UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Conversational resources of two-person psychotherapy Katz, Bruce Allen 1971

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1971_A8 K38.pdf [ 4.01MB ]
Metadata
JSON: 831-1.0302455.json
JSON-LD: 831-1.0302455-ld.json
RDF/XML (Pretty): 831-1.0302455-rdf.xml
RDF/JSON: 831-1.0302455-rdf.json
Turtle: 831-1.0302455-turtle.txt
N-Triples: 831-1.0302455-rdf-ntriples.txt
Original Record: 831-1.0302455-source.json
Full Text
831-1.0302455-fulltext.txt
Citation
831-1.0302455.ris

Full Text

tl CONVERSATIONAL RESOURCES OF TWO-PERSON PSYCHOTHERAPY by BRUCE ALLEN KATZ B.A., San Fernando Valley State College, 1968 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in the Department of Anthropology and Sociology We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA January, 1971 In presenting this thesis in p a r t i a l fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make i t freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the Head of my Department or by his representatives. It is understood that copying or publication of this thesis for financial gain sh a l l not be allowed without my written permission. Department of Anthropology & Sociology The University of B r i t i s h Columbia Vancouver 8, Canada Date March 51. 1971 The research reported here takes as its data tape-recordings and transcripts of a number of two-person psychiatric interviews, , conducted by two psychiatrists with a number of patients of both sexes. The transcripts are analysed by reference to speech acts as units, and the emphasis is on properties common to a l l speech in natural language. An attempt is made to show (a) that by reference to such unit acts, psychiatric events can be made intelligible, and (b) that an analysis along these lines is in principle capable of "explaining" the interactional mechanisms of the psychiatric interview, without recourse to psychiatric theory as part of the analytic apparatus. Among issues given special attention are (1) the opening of the psychiatric interview and its consequentiality for further developments, (2) the negotiated character of topics and the avail-ability of interactional devices for controlling topical development, and (3) the accomplishment of "treatment" through "talk". Findings are reported with respect to each of these issues, but the report should be read chiefly as an exercise in the application of a method of socio-linguistic analysis to a type of data usually reserved for substantive treatment in the area of social psychiatry. Page CHAPTER I Introduction • 1 Footnotes 6 CHAPTER II Speech and Psychiatric Practice 8 Footnotes 14 CHAPTER III Opening the Psychiatric Interview 15 Footnotes 34 CHAPTER IV Continuity Over Conversational Encounters: Personal Biography and Medical History 36 Footnotes 52 CHAPTER V Treatment Procedures 53 Footnotes 74 CHAPTER VI . Significance Markers 75 Footnotes 87 CHAPTER VII Conclusion 88 BIBLIOGRAPHY 92 ACKNOWLEDGEMENT 7 I would like to take this opportunity to thank Roy Turner for introducing me to this method of investigation and for providing me with helpful criticism during the research and writing of this report. In addition I would like to thank the doctors and patients who provided the data for this thesis. In order to maintain their anonymity a l l names and places have been changed. CHAPTER I INTRODUCTION The data presented in this thesis comes from tape recorded psychiatric interviews. Tape recordings were obtained from psychia-1 trists who recorded their interviews with the patient's consent. Once the tape recordings were in the possession of the researcher a 2 transcript of each interview was made. The transcripts constitute as near a verbatim account of what was said as is technically possible to produce, i.e. no paraphrasing of the talk took place, nor were any coding procedures used to construct the transcript. To quote Speier, "There is an object analysts construct called a transcript. It is a written record of some conversational encounter 3 that is produced from a tape of the event." Such transcripts constitute the body of data used. Now i t is a major contention of this thesis that by studying such transcripts of the "natural interaction", i.e. the talk that took place during some conversational encounter, that as analysts i t is possible to learn something about the social organization of such settings and encounters. Furthermore by studying such pieces of "natural interaction" i t is possible to discover some general and invariant features of the conversational resources members use when talking to one another. Let me elaborate. I have emphasized the point of the data being the ''natural interaction" between the participants rather than some transforma-tion of that data, e.g. content analysis. E.ecent developments i n philosophy, particularly that branch known as ordinary language 4 philosophy, have been concerned with the structure of natural language and the "speech-acts" produced by the participants. Consider the following remark by Searle: In a typical speech situation involving a speaker, a hearer, and an utterance by the speaker, there are many kinds of acts associated with the speaker's utterance. The speaker w i l l characteristically have moved his jaw and tongue and made noises. In addition, he w i l l characteristically have performed some acts within the class which included informing or i r r i t a t i n g or boring his hearers j he w i l l further characteristically have performed acts within the class which include referring to Kennedy or Krushchev or the North Pole; and he w i l l  also have performed acts within the class which included  making statements, asking questions , issuing commands.,  giving reports, greeting and warning. The members of  this last class are what Austin called illocutionary  acts and i t is with this class that I shall be concerned  in this paper, so the paper might have been called "What is an Illocutionary Act?" (Emphasis mine)^ With respect to the study of interaction some sociolo-gists have found i t desirable to adopt the philosophers' concept 6 of the performative character of language. That i s , members of the society accomplish certain activities through talk and that as analysts much can be. learned by treating the talk produced by members of the society as members' methods, i.e. methods-in-use 7 for accomplishing certain interactional a c t i v i t i e s . This concern by sociologists with speech and the methods members of the society use when talking to one another is nicely stated by Speier: Unlike past researchers who have only noticed in passing the most general significance of language (as in symbolic interactionism) this new direction in studying speech as the living performance of language has emphasized the methods participants use when building talk and practical activity around each other. By methods is meant what others in this volume have often alluded to as the pro-cedural basis for everyday interactions, or as Turner puts i t , our enterprise consists of !ithe uncovering of members' procedures for doing activities", talking, or "doing things with words" being a major component of those activities. (Emphasis in the original).8 The analytical utility of talk, i.e. the t;natural inter-action" that takes place between participants, as primary data for the study of the social organization of settings and encounters, cannot be overemphasized. What in effect is being advocated is a 9 revolutionary idea concerning the nature of sociology. Consider the following statement by Turner; It is increasingly recognised as an issue for sociology that the equipment which enables the "ordinary" member of the society to make his daily way through the world is the equipment available for those who would wish to do a "science" of that x<?orld....A science of society that fails to treat speech as both topic and resource is doomed to failure. And yet, although speech informs the daily world and is the sociologist's basic resource, its properties continue by and large to go unexamined. Linguistic models have had some recent influence on the development of sociolinguistics, but i t is s t i l l not at a l l clear that any specifically linguistic properties of talk can be related to central sociological concerns. If we take sociology to be, in effect, "a natural history of the social world", then sociologists are committed to a study of the activities such a world provides for, and the methodical achievement of those activities by social-ized members. (Emphasis in the original).^ This thesis is a study of the conversational resources employed by the members of a particular setting (the psychiatric interview) as a way of organizing that setting. It is advocated that: In exactly the ways that a setting is organized, i t consists of members5 methods for making evident that setting's ways as clear, coherent, planful, consistent, chosen, knowable} uniform, reproduceable connections, i.e. rational connections. In exactly the way that persons are members to organized affairs, they are engaged in serious and practical work of detectings demonstrating, and persuading through displays in the ordinary occasions of their interactions the appearance of consistent„ coherent, clear, chosen, planful arrange-ment. In exactly the ways in which a setting is organ-ized, i t consists of methods whereby its members are provided with accounts of the setting as countable, storyable, proverbial, comparables picturable, repre-sentable — i.e., accountable events.H By studying such conversational resources i t is hoped to learn something about the social organization of the psychiatric inter-view and furthermore that such an analysis may yield findings that are generalizable to interactional exchanges between participants regardless of the setting being one of a psychiatric interview. While I have attempted to provide the reader with some background information concerning the perspective of this thesis I admit that this attempt has been brief. The most important point I feel is to present the analysis and in this context I share Speier's views as expressed in a passage introductory to his analysis of children's talk: No attempt will be made to justify the topic of inquiry as an elaboration upon current sociological fact and theories. It does not seem to be a case of elaborating current facts and theories. Nor will any attempt be made to supply the reader with materials that could be organized into intellectual antecedents to the topic. The reader is advised to consult the available works in structural linguistics, psycholinguistics, transforma-tional grammar, anthropological linguistics, componen-tia l analysis, socio-linguistics, and philosophy of language and ordinary language. While such materials offer suggestive, clues to the sorts of problems encoun-tered in investigating talk they are entirely dispensable to a preliminary consideration such as this....It is assumed an unquestionable and unassailable fact of social l i f e that talk exists. Given the fact the next step is to directly confront the phenomenon in whatever form i t can be taken as empirical data.-^ In short the conversational analyst is presented with the following dilemma; either to attempt to provide a lengthy and elaborated set of arguments, justifying the analysis to those to whom i t is unfamiliar; or to plunge directly into the empirical work itself. While my preference is for the latter, in these few pages I have tried to meet a minimal obligation to the reader who is assumed to be already interested in work of this character. Any other working assumption would have required a "theoretical" mono-graph rather than a preface to an empirical investigation. 1. To those who would offer as an argument that by the psychiatrist taping the interview an " a r t i f i c i a l " situation has been created I suggest a reference to Roy Turner, "The Ethnography of Experi-ment", The American Behavioral Scientist, April 1967. 