shoulder and chest area. This is based onhis following sentence in which he says "the apprehensionwas right through there". He shifts from his presentfeeling of calmness to his previous apprehensive state.InteractionSam directly responds to the therapist's request andexpresses feeling {E4-S} calm, indicating {A-Feeling;Bodily} awareness of both feelings and bodily sensationswhen alcohol is not present. He then gestures and stammersas he expresses that in this calm area of his body hepreviously felt {El} apprehension and thereby {Experience}204he intensifies, deepens and heightens the contrast ofapprehension and calmness. Sam is noticing the contrastbetween feeling apprehension and calmness and thus,developing an experience of difference {Novelty}.Text 338 Th: *Yeah:* ((nods; gestures to shoulder)) So_ExpansionTh: Yes, I understand {Convey} Sam that you experiencedapprehension {El-S} in your shoulder and chest areawhen alcohol was present { -9}. Now that the alcohol isgone you have a calm feeling {E4-S} {A-Feeling}.InteractionThe therapist, through using gestures and soft spokenspeech, agrees empathically with Sam {Convey}. She {T-Track} notes and highlights his experience which aids inestablishing acceptance and safety in therapy. Thetherapist is about to continue speaking when Sam interrupts.Text339 Sam: ((gestures to shoulders)) But then I have been340 injured through here tooExpansion Sam: Even though I experienced a change in myself, I donot know if the apprehension {El-S}, tentativeness,anxiety, and uncertainty (E5-S} that welled up in myshoulders is directly linked to the alcohol beingpresent. I have also been physically injured in myshoulders so maybe those apprehensive, tense, andanxious feelings {El-S; {E5-S} are attributed to theinjury, not the alcohol being present {?-9}.InteractionSam continues completing his preceding sentence andasserts that the {El-S; E5-S} feelings of apprehension may205be linked to a physical injury and thereby indirectlychallenging that {? - 9} the presence of alcohol bothers himresulting in him feeling apprehension and tension in hisshoulders.By focusing on the physical injury as creating hisfeelings of apprehension and tension, Sam is lessening theintensity of the impact of alcohol on his life. He isattempting to place the feelings of apprehension, tension,and anxiety onto an injury rather than onto the alcohol.Text 341 Th: RightExpansionTh: I recognize that you are feeling doubtful about thelink between alcohol and apprehension. I also knowthat you have an injury in your shoulder area which youthink could contribute to you feeling apprehension{Convey}.InteractionThe therapist indirectly acknowledges that Sam feelsdoubtful and that he has an injury and thereby asserting{Convey} that she understands his dilemma and his desire toregulate the intensity of his experience.Text 342 Sam: So you=know ((drops hands on lap))ExpansionSam: So, considering that I also have an injury in myshoulder area, I have some doubt about linking myfeeling of apprehension {El-S} to the alcohol beingpresent {? -9}. Consequently, I am not sure whether Ican accept that the problem of my tension andapprehension in my shoulders lies with the alcohol. I206think the problem is connected with the injury.InteractionSam continues talking about his doubt and challenge to{?9} the presence of alcohol not bothering him. He uses thediscourse marker "you know" to enlist support from both Jilland the therapist in regards to what he spoke of earlier.That is, Sam refers back to his previous assertion of {9}the presence of alcohol not bothering him and thereby hecontinues to lessen the intensity and impact of alcohol inhis life. However, he soon withdraws from the verbalinteraction by stopping his speech turn and dropping hishands on his lap.Text 343 Th: ((continues with shoulder gestures)) So: Right now344 your experience is that the apprehension uh.. a few345 minutes ago=a few seconds ago changed to..346 calmness.ExpansionTh: I understand your dilemma Sam {Convey}. But, whatI want to say is that at this moment {Here} yourexperience is that the apprehension {El-S} that youfelt a few minutes in your shoulder area, or moreaccurately a few seconds ago, changed to calmness {E4-S} after alcohol was placed outside the door { - 9} {T-Track}. In other words, the change you experienced inyour shoulders occurred when you put alcohol outside.If the apprehension and tension in your shoulders waslinked to your injury, then these feelings would nothave changed to calmness when you put alcohol outside.Therefore, I would say that your feeling ofapprehension {El-S} in your shoulder area is directlylinked to alcohol being in the room { - 9}, not theinjury.InteractionThe therapist {Convey} conveys understanding of Sam's207dilemma and then re-directs the conversation to {Here} thepresent and {T-Track} highlights what just happened with Sam{Here} in the therapy session. She asserts that hisfeelings of {El-S} apprehension changed to {E4-S} calmnessafter alcohol was not present and thereby, she asserts that{ - 9} the presence of alcohol does bother Sam, and that theproblem is the alcohol, not the physical injury. Bypresenting the sequence of events that occurred, thetherapist asserts the logical conclusion and accents thatSam did in fact experience a change in his body when alcoholwas not present.By "talking about" and analyzing whether or not theapprehension was linked to the alcohol suggests that Sam isbecoming more cognitively oriented and removing himself fromdirectly experiencing what is happening within himself.Consequently, the therapist re-focuses Sam onto hisexperience of first feeling apprehension and then calmnessas she summarizes what had occurred and thereby shegradually intensifies and deepens his experience withalcohol. She indirectly asserts that she does not want himto "talk about" his experience and focus on pastexperiences, but wants him to directly experience thedifference between apprehension and calmness when alcohol isnot present.Text347 Sam: hmhm.((nods)) Settled down. sure208ExpansionSam: Yes, therapist, when you describe what happened tome as you just did, I must agree that my feeling ofapprehension {El-S} in my chest and shoulder areachanged when I put the alcohol outside the door { - 9}.Since I am not quite ready to fully accept the contrastbetween feeling apprehensive when alcohol is presentand calm when alcohol is absent, I will mitigate thechange that occurred by saying that the feeling ofapprehension {El-S} changed to me feeling lessapprehension {E6-S}, not all the way to feeling calm{"E4-S}. The leap from feeling apprehension to calm istoo great for me to accept at this moment. But, I amcertainly willing to concede to my re-definition offeeling less apprehension {E6-S} when alcohol is notpresent { - 9}.Interaction Sam agrees with the therapist's evaluation of hisexperience in the session and thereby acknowledges that aninternal change occurred within his body from feeling {El-S}apprehension to feeling {E6-S} less apprehension which wasdirectly linked to him putting the alcohol outside the room.Thus, he indirectly asserts that the { - 9} presence ofalcohol bothers him. Sam then asserts a correction to thetherapist's evaluation. He negates the feelings shiftedfrom {El-S} feeling apprehension to { - E4-8} feeling calm.Instead, the shift was from {El-S} feeling apprehension tofeeling {E6-S} less apprehension and thereby, Sam indirectlyasserts, through use of mitigation, that he is not yetwilling to accept the intensity of feelings and experiencesassociated with the alcohol. That is, he is not ready tolet go of the idea that alcohol is not the problem andtherefore, he lessens the impact of alcohol on his life by209lessening the contrast between apprehension and calmness.Sam's correction is also supported by referring back to hispreceding utterances on line 334. At that time, he madereference to feeling calm in relation to his "easierfeeling" which is not the same as his apprehension changingto calmness.Text348 Th: *Yeah:* ((nods, continues shoulder gesture)) OK.349 settled down a bit. (hhh)=so that calmness that sort350 of settling down a bit. (hhh) Do you have any sense351 of-of feeling the sensa-sation of that? What's that352 like? ((holds hand on chest))ExpansionTh: Ok, I understand and accept your correction thatyour experience was more of the apprehension levellessening {E6-S} when you put the alcohol outside thedoor, rather than an experience of calmness { - E4-S}, asI suggested {Convey}. Again, Sam, I am aware of thisexperience being intense for you which is evident byyour use of mitigation. Therefore, I am wanting to berespectful of your experience and not intrude uponthese intense experiences {Non-intrusive} and, yet, Iam wanting to go ahead with the intervention I haveintroduced and ask you to experience your emotions abit more. However, I will attempt to be careful andnot intrude as we move along with you experiencingyourself in relation to the alcohol not being present.So, Sam, you experience calmness, or as you pointedout, you feel less apprehension {E6-S} {T-Track}.Since you have doubt about your apprehensive feelingbeing related to alcohol being present, I want to focuson the difference you felt when the alcohol was notpresent. Do you have any awareness of feeling thephysical sensation associated with feeling {E6-S} lessapprehension in your chest {Awareness}? What is thephysical sensation of feeling {E6-S} less apprehensionlike in your chest area? {A-Bodily}Expanding the text. The discourse marker "Ok"signifies that the therapist has understood and acceptedSam's correction. She repeats his statement that his210experience is one of "settling down a bit". However, shequantifies this feeling by adding a modifying form, "a bit".This is consistent with Sam's earlier statement of feeling"less apprehension" which also mitigates the feeling. Thetherapist corrects herself when she says "calmness" ratherthan "settled down", but adds a mitigating phrase "sort ofsettling down." Her hand gesture to her chest areaindicates she wants Sam to focus on his physical sensation.InteractionThe therapist acknowledges and agrees with Sam'scorrection. She acknowledges that Sam does not experiencethe change as { - E4-S} calmness, but as {E6-S} feeling lessapprehension. She interrupts and corrects herself when sheagain repeats her definition of his experience of "calmness"and then adds his correction of "less apprehension". Afteraffirming his feelings, the therapist indirectlyacknowledges the intensity of this experience for Sam, whichis evident by him using mitigation. She then indirectlyasserts {Non-intrusive} not wanting to intrude on hisintense emotions and experiences and thereby regulates theintensity and contrast of his feelings. The therapist thenre-directs the conversation back to his {E6-S} feeling ofless apprehension, by {T-Track} noting and highlighting hisexperience, and thereby re-focusing on his doubt that hisfeeling of apprehension in his shoulders is linked to thepresence of alcohol { -9}. She then requests that Sam211experience the {E6-S} feeling of less apprehension and todescribe the sensations that are associated with thisfeeling and thereby she indirectly asserts that {Awareness}Sam develop awareness of his physical sensations. She firstasks a yes-no interrogative, requesting whether he hasawareness of physical sensations associated with {E6-S}feeling less apprehension. Before Sam can respond, sheindirectly requests that he {A-Bodily} develop awareness ofand experience bodily sensations in his chest area. Thepurpose of the request is heighten and intensify his{Experience} experience of feeling {E6-S} less apprehensivewhen alcohol is not present which may result in gainingawareness and change as well as lessen his doubt about thelink between tension and alcohol.The therapist is accompanying Sam in his process of"going in and out of emotions". That is, to brieflyexperience the intensity of his emotions/experiences andthen to talk about, analyze or explain what is happening.The process is then repeated.Text353 Sam: You mean physically? (Th: yes ((nods))) yesExpansion Sam: Are you asking me whether I am aware of thephysical sensation of the apprehension lessening {E6-S}in my chest? Yes, I do have an awareness of feelingthe physical sensation of the apprehension {E6-S}lessening in my chest {A-Bodily}. But, I am hesitatingabout focusing on my physical sensation because I amstill having difficulty accepting the change Iexperienced in my body as being linked to alcohol not212being present.InteractionSam requests information using the rules of embeddedrequests which, in this case, is a rhetorical request forinformation, and thereby indirectly refusing the request soas to lessen the intensity of his experience of alcohol. Heis experiencing difficulty accepting the impact alcohol hasin his life. The therapist nods yes to his request and Samresponds in the affirmative to her first question. That is,he asserts having an awareness of feeling the physicalsensation when he feels {E6-S} less apprehension in hischest {A-Bodily}, but does not comply with expressing hisawareness due to not yet being ready to accept that thechange he experienced is linked to alcohol. He has heldonto the belief that he is in control of alcohol and thatthe presence of alcohol does not adversely affect him.Text354 Th: ((continues holding hand to chest))355 physically=what's it like physically?ExpansionTh: I recognize that you may find it difficult toexpress what you experience physically because youstill have some doubt about your change in feelingsbeing linked to the alcohol {Convey}. Although you arehesitating, I am still inviting you to continuefocusing internally to your physical sensations andbecome aware of what you experience physically {A-Bodily} when you feel less apprehension {E6-S}. I willask you again. What do you experience physically {A-Bodily} in your chest and shoulder area when you feelthe apprehension lessening {E6-S}? {Experience}213InteractionThe therapist indirectly acknowledges Sam's hesitationand doubt and thus, {Convey} conveys her understanding. Thetherapist then reinstates her request more explicitly, whichis that he is to focus internally and {A-Bodily} developawareness of and express the physical sensations heexperiences in relation to feeling less apprehension and thealcohol not being present and thereby she {Experience}intensifies, deepens and heightens this experience. Shealso uses hand gestures indicating she wants him to focus onthe physical sensation in his chest. Essentially, thetherapist wants Sam to gain {A-Bodily} awareness of how hephysically experiences {E6-S} apprehension lessening in hischest area when alcohol is outside the door so that he mayachieve {Novelty} alternate ways of being in relation toalcohol not being present.The goal of ExST is to help clients become aware of notonly emotional, cognitive or behavioral states but alsophysical states. The therapist has moved Sam fromexperiencing his emotions, cognitions and now experiencinghis physical state when alcohol is not present. Rather thanhave him experience what it is like when alcohol is present,she has decided to focus on his experiences when alcohol isnot present. Since he is probably more able to identifywhat he feels in relation to alcohol being present, she ishelping him to experience and become aware of other aspects214of himself when he is not in the presence of alcohol. Sheis not focusing on the problem "alcohol", but letting himknow there is an alternate experience.Text:356 Sam: Ah.. ((shakes head)) the muscles have relaxed th-357 the ((gestures to shoulders)) you know.. right up in358 here ((drops hands on lap)) y-you know definitely359 relaxed subsided some [xxxExpansion:Sam: Alright, I will focus on what I experiencephysically in my chest and shoulders. As I focus on myphysical state, I am aware that my muscles in my chestand shoulder area have relaxed {A-Bodily}. My musclesin this area have definitely relaxed and the tensionhas subsided to some degree {A-Bodily}.Expanding the text. The intensity of this experiencefor Sam is evident by his hesitation, pauses, and shaking ofhis head. He uses hand gestures to indicate that he isreferring to his shoulder and chest muscles.InteractionSam directly responds to the therapist's request bycomplying and focusing internally. He then expressesfeelings of {E4-S} relaxation in his chest and shoulders andthereby indicating that he has developed {A-Bodily}awareness of and experienced the bodily sensation of feeling{E6-S} less apprehension. He then more definitely assertsfeeling that his muscles are {E4-S} relaxed and {A-Bodily}that he has gained this awareness. Sam then uses mitigationto assert that the tension in his muscles subsided to somedegree and thereby indirectly lessening the contrast in215sensations and concurrently lessening the impact of alcoholon his life. By conceding that the change in his internalstate is from tension to less tension, this suggests lessimpact than if it were to shift from tension to relaxation.Conceding to this latter shift would be too drastic of achange and would also heighten the contrast between feelingrelaxed and tense and hence, Sam mitigates the impact.Text:360 Th:^ [So the muscles.. ((continues361 with shoulder gestures)) you have a-an awareness that362 the muscles have relaxedExpansionTh: So, Sam, you notice and have developed an awareness{A-Bodily} that your muscles in your chest and shoulderarea have relaxed {E4-S} when the alcohol is outsidethe door {Novelty} which suggests that the presence ofalcohol does bother you { - 9}.InteractionThe therapist interrupts Sam when his words areinaudible. She empathically responds to Sam's feeling {E4-S} of relaxation by {T-Track} noting and highlighting hisexperience and thereby indirectly interpreting that his {A-Bodily} physical awareness, which is that his chest andshoulder muscles relaxed when he put the alcohol outside thedoor, has resulted in him {Novelty} gaining awareness of analternate way of being. That is, he feels relaxed whenalcohol is not present. The therapist reflects what he saidto aid in gradually intensifying his experience as well asdeepening the contrast between tension and relaxation. She216also indirectly denies his assertion that the { - 9} presenceof alcohol does not bother him.Text363 Sam: hmhm ((nods)) hmhmExpansion Sam: Yes, I agree with you that I have developed theawareness {A-Bodily} that my chest and shoulder areasare relaxed {E4-S} when alcohol is not present{Novelty; - 9}.InteractionSam agrees with the therapist's interpretation that hehas developed a physical {A-Bodily} awareness ofexperiencing relaxation when alcohol is gone and therebydenying the proposition that { - 9} the presence of alcoholdoes not bother him.Text364 Th: Ok.. OK.. ((continues with shoulder gestures)) And365 if those muscles had a voice.. what would they say366 right now?ExpansionTh: OK now that we have identified that you havedeveloped an awareness {A-Bodily} of feeling relaxed{E4 -S} in your chest and shoulder area when alcohol isoutside the door { - 9}, I want to explore this sensationfurther. But, again, I am hesitating because I awareof intensifying your feelings too much Sam, especiallyconsidering that this is only our second session andthat you have a desire to be in control. I do not wantto be intrusive when your experiences are intense {Non-intrusive}. My hesitation is also about wanting toeffectively introduce this intervention and being awarethat you may experience awkwardness in doing assuggested. However, I will proceed with following theprocess of implementing this intervention and hence,ask you to focus on your muscles. If we were toimagine your relaxed chest and shoulder muscles had avoice and could speak, what would your relaxed chest217and shoulder muscles say right at this moment? {A-Cognition}InteractionThe therapist reinforces and {T-Track} highlights the{A-Feeling; Bodily} awareness that Sam has developed thusfar, and thereby indirectly asserts denial of theproposition { - 9} the presence of alcohol does not botherSam. Before venturing into new territory the therapistexpresses the reason for her hesitation which includes: notwanting to {Non-intrusive} intrude upon clients when intenseexperiences emerge, especially in a second therapy session,and; wanting to implement the intervention competently andeffectively and thereby, the therapist accents {Safety} theimportance of pacing the therapeutic work by matching theneeds of the client as well as regulates the intensity ofthe therapeutic process. She then indirectly requests Samto perform an action requiring him to focus internally anddevelop awareness of and experience {A-Cognitions}cognitions associated with his recent {A-Feeling; Bodily}awareness of feelings and physical sensations and thereby,she {Experience} deepens and heightens his experience ofalcohol not being present. This intervention is introducedafter the therapist establishes with Sam that the presenceof alcohol makes him feel tense and that the absence ofalcohol makes him feel calm, or less tense. To heighten anddeepen this contrasting experience in the here and now thetherapist asks his muscles to speak.218Text367 Sam: Gee I don't know^ Thanks. ((laughs; opens368 hands and drops on lap)) I don't knowExpansionSam: I am surprised by your request and feel awkwarddoing as you requested because I typically do notimagine my muscles having a voice. However, since youhave generally demonstrated your