2. For a discussion of the construction of a transcript and the complexities involved see Matthew Speier, "Procedures for Speak-ing and Hearing: The Interactional Display of Social Organiza-tion" in David Sudnow (ed.), Papers in Interaction (forthcoming). 3. Ibid. 4. For works representative of those philosophers engaged in ordinary language philosophy the reader should consult Anthony Flew (ed.), Logic and Language-, Oxford,Basil Blackwell, 1966. 5. John Searle, "What is a Speech Act?" in Philosophy in America by Max Black (ed.), George Allen and Unwin Ltd., London, p. 230. 6. I am particularly thinking of the recent works by Matthew Speier, Roy Turner,, and the study of conversation by Harvey Sacks. 7. For a discussion of members' methods see Harold Garfinkel, Studies in Ethnomethodology, Prentice-Hall, Englewood Cliffs, New Jersey, 1967. In the area of childhood "socialization" see Matthew Speier, "The Organization of Talk and Socialization Practices in Family Household Interaction", unpublished Ph.D. dissertation, University of California, Berkeley, 1969. Chap-ters 4 and 5 aptly demonstrate members' methods (in this case children ;s methods) for accomplishing interactional activities. 8. Matthew Speier, "The Everyday World of the Child", prepared for Jack Douglas (ed.), Understanding Everyday Life, Aldine Press, 1970. 9. What is meant by a "revolutionary idea" in the development of a science is aptly discussed by Thomas S. Kuhn in The Structure of  Scientific Revolutions. University of Chicago Press, Chicago, 1962. 10. Roy Turner, "Words, Utterances and Activities" prepared for Jack Douglas (ed.), Understanding Everyday Life, Aldine Press, 1970. 11. Harold Garfinkel, Studies in Ethnomethodology. Prentice Hall, Engelwood Cliffs, New Jersey, 1967, p. 34. 12. Matthew Speier, "Some Conversational Sequencing Problems for Interactional Analysis: Findings on the Child's Methods for Opening and Carrying on Conversational Interaction." Paper presented at John Gumperz's Summer Workshop Group IV of "Lan-guage, Society, and The Child", University of California, Berkeley, Summer Quarter, June 19-September 7, 1968. CHAPTER II SPEECH AND PSYCHIATRIC PRACTICE It is the purpose of this thesis to examine some features of the social organization of two-person psychiatric interviews. Unlike other works in this area, I will not be concerned with pro-viding a psychiatric analysis of the interview nor will I be con-cerned with providing some explanatory scheme that will "instruct"' therapists in the proper ways of conducting such interviews. I will deal with an analysis of the "natural" interactions i.e. the talk that occurs during psychiatric interviews, with the hope of discover-ing some organizational features of such occasions. Contrasting therapy situations with the prototype doctor-patient relationship, one of the features of such a relationship is that 'talk' facilitates or accompanies "treatment", but unlike therapy situations does not consitutute the treatment. Freud dealt with this when he stated: To a l l appearances nothing takes place between patient and psychiatrist except that they talk to each other. The psychiatrist does not take recourse to any instru-ment, nor does he write out prescriptions. If i t can be arranged he will not even take the patient out of his usual surroundings or upset his daily routine in any way while treating him.-'-Turner, in a recent paper on "Some Formal Properties of Therapy Talk" makes reference to a similar point: 'Talk' with the p r a c t i t i o n e r may be acceptable to the c l i e n t as a necessary prelude for the i n s t i t u t i o n of appropriate treatment routines. With respect to some domains of expertise, however, i t seems to be the case that 'talk' i s also the chief medium of help and not merely the prediagnostic work whereby the p r a c t i t i o n e r gathers the facts and symptoms.2 Much of the p s y c h i a t r i c l i t e r a t u r e i s concerned with t h i s basic feature of the p s y c h i a t r i c interview, i . e . that what occurs between patient and therapist i s ' t a l k ' . While I am not concerned with p s y c h i a t r i c theory ; an examination of the way t h i s 'talk' i s characterized i n the l i t e r a t u r e i s useful for subsequent sections of this t h e s i s . In The F i r s t Five Minutes, the authors make an i n t e r e s t i n g comment concerning the s p e c i a l character of the t a l k that occurs i n therapy s i t u a t i o n s . The patient cannot leave h i s problems at home, even i f he wants to or thinks he has, since they are himself, or something about himself, and go where he goes. He may not be able to describe his problems very accurately (compare the engineer, who has a very precise termino-logy f o r what a i l s the bridge), but there i s an excellent chance that sooner or l a t e r he. w i l l demonstrate them i n the way he comports himself v i s - a - v i s the therapist. S i m i l a r l y , the therapist cannot leave his instruments elsewhere, as a plumber can forget h i s tools or a family physician his black bag, since they reside within him. At the outset there i s no simple dichotomy, as i n the bridge conference, between some "primary concern" and the " i n c i d e n t a l by-play"j the discovery of the basic trouble i s part of the work to be done, and u n t i l i t has been discovered nothing that transpires can s a f e l y be disregarded.3 Consider also the followirig statement by S u l l i v a n ; It simply means ( r e f e r r i n g to the p a r t i c i p a n t character of the p s y c h i a t r i c interview), as I said e a r l i e r , that the p s y c h i a t r i s t l i s t e n s to a l l statements with a c e r t a i n c r i t i c a l i n t e r e s t , asking, "Could that mean anything except what f i r s t occurs to me?" He questions (at l e a s t to himself) much of what he hears, not on the assumption that the patient i s a l i a r , or doesn't know-how to express himself, or anything l i k e that, but always with the simple query i n mind, "Now could t h i s mean something that would not immediately occur to me? Do I know what he means by that?"^ In terms of the talk which occurs between therapist and patient during the p s y c h i a t r i c interview and regardless of the psy-c h i a t r i c theory supported by the p a r t i c u l a r t h e r a p i s t , p s y c h i a t r i s t s are e n t i t l e d to treat t a l k generated by the patient as being "more than what i s j u s t s a i d " , i . e . as "demonstrating" the patient's problems. For example, consider the following remarks produced by a patient and the subsequent analysis of those remarks by competent c l i n i c i a n s : P8d I need to get away from them. (Referring to the patient's husband and c h i l d r e n ) . P8e I can't stay closeted up i n the house a l l the The phrase closet up i s somewhat unusual. *Shut-up' or * cooped up, or *closeted (without the up_) would be commoner. We suspect that to be closeted i s a natural idiom i n P's more elevated vocabulary, i n the meaning of confinement and constraint, p h y s i c a l and emotional; perhaps i t i s reinforced by memory or knowledge of con-finement i n a c l o s e t as a punishment i n childhood. The time. addition of up_ might then be a blend with, say, *cooped  up or might merely be an intensive (compare *used up, *drink one's milk a l l up., where up has no directional reference). At a deeper level, closet might conceivably be a sym-bol for the uterus, and up_ retain slight overtones of it s primarily directional meaning. Also, i n the light of earlier possibly anal references (P8a, r e l i e f duty), closeted might carry connotation of the water closet, and up_ may have associations with various extremely common expressions referring aggressively to the anus and to the insertion of various objects therein. P i s complaining here of being too confined; we should per-haps think of earlier experiences in her l i f e for which the bathroom was the secluded place for indulgence i n assorted viceral pleasures which, in addition to plea-sure, would have generated a certain amount of guilt and of desire to "escape" into the controlling context of being with other people.5 While the above analysis may represent a psychiatric account of the patient's remarks, to assume that such an account is a reflection of the way those remarks were actually 'heard' in the therapy situation i s , I suggest, to make an error. The above analysis is a socially produced account of the patient ;s remarks, the production of which took place "outside" of the interview and perhaps hours, days, etc. after the interview, and not by the thera-pist conducting the interview. Such an account t e l l s us very l i t t l e about how the participants interacted within that situation, i.e. that therapists are entitled to make such an analysis does not t e l l us how they 'hear' such remarks by the patient as "demonstrating his problems". Furthermore to say that psychiatrists 'hear' or "listen to a l l statements with a certain c r i t i c a l interest", using some p s y c h i a t r i c theory, seems to bypass the main issue of what c o n s t i -tutes p s y c h i a t r i c data for the therapist and how that data becomes recognized. In considering the 'talk 1' that occurs i n the p s y c h i a t r i c interview I am suggesting that whatever p s y c h i a t r i c theory a ther-a p i s t subscribes to, such theory does not e x p l i c i t l y enable, a thera-p i s t to recognize patients' remarks as p s y c h i a t r i c data nor does such a theory forecast what the therapist w i l l or should say i n terms of the on-going i n t e r a c t i o n between patient and therapist. I am not arguing that therapists do not treat patients' 'talk' from some p s y c h i a t r i c perspective, but only that such 'treatment' occurs a f t e r the therapist has recognized a piece of i n t e r a c t i o n as being data. Data i n p s y c h i a t r i c p r a c t i c e , I suggest, i s gathered the same way other competent members of the society would 'hear' patients' remarks. Therapists use i n t e r a c t i o n a l s k i l l s which they share with other members, and which r e l a t e to everyday common-sense knowledge of the world, to gather th e i r data. They recognize patients' remarks as f i r s t being, e.g., i n s u l t s , questions, greetings, etc., and then engage i n some transformational work on these everyday remarks to produce instances required by p s y c h i a t r i c theory or a set of p s y c h i a t r i c categories. For example, a patient "insults"' the therapist by r e f e r r i n g to him i n a derogatory manner. The therapist treats this "insult" in terms of some psychiatric pers-pective, e.g., reflecting the patient's problems with aggression. In order for this piece of interaction to be recognized the psychi-atrist uses his everyday common-sense knowledge about the world, i.e. i t is first 'heard' as an "insult" and then equated with a psychiatric category provided by a theory. Furthermore, such a psychiatric theory does not determine how the therapist will handle the patient interactionaily, i.e. what the therapist will say to the patient. Data for psychiatrists consists of recognisable forms of natural language, or speech acts, and the way the benefits of his therapeutic s k i l l are administered is similarly through forms of natural language. In the remaining sections of this thesis I will be exam-ining actual pieces of natural interaction that occurred during psychiatric interviews. While the data consists of the talk between patient and therapist i t is important to remember that the analysis is predicated on being able to explicate the everyday common-sense features of the. world and not some prior acceptance of a particular psychiatric theory. I am not concerned with providing clinical accounts of "what is happening'' between patient and therapist (I take this to be the job of competent clinicians), but rather in providing an analysis of the interactional development of the inter-view. The concern is with the actual progress of the psychiatric interview as developing sequences of interaction. 1. Merton G i l l , Richard Newman, and Fredrick C. Redlich. The I n i t i a l Interview i n Ps y c h i a t r i c P r a c t i c e . International U n i v e r s i t i e s Press Inc., New York, 1954, p. 24. 2. Roy Turner. "Some Formal Properties of Therapy Talk". Prepared for David Sudnow, (ed.), Papers i n Interaction (forthcoming). 3. Robert E. Pittenger, Charles F. Hockett, and John J . Danehy. The F i r s t Five Minutes. Ithaca, New York: Paul Martineau, 1960, p. 2. 4. Harry Stack S u l l i v a n . The P s y c h i a t r i c Interview. W.W. Norton and Company, Inc., New York, 1954, p. 20. 5. Pittenger, Hockett, and Danehy. The F i r s t Five Minutes, p. 71A. CHAPTER I I I OPENING THE PSYCHIATRIC INTERVIEW The data used i n this chapter comes from the beginnings of p s y c h i a t r i c interviews. It i s my purpose to examine how topics become i n t e r a c t i o n a l l y constituted, i . e . what i s i n t e r a c t i o n a l l y required i n order for an utterance to gain the status of being regarded as a topic for discussion. The importance of t h i s issue for an analysis of p s y c h i a t r i c interviews l i e s i n i t s r e l a t i o n to the problem of topic c o n t r o l , as I s h a l l show. That t a l k contributes to the s o c i a l organization of set-tings and occasions i s a major contention of t h i s t h e s i s . That s o c i a l settings and occasions can provide for the accomplishment of c e r t a i n a c t i v i t i e s and that such a c t i v i t i e s are accomplished 1 v i a t a l k can pose problems with respect to t o p i c a l i t y . It i s possible to view settings as constraining t o p i c a l t a l k . Thus when purchasing a newspaper t a l k usually concerns the buying of the newspaper and not, e.g., one's problems at home. Such a notion, however, can lead one to assume that the topics a v a i l a b l e to p a r t i c i p a n t s of c e r t a i n settings can be l i s t e d , i . e . a l i s t of topics that can occur i n s o c i a l s i t u a t i o n s could be produced. Such an assumption seems to be e m p i r i c a l l y f a l s e since I suggest i t i s a feature of d a i l y l i f e that while settings may constrain t o p i c a l t a l k i t seems not possible to describe those constraints by way of producing a l i s t of t o p i c s . Despite t h i s , however, there seems to be something i n -t u i t i v e l y correct i n wishing to say that settings constrain t o p i c a l i t y . For example, when entering a butcher shop one gets categorized as a "customer1'. In order for t h i s category to be maintained one must engage i n some talk about the buying of meat. This i s not to say that many items w i l l not be discussed but only that sometime during the i n t e r a c t i o n one must act l i k e a customer. Thus while no l i s t of the topics that would occur i n , e.g., a butcher shop can be constructed, one of the constraining features of the s e t t i n g i s that once categorized as a customer one cannot engage i n talk without the topic sometime being concerned with the purchase of meat. While c e r t a i n settings and occasions provide for the accomplishment of 'core a c t i v i t i e s " t h i s i s net to say that the t a l k that occurs i n such settings must only be about the core a c t i v i t y , but only that such t a l k cannot be absent without some form of re-evaluation of the p a r t i c i p a n t s . That i s , while t a l k contributes to the s o c i a l organization of settings i t can also contribute to the d i s r u p t i o n of settings and one way of d i s r u p t i o n i s not to t a l k about the core a c t i v i t y the s e t t i n g provides f o r . However, i t i s not only the case that core a c t i v i t i e s provide topics whose absence would be noticeable, but that whatever "side t o p i c s " get constructed must be placed, proportioned, etc., with an o r i e n a t i o n to the structure of the core a c t i v i t y , e.g., when purchased a r t i c l e s are being wrapped there may be a s l o t for small t a l k . While therapy sessions are ''methodically i n i t i a t e d en-2 counters" (MIE) and are often regulated by some system of appoint-ments i t seems to be the case that (1) ta l k i s supposed to occur between patient and therapist, even when patients complain of having nothing to t a l k about, and (2) what can constitute a topic i s something that i s not necessarily pre-arranged between patient and t h e r a p i s t . Rather i t seems to be the case that therapy sessions are settings i n which although the p a r t i c i p a n t s encounter each other on a methodically i n i t i a t e d basis the s e t t i n g i s one i n which the "core a c t i v i t y " i s not obvious. While patients know that t a l k i s supposed to occur they do not know what constitutes "therapy t a l k " i n the same way they know, e.g., what constitutes butcher shop t a l k . Such a feature i s not only applicable to therapy ses-sions but also to many sociable occasions, e.g., a c o c k t a i l party. (Although i t i s not being advocated that useable topics are i n t e r -changeable from setting to s e t t i n g ) . It seems to be empirically the case that therapy s i t u a -tions do not require t h e i r p a r t i c i p a n t s to speak on any s p e c i f i c 3 t o p i c . As such, a v a r i e t y of topics can be discussed during a p s y c h i a t r i c interview and furthermore any topic can be seen as occasion relevant, i . e . used as the basis for a discussion between the therapist and patient. Given the empirical condition that the parameters of what can become a topic i n the p s y c h i a t r i c interview are quite large, one of the i n t e r a c t i o n a l problems faced by the pa r t i c i p a n t s i s how an utterance can gain the status of a t o p i c . What we are dealing with then i s the notion of making a t o p i c , i . e . topics are i n t e r a c t i o n a l l y negotiated between the p a r t i c i p a n t s . I w i l l now present data from p s y c h i a t r i c interviews, the analysis of which w i l l hopefully allow the reader to follow how i n i t i a t i n g a topic i s i n t e r a c t i o n a l l y accomplished. 1. T. (Come on in) [Therapist i n v i t i n g patient into h i s o f f i c e from waiting room.] 2. P. (I t ' s getting cold) [Patient seems to be taking o f f coat; a l s o , there i s a pause] So how are you? 3. T. Okay. How about yourself? 4. P. I'm f i n e . Great. 5. T. What's so great? 6. P. Nothing. Just great. [pause] Nothing's great though, everything's the same. [pause] I'm f e e l i n g okay. I don't r e a l l y have too much to t a l k about. 7. T. Well I haven't seen you since you telephoned to l e t me know that C l i n t had not passed. 8. P. Yeah. 9. T. What's been the repercussion from that? 10. P. For about two weeks he was very depressed... I have presented t h i s data to engage i n an analysis of topic construction. Before analysing the data i n terms of topic construction I would l i k e to pursue a discussion of greeting ex-changes. My reason f o r doing so i s that such a diversion w i l l c l a r i f y my discussion of topic construction. The reader should note, however, that the r e a l issue under consideration i s the negotiation of a t o p i c between the p a r t i c i p a n t s . I w i l l be concerned with U's 2-5. One way of character-i z i n g the s p e c i f i e d exchange i s to say that i t i s an exchange of greetings between a patient and a t h e r a p i s t . Harvey Sacks has done considerable work on greetings and has r e f e r r e d to "How are you?" as being a greeting s u b s t i t u t e , and as such properly occurring at the beginning of conversation or at least following a p a i r of 4 greetings. Consider Sacks' examples: 1. a. How are you? b. Okay. How are you? a. Okay. (end) 2. a. Hi b. Hi a. How are you? b. Fine. How are you? Another property of the greeting substitute "How are you?" i s that an exchange of such greetings between two people can c o n s t i -5 tute a "minimal proper conversation". By t h i s i s meant that two people can pass each other and only exchange "how are you" without f e e l i n g that something has been " l e f t out" or "not. done" i n the conversation. I t i s not an uncommon experience to say "How are you?" to a person you know and for him not to say "How are you?" back, e.g., you pass a f r i e n d on the way to the l i b r a r y and say "How are you?" and he r e p l i e s " f i n e " and continues on his way. I suggest that t h i s i s one way of f o r e s t a l l i n g a conversation from dev-6 eloping without being seen as rude, impolite, etc. To understand what i s meant by " f o r e s t a l l i n g a conversa-t i o n " one has to consider the complexity of the utterances involved and the p a r t i c u l a r nature of the encounter. "How are you?", although a greeting substitute i s also a question, and one of the constraining properties of questions i s that they usually receive answers. By saying "How are you?" i n the above example the greeted person i s i n t e r a c t i o n a l l y bound to give an answer. To continue with the example, by the speaker j u s t g i v i n g an answer i n the a f f i r -mative "Fine" he has s a t i s f i e d the questioner and may move quickly on h i s way since a f t e r a l l i t was by accident that the encounter took place. If however, he r e p l i e d with not only an answer but also "How are you?" he would be required to await an answer and thus increase the chance that a conversation might develop. While i t seems to be true that the exchange of "How are you?" can constitute a minimal proper conversation, a q u a l i f i e r must be added. It appears to be empirically the case that a negative answer to the question "How are you?" i s an i n v i t a t i o n for the asker of the question to undertake some i n v e s t i g a t i v e procedures to deter-mine, e.g. what i s wrong. Given these observations Sacks notes that i t i s often the case that members i n order to f o r e s t a l l a conversation from developing about, e.g., why one i s f e e l i n g mis-erable, etc., often answer the question "How are you?" i n a p o s i t i v e 7 manner. Such an answer tends to close the greeting phase of a conversation and can eit h e r constitute a minimal proper conversa-t i o n or allow the p a r t i c i p a n t s to proceed to a topic rather than make the negative answer to a greeting substitute the f i r s t topic for d iscussion. A f u l l grasp of the import of greeting exchanges for the analysis of topic negotiation requires us to address some e x p l i c i t remarks to the c a t e g o r i a l r e l a t i o n s h i p between the questioner and 8 questioned. That i s to say that members of the society have at th e i r d i s p o s a l various and hence competing ways of categorizing each other and that s o c i a l s i t u a t i o n s provide for the employment of some categories and exclusion of others. Depending on the c a t e g o r i a l i d e n t i f i c a t i o n s assigned and hence the r e l a t i o n a l claims between the p a r t i c i p a n t s i t would appear, i n our society at l e a s t , that there are some people e n t i t l e d to know "how you are" and there are other people not e n t i t l e d to know "how you are". To quote Sacks, "That i s to say people belong to many categories. Some of them provide that i n general i f you see t h i s person you greet them and 9 no more." Etiquette manuals state t h i s r e l a t i o n s h i p between questioned and questioner rather n i c e l y , and while not a s o c i o l o -g i c a l analysis should not be dismissed: The t r a i t of character which more than any other pro-duces good manners i s ta c t . To one who i s a chronic i n v a l i d or i n great sorrow or anxiety, a gay-toned greeting: "Hello Mrs. Jones, how are you, you look f i n e ! " , while kindly meant i s r e a l l y t a c t l e s s . Since to answer t r u t h f u l l y would make the s i t u a t i o n emotional. In such a case she can only reply " A l r i g h t , thank you". She may be f e e l i n g that everything i s a l l wrong but to ' l e t go' and t e l l the truth would open the floodgates d i s a s t r o u s l y . " A l r i g h t , thank you" i s an impersonal, and therefore strong bulwark against further comment or explanation. As a matter of f a c t , " A l r i g h t , thank you" i s always the correct and conventional answer to "How are you", unless there i s some reason to beli e v e that the person asking r e a l l y wants to know the state of one's health.