support of me intherapy, allowed me to save face when necessary, andconsidering that you are the therapist and must havesome reason for suggesting this action, I will complywith your request. My first thought is that I do notknow what my relaxed chest and shoulder muscles wouldsay { -A-Cognition}. As I think about this questionsome more, I am aware that my relaxed chest andshoulder muscles might feel grateful and say "ThanksSam for allowing me to relax." {A-Cognition} But, thenI don't know about this request because it feels weirdto me.Expanding the text. The word "gee" is "used as anintroductory expletive or to express surprise or enthusiasm"(Webster's ninth new collegiate dictionary, 1983, p. 509).Sam's subsequent phrase, "I don't know" and pause alsoindicates his surprise at the therapist's question.InteractionSam begins by briefly putting off the request.Although he apparently feels awkward about the therapist'srequest, which is evident by his hesitation and laughter, heresponds. Sam's direct response to the request indicatesthat he perceives the request to be valid and thereby heindirectly asserts that the therapist has been competent {T-Track} in both noting and highlighting his experiences andsubsequently, establishing acceptance and safety in thetherapy. Sam initially denies { -A-Cognitions} having219awareness of cognitions related to the relaxed muscles.Shortly thereafter, he expresses {A-Cognition} his awarenessand thereby {Experience} deepening and heightening thecontrast between alcohol being present and absent andasserting that the presence of alcohol makes his musclestense { - 9}.Text 369 Th: ((rapid hand rolling gestures)) So they might370 say=they=might=say ((Sam leans to the right, puts head371 in hand)) *Gee I don't know* ((Sam laughs; "yeah"; and372 then crosses his legs)) or-or.. sure_ sure_ or they373 might say thanks=or they might say pro-likely ((nods374 head)) they would say both.ExpansionTh: So you imagine your relaxed chest and shouldermuscles might say at first, "Gee I don't know what tosay" {A-Cognition; T-Track}. I recognize that due toyour laughter you may be feeling awkward with myrequest to have your muscles speak {Convey}. I want toassure you that the response you just gave isappropriate and your muscles might say that {Convey}.Or your relaxed chest and shoulder muscles might feelgrateful and say, "Thanks Sam for allowing me to relax"{T-Track}. Or, more likely, your relaxed chest andshoulder muscles would say both, "Gee I don't know whatto say" and "Thanks Sam for allowing me to relax." {A-Cognition; T-Track}Interaction The therapist acknowledges Sam's expression of hiscognitions by {T-Track} noting and highlighting hisexperience. She then interprets his {A-Cognitions}cognitions as being related to his relaxed muscles. As itbecomes noticeable that Sam is feeling uncomfortable, by himshifting body position and laughing, the therapist beginsspeaking rapidly as she reassures him that his response is220appropriate and acceptable and thereby conveying {Convey}that she understands and supports Sam and simultaneouslyregulating the intensity of his experience. Furthermore, asshe highlights the cognitions associated with Sam's muscles,the therapist simultaneously confirms that { - 9} the presenceof alcohol does bother Sam, because it makes him feel tense,and also {Experience} deepens the contrast in experienceswhen alcohol is present and absent.Text375 Sam: Yeah. Quite possible. ((mumbling))ExpansionSam: Although, I usually do not imagine my musclesspeaking, I agree that my relaxed chest and shouldermuscles would probably respond in both ways you and Isuggested {A-Cognition}. This then would then probablysuggest that the presence of alcohol makes my musclestense { - 9}.InteractionSam expresses agreement with the therapist'sinterpretation of his experience and thereby asserts,through use of mitigation, that he is in the process ofaccepting that { - 9} the presence of alcohol makes hismuscles tense and hence, he gradually intensifies hisexperience. The use of mitigation is consistent with Sam'stendency to lessen the impact of alcohol and the contrastingfeelings.Text 376 Th: Yeah. ((gestures to her shoulders and chest)) Ok377 so I appreciate your willingness to-to just explore378 that a bit=so that's important that you notice221379 ((gestures behind her)) when alcohol went outside the380 door.. ((Jill looks at therapist and fidgets with381 fingers. Therapist gestures to chest and shoulder area382 and looks at Sam)) that you. felt calm, less383 apprehension, and.. uh that's an easier, more relaxed384 feeling.ExpansionTh: Yes, based on your experience in here Sam, yourmuscles become tense when alcohol is present andrelaxed when alcohol is absent. Sam, I recognize thatyour experience in here may be getting too intense foryou, resulting in you possibly feeling not in controland thus, feeling weak and a failure {25}. Since I donot want you to feel { -25} weak and a failure and donot want to intrude upon you when intense emotionsemerge {Non-intrusive}, I will focus on diffusing theintensity of your experience by highlighting yourstrengths {T-Highlight}. I admire your willingness,Sam, to allow yourself to explore your feelings,thoughts, and sensations in your body {Awareness} for alittle while after you put alcohol outside the door {T-Highlight}. It is important in your alcohol recoveryprocess to notice the impact of alcohol on you whenalcohol is both present and absent {Awareness}. Younoticed in here that when alcohol is not present inyour life that you experience within your chest andshoulder area a feeling of calmness {E4-S} and lessapprehension {E6-S}. This calmness and lessapprehension is an easier {E4-S}, more relaxed {E4-S}feeling {Novelty}.Expanding the text. The pro-form "to just explorethat" refers to Sam's recent exploration of his internalexperience of alcohol outside the door. This is determinedby the therapist's following reference to Sam feeling calm,less apprehension, and easier in his chest and shoulder areaas alcohol was outside the door. The therapist againgestures to her chest and shoulder to signal what area sheis referring. She uses a mitigating phrase "a bit",indicating that Sam explored his internal state to a smalldegree which is consistent with regulating the intensity of222experiences.InteractionThe therapist affirms that Sam's muscles are tense whenalcohol is present and calm when alcohol is absent andthereby indirectly asserting that { -9} the presence ofalcohol bothers Sam. She then acknowledges the intensity ofemotions that Sam experienced in therapy and indirectlyexpresses that this intensity may result in { - 8} him feelingnot in control and thus, {25} feeling weak and a failure.She also indirectly interprets that the intensity of Sam'sexperience may be too high and thereby asserts theproposition {Non-intrusive} that she, as a therapist, willnot intrude upon intense experiences that emerge. She then{T-Highlights} highlights his strength in taking the risk toexperience his emotions, thoughts, and bodily sensations inthe therapy session and thereby she regulates the intensityof his experience. She then asserts the importance of Sambeing {Awareness} aware of his internal experience of {E4-S}calmness and {E6-S} less apprehension when alcohol is notpresent and thereby indirectly asserting that { - 9} thepresence of alcohol does bother him and, therefore,{Alcohol} alcohol should not be in their house. Talkingabout his experience serves to again regulate the intensityof his experience. The therapist also simultaneouslysummarizes Sam's experience {A-Feeling} of feeling calm whenalcohol was outside the door and thereby asserting {Novelty}223an alternate way of being without alcohol was experienced.Text 385 Sam: But see now that is really interesting to me..386 because ((gestures)) that happened and I just got387 finished saying that it doesn't bother me being in the388 house and seeing it and that ((points to table for 8389 seconds)) was a plastic bottle. (Th: *yes*) (hhh) I390 think the size of it is one thing that really....caught391 me. as well. ((drops hands on lap)) The visual size of392 it (Th: *yeah* ((nods))) because the impact of alcohol393 in my life (hhh) for a bottle of this size ((hand394 indicates size)) is about as big as that in the impact395 [you know so:ExpansionSam: Yes, I do realize that I felt {E4-S} calm, {E6-S}less apprehensive, and an {E4-S} easier feeling whenalcohol was outside the door { -9}. But, what puzzlesme is the contradiction within myself {Split} betweenbeing affected and not affected by alcohol and thecontrasting feelings of tension and calmness in regardsto alcohol either being present or absent. I know thatI experienced feeling {E4-S} calmness and {E6-S} lessapprehension when alcohol was outside, yet, I had justfinished saying to you both that the presence ofalcohol in our house did not bother me {9}. Obviously,I was not really aware of the effect the presence ofalcohol had on me because it only took a plasticalcohol bottle, not even a real alcohol bottle, toimpact me so strongly. I am feeling so puzzled by myresponse in here to alcohol that I want to try tounderstand what happened to me by analyzing {7-S}. Ithink part of my strong response was due to the largesize of the plastic bottle. It represented the largeimpact that alcohol has on me in my life. The impactof drinking an actual bottle of alcohol, which isapproximately 6" tall, is actually as large as that bigplastic bottle. I recognize that sometimes I minimize{12} or am not aware of how big an impact alcohol hason me {Novelty}.Expanding the text. The discourse marker "now"represents a change in the time frame of the conversation.Sam wants to focus on his present state of experiencing acontradiction within himself.224InteractionSam agrees with the therapist's interpretation. Hethen re-directs the conversation to {Split} the conflict,within himself; between the { - 9} alcohol bothering him or{9} not bothering him and the contrasting feelings of {E4-S}calmness and {El-S} apprehension and tension in regards tothe alcohol. He gives an evaluation of his earlierassertion, {9} that the presence of alcohol does not botherhim, based on his recent awareness and experience, andasserts {Split} the contradiction and thereby denies theproposition { -9}. He expresses feeling puzzled about the{Split} contradiction. He then begins analyzing {7-S} hisrecent experience in therapy and gives an interpretation of{Novelty} the change he experienced, which is that theimpact of alcohol on his life is larger than he thought andthereby {Experience} deepening the contrast of hisexperience and the impact of alcohol. A bottle of alcoholis in reality only 6", but the impact on his life is muchlarger, like the symbol, for example.Text396 Th:397^[Sure.. ((several head nods)) sure.. I appreciate398 ((gestures to her head)) your willingness to analyze399^(hhh) and.. uh what I'm-I'm noticing is that uh.... you400 were willing. AND YOU MAY NEED TO TAKE a bit of time401 off: ((gestures to and from self)) right now and you402 can do that inside yourself (Sam: sure ((rubs his403 neck))) or (hhh) ah I ((sharp hand gestures)) remember404 last week that. you wanted to=you're here to talk about405 your feelings (open hand gesture)) and yet (hhh) uh..406 it seems important that you take some time off for407 yourself. And.. so we're sort of ((long back and forth225408 gestures)) go in and out of feelings (Sam: hmhm409^((nods))) (hhh) and ah you ((gestures toward Sam)) can410 be in charge of that process. (hhh) So: ((looks toward411 Jill and continues with gesturing to her chest and412 shoulder)) Jill what is it like for you?.. that uh..413 Sam is saying uh after alcohol went out the door (hhh)414 that he's saying that.. uh for him the experience was a415 relaxing, easy, letting go a bit.. and ah ah...416^[ExpansionTh: I am noticing Sam that you are beginning to analyze{7-S} how the symbol of alcohol impacted you. However,I want to ensure that you do not feel criticized by meand therefore do not get defensive {15} when I talkabout your tendency to analyze. Consequently, I willhighlight the strength I observe in you, which is yourwillingness to analyze {7-S} and understand what ishappening to you {T-Highlight}. I remember last week,we identified your tendency to go in and out offeelings when the intensity of these feeling get to betoo much for you {Safety}. One of the ways wediscovered that you create safety for yourself is toanalyze. And you may need to now take some time foryourself {Safety} and experience the effects of puttingthe alcohol outside the door. This may mean analyzing{7-S} quietly to yourself. I also remember last weekyou said that you are here, in therapy, to talk aboutyour feelings and, yet, it was also important for youto create a sense of safety by going in and out of yourfeelings {Safety}. Doing so, is an acceptable andappropriate way to be in therapy Sam. Although yousaid you wanted to talk about your feelings, Irecognize that for you it seems important to take timeoff from experiencing your feelings {Safety} byanalyzing {7-S}. What we have been doing here today,is going in and out of feelings. Sam, you can be incharge of your own process of going in and out offeelings. I want to now focus on your experience,Jill, and ask you about your experience? {Awareness}That is, what happens to you {Awareness} when Sam saysthat after alcohol was put outside the door he feelsrelaxed, easy, and letting go a bit of his ...?Expanding the text. This speech utterance is expandedto include information presented in session one, at whichtime the therapist and couple discuss Sam moving in and outof intense feelings and his desire to be attentive during226the therapeutic process. In the first session, thetherapist acknowledged Sam's pattern of experiencingfeelings and then stopping feelings by analyzing. She alsotalked about the importance of developing a sense of safetywithin himself which may mean that Sam experiences feelingsfor a while and then analyzes.InteractionThe therapist interrupts Sam and acknowledges hispreceding interpretation of the symbol as well as histendency {7-S} to analyze. To prevent the possibility ofSam becoming {15} defensive, the therapist {T-Highlight}highlights his strength in being willing to understand and{7-S} analyze himself. She then refers to the previoussession and interprets that Sam's tendency to analyze is hisway of {Safety} attaining a sense of safety when emotions orexperiences are intense and thereby she reduces theintensity of his recent experience. By explaining thefunction of his behavior, the therapist helps bring intoSam's awareness his pattern of going in and out of feelingsand that analyzing serves to protect him from intenseemotions and experiences and thereby, {Convey} normalizinghis internal process. The therapist supports Sam being inhis process by giving him the responsibility to decide whenhe will feel emotions and/or analyze his experience. Shealso reminds him of the importance of creating a sense ofinner {Safety} safety. The therapist then re-directs the227conversation to Jill. She indirectly requests that Jillfocus on her internal experience and thereby, asserting{Awareness} that Jill develop awareness of her inner processas well as simultaneously asserting {Relational} that bothspouses are affected by alcohol dependence.An externalization intervention, in ExST, requires thatboth spouses experience their relationship to the alcoholdependence which also supports the concept {Relational} thatalcohol is a relational experience affecting both spouses.The therapist then gives information and explains that shewants Jill to focus on her experiences when Sam expressedfeeling more relaxed, etc., when alcohol was put out thedoor.Text417 Jill:^ [less418 apprehension ((leans back slightly))ExpansionJill: Since I listen closely to what Sam says, I willtell you that I heard Sam say he felt less apprehension{E6-S} when alcohol is outside the door.InteractionJill interrupts the therapist and finishes hersentence. Jill helps the therapist remember what Sam saidand thereby, indirectly asserting that {23} she is caringand attentive toward Sam as well as fulfilling her role {W-Support} of being supportive and attending to her husband'sneeds.Both in the first and subsequent therapy sessions, Jill228often refers to it being important for her to listen andlearn about Sam's experiences and problems associated withalcohol. This is consistent with her earlier assertion thatshe wants to know what Sam thinks and says so as to not saythings that may result in him becoming defensive, mean, andintimidating her, and thereby protecting herself.Text419 Th: LESS APPrehension (Jill: *yeah*) ((Sam smooths his420 hair)) calming himExpansionTh: Putting alcohol outside the door resulted in Samfeeling less apprehension {E6-S} and also calming {E4-S} him which indicates that the presence of alcoholdoes bother him { - 9}.InteractionThe therapist continues with her preceding speech turn(i.e. request) and repeats Jill's words. Jill reinforcesthe therapist. The therapist adds that Sam felt calm whenalcohol was outside the door and thereby indirectlyasserting that { - 9} the presence of alcohol does bother Sam.Text421 Jill: ((fidgets with her fingers)) I have always422 wondered why^ we.. keep alcohol in the house423 when... he's not drinking. ((flicking away gesture424 and therapist moves her chair)) I mean.. ok.. ((tilts425 head to the right)) I-I still ((holds hands open on426 lap)) will have the occasional glass of wine427 ((therapist nods)) but very rarely ((looks at Sam and428 Sam moves hand to face)) unless somebody else is429 around.ExpansionJill: What happened in here today with Sam confirmswhat I had always thought, which is that having alcohol229in the house bothers Sam when he is not drinking { - 9}.Having always thought this, it has not made sense to mewhy he would want alcohol in the house when he was notdrinking {17}. There would be no point having alcoholpresent unless he thought it was for my benefit. Iadmit that I still have the occasional glass of wine,but this occurs very rarely and only when we haveguests in our home. However, my occasional drinking isnot a good reason to keep alcohol present when Sam isnot drinking. Considering that I only drinkoccasionally, I do not have a need or desire for thealcohol to be in our house {19-J}. I am worried thatyou might be experiencing me as challenging your {?2}competence Sam and thus, getting defensive {15}.Hence, I will ask you whether what I have said so faris acceptable to you.Expanding the text. The word "we" is a mitigating formused to address Sam. Jill perceives it to be Sam'sresponsibility to get rid of the alcohol, not both of them.InteractionJill initiates a narrative in response to thetherapist's request with the point being that what occurredin the therapy with Sam confirms her belief that {Alcohol}alcohol should not be in the house. She asserts, throughuse of mitigation, that she has always wondered why Samkeeps alcohol in the house when he does not drink andthereby indirectly asserting that {17} Sam is responsiblefor quitting drinking and how he deals with alcohol. Jillthen gives current information about herself as sheindirectly asserts that {19 -J} she does not want or need thealcohol in their house. Jill then looks toward Sam andindirectly asserts her {4} fear that he will feel challengedand get {15} defensive by what she has said, and therebyJill indirectly requests affirmation from Sam that what she230has said will not result in him getting {15} defensive.Text430 Sam: hmhmExpansionSam: Yes, Jill what you are saying is acceptable and Ido not feel defensive { - 15}.InteractionSam proves reinforcement to Jill's request foraffirmation.Text 431 Jill: In fact_ ((leans back; opens hands)) Never.. ...432 I never drink on my own ((Sam clears throat)) or^433 um^ things like that so.^ um...... .... but I've434 stopped wondering about that as well becaus:e435 ((therapist leans toward Jill)) Sam has always436 reinforced ((rolling hand gestures)) that it doesn't437 matter. ((Sam shifts position)) Leave it there. And438 we never have a lot.. ((holds open hands on lap)) I439 mean:: ((Th: yeah)) we have got a [ExpansionJill: Since you agree Sam, I can continue expanding onmy previous comment without you getting defensive{ - 15}. I never drink alone. Considering that I onlydrink when we have guests, which occurs occasionally,there is no reason for either you or I to have alcoholin our house, Sam {19-J}. Hence, alcohol should not bein our house {Alcohol}. I am feeling hesitant as Iventure into talking about the contentious issue ofalcohol in our house because Sam may feel challenged byme and thus, get defensive {15}. But, therapist, youasked me about my experience, so I will continue andmitigate when I deem it necessary. I have also givenup wondering why Sam has alcohol in our house when heis not drinking because he always reinforced thathaving alcohol in our house does not bother him {9}.He has always said to leave the alcohol in our house{17}. I did not interfere with his decision {20} toleave alcohol in the house because he would becomedefensive and mean {15} and this scared and intimidatedme {4}. I had always wanted Sam to get rid of thealcohol because I thought that having alcohol in the231house was an ineffective way of dealing with quittingdrinking {?2}. I am aware that I may be challengingyour competence in how you deal with alcohol {?2} againSam, which may result in you getting defensive {15}.So, I will be careful to not criticize you, Sam, bychanging the subject and talking about the quantity ofalcohol in the house. I just want both of you to knowthat I do not think Sam is completely incompetent orineffective in dealing with the alcohol {2} which isevident by him not keeping much alcohol in our house.He only has one bottle in the house now.Expanding the text. Jill begins by stating factuallythat she never drinks alone and then lets the sentence trailoff by pausing at length and saying "things like that so"which serves as a form of mitigation. She hesitates andpauses again before resuming with her speech turn. The nextsentence which begins with "but" refers back to Jill'spreceding statement in which she said she has alwayswondered why Sam keeps alcohol in the house. That is, shealways wonders and, yet, she has also stopped wondering.Before completing this statement, Jill begins to pause andself-interrupt indicating she may be worried about Sambecoming defensive.InteractionAfter receiving affirmation from Sam that he is { - 15}not defensive, Jill continues giving information aboutherself not drinking much. She repeats her assertion {19-J}that she does not want alcohol in their house and thereby,indirectly asserting that {17} Sam is responsible forkeeping alcohol in the house, not her, and that he shouldget rid of it because {Alcohol} alcohol should not be in232their house. Jill then hesitates and indirectly expressesconcern that {?2} Sam may feel his competence challenged asshe talks about {17} his way of dealing with alcohol,resulting in him possibly getting {15} defensive, andthereby she reduces the intensity of her assertion. Jillcontinues giving information about why she stopped wonderingwhy Sam keeps alcohol in the house when he is not drinking,and thereby asserting that {17} Sam is responsible forquitting drinking and handling alcohol related concerns andthat {20} she did not interfere due to feeling {4} fearfulof his {15} defensiveness and meanness. Jill alsoindirectly asserts a challenge to Sam about {?2} not beingcompetent and effective in dealing with alcohol. After sheindirectly challenges his {?H-Head} authority as head ofhousehold, Jill re-directs the conversation to preventingSam { - 15} from getting defensive. Jill gives informationabout the small quantity of alcohol in the house and therebyindirectly asserting that due to Sam not keeping muchalcohol in the house he is demonstrating {2} some competencein dealing with alcohol. This last utterance is used todiffuse { - 15} Sam's defensiveness and to demonstrate hersupport for him and thereby indirectly asserting {23} she iscaring and attentive toward Sam. Sam interrupts Jill andshe responds affirmatively to his comment and withdraws fromverbal interaction, allowing him to speak. The emphasis ondiffusing Sam's defensiveness also serves to reduce the233intensity of Jill's internal experience.Text440 Sam:441 xxx[we usually drink it Text442 Jill:^ a bottle of.. Well443 yeah ((looks at Sam)) y-you...Text444 Sam: We'll bring a bottle home and it will be gone in445 that night basicallyExpansionSam: When Jill and I buy alcohol we tend to buy onebottle of alcohol at a time and drink it all withinthat night. In other words, I agree with Jill thatthere usually is not much alcohol in our house {12-S}.InteractionSam interrupts Jill and attempts to finish hersentence. He interprets Jill's preceding utterance asindicating that she is supporting his {12-S} tendency tominimize the problem of having alcohol in their house andthereby asserts his agreement {2} that he is competent indealing with alcohol. However, his response is not directlyrelated to what Jill is saying. Jill is talking about thealcohol in the house since he quit drinking, while he isreferring to past incidents when they have drunk together.Text 446 Jill: Yeah. ((rubs face and neck)) But I mean also when447 you are not drinking there's never a lot there. There448 is a like a little bit (Th: So ((therapist leans449 forward with hand extended))) of Brandy (Th: So-So)450 for.. baking (Th: So what's) my cakes and things like451 that (hhh)234ExpansionJill: Sam, I agree that during your drinking periodswhen we would bring a bottle of alcohol home we woulddrink the entire bottle of alcohol within that night.But, what I meant in my last comment is that when youhave stopped drinking you never have a lot of alcoholin the house. This means to me that you are {2}showing some competence and effectiveness in dealingwith your alcohol problem. Therapist, I use the littlebit of Brandy that is in our house for baking my cakesand other items, which is an acceptable way of helpingSam get rid of the alcohol.Expanding the text. Jill's affirmative response is inrelation to Sam's preceding remark. The discourse coursemarker "but" is used to indicate on the contrary. Jill'suse of mitigation entails using impersonal and indirectpronouns. The phrase, "like a little bit of Brandy" isanother form of mitigation used by Jill.InteractionJill agrees with Sam's assertion about them not havingmuch alcohol in the house when he was drinking. She thenre-directs the conversation to her preceding assertion whichrefers to the times when Sam was not drinking. Jill thenre-asserts that she considers Sam {2} to be competent andeffective, to some extent, in dealing with the alcohol.Jill then gives information to the therapist about what shedoes with this small quantity of alcohol. She indirectlyasserts her method is an acceptable way to help Sam get ridof the alcohol in the house. Jill's use of mitigation inthis speech turn is used to prevent Sam from { - 25} feelingweak and a failure, due to her {?2} challenge of his235competence, and thus { - 15} not becoming defensive and meantoward her.Text452 Th: Yeah: ((gestures to and from mouth)) So you are453 filling me in with some of the details and.. uh454 ((rotating hand gesturing)) letting me know that uh....455 ((fingers move as if in dialogue)) it's easy to get456 into a discussion about how much you had or what you457 did with it how quickly it went. (Jill: hmhm458 ((fidgeting with fingers))) And kind of easy ((moves459 hand across forehead)) to get into our heads and you460 might notice ((gestures to chest and shoulder)) Sam461 what's happening to these muscles right now and um..462 ((gestures up and down her torso)) what's it-what's it463 like internally for you Jill' ^now that ((gesturing464 to her body))ExpansionTh: Yes, I understand that the alcohol in the house isa contentious issue that results in you, Sam, {15}becoming defensive when you think Jill may bechallenging {?2} your competence in dealing with thealcohol, and Jill, you have your own opinion about thealcohol in the house and are careful to try to diffuse{15} Sam's defensiveness because he can become mean,which you {4} fear {Convey}. So, to avoid thechallenges, defensiveness, intimidation, and feelingsof weakness and fear, both of you engage in deflectionby discussing how much alcohol you had in your housewhen Sam drank and when he is sober, what you did withthe alcohol in your house, and how quickly you got ridof the alcohol by either drinking the alcohol or usingit for baking purposes. Your use of deflection, inresponse to my earlier question, informs me that whenthe subject material is intense or contentious, bothyour tendency is to diffuse the issue by becoming morecognitively oriented and to analyze or explain {7 -S,J}rather than experience the intensity. Taking intoaccount what I said, I would like you, Sam, to noticewhat is happening in your chest and shoulder muscles atthis moment {A-Bodily} as you analyze {7-S} and are notexperiencing your feelings {"A-Feeling}. I am alsoaware of not wanting to intrude upon you, Jill, {Non-intrusive} and causing you to feel afraid andintimidated {4}. I know that Sam can get defensive{15} and mean when he thinks you are challenging himabout his {?2} competence in how he deals with hisalcohol dependence. However, I will venture forth and236ask you about your experience, but will also berespectful and attempt to not be intrusive {Non-intrusive}. So, Jill, what do you experienceinternally at this moment? {Awareness}InteractionThe therapist acknowledges that alcohol in the house isa contentious issue that results in {15} Sam feelingdefensive if he thinks Jill is challenging {?2} hiscompetence in how he deals with alcohol and, yet, Jill hasher own opinion about the alcohol in the house which shedoes not directly assert due to {4} feeling afraid andintimidated by Sam's {15} defensiveness. The therapistinterprets that the couple deflects from this contentiousissue by becoming more cognitively oriented and {7-S;J}analyzing and giving information which then serves toregulate the intensity of their experiences. She also {T-Common} accents their commonality in using analyzingbehavior. By explicating their pattern of analyzing, thetherapist brings to the clients' awareness their pattern oftalking about their behavior and being more cognitivelyoriented when that particular contentious issue is raised.Once they become aware of their pattern they then have achoice about how they respond and to also takeresponsibility for their choice. The therapist thenredirects the conversation to {Here} the here and now byindirectly requesting that Sam focus and become aware of his{A-Bodily} internal bodily sensation as he {7-S} analyzes.The therapist then indirectly acknowledges Jill's {4} fear237of Sam's {15} defensiveness and intimidation and therebyindirectly asserts {Non-intrusive} not wanting to intrudeupon Jill feeling {4} fear and intimidated. She then re-directs the conversation and indirectly requests that Jillfocus internally and become {Awareness} aware of herinternal experience {Here} at this moment and therebyasserting that {Awareness} clients are to develop awarenessof their inner process.Text465 Jill: Right now?ExpansionJill: Are you asking to describe what my internalexperience is at this specific moment {Here} or todescribe my internal experience when Sam shared hisfeelings of being less apprehensive, more relaxed, calmand feeling easier after he put alcohol outside thedoor?InteractionAs Jill requests more information she uses the rules ofembedded requests. Jill is perceived as asserting a needfor more information before being able to respond to thetherapist's request.Text 466 Th: Yeah: Now that um.. ((gestures to shoulder)) Sam467 shared with you that with=me=too=with=us that he felt468 more relaxed.... and um.... ((gestures to Jill and Sam469 turns head toward pictures on the wall)) I noticed how470 patiently you listened to him.... and uh I'm=just471 wondering what it is like for you inside? ((gestures472 to her body))ExpansionTh: Yes, I am asking you to describe what you238experience internally at this moment {Here; Awareness}since Sam shared with us that he felt less apprehensive{E6-S}, easier, and calm {E4-S} in his chest andshoulder area after alcohol was outside the door { - 9}.Again, I am aware that we may be venturing into asensitive area which may result in intense emotionsemerging. Hence, I do not want to intrude upon yourfeelings of fear and intimidation {4} {Non-intrusive}that result when Sam gets defensive {15} because hethinks you are challenging {?2} his competence indealing with the alcohol. So, instead, I will diffusethe intensity of your feelings by highlighting yourstrength Jill {Highlight}. I noticed how patiently youlistened to Sam when he was talking about hisexperience with alcohol which indicates yourattentiveness and support for him {23}. I wonder whatyou experienced internally, inside your body, as youlistened patiently to Sam share his internalexperiences when alcohol was outside the door?{Awareness}Expanding the text. The discourse marker "now that"represents a change in the direction of the conversation.The therapist wants Jill to describe her internal experiencesince Sam shared his feelings of being more relaxed, lessapprehensive, calm, and feeling easier. The therapistindicates, by gesturing to her chest and shoulder area, thatshe is referring to the feelings in Sam's chest after thealcohol was outside the door. The therapist then self-interrupts and her words are spoken rapidly as she correctsher statement about Sam sharing feelings with both of them.InteractionThe therapist responds directly to Jill's request forinformation and responds affirmatively to focusing on {Here}the present moment. She then gives more informationexplaining her request in more detail. The therapist thenhesitates and pauses as she indirectly expresses concern239about intruding upon Jill possibly feeling intense emotionsof {4} fear and intimidation, which are associated with Samgetting {15} defensive when he perceives Jill's experienceto be challenging {?2} his competence and effectiveness indealing with alcohol, and thereby asserting her desire to{Non-intrusive} not intrude. Subsequently, the therapistlessens the intensity of Jill's experience by {Highlight}highlighting Jill's strength {23} of patiently listening andattending to Sam and thereby she indirectly asserts thatJill is competent in her role as {W-Support} the supportivewife by not challenging Sam when he spoke. HighlightingJill's strength {23} also serves to {24} elevate Jill'sstatus in the marital relationship. That is, Jill is arespectful, attentive and caring person who is not intent onhurting Sam. This elevation in status also serves tohighlight for Sam that Jill is caring and does not want tonegate his competence. The therapist then re-directs andrepeats her earlier request, suggesting {Awareness} thatJill develop awareness and experience her internal process.Text 473 Jill: We:ll. ((therapist looks at her watch and leans474 forward)) I feel ((flicks back head and hair))475 uh^ like I-I'm taking note ((rapid hand476 gesturing)) of everything that he's saying ((fidgets477 with fingers)) because (Th: *yeah* ((nods 7 times))) it478 is important to me ((points to herself)).479 Like=really=important=to me to know.. how he feels....480 exactly.. so I feel^ uh that I've learned481 ((gestures toward therapist)) something from that. (Th:482 *yeah*)I ((gestures to self)) don't feel any different483 per se [as far as physically...240ExpansionJill: Well, I am feeling concerned about expressing howI feel because I am afraid {4} that Sam will think I amchallenging him which will result in him behavingdefensive and mean {15} toward me. To prevent thisfrom happening, I will be careful about what I say. AsI listened to Sam share his feelings of relaxation,etc., after the alcohol was outside the door, I amaware of carefully attending to all Sam said about hisexperience with alcohol {A-Cognition} becauseeverything Sam says and how he feels exactly is veryimportant to me {23}. If I know what he feels andthinks about the alcohol, then I can be careful to notsay or do things that may offend, criticize orchallenge him and thus, this would prevent him fromthinking I am challenging him about his competence{ -?2}. Hence, he would not feel weak and a failure{ - 25} and get defensive and mean with me { - 15}.Knowing what Sam experiences helps me to protect myselffrom his defensiveness and meanness {15}. Consideringthat Sam's exact feelings and experiences are veryimportant to me, I have learned today that he feelsless apprehension, calm, more relaxed and easier insidehis chest and shoulder area when alcohol is not presentand he feels tense when alcohol is present {A-Cognition}. I, however, in response to your request ofmy physical state, therapist, do not feel physicallydifferent per se when Sam shared his feelings inrelation to alcohol being outside the door {"A-Bodily}.Expanding the text. The discourse marker, "well""refers backward to some topic that is already sharedknowledge among participants. When 'well' is the firstelement in a discourse or a topic, this reference isnecessarily to an unstated topic of joint concern" (Labov &Fanshel, 1977, p. 156). In this utterance, Jill isreferring back to the preceding information disclosed aboutfeeling afraid and intimidated when Sam gets defensive andmean when he thinks she is challenging him. Jill describesherself as "taking note" which is defined as "to observe ortreat with special care" (Webster's ninth new collegiate 241dictionary, 1983, p. 1203), what Sam says because hisexperiences are important to her. She places stress on thewords "exactly" and "me" and points to herself whichsuggests that his experiences are very important to her. Insession three, Sam talked about not sharing his feelingsabout the alcohol cravings and other related alcoholconcerns because he had determined that alcohol was hisproblem to conquer. Furthermore, Jill stated, in the firstsession and in the earlier segment of this session, that shehad learned more about how Sam feels in relation to alcoholin session one because he had not ever given her thisinformation. The reason for knowing what Sam experiencesand what she learned regarding Sam's feelings is madeexplicit.InteractionJill responds indirectly to the therapist's request.She initially expresses {4} feeling fear and intimidationabout expressing her experience because Sam may {?2} thinkshe is challenging his competence in dealing with alcoholand then get {15} defensive and mean and thereby, sheasserts that she will respond carefully to the therapist'srequest in order to protect herself. This assertion servesto also reduce the intensity of Jill's experience. Jillthen asserts she intently listened to Sam speak {23} becauseshe wants to learn about his experiences with alcohol whichwill in turn help her learn how to respond to him and242thereby protect herself from {15} his defensiveness. Jillthen re-directs the conversation to herself and asserts thatshe does not { -A-Bodily} feel physically different.Text 484 Th:^[ah how do you feel inside? ((therapist gestures485 to her own body))ExpansionTh: So if you are not aware { -A-Bodily} of feelingphysically different, how do you feel inside your body?{A-Feeling}InteractionThe therapist interrupts Jill. Considering that Jillsays she is not aware { -A-Bodily} of her physicalsensations, the therapist then requests how Jill feels {A-Feeling} and thereby asserts that Jill {Awareness} developawareness of her feelings. The therapist implementsinterventions/requests to aid Jill in becoming aware of herinternal physical and emotional state in the here and nowand to gradually intensify her experience.Text486 Jill: um^ I feel.. ((Sam sniffles and487 turns toward Jill and therapist)) um.... normal,488 Really. I'm=just.. ((rapid rolling gestures)) taking489 it in (Th: ok (hhh))) CALM I guess. ((holds hands490 open)) I feel calm [ExpansionJill: I am aware of feeling the way I normally feel {A-Feeling}. I am primarily aware of listening and takinginto my mind what Sam says about his feelings andexperiences in the therapy session {A-Behavior} so thatI can learn how to be around him without him thinking Iam challenging him { -?2}. As I continue focusinginternally, I begin to be aware of feeling calm {E4-J}.243Yes, I definitely feel calm {E4-J}.InteractionJill directly responds to the therapist's request,expressing that she is aware {A-Feeling} of feeling hernormal feeling. She then asserts what she is aware {A-Behavior} of doing, which is to listen to and understandSam. This assertion is consistent with both Jill's earlierassertion that {23} she is caring and attentive toward Samand that she wants information to protect herself from his{15} defensiveness and meanness. Jill regulates theintensity of her experience by deflecting and focusing onSam. The therapist provides reinforcement. Jill thenhesitantly expresses awareness {A-Feeling} of {E4-J} feelingcalm and then asserts this feeling more definitely and thus,Jill develops {A-Feeling} awareness of and experiences thisfeeling.The long pauses and hesitations suggest Jill isattempting to identify and describe her feelings which ispossibly due to not often identifying her feelings. Thisinterpretation by the analyst is verified in session four,at which time Jill asserts that expressing feelings isunfamiliar to her. The therapist interrupts as Jill pausesmomentarily.Text491 Th:^ [Yeah ((gestures outward)) so492 you feel some calm too and.. sort=of, sort of your493 normal feeling (Jill: yeah) and when you feel calm494^[..244ExpansionTh: I understand that you also feel calm {E4-J}, asdoes Sam {E4-S}, plus you have your normal feeling.When you feel calm...Expanding the text. By saying, "too" the therapist isreferring back to Sam, who also felt calm. The therapistwas about to further explore the calm feeling when Jillinterrupted.InteractionThe therapist acknowledges that Jill feels {E4-J} calm,as did Sam {E4-S} when alcohol is not present, and feels hernormal state and thereby accents {T-Common} commonexperiences between the couple. The therapistsimultaneously heightens and deepens Jill's calm feeling andis about to continue when interrupted.Text 495 Jill: [I ((wriggles fingers)) shouldn't say I feel calm496 I'm picking at my fingers I'm not ((laughing and looks497 at Sam)) really as calm as I think I amExpansionJill: As I continue becoming aware of my internalstate, I am aware of picking at my fingers and,therefore, I should not say that I feel calm {"E4-J}.Picking {A-Behavior} at my fingers indicates to me thatI am not really as calm { - E4-J} as I think I am{Split}. Recognizing this contradiction within myselfresults in me feeling anxious and awkward and, so todeflect from this