-^ To further i l l u s t r a t e the importance of the r e l a t i o n s h i p between questioned and questioner consider the following s i t u a t i o n of h o s p i t a l patients reported by David Sudnow: An a d d i t i o n a l way of describing the di f f e r e n c e be-tween doctor — lay medical i n t e r a c t i o n and the s p e c i a l quasi-sociable character i t takes here i s by observing the use of ceremonial type exchanges. In the hallway of the h o s p i t a l I observed doctors greet t h e i r patients with "How are you today Mrs. Smith?" to which frequently the return " f i n e thanks, doctor" was given, even when the patient was obviously not f i n e . The remark "How are you?" can be heard as a ceremonial piece, to which there i s a proper ceremonial return and can be so treated. Or i t can be heard "construc-t i v e l y " , i . e . how are you today, as a question, an answer to which would entail enumeration, perhaps of one's feelings. Returning to our data from the psychiatric interview, the patient has offered the therapist a standard greeting, "So how are you?", and the therapist replies with what Sacks would c a l l a cere-monial answer plus a ceremonial greeting in return. The patient does not inquire into what is "OK" with the therapist, but rather accepts the therapist's answer at "face value" so to speak. The therapist, however, does not treat the patient's ceremonial answer, "I'm fine. Great" i n the same manner. The therapist in U5 re-quests the patient to provide an account of "what's so great?", i.e. he does not honor the patient's positive answer to his greeting as being "good enough". Interactionally U5 accomplishes a redefinition of the i n i t i a l greeting exchange. While in U3 the therapist asks the patient a ceremonial "How about yourself?", by so treating the patient's positive reply as the basis for further investigation I suggest the therapist has redefined his i n i t i a l ceremonial greeting into a constructive, i.e. to be heard by the patient "constructively". Furthermore, I suggest that therapists have the option of treating patients' talk in such a manner and these entitlements are not sym-metrical between patient and therapist. For the patient to perform the same operation on the therapist's utterance by saying, e.g., "I'm fine. Great. How come you're feeling Okay?" I suggest would be seen as being strange, odd, or inappropriate. In addition to redefining a greeting substitute from a ceremonial to a constructive U5 i s accomplishing other work inter-actionally. Consider for a moment the consequentiality of a nega-tive answer to the therapist's question "How about yourself?". Sacks has stated that i f one answers with a negative term such as 'lousy' then the asker of the question is entitled to ask, e.g., "What's wrong?". Furthermore, a negative answer to the ques-tion "How are you?'"' not only allows the asker to inquire into one's personal state of health, but also provides a slot allowing the questioned party's personal state to become a topic for conversation. One way to get topical control of a conversation i s to offer a negative answer to a greeting substitute. This not only allows (or requires) the asker to inquire into the reason for your "trouble" but also gives one the floor to explicate the reason for his feeling "lousy", "rotten", "terrible", etc. It i s for this reason that our previous quotation from Emily Post lacks a certain qualification, i.e. that a person wishing to engage another i n a conversation and "talk about one's problems" merely has to answer the question "How are you?" i n the negative to provide the asker with a sanctionable re-quirement to make one's personal state a topic. In the data U 5 is treating the patient's ceremonial answer as a constructive in that i t transforms what might have been the completion of a greeting sequence into a possible f i r s t topic. However, that topics are negotiable is to be seen by U6 which while after a l l does recognize the constraint of U5, considered as a top-i c a l directive, nevertheless seems to insist upon the ceremonial character of 1)4 and to disallow what the therapist wishes to make of i t as a f i r s t topic. I speculate that one of the demand characteristics cf psychotherapy is that therapists must generate talk on the part of 12 their patients. That i s , while i t is possible for the patient to remain silent such silences are not welcomed by the therapist. One of the problems of such encounters is what shall "get talked about" and this is something that gets negotiated interactionally as the interview progresses„ U 6 is problematic i n that no topic as of yet has developed. In U7 the therapist engages in the use of what I w i l l c a l l a "selection d e v i c e ' B y this I mean that U7 can constitute a topic for discussion, i.e. i t is relevant for this session. The patient has been having emotional problems with her boyfriend and recently phoned the therapist to inform him that her boyfriend had not passed his school exams (or at least during the telephone con-versation such information became known to the therapist). By proposing this as a possible candidate for a topic i t s relevance is seen by the patient. Interactionally, however, the patient does not "pick up" on the therapist's utterance but merely confirms the therapist's comment, U8 "Yeah". U9 i s therefore very important i n that i t i s a question le s s e a s i l y dismissed than U5 and i s asking for s p e c i f i c information concerning a past occurrence that i s r e l e -vant for the therapist and the patient. I suggest, however, that i t i s not u n t i l the patient treats the utterance as grounds for a d i s -cussion concerning the fate of her boyfriend that we can say a topic has been negotiated. We have been concerned with how p a r t i c i p a n t s negotiate a t o p i c . Consider the following data from another p s y c h i a t r i c i n t e r -view. 1. T. So what's happened since I talked to you, yes-terday? 2. P. Was i t yesterday? It was on the phone yester-day. Well (( )) I went up to my brother's for dinner and I was t i r e d I came home, washed, and went to bed. Got up t h i s morning and went to work. [pause] 3. T. Uh, at the downtown store? 4. P. Yeah. That's where I came from j u s t a few minutes ago. 5. T. Did anyone say anything to you about uh, giving up your other job. 6. P. No. A few did but I j u s t steered i t o f f . You know. I j u s t s a i d . Well anyway, I j u s t said I wasn't f e e l i n g w e l l or something and came back to Middle C i t y . I don't go into a l l the d e t a i l s , I don't think that necessary. Notice the generative character of Ul, i.e. i t i s an utterance that generates talk on the part of the patient, and also constitutes a search for a topic by requiring the patient to pro-vide an answer. I would like to offer for consideration that while many things may have happened to the patient since he called the therapist (and we do not know the specific reason for the call) the therapist does not expect the patient to come forth with a l i s t of "everything" that has happened since the phone c a l l . As in Sudnow's analysis, the question carries with i t the assumption that the patient w i l l see the parameters of the question, i.e. what has  happened that is relevant for the therapy session. The patient's answer in U2 comes close to being a l i s t , but i t is a special l i s t comprising a set of what might be called "mundane ac t i v i t i e s " . The consequentiality i n terms of answering the therapist's f i r s t question might be summed up by saying "nothing much has happened". We are s t i l l faced with a problem in terms of the co-presence of the interactants. It seems to be a feature of psychiatric interviews that although nothing much may have happened since the last encounter with the therapist, the present session is not cancelled because "nothing has happened". This is what I have referred to as a demand characteristic of therapy. The therapist must continue the interview and i n so doing a topic on which to continue the interview must be negotiated between the p a r t i c i p a n t s . The f i r s t problem i s solved by U3 since by tying to the patient's previous utterance the conversation i s i n t e r a c t i o n a l l y sustained one more turn. I speculate that the therapist could have asked the patient, e.g., "How are things with you and your brother?" i n which case the substantive character of the t a l k that followed would be d i f f e r e n t but i t s consequentiality the same as that produced by U3. Notice i n U5 that out of a l l the possible items that could occur to the patient at work, the therapist s e l e c t s an item relevant for the patient and the occasion, "Did any-one say anything to you about uh, giving up your other job?" The consequentiality of the utterance i s that being a question i t r e -quires an answer, and once that answer i s given allows the therapist to ask another question, thereby providing not only the i n t e r a c -t i o n a l construction of the conversation but also for such t a l k to be seen as t o p i c a l . While what can c o n s t i t u t e a topic i n the opening of a p s y c h i a t r i c interview i s something that has to be negotiated i t should not be assumed that i t i s always the therapist who provides the proposed t o p i c . Consider the following data,: 1. T. How are you? 2. P. Key, i f I've got an hour, could I have a coffee? Please. 3. T. Hmhum. 4. S. What do you take i n i t , [Ul - 5 take place i n the presence of the therapist's secretary (S)] 5. P. Three and milk. [pause] 6. T. [Patient and therapist are now i n therapist's o f f i c e ] You got an hour's worth to t a l k about? 7. P. I don't know. It depends. [pause] You're never there when I r e a l l y need you. 8. T. What did you need me for? 9. P. Oh (I wanted to see) Jesus [patient attempting to l i g h t a ci g a r e t t e ] Ray and I have some pretty bad f i g h t s some times. Where I want to walk out and never come back... The analysis of the above w i l l be r e s t r i c t e d to U's 6-8. Similar to a previous example i n which the therapist treated a patient's answer to a greeting exchange as the basis of inq u i r y , U6 makes reference to the patient's e a r l i e r utterance as the basis on which to s t a r t inquiry for t h i s session. U6 seems to be a "topic searching device'' i n that while i t does not provide a topic i t somehow places a c e r t a i n constraint on the patient's t a l k that follows, i . e . i t generates t a l k on the part of the patient, t a l k which might allow f o r a topic to become negotiated. While I have suggested that therapists are e n t i t l e d to treat patients' t a l k i n such a manner, to assume that patients must always address such questions i s misleading. In U7, while answering the therapist's question the patient does not take the therapist's utterance much further, i . e . she does not i n t e r a c t i o n a l l y make much of the question.' "I don't know. It depends". Instead, the patient proposes a very interesting statements "You're never there when I really need you." The last portion of U7 presents a problem in that one way of handling this comment by the patient is to suggest that patients "need" their therapist since they are unable to success-fully conduct their everyday affairs. Patients "need" assistance since they are "sick". Another possible contention is that there exists some relationship between the patient and the therapist such that the claim "You're never there when I really need you" would be a legitimate