feeling, I laugh.Expanding the text. Jill wriggles her fingersaccenting that picking at her fingers implies she does notfeel calm. Her laughter suggests that she feels anxious andawkward and thus, uses humour as a deflection.245InteractionJill interrupts the therapist and contradicts herprevious assertion of feeling { -E4-J} calm as she developsawareness {A-Behavior} of her behavior and the {Split}contradiction, which is between what she thinks she feelsand with what she is actually doing to her body. Jill thengives an interpretation of her behavior as not feeling {"E4-J} calm. She uses laughter as a deflection when she gainsthis awareness about herself and thereby lessens the impactof this contrasting feeling. Essentially, Jill isdeveloping awareness of both her internal and externalstate.Text498 Th: ((laughs, gestures to her head and Sam shifts499 position)) part of you that uh takes another500 perspective (Jill: yeah) that says "hey just wait a501 minute ((wriggles fingers)) notice what I am doing with502 my fingers" ((joking tone of voice)) [ExpansionTh: Jill, I recognize that this experience of becomingaware of the contradiction within yourself {Split}results in you feeling anxious, which is evident by youusing humour to deflect. And again, I do not want tointrude upon you when you experience this intenseemotion {Non-intrusive}. So, instead, I will becautious and join you in your laughter as I note andhighlight {T-Track} your recent experience. I noticethat you have become aware of your feelings of calmness{E4-J} and, yet, another part of you has a differentperspective {Split} besides feeling calm { -E4-J}. Thisother part of you does not feel calm and the way youknow this, Jill, is by your fingers wriggling {A-Behavior}. It is almost as if this non-calm part letsyou know it is present by saying to you, "Hey just waita minute, I am not feeling calm { -E4-J} which isapparent if you notice what I am doing with my fingers"{A-Behavior}.246InteractionThe therapist acknowledges that Jill may be feelinganxious due to her using humour to deflect, and thus, thetherapist indirectly asserts caution about {Non-intrusive}not wanting to intrude upon Jill when she experiencesintense emotions. The therapist then {T-Track} notes andhighlights, through use of humour and matching Jill's styleof speech, the {Split} contradiction within Jill, whichincludes a calm part and an emerging non-calm part, andthereby regulates the intensity by gradually {Experience}heightening and deepening Jill's contrasting feelings. Thetherapist then, by using humour, which is evident by herlaughter and her singsong voice, gives a voice to Jill'snon-calm part. She gives an interpretation of this fingerpicking as informing Jill when she is not calm and therebyasserts that Jill is {A-Behavior} aware of what her behaviormeans. That is, Jill's body informs her about what shefeels and thus, Jill should notice her fingers to help herdevelop awareness of her internal state.Text503 Jill:^ [I notice what I504 did last week. I picked at my skin ?here?505 ((inflection; points to hand and looks at Sam)).. and I506 was all red.. ((Sam laughs and therapist nods head)) so507^I mean...ExpansionJill: Last week, I noticed that during our therapysession I had picked at my skin right here on my hand,Sam, which resulted in reddening of my hand {A-Behavior}. Considering that I am picking at my skin247during the therapy sessions this indicates to me that Iam obviously not as calm { -E4-J} as I think I am {A-Feeling} when we discuss our experiences with alcohol.So, what I suppose this means is that I do have somefear about expressing my experiences about alcohol withyou, Sam, but I do not want to tell you I feel fearful{El-J} at this moment because you may interpret this asme challenging you, which is not what I am doing { - ?2}.InteractionJill interrupts the therapist to initiate a narrativeproviding orientation to time (last week), place (therapyroom), person (herself), and behavior (picking at herself).She then gives an evaluation of the narrative which is thatshe is not really calm in the therapy sessions, which arefocused on discussing the alcohol dependency. Jill thenindirectly asserts that the reddening of her skinmetaphorically represents her {El-J} feelings of fear andapprehension about discussing the alcohol dependency becauseof Sam's {15} defensiveness and intimidation, and thereby{Experience} heightening and deepening the contrastingfeelings of fear and apprehension.Text508 Th: So there is some ((rolling hand gestures)) fear and509 apprehensionExpansionTh: So, Jill you have noticed {A-Behavior} that yourpicking at your skin means that you feel some fear andapprehension {El-J} while in the therapy sessions whenwe discuss the alcohol dependency. You feel fear andapprehension {El-J} because what you say may result inSam feeling challenged {?2} and thus, getting defensive{15} and becoming mean and intimidating with you, whichyou fear {4}.248InteractionThe therapist completes Jill's preceding sentence andgives an interpretation of Jill's finger picking behavior asher feeling {El-J} fear and apprehension about Sam feeling{?2} challenged by her if she discusses her feelings andconcerns about the alcohol and thereby, she {Experience}heightens and deepens Jill's contrasting feelings of fearand apprehension.Text510 Jill: Yeah. ((nods 3 times)) there is, there isExpansionJill: Yes, therapist, you are correct, I do feel fearand apprehension {E1-J} about discussing my feelingsand thoughts in regards to the alcohol.InteractionJill strongly agrees with the therapist'sinterpretation and advanced empathy that she feels {E1-J}fear and apprehension, which is evident by her repeatedassertion and head nod, yes, and thereby {Experience} sheheightens these contrasting feelings.Text511 Th: Ok (hhh)ExpansionTh: Ok now we are in agreement that you, Jill, feelsome fear and apprehension {E1-J} while we discuss thealcohol dependency.InteractionThe therapist reinforces Jill's feeling of {E1-J} fear249and apprehension and continues to {Experience} heighten anddeepen Jill's contrasting feelings.Text512 Jill: Yeah so=I'm.... ((sharp downward gestures)) but513 as far as what Sam said I've taken it in.. ((gestures514 to self)) (Th: *Yeah* ((nods))) and uh... ... I feel515 good about.... what he said because it-I've learned516 from it. (Th: *yes*) ((looks at Sam)) I think when we517 go home we'll^ if that is what you want we can just518 get rid of IT.ExpansionJill: Yes, I am feeling fear and apprehension {E1-J}which I want to lessen for myself. I am also beginningto feel concerned about discussing my fear because whatI have to say may result in Sam interpreting it as achallenge {?2} to his competence and I want to avoidhim getting defensive 1 - 151. So, to diffuse anydefensiveness, I will focus on what Sam said which willbe a safe topic to talk about and it will also lessenmy feelings of fear. If I repeat what Sam says then Ican be assured that I will not be challenging him{ - ?2}. As far as what Sam said earlier, I haveinternalized this information which feels good to mebecause now I have learned how he feels and what hethinks in relation to alcohol. This information willhelp me to now not to say things that result in himfeeling challenged { -?2} and becoming defensive {15}and then intimidating me. Sam, considering what yousaid about feeling calm, relaxed, less apprehension,and easier when alcohol is not in your presence, Ithink when we go home today, and if you agree {17},that you should get rid of the alcohol in our house{Alcohol}. Even though we have both agreed to notwanting the alcohol in the house, I still respect thatyou want to make the decision about how you handlealcohol, so I will let you decide to get rid of it{17;20}.Interaction Jill agrees that she feels {El-J} fear andapprehension. She then interrupts herself and re-directsthe conversation from discussing her fear because she wantsto lessen the impact of these contrasting feelings both250within herself and in relation to Sam. She indirectlyasserts feeling concerned that Sam may interpret what shesays as {?2} challenging his competence in dealing withalcohol which results in him getting {15} defensive and thenintimidating her. She then diffuses Sam's possibledefensiveness by re-directing the conversation to things shelearned from Sam. She indirectly asserts that learning whathe thinks and feels in relation to alcohol will aid her{ -?2} in not challenging him and thus, not { - 4} feelingfearful and intimidated by him. She expresses feeling goodabout learning how Sam is affected by the alcohol andthereby, asserting that she is competent in her role {W-Support} of wife, which is to understand and help herhusband. The therapist provides reinforcement. Jill thenindirectly asserts to Sam that he get rid of the alcohol inthe house and thus, asserts that {Alcohol} alcohol shouldnot be in their house. She uses a mitigating form to assertthat this action would only be performed if Sam wants andshe is therefore not challenging either his authority as{"?H-Head} head of household nor { - ?17} his responsibilityin making alcohol related decisions. Jill simultaneouslyasserts that her role as {W-Support} wife is to besupportive and not {20} interfere with her husband'sdecision. Jill is offering her support to Sam to get rid ofthe alcohol based on how he is negatively affected by thealcohol. By shifting the focus onto Sam, she reduces the251intensity of her fear.Text 519 Sam: (hhh) Yeah see I'm thinking that it doesn't bother520 me (Jill: yeah) but it mustExpansionSam: Yes, I will get rid of the alcohol in our house{19-S; Alcohol}. I realize that I have all along beenthinking {A-Cognition} that the presence of alcohol inour house does not bother me {9}. But, considering howI responded by feeling less apprehension {El-S}, calm,relaxed, and easier {E4-S} when I put alcohol outsidethe door in this session, this experience has proven tome that I obviously must be bothered by the presence ofalcohol in our house { -9; Novelty}. I accept that thepresence of alcohol bothers me { -9;Novelty}.Expanding the text. The discourse marker "see" means"to grasp something mentally" (Webster's ninth newcollegiate dictionary, 1983, p. 1062). Sam grasped therealization that he actually was affected when alcohol waspresent. He then places contrastive stress on the word,"must" which again indicates that the presence of alcoholdoes bother him, as opposed to not bothering him as heoriginally claimed.InteractionSam agrees to Jill's request to get rid of the alcoholand thereby indirectly asserts {Alcohol} alcohol should notbe in the house. He then re-directs the conversation backto the contradiction of his earlier assertion {9}, that thepresence of alcohol does not bother him, and to the contrastin feelings he experienced. He gives an evaluation of thisassertion {9}, which is based on him experiencing {Novelty}252a definite change within himself when the alcohol wasoutside the door, and thereby he denies that { - 9} thepresence of alcohol does not bother him. Sam redefines forhimself, and is more accepting, that he is bothered by thepresence of alcohol.Text 521 Jill: but it must doExpansion Jill: I know that you thought that the presence ofalcohol did not bother you {9}. But I agree with youthat based upon your experience in here today withfeeling less apprehension {E6-S} and calm {E4-S} whenalcohol was not present, that you must be bothered bythe presence of alcohol { - 9; Novelty},InteractionJill agrees with Sam's { - 9} interpretation andredefinition by repeating his last phrase. Thus, they haveboth come to the {Collaborate} same realization andagreement that the presence of alcohol does adversely botherSam.Text522 Th: So: (hhh) ((gestures with hand; Sam looks toward523 pictures on the wall)) you're willing to be honest and524 to know that.... there's more to the situation than525 we're normally aware of. There is much more and you526 are willing to be open to new information. (Jill:527 hmhm) ((Sam turns back toward Jill and therapist))528 (hhh) And what some of the feelings that I imagined529 you had toward Sam was ah (hhh) a lot of caring (Jill:530 *Oh yeah*). You are feeling attentive towards him,531 ((rests head on chin)) listening, ah being concerned.532 It sounds like you are very caring and concerned about533 him. (hhh) And also you had a feeling of sort of OH534 YEAH feeling of sort of inner familiar state, fairly535 calm.^((fidgeting with her fingers)) But somewhere536 ((singsong voice)) there's a little bit of agitation.253537 (Jill: hmhm) It was kind of in your fingers. You're538 kind of picking at-at yourself a bit. It reminded you539 of what happened last week. (Jill: hmhm) OK. I540 appreciate knowing those details. So-uh ((Jill541 scratches face and fidgets with fingers)) there's some-542 something in the fingers that lets you know that uh..543 hey all is not so calmExpansionTh: Considering that I noticed you, Jill, deflectingfrom the intense feelings of fear and apprehension,this informs me that maybe the deepening of thesefeelings is not appropriate for this session. So,instead, I will also aid in reducing your intensefeelings (Non-intrusive}. I will then take a momentand highlight the strengths {T-Highlight} andcommonalities {T-Common} that I observe in both of you.I notice that you are both willing to be honest andacknowledge to yourselves and each other the changesand discoveries that you respectively experienced inhere today even when intense emotions were experienced{T-Highlight; T-Common; S-Share}. As well, you bothare willing to accept that there are aspects of ourawareness that are hidden from us resulting in therebeing more to situations than we, as conscious humanbeings, are normally aware. There are manyperspectives to a situation and both of you areexpressing a willingness to be open to new informationthat may be presented {T-Common}. In getting back toyour experience in here today, Jill, I want to say thatI imagined that as Sam experienced the effect ofalcohol on him, you were not challenging him { - ?2}, butrather, you felt a lot of caring toward him {23;24}.You appeared to be attentive towards him, listening towhat he said and feeling concerned about him {23}.Based on what you have said in here and how youresponded while Sam spoke, you seem to be very caringand concerned about Sam {23}. Furthermore, you alsoexperienced feelings of an inner familiar state,feeling fairly calm {E4 -J}, but then somewhere in yourbody you experienced a little bit of agitation. Thisagitation was experienced in your fingers which isevident by you picking at yourself {Novelty}. Thispicking at your fingers today reminded you about howyou picked at your skin last week and that you feelfear and apprehension {E1 -J}. I appreciate being toldabout awareness that you gain about yourselves{Awareness} because that is part of the therapeuticprocess. So there is something in what you do withyour fingers that informs you that you are not feelingas calm as you may think you are {Novelty; A-Behavior}.254Interaction The therapist indirectly acknowledges that Jill'sdeflection from her intense feelings of fear andapprehension was used to lessen the intensity of thesecontrasting feelings and thereby asserts {Non-intrusive} shewill not intrude upon Jill's intense feelings. To aid inregulating the intensity of Jill's experience, the therapistthen gives an interpretation and summary of what hadtranspired. She {T-Highlight} highlights both spouse'sstrengths and {T-Common} commonalities, which include themboth being willing to develop awareness of and experiencetheir internal process and demonstrating a willingness toexplore contradictions within themselves that had been outof their conscious awareness. She acknowledges theiropenness to new experiences and to new awareness. Thetherapist then re-directs the conversation back to Jill'sexperience and gives a summary. In her summary, thetherapist gives an evaluation of how she perceived Jill'sbehavior toward Sam. She asserts that Jill was {23}attentive and caring toward Sam which suggests that Jill iscompetent in fulfilling her role {W-Support} of being anattentive, supportive, and understanding wife who does not{ - ?2} challenge her husband's competence in dealing with thealcohol and thereby, {24} elevating Jill's status as acompetent and caring person who is, and should be, involvedin Sam's alcohol recovery. Jill provides reinforcement.255The therapist continues with her summary as she acknowledgesJill's experience of feeling {E4-J} calm and agitated andhow Jill developed the {A-Feeling; Behavior} awareness ofher feelings and behavior and thereby, through use ofmitigation, she regulates the intensity of Jill'sexperience. The therapist then asserts that she appreciatesknowing about the clients' awareness and thus, indirectlyasserts that {Awareness} clients should become aware oftheir internal state. She then repeats her earlierassertion that Jill's finger picking is a signal that Jillis not calm and thus, asserting that {Novelty} Jill has cometo a new awareness of herself not being calm. She alsosimultaneously {Experience} heightens and deepens Jill'scontrasting feelings. Jill throughout this speech turngives reinforcement.Text544 Jill: Yeah. *yeah*ExpansionJill: Yes I agree that my finger picking {A-Behavior}informs me that I am not as calm { -E4-J} as I may thinkI am {Novelty}.InteractionJill agrees with the therapist's interpretation thatshe is not calm and thereby {Experience} this experience isheightened and deepened.Text545 Th: Ok. ((nods twice)) (hhh) So:-um^ ((moves chair546 forward, smooths hair))what-what's happening for me: is256547 that uh^ I'm feeling ah calm myself^ a:nd I'd548 like to invite you.. if you're willing to turn your549 chairs to face each other. Would you be willing to do550 that? Let's just find out.ExpansionTh: Since the three of us are involved in thistherapeutic relationship it is important for us all todebrief our experiences. Since we have concluded withdebriefing both of your experiences of thisintervention, I want to take a moment and express whatI experience. I feel calm {E4-Th}. Now that thisintervention is concluded I would like to focus onanother intervention.InteractionThe therapist ends the debriefing of the clients'experience of the externalization intervention and thenexpresses her own feelings of calmness. The therapist thenre-directs the conversation to another intervention.Summary of Therapy EpisodeRelational novelty is the enactment of alternate waysof being in therapy that allows substantive relationalthemes and patterns to change (Friesen et al., 1989).Relational novelty may occur on three levels including; theintrapersonal, interpersonal and at the level of thepresenting problem (Friesen et al., 1989). The therapyepisode under investigation revealed that the clients andtherapist co-created the three levels of relational noveltyusing the symbolic externalization intervention of ExST.For example, the intrapsychic relational novelty experiencedincluded; Sam felt relaxed when alcohol was not present andJill felt agitation, fear and apprehension, which was257different from the calmness she thought she felt. On theinterpersonal level, Jill's status in the relationship waselevated. She began to have an equal voice and Sam began toinclude Jill in his alcohol recovery. With respect to thepresenting problem, the relational novelty created involvedSam symbolically removing the alcohol from his life and Jillhaving a voice in its removal.A micro-analytical investigation revealed eight themesthat contributed to the co-creation of relational novelty.These themes were not discrete, rather they recurredthroughout the episode and were inter-connected with oneanother. Although the eight themes generally followed asequential progression, from beginning to end of theepisode, in attaining relational novelty, there was arecursive looping back and forth of the themes as newinformation was introduced into the therapeutic system. Howthe clients and therapist responded and influenced oneanother in the course of therapy is revealed through thefollowing themes. The discussion below will examine each ofthe eight major themes found in this case study: (a)creating and maintaining a collaborative atmosphere, (b)challenging propositions and competence, (c) refrainingalcohol as a seducer, (d) moving from an individual to arelational understanding of the role of alcohol in therelationship, (e) re-defining and accenting the couple'scommonalities, (f) diffusing tension and defensiveness, (g)258regulating the intensity of experiences and, (h) deepeningcontrasting experiences.Theme I: Creating and Maintaining a Collaborative AtmosphereA collaborative atmosphere is one in which an I-Thourelationship exists which includes mutual trust, respect,cooperation and a sense of togetherness between the clientsand therapist while on the therapeutic journey. Acollaborative atmosphere results in establishing a safetherapeutic context which allows for implementing thesymbolic externalization intervention and attainingrelational novelty (Friesen et al., 1989). An example willbe used to illustrate how the therapist aided in creating acollaborative atmosphere. This will then be followed by adiscussion of the interactive process between the therapistand clients and how they influence one another.Example of creating a collaborative atmosphere.  Thetherapist aided in establishing a collaborative atmospherein three ways. First, the therapist set the framework andstructure of how the therapy would proceed by asserting thatclients were to become aware of and express theirexperiences which include; emotions, cognitions, behaviorsand physical sensations. The therapist established thecontext of the therapy by implicitly asserting therapeuticpropositions and adhering to the principles of the ExSTmodel, such as establishing a therapeutic mandate, asystemic focus, and a here and now focus. Second, through259explicating the clients' goals, the therapist attempted toattain mutually agreeable therapeutic purposes. Third, thetherapist highlighted both spouses' difficulties andstrengths and conveyed understanding of and normalized theirexperiences throughout the course of therapy.The interactive process of creating and maintaining acollaborative atmosphere between the therapist and clientsincorporates the concept of structural coupling. Structuralcoupling, as defined by Maturana (cited in Friesen et al.,1989), refers to the ongoing relationship building between aperson's personality structure and the environment. Boththe structure and environment influence one anotherresulting in a mutual interlocking and common state betweenthe two systems. Maturana (cited in Friesen et al., 1989)identified this interlocked conduct as the consensual domainin which people can learn about self, the environment andestablish meaning of their behavior.Example of developing structural coupling. The focusfor the therapist at the outset of the therapy episode wasto establish the context for therapy. The therapist re-directed the topic of the conversation to encouraging thecouple to continue expressing and sharing their feelings inthe therapeutic setting and with one another (lines 1-15).She then summarized what had happened in the therapeuticcontext to date, particularly, in relation to the clientsfeeling fear and apprehension about the alcohol problem.260Sam responded to the therapist's emphasis on his feelings offear by interrupting and indirectly asserting that thisfocus on his fear resulted in him feeling not in control ofhis battle with alcohol and subsequently, he felt weak,worthless and a failure. To rid himself of these intenseemotions, re-gain control of his experience and save face,he deflected from the intense emotions by giving informationabout the reason he stayed in therapy (lines 16-17). Samindirectly asserted that, for himself, the intensity ofexperiences were to be regulated which the therapist thenagreed with.Sam's perception of himself as weak and a failureinfluenced the process of the therapy as well as how heinteracted with the therapist. The therapist became awareof Sam's anxious and fearful personality structure. Shesubsequently realized that she must accommodate him or elsehe may leave therapy. This point is further illustrated inthe ensuing interaction between Sam and the therapist.Sam expressed feelings of fear about his challenge tokeep the top on the bottle of alcohol (line 19). Thetherapist acknowledged his fear and re-directed to Sam'sgoal to handle his fear and his perception of how dullnessaffected him (lines 20-23). She highlighted the strength ofhis analyzing behavior as helping him gain control of hisexperience and re-assured him that while in therapy he wouldbe challenged to not experience the dullness that led him to261drink. The therapist's empathic responses helped Sam saveface, which then allowed him to express his own feelings ofbeing weak, worthless and a failure for not competently andeffectively quitting drinking. As these feelingsintensified within Sam, he then reduced these intensefeelings by expressing his desire to be in control of hisbattle with alcohol and by analyzing his experiences (lines24-26; 30-33). The therapist responded by explicating hisgoal of confronting and handling his fear which aided infurther reducing the intensity of his experience (lines 34-38) and thereby implicitly collaborating with Sam toregulate the intensity of his experiences. Sam agreed withthis goal and provided evidence about his past successeswith alcohol so as to not only reduce his feelings of beingweak and a failure, but also change those same perceptionsin Jill and the therapist (lines 39-78). He described theintensity of his alcohol cravings and thereby accented theenormity of his problem which then justified him seekinghelp by attending therapy.Essentially, what occurred is that Sam expressedfeeling weak and a failure for not being in control of hisbattle with alcohol. As a result, he fluctuated betweenperceiving alcohol as a problem and not perceiving it as aproblem and as well he fluctuated between asserting both hiscompetence and incompetence and feeling weak and a failureand feeling strong and successful. The therapist, Sam and262Jill collaborated about how they would interact with oneanother in the therapeutic relationship. The consensualdomain was created, as well as the particular direction andcourse of therapy, as they modified their interactions withone another.As demonstrated, establishing a collaborativetherapeutic relationship does not centre upon the therapistimposing a rigid treatment program toward adhering to thetherapeutic propositions and principles. Unless thecouple's words, actions and personality structures are alsoincluded in the construction of the therapeutic discourse,the therapist would be unable to accomplish her goals. Eachmember of the therapeutic system provides information abouthis or her own agenda and personality structure of which theinteractions are created as well as each influences theothers in creating the interactions. The therapist adjustedand modified her discourse to accommodate the interactionsthat were embedded within the context.The theme of creating a collaborative atmosphere wasintegral to all three levels of relational novelty in thetherapy episode and was consistent with the premises ofExST. It was evident from the interactions between clientsand the therapist that relational novelty only occurs in asafe context. In order for clients to create relationallynovel experiences through intensifying either intrapsychicaspects of self, relationship with others, or with the263presenting problem, they must experience a sense of safetyin the therapeutic relationship.Theme II: Challenging Propositions and Competence Challenging has been defined by Egan (1986) as a way tohelp clients develop alternate perspectives and frames ofreference to clarify problem situations. Challenging cantake the form of challenging discrepancies and distortionsthat keep clients mired in their problem situations. Theintent is to invite clients to challenge the discrepanciesand distortions that keep them entrenched in restrictive andrigid ways of being in the world (Egan, 1986). Challengescan induce various responses within clients. It may resultin either a defense or an admission (Labov & Fanshel, 1977).In this episode, Sam responded defensively which isconsistent with the view presented by Egan (1986), who saidthat challenge can induce dissonance (Festinger cited inEgan, 1986) (discomfort and disequilibrium) resulting in theclient attempting to rid self of this discomfort. Accordingto dissonance theory, the way in which Sam dealt with hisdissonance, in regards to the challenges to him, was to"persuade challengers to change their views" (Egan, 1986, p.205). The client dealt with the challengers by reasoningwith and encouraging them to change their perception andaccept his point of view.Example of challenging clients' propositions andcompetence. Sam asserted that the presence of alcohol did264not bother him to illustrate his improvement in his controlover alcohol (lines 39-77). That is, he could now be in thepresence of alcohol and not drink. The therapist's responsewas to heighten the proximity of alcohol indicating thedifficulty created in abstaining (lines 78-79) and to beginthe process of indirectly challenging Sam's assertion thatthe presence of alcohol did not bother him. Consideringthat Sam's proposition was supported by his status of beinga competent and responsible head of household, who wassolely responsible for alcohol related decisions and whosedecisions were final and did not involve his spouse, thenthe therapist was heard as challenging both Sam's competencein his status as head of household and him being in controlof his battle with alcohol. When he was perceived, eitherby himself or others, not to be in control of his battlewith alcohol, Sam felt weak and a failure. Hence, hedefended himself against these challenges and his subsequentfeelings by providing evidence of his successes andcompetence in relation to dealing with alcohol (lines 88-108). The therapist's response was to normalize hisconstant alcohol cravings and thereby asserting that he wasnot weak and a failure (lines 109-112). She then suggestedthat alcohol should not be in the house and thereby againchallenged Sam about his views (lines 113-118). Samdefended against the challenges by giving information abouthis plans to get rid of the alcohol (lines 119-137). Jill,265as a result of the therapist challenging how Sam dealt withalcohol which also was consistent with her own beliefs, feltsafer and supported in expressing similar challenges to Sam(lines 138-141). Jill asserted that she did not interferewith alcohol related decisions because Sam would actdefensively and intimidating toward her (lines 138-141).Sam responded by defending his competence and effectiveness(lines 145-148). As the challenging and defending ofchallenges ensued between the couple, Jill continued topersuade Sam to accept that the alcohol should not be in thehouse and that he get rid of it (lines 153-155).Both the therapist and Jill had formed an alliance withrespect to adhering to the propositions that alcohol shouldnot be in the house and that Sam was bothered by thepresence of alcohol. In order to deflect from theirchallenges and to save face, Sam used humour to concur withtheir suggestion to get rid of alcohol (lines 159-160).What occurred in the interaction of challenging anddefending propositions and competence was that Sam concurredthat he also believed that the alcohol should not be in thehouse. Furthermore, both the therapist and Jill confrontedand challenged Sam's denial and belief that he had controlover alcohol. He could no longer remain entrenched in hisbelief that others support him in believing the presence ofalcohol did not bother him.Challenging clients' propositions and competence helped266co-create relational novelty in both intrapsychic andinterpersonal domains and with the presenting problem. Bychallenging Sam about his asserted proposition, that thepresence of alcohol did not bother him, the therapistintroduced new information to the couple's subsystem. Thisinformation helped to facilitate the process of Jill voicingher opinion and challenges to Sam and thus, she beganacquiring an equal voice with respect to alcohol. On theintrapsychic level, the challenging of Sam's propositionserved to confront his denial of the affect of alcohol. Thechallenge to how Sam was affected by alcohol became thefocus of the therapeutic work in the episode and contributedto him eventually resolving that the presence of alcohol didbother him.Theme III: Reframing Alcohol as a Seducer Refraining is defined by Watzlawick, Weakland, and Fisch(1974) asto change the conceptual and/or emotional setting orviewpoint in relation to which a situation isexperienced and to place it in another frame which fitsthe 'facts' of the same concrete situation equally wellor even better, and thereby change it's entire meaning(p. 95)Reframing may have a direct impact on people'sconstruction of reality by contributing to changes incognitive, behavioral and emotional responses to thesituation. Through refraining, new perspectives may beintroduced, lessening the possibility of perceiving thesituation in the same way. Reframing is based on the267concept that people use cognitive activity to aid increating their reality. Subsequently, people's reality isoften constructed through use of language. When people arestuck in rigid and restrictive realities, therapists may usereframing to aid in developing a more flexible reality. Inthis particular episode of the therapy, the therapist'sreframe of alcohol as a seducer allowed both Sam and Jill tono longer perceive Sam as being weak and a failure.Reframes and re-definitions may facilitate changing clients'perceptions about their actions and motivations resulting indeveloping a new frame of possible actions and enhancingtheir sense of self-control and self-esteem (L'Abate, Ganahl& Hansen, 1986). Once the old frame is blocked, permittingthe new frame to be explored and highlighted, the clientsmay now perceive the problem as manageable and under theircontrol. Reframes provide positive and acceptable qualitiesin a non-judgemental way with explanations of behavior whichare not a result of inherent individual deficits (L'Abate etal., 1986).Example of reframing alcohol as a seducer. When Samfluctuated between feeling weak and a failure and feelingstrong and successful in his battle with alcohol, thetherapist heightened the proximity of alcohol (lines 78-79).The therapist asserted that the alcohol was very powerful;tempting and seducing Sam to drink and thus, he was not weakand a failure (lines 81-87). The problem was framed as the268alcohol, not Sam.Sam, however, disagreed that alcohol compelled him todrink because he interpreted being tempted as indicatingweakness. He subsequently defended against perceivedchallenges to his competence and alcohol not bothering him(lines 88-108). After Sam illustrated his competence thetherapist agreed. She then continued with the reframe ofalcohol as a seducer while she simultaneously suggested thatthe alcohol should not be in the home (lines 109-118). Samagain responded to the perceived challenges rather than thereframe of alcohol.Jill re-introduced the reframe of alcohol as a seducerto diffuse Sam's emerging defensiveness as well as challengehim about the presence of alcohol not bothering him (lines153-155). Sam responded directly to the possibility ofgetting rid of the alcohol rather than the reframe becausehe still perceived his competence to be challenged.Consequently, the focus of the therapy shifted from thereframe to challenging and defending propositions. Once thetension was diffused and Sam could save face again, thetherapist re-asserted the reframe of alcohol as a seducer(lines 218-221). The problem, she asserted, was the alcoholenticing him to drink. Sam agreed with the therapist'sreframe (line 222). Jill interrupted and concurred with thereframe and used it to persuade Sam to accept that alcoholshould not be in the house and to get rid of it (lines 223-269227). As Jill changed the topic to herself and spoke abouthow she wanted to get rid of the alcohol, Sam looked awayand briefly dis-engaged from the conversation. Theconversation then shifted to discussing Jill's role andinvolvement with alcohol. Now that it was understood thatalcohol was the problem, not Sam, the couple could then dealwith other relationship concerns such as, Jill's involvementin Sam's alcohol recovery.The theme of reframing alcohol as a seducer fits withall three levels of relational novelty. The reframe notonly challenged and shifted Sam's restrictive self-perception, but also shifted Jill to not perceive Sam asweak and a failure in relation to alcohol. Sam's entrenchedview of himself was expanded, as was the problem. Now thateveryone agreed that alcohol was the perceived problem, notSam, the problem definition was expanded which resulted inestablishing, together, a workable problem and task oftherapy such as, getting rid of alcohol.Although Jill immediately accepted the reframe ofalcohol, Sam did not because of challenges to his competenceand status. It was only after the couple engaged inchallenging and defending behavior and the therapist aidedin diffusing the defensiveness and tension between thecouple that Sam was willing to accept the reframe. Thus, itwas important for the therapist to re-assert the reframetwice and address other interfering concerns before the270reframe was accepted by Sam.Theme IV: Moving From an Individual to a Relational Understanding of the Role of Alcohol in the RelationshipThe symptom of alcohol dependence is viewed by ExST asevidence of relational difficulties. The development,continuation and treatment of alcohol dependence is affectedby various relational systems such as intrapsychic andinteractional systems of family members (Friesen et al.,1989). Both the alcoholic and nonalcoholic family membersare psychologically and behaviorally impacted by alcoholism(Steinglass et al., 1987). Thus, therapy will requireexamining how both spouses are affected by the symptomaticbehavior of alcohol dependence. The systemic perspectivesuggests that people engage in a dynamic interactionalprocess in which they are both affected by and affecting acontinually developing environment. Neither causes theother to behave in a particular way, but both mutuallyinfluence and are influenced by one another.Example of the couple shifting to a relational understanding of alcohol. The therapist's emphasis onworking systemically resulted in her often either implicitlyor explicitly introducing and accenting the relationalexperiences between the couple. For example, the therapistintroduced the concept of alcohol being a relationalexperience involving both spouses when she asked them whythey had alcohol in the house considering that it made it271more difficult for Sam to abstain (lines 109-118). Inmaking the request to both spouses, the therapist wasimplicitly asserting and re-defining that both wereresponsible for the alcohol in their home and that alcoholwas a relational experience affecting both spouses. Sam wasopposed to this concept because he believed himself to besolely responsible for dealing with alcohol and involvingJill in this decision making process would result in himfeeling incompetent, weak and a failure. Thus, his responsewas to assert the plans he had to get rid of the alcohol andthereby clearly asserting that since alcohol was hisresponsibility, not Jill's, he would plan how to get rid ofit (lines 119-137). Consequently, due to his unwillingnessto relinquish any control of alcohol to Jill he minimizedand dismissed Jill's input.Jill, however, got involved with alcohol-relatedconcerns as she expressed agreement with the therapist thatalcohol should not be in the house and that Sam should getrid of it (lines 138-141). Although Sam continuedinterrupting Jill and deflecting from the issue, Jillpersisted with her involvement (lines 223-227). Sheasserted wanting to get rid of the alcohol herself but didnot because this would undermine Sam which could result inhim getting defensive and intimidating (lines 230-233). Thetherapist then re-defined that Jill had chosen to let Sammake alcohol related decisions and thereby she elevated272Jill's status in the marital relationship, as one who iscapable of making decisions. In her re-definition, thetherapist did not negate Sam's desire to be responsible forthe alcohol (lines 249-250). Sam disagreed with thetherapist's re-definition. He re-interpreted that heblocked Jill from interfering and therefore Jill did notwilfully decide to let him make the decisions (lines 251;254-256). The therapist continued to accent the couple'scollaboration in deciding that Sam was to quit drinking andbe responsible for dealing with the alcohol (lines 257-265).Hence, the therapist indirectly challenged Sam'sindividualistic beliefs that he was not in control ofalcohol and was incompetent, weak and a failure if he didnot quit drinking alone and in his own way, and did notinclude Jill. She asserted that alcohol was a relationalexperience affecting both spouses and that Sam did not haveto be alone in his alcohol recovery. Sam agreed and thetherapist then re-asserted that Jill was, and should be,involved in his recovery process.The therapist again accented the relational aspect ofalcohol when she asked the couple where they would each putthe symbolic representation of alcohol (lines 272-275) andwhen she intensified both their experiences of alcohol beingabsent. The implicit message in this request was that bothJill and Sam were affected by alcohol. Furthermore, inasking Jill where she would place the alcohol served to273elevate Jill's status and competence in making decisionsabout alcohol. Both spouses responded to the therapist'srequest without minimizing or challenging one another.Essentially, the above interactions resulted in agradual shift toward a systemic understanding of the role ofalcohol which led to co-creating interpersonal relationalnovelty. Sam began permitting Jill's involvement in hisalcohol recovery process and simultaneously Jill's status inthe marital relationship was elevated to include her in hisrecovery process. The therapist held to her systemicperspective throughout the episode which was evident by hercontinually accenting and including Jill in Sam's alcoholrecovery process and aiding Sam in not minimizing Jill'sinput.Theme V: Re-defining and Accenting the Couple's Commonalities Identifying and then re-defining couples' commonalitieshelps couples to recognize their initial goals andintentions, especially when they may be entangled inrecursive challenges and arguments and no longer see thelarger picture. The couple may have limited cognitivecategories to describe their experience which results incategorizing their experiences in concepts that are eitherblack