one, the speech-act character of which would be open to analysis. I suggest that there are some relationships, e.g., husband-wife, such that the members can have certain claims on each other. In such a case the proposition of "You're never there when I really need you" carries with i t an evaluative 'should' be there by virtue of your/our relationship. Is there any reason to expect that the therapist would be "there" or should be "there" just because the patient felt a "need1, for his presence, i.e. would one think that the therapist is sanctionable for not being there? Rather than examine U7 in terms of some pathology of the patient or some system of "obligatory rights" between the patient and the therapist, the question of interest i s what is happening interactiorially. Consider for a moment a hypothetical situation between two members where member A says "you should have been at the party, (at work, home, etc.) today." Member A is accomplishing several things interactionally. First he is suggesting to member B that "something happened", e.g. at work, at the party, etc., that he is aware of, and that member B would also like to know. Second, by saying that "you should have been there", member A is inviting member B to inquire 'why' he should have been there. This allows member A to t e l l his story and thereby to select what w i l l be the f i r s t topic of the conversation. In our data "You're never there when I really need you" is an invitational device that we might think of as achieving the strategy of preparing the hearer for talk by getting the hearer to ask the 'why' of the speaker's remark. Interactionally this i s what happens in U9 when the therapist asks "What did you need me for?" The patient is now i n a position of being able to "present her case", i.e. provide the f i r s t topic for discussion i n the interview. This chapter has attempted to examine a common place occurrence: the development of a topic in a conversation between two participants. Such topic development need not be a problem for the participants but by treating the notion of topic construction as "problematic" I have attempted to explicate what is interactionally required for a topic to occur i n a conversation. It has been suggested that a therapist is always able to treat patients' talk as the basis on which to conduct further in-quiry, i.e. as "occasion relevant". While the encounter between patient and therapist is methodically generated the participants need not have a pre-arranged agenda of topics for discussion. Indeed i t has been a major contention of this chapter that the participants jointly arrive at a topic, i.e. topics are interac-tionally constructed between the participants. What can be dis-cussed during a psychiatric interview, however, is not something that can be delimited by attempting to provide a l i s t of topics suitable for psychotherapy. Rather i t is important to remember the categorial identifications of the participants and to realize that those items mentioned by the patient are heard by the therapist as occurring in utterances produced by a patient and hence as rele-vant for the occasion of the psychiatric interview. It is for this reason that I suggest that the topics discussed during a psychiatric interview can vary from, e.g., talk about meeting people on the elevator to the patient's family problems. The point being made is that if the therapist is able to treat a comment by the patient as the basis for further psychiatric investigation he will do so. Through an examination of greeting exchanges i t was1 shown that therapists are able to give non-ceremonial treatment to the ceremonial utterances: of the patient. Therapists, then, have at their disposal the interactional technique of "undercutting" the normative practices of ordinary conversation, e.g>, they can question the ceremonial return of a greeting. In addition to the above a more general feature of topi-cality was discovered. One way of gaining control of a conversation and being able to introduce the first topic is to answer a greeting substitute with a negative term such as, e.g., "lousy", "terrible", etc. Such an answer tends to invite questions concerning one's personal state and thereby allow one the first slot in the conver-sation for the initiation of a topic. Finally i t has been shown that members have at their disposal a variety of interactional techniques such as "topic searchers", "selection devices" and "invitation devices" whereby the negotiation of a topic is inter-actionally accomplished. FOOTNOTES 1. I would l i k e to thank Dr. Roy Turner and Dr, Matthew Speier for t h e i r comments regarding t o p i c a l i t y and t o p i c a l constraints. Whatever f a u l t s occur i n the subsequent analysis n a t u r a l l y are mine. 2. Emanuel A. Schegloff. "Sequencing In Conversational Openings". American Anthropologist, Vol. 70, No. 6, December, 1968. 3. Contrast t h i s with such encounters as, e.g., i f a student should c a l l his professor with whom he i s currently engaged i n a student-professor r e l a t i o n s h i p then the onus w i l l be on the student to do some legitimating xrork i f the c a l l cannot be seen as genera-ted by that r e l a t i o n s h i p . Also consider the p s y c h i a t r i c l i t e r -ature dealing with "free a s s o c i a t i o n " and the f a c t . t h a t therapists often t e l l t h e i r patients that they can say "whatever comes to mind". 4. Harvey Sacks. Unpublished l e c t u r e s . Lecture 8, A p r i l 21, 1967, Spring Quarter, U.C.L.A. 5. Harvey Sacks, unpublished l e c t u r e s . 6. An exchange of greetings can constitute a minimal proper conver-sation. Using t h i s feature of i n t e r a c t i o n i t i s possible for members to exchange greetings and no more, and that such an exchange need not be seen as improper, inappropriate, etc. Eecause such an exchange of greetings constitutes a minimal proper conversation members can get o f f the "hook" of further t a l k quite e a s i l y and properly by such a return. This i s net to say that such an exchange of greetings alx^ays f o r e s t a l l s further t o p i c a l t a l k between the p a r t i c i p a n t s but only that i t i s a v a i l a b l e for such use. 7. Harvey Sacks, unpublished le c t u r e s . 8. For a d e t a i l e d discussion of the devices that members have a v a i l a b l e to assign c a t e g o r i a l i d e n t i f i c a t i o n s to one another the reader should consult Harvey Sacks, "The Search f o r Help", unpublished Ph.D. d i s s e r t a t i o n , Department of Sociology, Uni-v e r s i t y of C a l i f o r n i a , Berkeley, 1966. 9. Harvey Sacks, Lecture 9, A p r i l 24, Spring Quarter, 1967, U.C.L.A. 10. Although incorporated i n Sacks' analysis the quotation comes from Emily Post. Etiquette, 1955, pp. 16-17. 11= David Sudnow. Passing On; The S o c i a l Organization of Dying. P r e n t i c e - H a l l , Englewood C l i f f s , New Jersey, p. 151. 12. By "demand characteristics'' I follow Turner's formulation of "those s i t u a t i o n a l and contextual features which persons engaged i n everyday routines orient to as governing and organizing t h e i r a c t i v i t i e s . . . " See Roy Turner, "Occupational Routines: Some Demand C h a r a c t e r i s t i c s of P o l i c e Work", paper presented to the C.S.A.A., Toronto, June, 1969, See also Egon B i t t n e r , "The Po l i c e on Skid Row: A Study of Peace Keeping", American Socio- l o g i c a l Review, Vol. 32, No. 5, October, 1967, pp. 699-715; and Martin T. Orne's paper "On the S o c i a l Psychology of the Psycho-l o g i c a l Experiment", American Psychologist, November, 1962, pp. 776-783. CONTINUITY OVER CONVERSATIONAL ENCOUNTERS: PERSONAL BIOGRAPHY AND MEDICAL HISTORY In this chapter I will introduce some of the ideas and concepts previously discussed with respect to topicality. While this chapter may appear to be restating earlier arguments I suggest their development will lead us to a set of new issues. For the moment we will be concerned with the following pieces of interaction from two different psychiatric interviews: 1. T. So what's happened since I talked to you yesterday. 2. P. Was i t yesterday? It was on the phone yes-terday. Well I went up to my brother's for dinner and I was tired. I came home, washed, and went to bed. Got up this morning and went to work. 13. T. What else has happened that's been eventful? 14. P. Nothing too much. I'm certainly getting an interesting look at a l l the people in the office. .. We may say that the above exchanges are the result of 1 what Schegloff has called "methodically initiated encounters" (MIE). Persons in need of psychiatric help seek out those persons so quali-fied to offer such help, i.e. the encounter is not one resulting from chance. This seems like a fairly obvious and trite bit of informationj but perhaps may give us some insight into the social organization of psychotherapy. Turner in a recent paper dealing with group therapy dis-cusses the omni-relevance of the question "why are you/we here?", 2 i.e. i t i s a question that can always be asked by the group members. I would like to suggest that the question "Why are. you/we here?" i s not only an omni-relevant question for group psychotherapy but also a question which for many social situations i s self evident and need not be asked. By this I mean that the relevance for your being 'here' is implicitly implied i n the context of the interaction. Turner discusses this in terms of "transaction bound talk"; In establishments the i n i t i a t i o n of stretches of talk is frequently accomplished by, e.g., a sales person approaching any member of the public and asking, e.g., "May I help you?" But of course by so stating i t , I have already presupposed a feature of the social organ-ization that in fact i s equally a matter for analysis, namely the categorial identification of a person as one credentialed by the establishment to handle i t s business with prospective customers (I owe this notion of credentialing to Harvey Sacks). Similarly, the formulaic utterances produced on such occasions do the work of providing that the addressed member of the public i s or is to be treated as a "customer" and not,  e.g., as one who has entered to escape the rain or to shoplift!