or white, bipolar, and over-inclusive (L'Abate et al.,1986). The context of their relationship may be expanded byintroducing new information that provides alternate goals274that allows them to work together and identify theirsimilarities rather than work in opposition.In this particular therapy case, the couple was engagedin win-lose interaction patterns while failing to see theircommon goals. The therapist's re-definition of the couple'scommonalities changed their interaction patterns which thenaided them in making changes with respect to the presentingproblem such as, symbolically getting rid of alcohol.Example of re-defining couple commonalities. The re-definition of the couple's commonalities occurred throughoutthis episode and was related specifically to Sam'sresponsibility to quit drinking and deal with the alcohol.When the couple engaged in challenging and defending againstpropositions and competencies, they both indirectly assertedagreement about Sam's responsibility. Jill argued she didnot have a need or desire for alcohol to be in the housewhile Sam argued he could get rid of the alcohol if he choseto do so. In asserting his plans for getting rid of alcohol(lines 119-137; 159-160), Sam indirectly asserted hisagreement that alcohol should not be in the home. Thetherapist accented both spouses' agreement about theirchoice and possibility of getting rid of the alcohol (lines167-168). Once the couple's commonality had beenintroduced, the therapist then re-directed Sam to takeresponsibility for his choice in having the alcohol in thehouse and drinking. The re-definition of their interactions275as having a common underlying theme helped shift the couplefrom their challenging and defending interaction pattern.The couple's understanding and acceptance of theircommon goal, that Sam was responsible for quitting drinkingand getting rid of alcohol, then led to the therapistintroducing the symbolic representation of alcohol (lines272-275). Sam asserted wanting the alcohol outside (line276), as did Jill (lines 280-281), and thereby theyindirectly expressed their common desire to have alcohol outof their lives. The therapist accented this agreement andcollaboration (lines 282-284). Sam then performed therequested action of putting alcohol outside with Jill'ssilent support, which was consistent with theircollaborative decision that this was his responsibility.Explicating both spouse's agreement and them workingtoward common goals helped to reduce the defensiveness andchallenging interaction patterns that ensued between thecouple. They were then able to explore, together, theirrespective experience of alcohol being out of their lives.The acknowledgement and acceptance that Jill hadsimilar goals as Sam served to co-create interpersonalrelational novelty. The result was that Jill's status inthe relationship was elevated to her being included in Sam'salcohol recovery.Theme VI: Diffusing Tension and Defensiveness Diffusing tension and defensiveness is similar to the276interactive dimension of mitigation (Labov & Fanshel, 1977)in which the person mitigates or modifies expressions thatmay be offensive or produce conflict. Throughout theepisode all three members of the therapeutic subsystemengaged in diffusing tension and/or defensiveness. Each hadtheir own style of diffusing. For example, Sam diffused hisdefensiveness, avoided contentious issues and saved face byusing deflection, particularly humour. Jill, on the otherhand, used mitigation to diffuse Sam's defensiveness so asto protect herself. She tended to use words, style ofspeech and changed the topic to herself to diffuse tension.The therapist diffused tension between the couple and Sam'sdefensiveness by positively connoting the deflectingbehavior, providing reinforcement and highlightingstrengths. Many of the challenges and defenses, discussedearlier, were asserted through use of such mitigatingdevices as indirectness.Example of diffusing tension and defensiveness.  Whenthe therapist suggested that alcohol compelled Sam to grabit (lines 81-87), Sam deflected from his subsequent feelingof being weak and a failure as he asserted his competenceand success with alcohol (lines 88-108). The therapistprovided reinforcement about the enormity of his alcoholcravings and thereby supported Sam in his desire to becompetent and successful (lines 109-118). She then askedthe couple about having alcohol in the house which resulted277in her challenging Sam's views and competence.Subsequently, Sam became defensive (lines 119-137). As Jillinterrupted Sam and asserted her agreement with thetherapist that alcohol should not be in the house, shesimultaneously diffused his defensiveness by using lengthypauses and carefully choosing her words (lines 138-141).Continuing to use mitigation, Jill asserted why she did notget rid of alcohol herself and also indirectly challengedSam's competence. Sam again defended against the challengesto himself and then deflected from himself as he challengedJill's supportiveness (lines 151-152). Jill attempted todiffuse his defensiveness as she referred to the therapist'sreframe that alcohol is a seducer and thereby, asserted thatshe did not perceive him as weak and a failure (lines 153-155). To encourage Sam to get rid of the alcohol and notbecome defensive, Jill mitigated her request by saying theyboth could get rid of the alcohol. Sam deflected fromJill's request by responding to the ease of getting rid ofalcohol and thereby simultaneously asserting his competence(line 156). He then proceeded to deflect from both thetherapist and Jill's challenge and suggestion to get rid ofthe alcohol by using humour (lines 159-160). He used humourto deflect from the contentious issue of alcohol in thehouse and to save face. The therapist acknowledged both thecontentious issue and tension between the couple and hence,to diffuse the tension she highlighted their strengths and278positively connoted Sam's deflection (lines 172-183). Thetherapist's response allowed Sam to save face and not feeldefensive and thus, move toward exploring the issue of himgetting rid of the alcohol.This example illustrates that tension and defensivenessin the therapeutic subsystem had to be diffused before thecouple could attain their goal of getting rid of alcohol.Diffusing tension and defensiveness was used throughout thisepisode and served to help the clients express theirthoughts and feelings to one another which contributed tothe initial promotion of couple equality as well assymbolically getting rid of alcohol.Theme VII: Regulating the Intensity of Experiences Regulating intensity of emotions and experiences is away to develop a sense of safety in the therapeuticrelationship as well as help clients to gradually explore,intensify, and accept their experiences which may then leadto attaining relational novelty. Throughout this episodethe intensity of experiences was regulated and co-constructed by all three members of the therapeutic system.Example of regulating the intensify of clients' experiences. The therapist and clients co-constructedregulating the intensity of clients' experiences after thetherapist introduced an ExST intervention designed tointensify the couple's experience of having alcohol out oftheir lives (lines 293-298). When introducing the279intervention, the therapist, through hesitation and use ofmitigation, indirectly asserted not wanting to intrude uponthe clients' intense experiences, especially consideringthat this was only their second therapy session, the coupletended to be more at ease functioning in a cognitive domainand that she, herself, was new to the therapy model. Thetherapist then proceeded to ask both clients to become awareof and express their respective experiences of the absenceof alcohol. Sam began describing his experience and whenhis feelings intensified he shifted to a cognitive domain.Functioning in a cognitive domain was a safe and morefamiliar way of being for Sam and it simultaneously aided inregulating the intensity of his emotions. After Samlessened the intensity of his emotions, through analyzing,he shifted back to experiencing his emotions.Sam's tendency to go in and out of intense experienceswas also consistent with the therapist's desire to notintrude upon the clients when intense experiences emerged.When Sam's experiences became intense, both he and thetherapist shifted the intensity so that he could gain asense of control of his experience.The therapist gradually intensified Sam's experience asshe asked him to describe and experience more fully hisemotions, physical sensations and cognitions associated withhaving alcohol outside. As Sam responded to each request,and the therapist tracked his experience, both therapist and280Sam continued to gradually intensify his experience (lines327-328; 330-333). The therapist, through use of gestures,pauses and matching Sam's pattern of speech, indirectlyasserted the importance of pacing the therapeutic work toprevent Sam from feeling weak and a failure (lines 319-324).Sam, at times, reduced the intensity of his experienceas he "talked about" the apprehension he experienced earlierin the session (lines 334-337) and focused on an injury(lines 339-340). The therapist tracked what had occurredwhen alcohol was put outside and re-directed Sam back to hishere and now experience and thereby gradually intensifiedhis experience with alcohol (lines 343-346). Sam concurredwith the therapist's evaluation and then asserted acorrection to his feeling which served to again lessen andregulate the intense impact of alcohol (line 347).The therapist acknowledged Sam's use of mitigation tolessen the intensity of his experience when alcohol waseither present or absent. Subsequently, the therapist aidedSam in regulating the intensity of his experience byhighlighting his strengths and talking about the importanceof his awareness of calmness when alcohol was not present(lines 376-384). Sam, however, continued to intensify hisexperience with alcohol as he re-focused on his innerconflict regarding the presence of alcohol (lines 385-395).The therapist reduced the intensity of Sam's experience byfirst interpreting that Sam's analyzing behavior was his way281of gaining control and creating safety within himself andthen asking Jill about her experience (lines 396-416).Jill's response was to diffuse Sam's defensivenesswhich simultaneously served to lessen the intensity of herown experience with alcohol (lines 421-429; 431-439). Asthe couple engaged in explaining and analyzing theirexperiences with alcohol, the therapist acknowledged theanalyzing as their method of reducing intense experiences(lines 452-264). The therapist continued to lessen Jill'sexperience with alcohol as she highlighted Jill's strengths(lines 466-472). Jill again initially diffused Sam'sdefensiveness (lines 473-483) and then fluctuated betweenexpressing her intrapsychic experience and focusing on whatSam had said. Jill asserted awareness of another feelingand then used laughter to deflect and lessen the intensityof this experience (lines 495-497). The therapistcollaborated in lessening the intense impact of Jill'sbehavior by using laughter and a sing-song voice andmatching her style of speech as she tracked Jill'sexperience (lines 498-502). Shortly after both thetherapist and Jill intensified Jill's feelings of fear andapprehension, Jill lessened the intensity of these feelingsby re-directing the conversation to what she learned in thesession and shifting the focus onto Sam getting rid ofalcohol (lines 512-518). The therapist again implicitlycollaborated with Jill in regulating the intensity of her282feelings as she highlighted the couples's strengths,accented their commonalities and used mitigation as shesummarized Jill's experience (lines 522-544).In summary, regulating the intensity of experienceshelped both clients gradually explore, intensify and accepttheir internal experiences in relation to alcohol beingpresent and absent which contributed to attainingintrapsychic and interpersonal relational novelty. Forinstance, the shifting back and forth between analyzing anddirect experiencing resulted in Sam gradually intensifyinghis experience to the point of realizing he felt relaxed inthe absence of alcohol and tense and apprehensive in itspresence. Regulating the intensity of experiences alsoenabled Jill to gradually become aware of and intensify herfeelings of agitation, fear and apprehension. Furthermore,in regulating the intensity of experiences both clientsgradually experienced their respective relationship toalcohol and each other at the physical, emotional,behavioral and cognitive level and thus, gained a broaderunderstanding of the impact of alcohol.Theme VIII: Deepening Contrasting Experiences Clients intensify and deepen polarities and contrastingexperience by methods such as symbolic externalization andrepetition. Through the intensification of experiences,alternate ways of being in the world may emerge. Theintensification process involves a holistic approach which283includes cognitions, emotions, bodily responses, behaviorsand perceptions. Deepening contrasting internal experiencescontributed to both Sam and Jill attaining relationalnovelty on an intrapsychic level. By gradually deepeningthe contrast of feeling tension and relaxation, Sam was ableto experience and accept that he felt relaxed when alcoholwas not present. Jill also experienced agitation, fear andapprehension through the deepening of her experience.Example of deepening contrasting experiences. Samintroduced a contrasting experience after first assertingthe presence of alcohol did not bother him (lines 88-108)and then concurring with the therapist and Jill that itprobably bothered him (lines 214-217) which marked thebeginning of him fluctuating between these two contrastingexperiences. If he admitted to the alcohol bothering himthen he perceived himself as weak and a failure and if headmitted to the alcohol not bothering him he perceivedhimself as strong and successful. This polarity wasintensified after the therapist introduced the concept ofdirect experiencing.After engaging with the symbol, Sam expressed feelingless apprehension and surprise because he did not expect tobe affected by the absence of alcohol (lines 300-311). Thetherapist focused Sam on his less apprehensive feeling whichthen resulted in him identifying the contrast in feelingswhen alcohol was absent or present. The therapist284heightened and deepened the contrast between him feelingapprehension and tension and relaxation as she asked wherein his body he physically experienced the relaxation andwhat it felt like. As Sam expressed awareness of what heexperienced internally when the alcohol was not present,both he and the therapist heightened and deepened hisexperience through use of repetition and highlighting ofresponses.When Sam became aware of feeling calm he then focusedon the apprehension he experienced earlier and therebyheightened and deepened the contrast between feeling calmand apprehensive. Subsequently, he asserted that theapprehensive feeling may be linked to his physical injury,not the alcohol, and thus, he challenged whether heexperienced tension and apprehension when in the presence ofalcohol. Focusing on the physical injury, as creatingfeelings of apprehension and tension, served to lessen theimpact of alcohol on his life. The therapist re-directed tothe present and highlighted what had transpired, which wasthat the feelings of apprehension changed to calmness afteralcohol was put outside which then logically suggested thatit was the alcohol that resulted in the change (lines 343-346). Sam agreed, but then again lessened the impact ofalcohol by mitigating the contrast between feelings ofapprehension and calmness (line 347). Although Sammitigated the effect of his experience, the therapist285continued to re-direct him to continue experiencing thedecrease in apprehension and the associated cognitions whenalcohol was absent in order to heighten and deepen thiscontrasting feeling and to deepen the link between alcoholand tension.Once the therapist explored emotions, physicalsensations and cognitions associated with the experience ofplacing alcohol outside, the therapist summarized theexperience. That is, Sam had experienced another way ofbeing without alcohol, which was to be relaxed. Sam thenre-directed the conversation back to the conflict withinhimself. He denied his earlier proposition that thepresence of alcohol did not bother him based upon his recenttherapeutic experience and then asserted his realizationthat alcohol had a larger impact on his life than he hadthought (lines 385-395). The therapist interrupted andlessened the intensity of Sam's experience and thenheightened Jill's experience of the absence of alcohol(lines 396-416). Shortly thereafter, Sam expressed moredefinitely his realization that the presence of alcohol mustbother him (lines 519-520).Jill's experience of symbolically externalizing thealcohol was also heightened and deepened by both thetherapist and Jill. The therapist continued to re-directthe conversation back to Jill's intrapsychic experience(lines 462-464; 466-472). Jill eventually expressed that286she did not feel physically different, but felt calm (lines489-490). The therapist heightened and deepened the calmfeeling through reflection. Jill interrupted and expressedawareness of another contrasting feeling which was evidentby her finger picking behavior (lines 495-497). Jill usedlaughter to deflect from the intensity and impact of thiscontrasting experience. The therapist acknowledged the useof deflection by using humour herself as she heightened anddeepened Jill's contrasting experience (lines 498-502).Jill deepened this non-calm feeling as she expressedexperiencing this feeling during the previous therapysession (lines 503-507). The therapist then interpretedJill's finger picking behavior as an expression of fear andapprehension, to which Jill strongly agreed, and therebythey both engaged in deepening the contrasting feelings.When Jill re-directed the conversation (lines 512-518), thetherapist recognized this shift as Jill's deflection fromthe intensity and impact of these contrasting feelings andthus, the therapist summarized what had occurred rather thancontinue heightening and deepening Jill's experience (lines522-544).In summary, all eight themes influenced one anotherthroughout the therapy episode in creating the three levelsof relational novelty. What emerged in the therapy episodewas that a collaborative atmosphere was first establishedwhich also entailed regulating the intensity of the287therapeutic process. The ensuing challenging and defendingof propositions and competence resulted in exploring theproblem of alcohol dependence so as to expand, shift andchange the perception of the problem. After reframingalcohol as a seducer, moving from an individual to arelational understanding of the role of alcohol in thecouple's relationship, accenting and re-defining thecouple's commonalities and diffusing tension anddefensiveness, the therapist and clients were then able towork together to explore the clients' respectiverelationship to alcohol and explore the goal of getting ridof alcohol. Intensifying and deepening the clients'experiences of getting rid of alcohol could now occur due tomutual understanding and agreement about the problem, thetherapeutic goals, couple collaboration, promotion of coupleequity and the direction of the therapy.288CHAPTER VDISCUSSIONThis investigation has examined a segment of atherapeutic interview using comprehensive discourse analysis(Labov & Fanshel, 1977). By documenting proximal outcomesof the therapeutic process, a greater understanding of thechange process was realized. A review of family therapyprocess research literature identified the importance ofutilizing methodologies that assist in understanding thechange process in family therapy. In this investigation,comprehensive discourse analysis which examines the co-construction of people's social realities was identified asa suitable methodology to serve our purposes. An episode ofa therapy case was analyzed using this methodology toexamine how the therapist and clients co-create relationalnovelty using symbolic externalization intervention with asuccessful ExST case involving marital treatment of alcoholdependency. The principles of therapy utilized in theactual therapy episode and the therapist and couple'sinteractions and themes identified that contributed towardco-creating relational novelty were examined. This chapterfocuses on the research question and rationale forconducting this study and include the theoretical refinementand the establishment of the clinical utility of theconstructs of symbolic externalizing and relational novelty.The chapter also presents the major findings of this case289study, the implications of it for research and practice, thelimitations of this approach and directions for futureresearch.Major Findings Revealed in the Case StudyThe case study has explored and analyzed thetherapeutic process of change, particularly the construct ofrelational novelty co-created by the therapist and clientsusing the symbolic externalization intervention of ExST inaddressing alcohol dependency. The theory and clinicalpractice of ExST and its accompanying symbolicexternalization intervention has been previously describedin the manual (Friesen et al., 1989). The fit between theExST theory of change and what actually occurred in therapyis of central importance to the model. This therapy episodeinvolving