(Emphasis mine).3 The consequentiality of the above fact for the interaction is that often both parties are aware of the parameters of the 'talk' that w i l l occur and the 'topics' available for discussion. The encounter between patient and therapist i s not only "methodically ini t i a t e d " but i t would seem that there would not be an "information gap" as reported by Schegloff with respect to tele-A phone conversations. In some sense less work has to be done to discover why the encounter was initiated. Consider the following statement by Sullivan: In finding out in what areas the interviewee has trouble i n functioning the interviewer would do well to remember that no matter how vastly superior a person may be, there is enough in the culture to justify his having some trouble. I have rarely experienced the embarrassment, or the privilege, of being consulted by a person who had no troubles, and I may say that when this did appear to be the case i t rapidly proved to be an artifact. Thus we may safely assume that everybody has some trouble i n liv i n g ; I think this is ordained by our social order i t -self that none of us can find or maintain a way of l i f e with perfect contentment, proper self respect and so on,-> From the above i t appears that members once categorized as 'patients' are seen as having some 'problems' regardless of the specific nature of such problems', i.e., patients come to the thera-pist to talk about their problems. Unlike other social situations, e.g., sales' person-customer, where the parameters of 'talk' are often known by the participants,, therapy sessions, oven though pre-arranged' and often scheduled cn an appointment basis, do not pr'o* vide the participants with any agenda of "what w i l l be discussed today." In our data, U's 1 and 13, we may common-sensically say that therapists are concerned with what has occurred or happened to their patients since the last session. The therapist and patient are acquaintances and U's 1 and 13 seem to be questions relating to events that occurred since the last encounter. Thus, some 'resuming behavior' is appropriate or allowed to take place 6 between the participants. I speculate, however, that the resuming that occurs in psychiatric sessions is rather one-sided, i.e. entitlements with respect to inquiring into "what has happened since the last session" are not symmetrical between therapist and patient. As stated by Turner: The situation rapidly becomes more complex, however, when we recognize that such matters as the duration and occasion of the absence are germane to how persons ought to 'resume' and the informational rights with respect to sharing news of 'what has happened' in the interim — however brief — however long •— are appar-ently observed.? The 'resuming' that takes place in psychiatric interviews is more than merely an asymmetrical sharing of news, but i t is pre-cisely this sharing of news that constitutes a large proportion of the 'talk' that occurs during the interview. Furthermore, while the therapist may be concerned with "what has happened" since the last encounter with the patient, such a concern can be contrasted with that of, e.g., a medical physician. A general practitioner may very well be concerned with "what has happened" to his patient since their last encounter, but the parameters of what can constitute an appropriate answer to such a question usually refer to the patient's illness and not to his thoughts, feelings, dreams or personal problems. The psychiatric interview appears to be quite different in that (1) there i s l i t t l e continuity between sessions, i.e. therapists do not usually "pick up" where the last session " l e f t off" and (2) because of this what w i l l be discussed between therapist and patient i s something that has to be negotiated between them. The important point to note, is that talk between parti-cipants who have not seen each other constitutes what has been referred to as "resuming behavior". For the psychiatric interview, however, the "resuming behavior" exhibited by the participants is of a rather special character. The interactional consequences of such talk not only reaffirm 'relationship claims' but also generate talk on the part of the patient which in turn allows the negotiation of a topic to occur. The rather asymmetrical character of the "resuming talk" between therapist and patient i s especially important since when a topic does emerge such topical talk concerns the affairs of the patient. For example, i f a patient should inquire into the affairs of the therapist such talk can be treated by the therapist not as a question to be answered but as the grounds for inquiring, e.g., why the patient wants to know about his l i f e . The asymmetrical sharing of news allows the therapist to treat patients' " c u r i o s i t y " as the basis of discussion and such discussion revolves around the patient and not, e.g., what has been happening with the the r a p i s t since the l a s t encounter. The therapist i s not j u s t concerned with what has happened to his patient i n the i n t e r v a l between sessions, i n the same way that two friends might be concerned with what has occurred to each other since t h e i r l a s t encounter, but i s rather concerned with generating t a l k and conducting the p s y c h i a t r i c interview. Talk i s necessary between the therapist and patient. "Presuming t a l k " tends to generate t a l k between patient and therapist and often allows for the negotiation of a topic to occur. During the course of a p s y c h i a t r i c interview patients often share news about persons and events i n t h e i r l i v e s . The therapist i s often "brought up to date" with the a f f a i r s of h i s patient. Consider the following data: 1. "Jennifer's got a boyfriend." 2. "I got a l e t t e r from Bob yesterday, Jones." 3. "Clive ' s awful crabby." 4. "Oh I saw Harry and Arnold up there. Just b r i e f l y said Hi. I see Arnold at school a l l the time." The patient shares his biography with the therapist. To use a phrase from Schutz, therapist and patient "grow old together". For the therapist, however, the patient's personal biography also constitutes his "medical history" and by inquiring into what has happened since their last encounter the therapist is also gathering data from which to do his work. That patients have histories and therapists are 'knowledge- able ' or at least in the process cf becoming 'knowledgeable' of their patients' history allows us to speculate on the consequential-ity of this feature for the therapy situation. As a way to "cut into" this area I would like to consider the following exchange between two friends: A. I got a letter from Bob. B. Bob who? I speculate that speaker A assumed that speaker B would see the relevance of his utterance, i.e. while only providing a f i r s t name i t was assumed that speaker B would be able to engage, in some selection procedure whereby 'Bob* would be transformed into, e.g., 'Bob Smith'. It appears that while A assumes B knows 'Bob' and that receiving a letter from 'Bob' is an announceable event to B, speaker B does not know 'Bob' or at least he i s uncertain as between alternatives. Speaker B's reply, "Bob who?", allows speaker A to re-evaluate his appraisal of B's knowledge of h i s a c t i -v i t i e s , f r i e n d s , r e l a t i o n s h i p s , etc. Speaker A i s e n t i t l e d to make some inference concerning speaker B. With the above comments i n mind l e t us now examine some data which occurs i n psychotherapy. 50. P. It x<ras r e a l l y cute. I think my taste i n men i s improving. So uh I got a l e t t e r from Bob yesterday, Jones. 51. T. Oh yeah. I wish to examine the l a s t part of U50, "So uh I got a l e t t e r from Bob yesterday, Jones"(emphasis mine). A noticeable feature of the utterance i s that i t does not contain a c a t e g o r i a l i d e n t i f i e r but only a f i r s t name (FN) and a l a s t name (LN) and that the FN i s not immediately followed by the LN. As naive rea-ders of the data we have very l i t t l e idea of who the patient i s r e f e r r i n g to, e.g., he may be a boyfriend, lover, employer, ex-husband, etc. Furthermore, although the therapist might be aware of the c a t e g o r i a l r e l a t i o n s h i p of 'Bob Jones' to the patient there i s no reason f o r us to immediately assume that t h i s i s the case, What we are dealing with i s "reference to t h i r d p a r t i e s " . I suggest i t i s often the case that when people r e f e r to persons for the f i r s t time that not only i s a name provided but also some category term, e.g., "My roommate Je n n i f e r " . Naturally there are times when the category term i s not used but i s i m p l i c i t l y implied by other circumstances. For example, saying ''Julie and I went to the show l a s t night" to a person who knows you are married but has not met your wife allows the warrantable inference that " J u l i e " i s your wife. Also a name plus some category term may be used at times other than the f i r s t mentioned, e.g., when i t i s assumed that the person addressed w i l l not remember. In our data, I assume that 'Bob Jones' has been previously mentioned i n an e a r l i e r session. If t h i s was the f i r s t time such a person was mentioned, I speculate that the therapist's following utterance would not attend to the patient's remark. The therapist would be e n t i t l e d to inquire ''Who i s Bob Jones?" Thus the data seems to i n d i c a t e that the therapist recognizes the s i g n i f i c a n c e of the patient's remark by way of a name recognition. P r i o r to the l a s t part of 0 5 0 , "I got a l e t t e r from Lob yesterday, Jones" the patient has been discussing a person she met while at work. One noticeable consequence of t h i s l a s t utterance i s that i t introduces a new topic and I plan to discuss the issue of 'topic changers' at a l a t e r date. The i n t e r e s t i n g feature of the construction of the p a t i e n t ' s utterance i s that she "tacks on" the person's L N v While I assume the patient expects the therapist to see the relevance of her utterance, i . e . know who "Bob Jones" i s and assign a c a t e g o r i a l i d e n t i f i c a t i o n to him1, she i s also attending to a normal feature of i n t e r a c t i o n s , namely people can forget. I suggest that the patient: i n adding the person's LN i s attempting to provide s u f f i c i e n t information f o r the therapist to see the r e l e -vance of her remark. The patient i s methodically assessing the i n t e r a c t i o n a l s i t u a t i o n of her fellow i n t e r l o c u t o r and i s providing what she assumes i s adequate information for him to supply the necessary c a t e g o r i a l i d e n t i f i e r to the person being discussed. This I suggest i s a common feature of conversation where speaker A mentions another person to speaker B by using only a FN and then adds the person's LN to enable speaker B to perform the necessary reference work. An i n t e r e s t i n g question that might now be r a i s e d i s given the f a c t that therapists are expected to remember each patient's h i s t o r y and that an i n d i v i d u a l therapist might be seeing several patients who each have a whole set and cast of characters, how-does the therapist manage? One possible answer i s that a therapist possesses a f a n t a s t i c memory. I suggest, however, that i t might very w e l l be the case that therapists forget names and r e l a t i o n s h i p s of persons mentioned by t h e i r patients during the p s y c h i a t r i c i n t e r -view, but r e l y on c e r t a i n i n t e r a c t i o n a l conventions to ''pull them through" so to speak. I presume i t i s not an uncommon p r a c t i c e for c l i n i c i a n s to engage i n some categorization of t h e i r p a t i e n t s , e.g., having problems with men, unable to adjust to work, domestic problems, etc. Given this categorization process such problems often allow for appropriate slots to be f i l l e d by persons mentioned during the psychiatric interview even i f the therapist should "forget" the person mentioned. For example, by knowing that a patient is a single male and is having d i f f i c u l t i e s with female relationships any reference to a female such as, e.g., "Susan really gave me a bad time last night" can allow the therapist to infer that "Susan" is a g i r l f r i e n d even though the patient may have mentioned "Susan" at an earlier session and the therapist has forgotten. Further-more I suggest that such an inference is not made using any spe-c i a l knowledge obtained through psychiatric training but i s made using the same conventions that you or I would use. That i s , I assume we could also infer that she was a g i r l f r i e n d of the patient. A related issue is that often patients w i l l make third person references i n relation to some category bound activity, e.g., "I was typing at work when Mr. Smith started bugging me again". Again, "Mr. Smith" has been mentioned in a previous ses-sion by the patient, but i t is possible that the psychiatrist has forgotten who Mr. Smith i s . By virtue of the utterance, however, I suggest i t is possible to make the inference that Mr. Smith is the patient's employer, supervisor, etc. The point to notice is that certain activities allow for the appropriate categorial iden-tifications to be assigned. Returning now to our data U51, i t becomes a b i t more i n t e r e s t i n g to examine the consequentiality of the utterance for the i n t e r a c t i o n . E a r l i e r I suggested that i t appears that the therapist recognizes the s i g n i f i c a n c e of the patient's previous remark, but i t should be added that t h i s need not be the case. I f i n d the therapist's utterance i n t e r e s t i n g i n that i t (1) attends to the patient's previous utterance and (2) suggests to the patient that the therapist "remembers" 'Bob Jones' (which indeed might not be the case) and (3) generates further t a l k on the part of the patient, i n the course of which the therapist may be provided with further information concerning the mentioned person. Thus psychia-t r i s t s , l i k e other conversational partners, may wait f o r l a t e r r e -marks to c l a r i f y the import of an utterance or the c a t e g o r i a l i d e n t i f i c a t i o n of a mentioned t h i r d party. In our data from p s y c h i a t r i c interviews, patients seem to suppose that names can be used where i t i s c r u c i a l f o r under-standing the relevance of the patient's utterance that the therapist be able to supply the necessary category term to the mentioned person. That patients use personal names when r e f e r r i n g to persons mentioned on e a r l i e r occasions i s not a p a r t i c u l a r feature of psy-chotherapy but a general feature of conversation, i . e . conversation-a l i s t s tend to drop the category term a f t e r i t has been mentioned. For example, consider the construction of jokes where "There was this policeman named A l " becomes "and Al picked up this drunk" as the joke progresses. That conversationalists tend to use names when referring to third parties previously mentioned on earlier occasions, and thereby assume that the necessary category term w i l l be supplied, seems to be a rather unnoticed feature of daily l i f e . By this I mean that the a b i l i t y to remember who, e.g., 'Bob' i s , i s not seen as any great accomplishment. While pursuing psychiatric care I suggest that patients are aware that the therapist they see i s also seeing several other patients and that each patient has his own history, which he ex-pects the therapist to remember. From the perspective of each individual patient 1 speculate that there i s a general concern with whether the therapist "remembers who I am", "what are my problems", etc. Compare this situation with that of a general practitioner and his patients. While such a relationship would not be concerned with the personal problems of the patient nor would patients t e l l their doctor, e.g., "I got a letter from Bob yesterday", nevertheless the consequentiality of 'not remembering" certain aspects about the patient is very great. A patient who sees a doctor on a regular basis does not expect each subsequent v i s i t to be "like the first"' but rather expects the doctor to become "familiar" with his medical problem. I speculate that one of the reasons persons go to pri v a t e physicians as opposed to public c l i n i c s , where each v i s i t might get you a d i f f e r e n t doctor, i s on the grounds that the doctor w i l l become f a m i l i a r with your case and your h i s t o r y . In the p s y c h i a t r i c interviextf, as stated e a r l i e r , a 9 patient's "medical h i s t o r y " also i s h i s "personal biography". In some sense the therapist has much to remember and furthermore hi s remembering i s seen by the patient as demonstrating that he i s "tuned i n " to the problems of the patient. Once the therapist acquires information concerning, e.g., 'Bob Jones' he i s not e n t i t l e d to forget that information for to do so c a r r i e s with i t i n f e r e n t i a l value much i n the same way that, e.g., a general prac-t i t i o n e r t r e a t i n g you as a new patient on your tenth v i s i t might. Consider the following piece of data i n which a t h i r d party reference i s made and the way the therapist demonstrates that he understands the s i g n i f i c a n c e of the patient's remark. 29. P. ...Oh I saw Harry and Arnold up there. Just b r i e f l y said Hi. I see Arnold at school a l l the time. 30. T. Harry does not shake you up any more hey? I am interested i n how U30 gets constructed. By th i s I mean that i n U29 the patient has reported that she has seen someone c a l l e d Harry and someone c a l l e d Arnold; how i s i t that the therapist produces U30 and what i s i n t e r a c t i o n a l l y being accomplished by such an utterance? Again we must assume that the patient takes i t that the therapist can properly assign c a t e g o r i a l r e l a t i o n s h i p s to the persons mentioned. The therapist i n producing U30 i s demon-s t r a t i n g to the patient that (1) he knows who Harry i s and (2) thi s i s i n t e r a c t i o n a l l y accomplished by providing a possible ques-t i o n concerning 'Harry' that could be seen by the patient as a "possible question" the therapist might ask given the h i s t o r y of the patient, i . e . a question that could only be asked by one fam-i l i a r with the patient's shared biography with Harry. This chapter has presented some data and discussion on three r e l a t e d issues; t o p i c a l i t y , "resuming", and references to t h i r d p a r t i e s . I t was demonstrated that the "resuming behavior" engaged i n by the therapist was primarily a device to f a c i l i t a t e the negotiation of a 'topic'. Furthermore the asymmetrical charac-t e r of the "resuming" between therapist and patient prohibited " t o p i c a l t a l k " about the a f f a i r s of the therapist and consequently always generated t a l k about the patient. It was i l l u s t r a t e d that much of the t a l k that occurs i n psychotherapy constitutes t h i s asymmetrical sharing of news, i . e . , a patient's personal biography also constitutes h i s medical h i s t o r y . Often such sharing of news involves references to t h i r d p a r t i e s with the patient assuming the therapist i s able to provide the necessary categorial identification of the person mentioned. It was suggested that therapists might often forget the relationship of persons mentioned by the patient, but rely on the same inter-actional techniques of everyday members of the society to assign category identifications when only a FN or FN + LN is used by the patient. Finally i t was shown that one of the concerns of the patient is "whether the therapist remembers me" and i t was demon-strated how the therapist interactionally attends to this problem. 1 FOOTNOTES 1. Emanuel A. Schegloff. "Sequencing i n Conversational Openings". American Anthropologist, Vol. 70, No. 6, December, 1968, p. 1076. 2. Roy Turner. "Some Formal Properties of Therapy Talk 5', prepared for David Sudnow (ed.). Papers i n Interaction (forthcoming). 3. Roy Turner. "Some Features of the Construction of Conversation". Paper presented to the A.S.A. meetings, San Francisco, 1969, p. 6. 4. Schegloff. "Sequencing i n Conversational Openings", p. 1076. 5. Harry Stack S u l l i v a n . The P s y c h i a t r i c Interview. W.W. Norton and Company Inc., New York, 1954, p. 18. 6. For a discussion of 'Resuming* see Roy Turner, "Talk and Trou-b l e s : Contact Problems of Former Mental Patients". Unpublished Ph.D. d i s s e r t a t i o n , Department of Sociology, University of C a l i f o r n i a , Berkeley, 1968. E s p e c i a l l y chapters 4 and 5. 7. Ibid . 8. A l f r e d Schutz. Collected Papers I: The Problem of S o c i a l  R e a l i t y . Martinus N i j h o f f , The Hague, 1967, p. 17. 9. For a discussion of the importance of being among one's "knowing biographical others" and a general discussion of biography see Erving Goffman, Stigma. P r e n t i c e - H a l l Inc., Englewood C l i f f s , New Jersey, 1963. P a r t i c u l a r l y chapter 2. CHAPTER V TREATMENT PROCEDURES It i s the- purpose of t h i s chapter to examine some fea -tures of the 'talk and troubles' of the patient and the way such 'talk' i s i n t e r a c t i o n a l l y handled by the therapist. Since my concern i s with developing sequences of i n t e r a c t i o n rather than p s y c h i a t r i c theory, no attempt w i l l be made to provide a general de s c r i p t i o n of how therapists 'treat' p a t ients' problems. Our concern i s with 'treatment" as an on-going accomplishment between therapist and patient. In an e a r l i e r chapter we examined a piece of data i n which the patient t o l d the therapist "You're never there when I r e a l l y need you". The analysis disclaimed the notion that such a comment was demonstrating the patient's pathology, e.g., she could not manage without the assistance of her therapist, Rather, i t was demonstrated that such a comment i n t e r a c t i o n a l l y enabled the patient to introduce the f i r s t ' t o p i c 1 of the interview. The comment nev-ertheless i s i n t e r e s t i n g when examined i n terms of the administra-tion of treatment i n psychotherapy. Since the therapist does not usually engage i n any procedures other than t a l k i n g to the patient, and such t a l k usually takes place i n the doctor's o f f i c e , whatever 'help' or 'benefit' r e s u l t s from psychotherapy i s accomplished during the ps y c h i a t r i c interview. Consider the following exchange between therapist and patient: 71. T. Where else would you meet the kind of men that you're being exposed to? 72. P. In another h o t e l . I l i k e h o t e l work s t i l l . That place i s t e r r i b l e . You j u s t wouldn't believe i t . The a s s i s t a n t manager. She's the most h y s t e r i c a l woman I've ever seen... In U72 the patient s t a r t s the i n i t i a t i o n of a complaint about the a s s i s t a n t manager. While the patient may complain about her "working conditions", for present purposes I wish to note that the therapist i s not able to remedy the working conditions of the p a t i e n t , e.g., the therapist i s not going to c a l l up the a s s i s t a n t manager and t e l l her to stop causing trouble for h i s patient. Whatever help the therapist may be able to o f f e r i s accomplished by him i n the p s y c h i a t r i c s e t t i n g and not by, e.g., the therapist going to the h o t e l where the patient works and engaging i n some cor r e c t i v e procedures. To use a common-sense phrase, therapists are not "troubleshooters" for t h e i r p a t i e n t s . Before confronting the data we w i l l be examining I would l i k e to r e l a t e a joke t o l d to me about a patient and h i s p s y c h i a t r i s t . The patient seems to be s u f f e r i n g from f e e l i n g s of depression and i n f e r i o r i t y and during an interview makes some statement to the e f f e c t that he f e e l s " i n f e r i o r " . The therapist's reply to t h i s i s , "Mr. Jones, you know, you don't have an i n f e r i o r i t y complex, you r e a l l y are i n f e r i o r " . Now I suggest that i t i s quite obvious the above con-s t i t u t e s a joke and I f e e l an examination of how the above 'joke' i s constructed w i l l prove b e n e f i c i a l f o r the remaining data to be analyzed. F i r s t , i t i s nothing unusual i n p s y c h i a t r i c p r a c t i c e for patients to complain about f e e l i n g depressed or i n f e r i o r . Indeed, to be categorized as a p s y c h i a t r i c patient often allows such a d e s c r i p t i o n of a patient to be used. Second, I assume i t i s a rather common-sense notion that p s y c h i a t r i s t s , being compe-tent c l i n i c i a n s , are concerned with 'helping' t h e i r patients out of t h e i r d i f f i c u l t i e s and not, e.g., r e i n f o r c i n g p a t i e n t s ' f e e l -ings of inadequacy, i n f e r i o r i t y , etc. The powerful nature of the 'joke' then i s evident by the therapist's reply since i t i s some-thing that we (I mean by t h i s ordinary members of the society) would not t y p i c a l l y expect a doctor to say to h i s patient, since by admitting the patient i s i n f e r i o r one i s i n e f f e c t admitting "nothing can be done" to remedy the s i t u a t i o n . The power of the 'joke' comes from our everyday common-sense knowledge of what c o n s t i -tutes doctor-patient r e l a t i o n s h i p s and the r i g h t s and obligations of the respective category members. Keeping these comments i n mind I would now l i k e to consider the following exchange between a patient and h i s t h e r a p i s t . The patient i n the following piece of data has been recently transferred from a managerial p o s i t i o n of a small bookstore to another bookstore i n which he i s merely "another employee", i . e . there i s some loss of prestige involved i n the change of jobs. 60. P. Well. My opportunities here are good. [patient r e f e r r i n g to his new job] I've s t i l l got my job and carry on. [pause] But I'm not very happy these days over the whole thing. 