the co-creation of relational novelty providedfurther descriptions and understandings of this theoreticalmodel.The concepts that underlie the themes revealed in thestudy and which are essential to an understanding of howrelational novelty was co-created in the therapy episodeinclude; social constructivism and contextualization. Theeight themes identified in the study and reported in thischapter contribute to our understanding of theexternalization intervention, the therapeutic process, andthe construct of relation novelty. The themes found in thiscase study include: (a) creating and maintaining a290collaborative atmosphere, (b) challenging propositions andcompetence, (c) reframing alcohol as a seducer, (d) movingfrom an individual to a relational understanding of the roleof alcohol in the relationship, (e) re-defining andaccenting the couple's commonalities, (f) diffusing tensionand defensiveness, (g) regulating the intensity ofexperiences and, (h) deepening contrasting experiences.Social ConstructivismThis investigation supports the constructivists' beliefthat the co-creation of people's social realities, such astherapeutic realities, is mediated through language. Peopleare language-generating and concurrently are meaning makersand achieve understanding through the use of language asthey interact with others (Anderson & Goolishian, 1988). Itis through engaging in such communicative action as meaning-generating discourse in particular social milieus thatmeaning and understanding specific to that milieu isattained. In a therapy context, communicative actionspecific to the therapeutic system is employed to generatelanguage and meaning around a problem. The therapeuticsystem is organized around a presenting problem and thetherapist and client(s) are engaged in evolving language andmeaning specific to the problem, specific to theorganization of the problem and specific to the dis-solutionof the problem (Anderson & Goolishian, 1988). Therapyoccurs through a process of ongoing conversation, that is, a291therapeutic conversation of mutual exploration throughdialogue in which new meanings continually evolve towardresolving the problem. The therapist and client(s) co-construct a reality, or meaning-generating system during thetherapeutic discourse. In the process of co-creating thisreality they each contribute their own ideas, values andbiases. By perceiving therapy as occurring in a socialmilieu in which change can be socially co-constructed bytherapist and client(s), we can study the therapeuticdiscourse to understand how relational novelty was sociallyco-created through the activity of symbolic externalization.The themes identified in the case study demonstratethat the process of therapy involved both the clients andtherapist participating, sharing and developing meaning(Goolishian & Anderson, 1990) with respect to the presentingproblem and the therapeutic process. Each of the themes wasco-constructed through conversation between the therapistand clients. For example, the theme of creating andmaintaining a collaborative atmosphere in therapy involvedboth the therapist and clients determining the nature of thetherapeutic process. The therapist learned that she mustaccommodate the clients by regulating the intensity of theirexperiences. The clients learned, based upon thetherapist's assertions of therapeutic propositions, what theframework of the therapy would be and what was expected ofthem. That is, they were expected to develop awareness of292and express their experiences in therapy. The therapeuticsubsystem also participated in creating meaning of thepresenting problem of alcohol dependence when the husbandasserted the proposition that he was not bothered by thepresence of alcohol. This assertion, and his subsequentdiscrepant description of how he was affected by alcohol ledto the theme of challenging the husband's proposition andcompetence in dealing with alcohol via the theme ofreframing alcohol as a seducer. After suggesting thealcohol was the problem, based upon the husband'sdescription of the problem, the therapist challenged himwith the proposition that he was bothered by the presence ofalcohol. The introduction of this new information into thetherapeutic subsystem by the therapist resulted in the wifealso challenging the husband's perspective. The husbandeventually concurred that he was bothered by the presence ofalcohol. An example of co-creating meaning regarding theissue of who was involved with the presenting problem andhow such involvement occurred is illustrated in the theme ofre-defining and accenting the couple's commonalities. Asboth spouses described their respective beliefs andexpectations about who was responsible for dealing with thealcohol in the house, the therapist noted and highlightedthat they shared a common goal regarding the husband'sresponsibility to deal with the problem. Once the therapistexplicated the couple's implicit collaboration in making the293decision about the alcohol in the house, the couplebroadened their understanding of the wife's involvement inalcohol related decisions. In the above examples, eachmember of the therapeutic subsystem participated indeveloping meaning. The co-construction of realities is animportant shift from the perspective that the therapistchanges the clients by implementing specific interventions.The above findings of the case study support the viewthat by exploring the logic of the descriptions of a problemsystem, other descriptions and meanings will emerge thatresult in the problem no longer being labelled as a problem(Anderson & Goolishian, 1988). Through expanding and sayingthe "unsaid", a new reality is created.The constructivist view is that problems areconstructed realities in language, which are fluid andchanging. Family members' multiple and conflictinginterpretations of the problem suggest the fluidity of theproblem definition (Anderson & Goolishian, 1988). Theproblems presented in therapy are often constrictive andfixed in meaning. Through therapeutic conversations, thefixed meanings and behaviors are expanded and changedallowing for more flexibility and alternate ways of beingfor the client (Anderson & Goolishian, 1988).The case study revealed that the clients and therapistorganized themselves around the problem of alcoholdependency. The clients' meaning and understanding of the294problem was restricted which circumvented changes occurringin either intrapsychic or interpersonal levels. Forexample, the husband perceived that he was weak and afailure for not being in control of his battle with alcohol.Moreover, this perception was reinforced if he involved hisspouse in his alcohol recovery. Subsequently, he decidedthat he had to quit drinking in his own way without theassistance of others. The wife perceived the husband to beineffective in how he handled alcohol related concerns, butshe did not interfere due to fear of his defensiveness andintimidating behavior.The task of the therapist was to aid in expanding therestrictive meanings and understandings of the problem(Anderson & Goolishian, 1988). In order for the expansionof meaning to occur, a collaborative problem definition hadto be developed. This was accomplished in the case studythrough the therapist making space for and understanding ofthe multiple perspectives of the problem. Through inquiryand using the clients' description of the problem, thetherapist discerned and expanded the meaning of the clients'restrictive problem definition. The therapist reframed theproblem as alcohol seducing and tempting the husband todrink. Once the reframe was accepted by the therapeuticsubsystem, the husband was no longer identified as having acharacterological deficit because the problem was thealcohol, not his weakness and failure. Reframing the295alcohol as a seducer enabled the husband to reconstruct hisinitial meaning of his alcohol cravings, giving him a newunderstanding and expansion of the restrictive relationalpatterns with self, others, and the presenting problem. Theinterpersonal context of the problem definition was furtherexpanded and shifted as the therapist introduced both themesof moving from an individual to a relational understandingof the role of alcohol and redefining and accenting thecouple's commonalities. The two latter themes contributedto the elevation of the wife's status in the maritalrelationship which resulted in the initial promotion of heracquiring an equal say with regard to the alcohol. The twothemes just described, helped to expand the husband'sindividualistic beliefs that he had to go through hisalcohol recovery on his own and minimize and dismiss hisspouse's input. Subsequently, the couple could worktogether on the problem. This expanded meaning led to thecouple addressing how they were impacted by both thepresence and absence of alcohol. The above-mentionedexamples illustrate that "meaning and understanding indialogue and conversation are always an interpretiveactivity and always in flux... All meaning, understanding,and interpretation is inherently negotiable and tentative"(Anderson & Goolishian, 1988, p. 381). There is a continualshaping of worlds through dialogue and conversation. Thus,"change is the evolution of new meaning through dialogue"296(Goolishian & Anderson, 1990, p. 108).As the therapeutic system engages in generatinglanguage and meaning in relationship to the problem and itsorganization, we need to first understand the meaningattributed to the problem. That is, the problem of alcoholdependence must be contextualized.Contextualization: The Therapeutic Episode, Alcohol Dependency and Constructs of Relational Novelty and SymbolicExternalization Throughout the analysis of the therapy episode, arecurring realization emerged indicating that this analysiswould lack coherence without contextualizing the episodeunder study within the larger therapeutic framework.Therapeutic events and interventions are not fragmentedactivities that occur in isolation from the rest of thetherapeutic process (Orlinsky & Howard, 1986). It istherefore essential to investigate and understand how theseevents and interventions inter-connect with the ExSTtheoretical and therapeutic process. The particularconstructs and specific change moments being studied mustreflect the therapy process under consideration (Newman,1991). Moreover, the meaning of both the process of thetherapy and the particular therapeutic intervention utilizedmust be identified to aid in illustrating the theoreticallysignificant change that occurred. De-contextualizingtherapy episodes and therapeutic interventions would fail to297contribute significant knowledge of the change process.Unless the therapy episode is contextualized, an adequateunderstanding of how change occurs in therapy would not beattained. The theoretical importance of contextualizing therelational matrix of alcohol dependence and how it affectsclients' intrapsychic and interpersonal world in the changeprocess needs to be addressed. It is our purpose in thisinvestigation to illustrate how ExST theory and processexplains the observed co-creation of relational novelty.The following discussion describes how the ExST modelattempts to contextualize the alcohol dependency, theconstruct of relational novelty, and the symbolicexternalization intervention and how this process leads tochange.Contextualizing the Symptom of Alcohol DependenceThe interactional model of alcohol dependence proposedby ExST is based on multiple levels of system analysis(Friesen et al., 1989). The interactive process may includethe physiological, intrapsychic, interpersonal, and socio-cultural functioning of people. Davis et al. (1974) suggestthat the adaptive consequences of alcohol dependence, whichmay operate at an intrapsychic level, interpersonal level,or at a level of maintaining homeostasis, reinforce theabuse of alcohol. The implication for clinicians is todetermine the adaptive function of the alcohol dependencewith regard to the above-mentioned three levels. Clients298are then aided in acquiring the adaptive behaviors whilesober and to learn alternate coping behaviors.The analysis of the case study demonstrated theimportance of conducting an ecological assessment of thealcohol dependence problem in phase one as described by theExST model. This assessment, which examines thephysiological, intrapsychic, interpersonal, social andcultural functioning related to the alcohol dependence,helped to determine the meaning the clients generated aboutthe alcohol dependence problem as well as where therelational rigidity and restrictiveness of the problem lay.The gathering of information about the symptomdevelopment is important because symptoms are viewed asmessengers summoning attention and analogically conveyingthat there are problems in the relationship (Friesen et al.,1989). Behavior is then considered to be arbitrary and itsmeaning is understood contextually. The contextual meaningof the alcohol dependence in each therapy case has manyfunctional aspects that must be explored.The case study investigated revealed that there were atleast six functions of alcohol which influenced the issues/themes addressed in therapy. Primarily, as identified insession one of the study, alcohol provided the husband witha means to gain acceptance from his peers and helped himfind a place where he belonged. Secondly, the alcoholprovided him with a means to escape and distract from his299pain and sadness, particularly in relation to the manylosses he suffered. Thirdly, alcohol functioned to liven upthe couple's marital relationship because during drinkingperiods there was arguing and generally much moreinteraction. Fourthly, alcohol served to maintain a levelof intimacy which they could accommodate. With alcohol,both spouses kept their pain to themselves. Theirinterpersonal conduct revolved around the alcohol and thusthe alcohol served to keep distance between them. Fifthly,the alcohol dependence functioned to provide a sociallyacceptable reason that summoned therapeutic aid. Lastly,the alcohol served as a way to provide a context throughwhich both spouses could directly express their fears andpains to one another and to establish a more satisfactorylevel of intimacy in their marital relationship. Insummary, the symptomatic behavior of alcohol dependencydeveloped and continued as a medium which was used to dealwith the intrapsychic and interpersonal relationships towhich it was connected. The alcohol dependency symbolicallyrepresented disturbances in the relational matrix. Therelational difficulty lay with the alcohol dependency beingrigidly entrenched in the clients' ecology of how theyexpressed and communicated problematic issues. Flexibleways of communicating and addressing the relational problemswere not available within the clients' repertoire and thusan important part of therapy was to expand alternative300possibilities through experiencing concrete relationalnovelty. Considering the various relational and systemlevels of involvement in the therapy case and theirinfluences on each other, the transformation or dis-solvingof the problem included exploring the intrapsychicpsychological systems of each spouse, interpersonalfunctioning between the spouses, peer group culture, and thetherapeutic system.The findings of the study demonstrated that once thealcohol dependency had been contextualized within thetherapy case, this then led to transforming the varioussystems and relational levels affecting the alcoholdependency. Each of the eight identified themes wereconnected to one or more of the systems and relationallevels attended to in the therapy episode. For example,both the intrapsychic and interpersonal systems weretransformed when alcohol was reframed as a seducer. Theperceptions and meaning attributed to the alcohol shiftedfor both the husband and wife so that they then perceivedthe alcohol, not the husband, as the problem. The theme ofdiffusing tension and defensiveness illustrates how thetherapeutic system was involved with and helped influencethe transformation of the problem. Both the therapist andclients determined that in order for clients to experiencean alternate way of being in relation to alcohol the tensionand defensiveness in the therapy session had to first be301diffused. For example, prior to the husband concurring withthe therapist and his spouse that the alcohol should not bein the house, he deflected from the tension by using humour.The therapist acknowledged the tension between the coupleand hence she positively connoted the couple's strengths aswell as connoted the strength of the husband's use ofdeflection. Diffusing the tension between the coupleresulted in the conversation being re-directed to theproblem of alcohol in the house. Furthermore, the theme ofregulating the intensity of clients' experiences alsocontributed to influencing the transformation of theproblem. This co-constructed theme helped pace and matchthe therapeutic process of dealing with the alcoholdependency according to the clients' comfort level.Contextualizing Constructs of Relational Novelty andSymbolic ExternalizingThe ExST therapist strives to offer opportunities toexperience relational novelty and to directly influenceunsatisfactory relationships with self and others ratherthan continue the process of engaging in repetitive andinvariant behavioral sequences (Friesen et al., 1989).Perturbing patterns and sequences with self, others, and thepresenting problem is phase two of the ExST model. Duringthis phase of therapy, specific interactional sequences areattended to and given symbolic significance. The therapistemploys various interventions to disrupt, challenge and302change entrenched and dissatisfying sequences ofinteraction. The clients' sense of constriction through animmediate experience is expanded and new potential emerges.It is important that the interventions are implemented inaccordance with the clients' readiness and/or modifieddepending on the clients' changing needs.The themes identified in the case study revealed thatvarious meaning shift interventions (Friesen et al., 1989)were used to perturb restrictive intrapsychic andinterpersonal systems. The themes pertaining to meaningshift interventions included; refraining alcohol as aseducer, challenging clients' restrictive propositions,moving from an individual to a relational understanding ofthe role of alcohol and re-defining and accenting thecouple's commonalities.The crucial components that helped shift the focus fromthe couple's challenges and defenses to getting rid of thealcohol was the acceptance of the above alternate re-definitions or themes. That is, once the couple acceptedthe re-definition of the alcohol problem and theirinteraction patterns, they could then view one another asbeing on the same side and hence, explore together how toget rid of the alcohol from their lives.It was after the above-mentioned themes were co-createdand accepted by the therapeutic subsystem that the symbolicexternalization intervention was implemented. Engaging with303a symbolic representation of the alcohol in the here and nowwas introduced as another way of addressing the couple'srelationship with the alcohol. The principle of directexperiencing was introduced as the therapist asked theclients where they would metaphorically place alcohol. Thetheme of deepening contrasting experiences was a method usedto intensify the clients' experience of alcohol.Contributions to Understanding Symbolic ExternalizationThere are three methods of externalizing. Thesemethods include externalizing through use of language,through objects and images, and through experientialenactment. Jung (1964) stated that "because there areinnumerable things beyond the range of human understanding,we constantly use symbolic terms to represent concepts thatwe cannot define or fully comprehend" (p. 4). There are twotypes of symbols. Words are discursive symbols and objectsare representational symbols.The externalizing method used by White and Epston(1990) is discursive experiencing. In this approach,externalizing is mediated through use of language todetermine the influence of the problem and the client'sinfluence in the "life" of the problem. White and Epston(1990) suggest that externalizing the presenting problem"enables persons to separate from the dominant stories thathave been shaping their lives and relationships" (pp. 40-41). Questions asked by the therapist allow for the304emergence of unique outcomes and alternate stories inrelation to self and others that have been previouslyneglected or unknown.An alternative to a discursive approach to therapy isto use objects. Objects have the potential to move thetherapy from a discursive level to a representational level.Representational symbols touch deeply the client's sense ofpersonal meaning and significance (Friesen, 1991). Andolfiet al. (1989) suggestThe metaphoric object offers many levels for changingconnections. The clear visual and tactile presence ofthe object accentuates the contrast between itsliteral, concrete meaning and its symbolicimplications, creating confusion as to which level isrelevant to the message received (p. 78).By using objects, the therapeutic process is energized andadds an element of play (Andolfi et al., 1989). The theoryunderlying symbolic externalizing in ExST is that whenclients separate and gain distance from the problem throughengaging with a symbolic representation of it, they areallowed to examine other aspects of their relationship(Friesen et al., 1989). This process may result in a shiftin the client's identity leading to alternate ways of being.The findings of the case study support the notion thatrepresentational symbols aid in developing creative novelty.The theme of deepening contrasting experiences revealed thatby gradually intensifying and deepening the husband'sexperience of alcohol symbolically placed outside the doorresulted in him experiencing and realizing that he was305affected by the presence of alcohol. That is, he wasrelaxed in the absence of alcohol and tense and apprehensivein its presence. Furthermore, the gradual deepening of thewife's contrasting experience of calmness and fear andapprehension resulted in her experiencing a previouslyunacknowledged aspect of herself. That is, she experiencedthat she was not as calm as she had thought.Intensifying and deepening the clients' experiences inrelation to the symbolic representation of alcoholfacilitated a deep and profound knowing which was notattained during their dialogue about the problem of alcoholand its effect. This finding supports the ExST theory thatthrough the process of symbolic externalization a holisticintegration of the client's world occurred includingcognition, behavior, affect and perception. It was evidentfrom the clients' conversation that when clients discussedthe alcohol problem and their relationship to it, theyengaged in a restrictive, challenging and defending behaviorpattern. It was only after they symbolically externalizedand intensified their respective experiences that relationalnovelty occurred.Implication for Theory and Practice The description of the theory underlying symbolicexternalizing is broad and through this analysis morespecific details of the construct were captured. Theessential component of symbolic externalization is to create306a symbolic representation of the problem and then distanceand separate from it so that the problem is no longerperceived as an inherent and fixed quality residing withinthe person. Hence, it seems that externalizing dealsprimarily with representing and distancing from stories ormeanings associated with the problem. The themes thatemerged from the case study, however, indicate that there ismuch more involved in externalizing than representing anddistancing from the problem. Prior to introducing thesymbolic representation of the alcohol both the therapistand clients began to shift from the old story or meaningabout the alcohol dependency to a new story whilesimultaneously moderating the therapeutic atmosphere. Asthe clients' experience with the symbol was intensifiedthere was a separation and clarification of the two storiesor meanings that were developing.Three themes, resulting from the old story or meaningof the alcohol dependency, became the ground for novelty andfocused on kindling a new therapeutic story for the clients.First, the theme of reframing alcohol as a seducer focuseddirectly on changing the old story from the husband'sweakness and failure for not controlling alcohol, to alcoholbeing the problem that enticed him to drink. Second, thetheme of moving from an individual to a relationalunderstanding of the role of alcohol in the couple'srelationship did not just deal with representing the old307story, but was also designed to create novelty anddifference in their relationship. That is, there was ashift to include the wife in the husband's alcohol recoveryand to begin the promotion of equity in their decisionmaking process. Third, the theme of challengingpropositions and competence focused on shifting thehusband's existing belief that he was not affected by thepresence of alcohol. Again, the emphasis was on looking foralternate perspectives in relation to how alcohol waspreviously perceived. Although these three themes deal withrepresenting the old story, they all contribute to makingmajor movements toward difference, novelty and change.Movement toward developing the basis for the new storyor meaning was evident through the theme of re-defining andaccenting the couple's commonalities. The new storyemphasized the couple working together toward common goalswhich simultaneously served to elevate the wife's status inthe marital relationship so that she could be involved inthe alcohol recovery. The new story was about exploring,together, their goal of getting rid of alcohol and theirrespective experiences of alcohol being out of their lives.The basis for the new story focused primarily on theinterpersonal functioning between the spouses.Other themes identified in the study were not concernedwith either the old story of the alcohol dependency or thenew story that was emerging, but were concerned with308developing a certain atmosphere or character of the therapyfor the externalization to be effective. These themes dealtprimarily with accompanying and accommodating the clients'internal process in order to moderate the therapy. Thethemes of regulating the intensity of experiences anddiffusing tension and defensiveness were found to moderatethe therapeutic process. Moderating the therapy includedpacing the therapeutic process to help clients graduallyexplore, intensify and accept their experiences. The thirdtheme, dealing with the therapeutic climate, was creatingand maintaining a collaborative atmosphere which served toestablish the ground or base of the therapy. In order forthe symbolic externalization intervention to accomplish itstask of creating relational novelty, the therapeuticalliance had to develop a sense of safety and collaboration.The final phase of the therapeutic story in the therapyepisode was to separate and clarify the two kinds of storiesthat were developing in relation to the alcohol dependency.This separation and clarification occurred via the theme ofdeepening contrasting experiences. Heightening the contrastbetween the clients' previously existing experiences and newexperiences resulted in the clients becoming aware of,experiencing and accepting the new story or meaning aboutthe alcohol dependency problem.In summary, using the symbolic externalizationintervention entailed a movement from the old story or309meaning about the alcohol dependency to developing a newstory. To reinforce the new story, both stories wereseparated and clarified and then heightened. An integralelement for the intervention to be effective required thatthe therapeutic alliance moderated the therapy byestablishing a certain atmosphere.As a result of these above findings, the theoreticalconstruct of symbolic externalizing was made more specificwhich then contributed to enhancing clinical utility. Thespecific aspects documented in this study provide clinicianswith knowledge about necessary components to effectivelyintroduce and implement the symbolic externalizationintervention. In particular, the findings revealed thecomplexity of using symbolic externalization and that it isnot sufficient for clinicians to just introduce theintervention and then intensify and deepen the experience.Clinicians must first acquire information about the oldstory of the presenting problem and then create movementtoward difference, novelty and change. This movement towardthe new story will be most effective if the atmosphere ofthe therapy is continually moderated and both the old andnew story are separated, clarified and heightened.Attending to the Therapeutic Process The findings of the case study support the view thatthe quality of the relationship between client and therapistinfluences much of what occurs in therapy (Rogers, 1957).310An effective type of therapeutic relationship varies withdifferent client-therapist systems, but it is generallyconsidered that focused attention and mutual respect areinvariably important components. These components weremanifested in this study's theme of creating and maintaininga collaborative atmosphere. It is also important thattherapists remain flexible in their role so they mayfacilitate the variety of experiences required in the courseof therapy.In their review of process-outcome studies, Orlinskyand Howard (1986) found that "effectively therapeutic"components of psychotherapy included: (a) the therapeuticbond between therapist and client which entailed reciprocalrole-investment, empathic resonance, and mutual affirmation;(b) therapeutic interventions implemented skilfully and withsuitable clients; (c) the therapeutic subsystem focused onthe client's feelings; (d) preparing the client for theensuing therapeutic process and therapist-clientcollaboration with regards to the therapeutic contract; and(e) at times having more than less therapy. Theseresearchers suggest that the reason for their findings ofinconsistent associations between client outcome andtherapeutic interventions is because therapeuticinterventions do not directly influence therapeuticrealization. Instead, therapeutic interventions "require an`open' state of self relatedness for this influence to311become effective" (Orlinsky & Howard, 1986, p. 369). Thefindings of their research suggest that a strong therapeuticbond increases the client's willingness to participate intherapeutic interventions. It was proposed that severalfactors influence the development of the therapeutic bond.First, the accumulation of meaningful interventions that areexperienced as helpful by the client may enhance thetherapist's credibility as well enhance the client'sinvestment in the therapeutic bond. Second, implementing acollaborative client-therapist therapeutic contract enhancesthe development of a good therapeutic bond.The findings of the case study are consistent withOrlinksy and Howard's (1986) suggestion that other factorsrelating to the therapeutic alliance influence theeffectiveness of the intervention. The co-construction ofthe themes by the therapist and clients in and of itselfenhanced the quality of the therapeutic bond. Additionally,the accumulation of such co-constructed and accepted themesand interventions as, reframing alcohol as a seducer,challenging propositions and re-defining commonalities mayhave enhanced both the therapist's credibility and theclients' investment in the therapeutic relationship.The case study supports Goolishian and Anderson's(1990) notion "that it is the slow and careful developmentof a co-created reality in a narrative that provides thecontext and the space for change" (p. 104). The therapist312provides the space for and facilitates the dialogicalconversation. This is done through inquiry that opens upand mobilizes rather than closes down and immobilizesclients (Anderson & Goolishian, 1988). The carefuldevelopment of a co-created reality in the therapy episoderequired that the therapist and clients engaged in firstforming a collaborative therapeutic atmosphere. The contextand space for change was further opened by diffusing tensionand defensiveness, regulating the intensity of experiences,and a gradual deepening of contrasting experiences.Implication for Theory and Practice Prior to the intensification of the clients'experiences, which led to attaining relational novelty, thetherapeutic subsystem attended to the seven themes thatpreceded the eighth theme of deepening contrastingexperiences. Although relational novelty was accomplishedafter experiencing the relationships to self and others inthe absence of alcohol, these preceding seven themes thatemerged from the analysis of the therapeutic episode had tobe resolved and accepted. These seven themes, which will bediscussed in the following section, have implications fortheory and practice with regards to both the therapeuticrelationship and process.1. Creating and maintaining a collaborative atmosphere.This study confirmed, through the theme of creating andmaintaining a collaborative atmosphere, the ExST's theory of313therapist and client collaboration. The therapeuticrelationship created an atmosphere of mutuality and respectfor others and their ideas in the therapy. The mutualityand respect was demonstrated by the therapist and clientsco-constructing the eight identified themes. Based uponOrlinsky and Howard's (1986) findings, establishing acollaborative therapeutic mandate further enhanced thetherapeutic bond. Considering that the collaborativerelationship between therapist and client is essential toboth symbolic externalizing and relational novelty, then itwould seem that this theme is a condition for therapy ratherthan a mechanism of change in itself. The collaborativeatmosphere moves the therapy toward a process in which allmembers of the therapeutic system can be open to change andthe meaning and integrity of members is not challenged(Anderson & Goolishian, 1988).The clinical utility of this finding is that thequality of this safe and trusting collaborative atmosphereis crucial when externalizing and intensifying experiences,especially considering that clients may take personal riskin experiencing previously unacknowledged and possiblethreatening aspects of the experience both within self andwith their spouse and therapist. It was evident in theinvestigated therapy episode that both clients experiencedpreviously unacknowledged aspects of themselves during theexternalizing intervention. Creating a collaborative314atmosphere is integral to the beginning phase of ExST andinvolves the therapist validating each spouse's experienceof the marital relationship. As this validation processenhances the creation and maintenance of collaboration, italso validates clients' responses and encourages them tofurther explore their relationships. In marital ExST thetherapist must join with both spouses in their inner andouter realities even though there may be differing views.As the therapist joins with and validates each spouse'sexperience, without alienating the other person, it requiresnot ascribing blame to the other. An example of how thetherapist in the case study joined the clients in theirrespective experiences without minimizing or dismissing theother, was when she introduced (via the theme of re-definingthe couple's commonalities) their implicit collaborationabout what to do with the alcohol in the house. Thetherapist simultaneously elevated the wife's status in themarital relationship to one who had the ability to makealcohol related decisions and did not negate the husband'sdesire to be in charge of his battle with alcohol.The other component linked to the theme of creating acollaborative atmosphere, as found in this case study, wasconsistent with Maturana's (cited in Friesen et al., 1989)theory of structural coupling and developing a consensualdomain in the therapeutic relationship. There was a commonjoining of aspects of the personality structures of each315participant and the therapeutic environment which resultedin agreement of the therapeutic goals and perceivedrelevance of the tasks associated with the therapy process.This study found that forming the consensual domain requiredthe therapist to accommodate the clients' particularpersonality structure in the therapy process and the clientsto accommodate the therapist's therapeutic principles viathe process or theme of regulating the intensity ofexperiences. Creating and maintaining a collaborativeatmosphere requires that clinicians incorporate andintegrate clients' particular personality structure into thetherapy which will ultimately determine the idiosyncraticcourse and process of therapy for each client. Thetherapist and clients co-construct the therapeutic context.2. Regulating the intensity of experiences. The themeof regulating the intensity of experiences is linked tocreating and maintaining a collaborative atmosphere. Thetherapist must remain attuned to each client's readiness forchange and then match the intensity of the therapeuticprocess to that of the client's internal and contextualworld (Friesen et al., 1989). As was found in the casestudy, this may require shifting back and forth fromheightening a particular emotion, physical sensation,behavior or cognition through repetition to analyzing theexperience. In tracking the clients' experiences andmatching their pattern of speech, the therapist in the case316study paced the process of therapy. The use of mitigation,analyzing of experiences and highlighting strengths areexamples of how the therapist lessened the intensity ofexperiences. The clients in the case study regulated theintensity of their experiences by using mitigation and byanalyzing their behavior and experiences. It was thegradual progression toward and the eventual intensificationof experiences that contributed to co-creating relationalnovelty. Observing and becoming aware of the ways in whichclients and therapists lessen the intensity of experienceswill aid clinicians in assessing clients' readiness forchange and the need for regulating intense experiences.3. Diffusing tension and defensiveness. A corollary tothe regulation of intense experiences is the theme ofdiffusing tension and defensiveness. To avoid creatingoffense and to lessen the impact of overt expressions,assertions, suggestions and challenges, both the therapistand clients in this study mitigated and modified expressionsthat may result in conflict. Diffusing tension anddefensiveness contributed to building and maintaining thetherapeutic relationship and was a means of achieving thegoals of therapy. For instance, when the therapist diffusedthe tension between the couple as they engaged in aninvariant pattern of challenging and defending behavior,this enabled the focus of the therapy to be re-directed tothe goal of getting rid of alcohol. The process of317mitigating responses and assertions was the way members ofthe therapeutic subsystem tried to understand each other andthe presenting problem. The clients and therapist relatedto their understanding of the problem idiosyncratically andwith differing levels of value investment. They also had anopportunity to discourse and change at their own pace and intheir own way (Anderson & Goolishian, 1988). By use ofcooperative rather than uncooperative language, linguisticmobility was enhanced and the interview moved toward"collaborative conversation rather than towardconfrontation, competition, polarization, and immobility"(Anderson & Goolishian, 1988, p. 382). This led to thetherapeutic conversation remaining open to allow forevolving of new meaning and understanding of the problem.In regards to clinical utility of the theme ofdiffusing tension and defensiveness, clinicians must learn,understand and converse in the clients' language because thewords, language and meaning used by clients in therapeuticdiscourse is the metaphor for their experiences (Anderson &Goolishian, 1988). Diffusing tension and defensiveness,through various means, was the therapeutic subsystem'smethod of generating meaning about the problem.4. Challenging propositions and competence. The themeof challenging propositions and competence is related to theidea that clients may understand their problem relationshipsin ways that typically impedes the possibility of318resolution, resulting in repetitive interaction patterns.Thus, in order for the possibility of resolution to occur,it is important to change the perception of the problemrelationship and of self. Challenging propositions andcompetence in relation to the clients' perception of self,others, and the effect of alcohol perturbs interactionalsequences on various relational levels. For example, inthis study challenging the alcohol dependent client'sperception that he was not adversely affected by thepresence of alcohol provided new information whichcontributed to co-creating relational novelty in bothintrapsychic and interpersonal domains. That is, thehusband's perception of how he experienced alcohol wasexpanded. The challenge introduced information to thetherapeutic subsystem that led the wife to begin having asay with respect to the alcohol.In regards to the utility of challenging propositions,the therapist must inquire about discrepancies anddistortions that keep clients mired in their problemsituation. As suggested by Anderson and Goolishian (1988),the therapist inquires in such a way that does not judgewhether the client's view is right or wrong. This processmay then lead to a mutual inquiry about entrenched ideas,resulting in expanding and creating new meaning.5. Reframing alcohol as a seducer. Another method ofexpanding and creating new meaning found in this study was319to reframe the perception of the problem. Rather thancontinue with a constrictive perception of self in relationto alcohol, information may be introduced that effectivelyshifts the meaning of the relationship with alcohol and thenature of the problem itself (Friesen et al., 1989). Theintent is to alter the clients' perception of theirrelationship with alcohol so that the behavior connected tothe alcohol and the meaning attached to this behavior arere-examined and understood differently.This study found that the reframe of alcohol as aseducer was re-introduced several times before it wasaccepted by the alcohol dependent client. His previousself-perception of being weak, worthless and a failure inrelation to his battle with alcohol was not easily altered.Thus, clinicians may need to introduce the reframe more thanonce in order for it to be accepted by all members of thetherapeutic subsystem.6 & 7. Moving to a relational understanding of alcohol and re-defining the couple's commonalities. These twothemes are specifically connected with addressing theinterpersonal functioning between the spouses in relation tothe symptomatic behavior of alcohol dependency and areintegral to the systemic principle of ExST. The systemicperspective holds that individuals engage in a dynamicinteractional process in