61. T. You're f e e l i n g you've l e t Mr. Smith Down? [Mr. Smith being the owner of the bookstore] 62. P. Well I f e l t that, I l e t my own s e l f down. The goals I had i n mind you know. 63. T. In other words you thought you had every-thing beat. In U61 the therapist proposes that he can understand the patient's reason for being "not very happy these days over the whole thing". The proposal, however, i s of a s p e c i a l kind i n that the therapist i n U61 o f f e r s a reason for the patient f e e l i n g "not very happy" that the patient himself might o f f e r . This phenomenon i s not n e c e s s a r i l y p e c u l i a r to psychotherapy but I suggest i s a feature of i n t e r a c t i o n s between members who either possess knowledge of each other, or of each other's relevant category memberships, that would allow such formulations to be seen as appropriate, proper s etc. In the above i n t e r a c t i o n the therapist i s well aware of the patient's h i s t o r y . Such awareness allows the therapist to propose that he 'knows" the reason for the patient being "unhappy" and that i t i s a reason the patient might use i f asked "What's wrong?". Using Sacks' terms, the patient has described h i s per-sonal state as being 'negative': "I'm not very happy these days 1 over the whole thing". Such a proposal allows the 'hearer' to inquire into the reason for f e e l i n g t h i s x^ay. Instead of i n q u i r i n g "why are you f e e l i n g unhappy" the therapist i s proposing that he "knows" the answer the patient would give .if asked the question "Why are you not happy these days?" Before proceeding further i t should be noted that while the above data occurs during a p s y c h i a t r i c interview, the proposal of an account i n terms of what the 'other'" would say i s not unique to psychotherapy. It i s not an uncommon occurrence that two peo-ple, e.g., husband-wife, could produce a s i m i l a r type of exchange. For example, the husband comes home from work and says "I f e e l lousy" and his wife r e p l i e s "Bad day at the o f f i c e " where she i s proposing the reason f o r f e e l i n g 'lousy' her husband would o f f e r 2 i f questioned. She has selected out of those possible reasons her husband would give f o r 'f e e l i n g lousy' a s a t i s f a c t o r y proposal and one that from her husband's viewpoint i s 'acceptable' even though i t might not be the reason for h i s 'feeling lousy'. Before continuing with an analysis of U's 61-63 I would l i k e to restate the patient's s i t u a t i o n . The patient has been "demoted" from his job and i s "not very happy these days over the whole thing". The the r a p i s t , being aware of the patient's h i s t o r y , o f f e r s a pos s i b l e reason for the patient's a t t i t u d e . I suggest that the exchanges between therapist and patient i n U's 61-63 are very complex and t h e i r a nalysis will reveal some i n t e r e s t i n g fea-tures of treatment procedures i n psychotherapy. U61, "You're f e e l i n g you've l e t Mr. Smith down?" c o n s t i -tutes a question. It i s a s p e c i a l type of question r e f e r r e d to by 3 Sacks as a 'correction i n v i t a t i o n device'. By t h i s i s meant that the questioned party can either (1) assent to the formulation pro-posed by the questioner or (2) provide a co r r e c t i o n to the formu-l a t i o n . For the patient to assent to the therapist's formulation constitutes what we might common-sensicaliy describe as 's e l f debasement', i . e . the patient was given the r e s p o n s i b i l i t y of man-aging a bookstore and " f a i l e d " , "Let Mr. Smith down"'. Such debase-ment, however, I suggest would tend to be discounted by the thera-p i s t . As suggested e a r l i e r , therapists are not concerned with making t h e i r patients f e e l any worse, while speculative, I propose that had the patient answered i n the a f f i r m a t i v e the therapist would engage in-some work to discount the patient's f e e l i n g s of " l e t t i n g Mr. Smith down". For example, the therapist could have suggested to the patient "Did you ever think that maybe Mr. Smith l e t you down". The important point to note about U61 i s that i t not only proposes a possible reason for the patient's f e e l i n g s but allows the patient to eit h e r accept or correct the proposed reason. This i n turn allows the therapist to engage i n some procedure to engage i n a discussion with the patient about the patient's problem. In U62 the patient provides an account which tends to discount the therapist's previous formulation, i . e . the patient o f f e r s a 'correction' to U61. Notice, however, that the patient's formulation i s also one of 'self debasement' and furthermore seems to carry a c e r t a i n f i n a l i t y and sense of f a i l u r e , e.g., "Well, I f e l t that, I l e t my own s e l f down...." For the therapist to accept t h i s formulation would again be assenting to the patient's negative account of himself. P r i o r to U63 I suggest that what we have i s the sta t e -ment of a problem by the patient and some type of i n v e s t i g a t i v e work by the therapist to determine what i s 'troubling' the patient. The therapist has offered one possible 'reason' which the patient has rejected and replaced by another, e.g., "I l e t my own s e l f down". U63, "In other words you thought you had everything beat", constitutes what I consider a very complex utterance i n terms of treatment procedure i n psychotherapy. F i r s t I suggest i t i s a " c r i t i c i s m " of the patient much i n the same way that the patient's U62 i s s e l f c r i t i c a l . That i s , both U62 and U63 are c r i t i c a l comments concerning the patient. The important point to note i s that the patient's utterance e n t a i l s some d e f i n i t e moral tones to i t . Indeed from l i s t e n i n g to the a c t u a l tape recorded interview the patient sounds completely i n "despair 1'. The thera-p i s t ' s utterance i s quite d i f f e r e n t . While a c r i t i c i s m of the patient, i t i s a c r i t i c i s m that does not carry any moral overtones. Let me elaborate. I hear the f i r s t part of U 6 3 as c o n s t i t u t i n g something that might be likened to a "summation device", i . e . both patient and therapist have been engaging i n an exchange of utterances and I suggest that the therapist's use of "In other words" acts as a "summation device" i n terms of what has been previously s a i d . The remainder of the utterance, "You thought you had everything beat", I have suggested i s also a c r i t i c i s m of the patient but a c r i t i c i s m quite d i f f e r e n t from the patient's c r i t i c a l account of himself i n U62. F i r s t i t should be noted that i t i s the type of remark which i s exceptionally hard to assent to, i . e . few people, i f any, can have "everything" beat. Second, i n proposing such a comment to the patient the therapist i s being c r i t i c a l of the patient but not c r i t i c a l on moral grounds, as the patient was i n U 6 2 , but c r i t i c a l i n that the patient should have even thought that "everything" was solved. In the above data the therapist's utterance suggests that the patient's formulations are unfounded or not warranted. The patient has i n some sense made an 'error i n judgement' concerning his progress or state of health. Furthermore while the patient i n i t i a l l y proposed his c r i t i c a l comments of himself i n terms of some "moral degradation" the therapist's utterance seems to i n d i -cate that the patient has made an error i n judgement concerning his progress. I n t e r a c t i o n a l l y , the therapist has managed to exchange the patient's moral problems for 5 t e c h n i c a l ones' and the l a t t e r are r e c t i f i a b i e through discussion with the therapist. The c u l -mination of the exchange between patient and therapist from U60-63 seems to have provided the patient with an acceptable "excuse" f o r "things not working out". I would now l i k e to examine several utterances from a p s y c h i a t r i c interview to further i l l u s t r a t e how 'treatment' occurs during the on-going process of i n t e r a c t i o n . 1. T. Took me a few minutes to f i g u r e out how i t worked. [reference to tape recorder.] 2. P. Oh [laughs] [pause] Oh I met somebody that was a r e a l d o l l on the elevator i n the elevator rather. 3. T. Yeah? 4. P. Yeah. Somebody who I hadn't seen i n a long time. I went to school with him and I sort of looked at him and said to myself, "Gosh what a doll". He had a mustache which, um, he didn't have before so he looks somewhat better than he did before. [pause] So we talked for a few minutes. I did most of the talking [laughs] Gosh i t was funny (When I saw him) It sort of struck up something new (emphasis mine) That's what I was thinking about when I came back into (the office). But I thought to myself, "Wouldn't i t be nice i f maybe I heard from him?" I doubt that very much. [pause] Why don't you talk? [laughs] 5. T. What, do you think you might hear from him? 6. P. Who knows. Well I mean i t ' s like everybody else that I went to school with. I don't hear from any of them, so. Why should I ex-pect to hear from him? He was a l i t t l e sur-prised though you know. A l l of a sudden he noticed me like well I was trying to get his attention because he wasn't looking my way and then a l l of a sudden we caught each other's attention and [laughs] he sort of came over and talked for a few minutes. 7. T. Well he might, suddenly liven up or something, by calling you. 8. P. It would be nice. [laughs] 9. T. You said you were surprised that you could experience a good feeling about him? (emphasis mine). Although the above is quite lengthy I have particular interest in utterance 9, "You said you -were surprised that you could experience a good feeling about him?" In carefully rereading the patient's utterances I cannot find any instance where she had a "good feeling" about meeting this former acquaintance. U4 is per-haps the closest the patient comes to approximating what the thera-pist proposes she said. In some interesting way the therapist has 'transformed' the patient's description of what occurred i n the elevator into a therapeutically relevant occurrence for the patient. I suggest that one of the features of the 'talk' that occurs be-tween a patient and his therapist is that whatever 'talk' i s pro-duced by the patient, such talk can always be treated as " c l i n i -cally relevant" by the therapist. In some sense a l l talk produced by the patient is "good enough" for the therapist to do his job. Continuing with the same interview: 10. P. Yeah. It's sort of funny you know. It's almost the same like I f e l t with Tom. [patient's boyfriend] A l l of a sudden I f e l t a closeness to him. But I think what what uh, I found attractive about him most of a l l was his looks, you know. When I saw him, I thought "Wow!" I'd better x^atch myself because looks could deceive you. 11. T. We w i l l have to schedule daily meetings so that you'll run into more people on the elevator. 12. P. [laughs] Yeah. The patient's reply in U10 does not discount the thera-pist's handling of her account, i.e. i f the therapist was wrong in his 'transformation' of the patient's account the patient could have corrected him. I suggest that i n U10 by the patient saying "Yeah" she i s assenting to the therapist's handling of her account and thereby affirming the expertise of the therapist. Continuing vzith the data we might common-sensically c a l l the therapist's utterance, U l l , a 'joke'. Since I am assuming that a therapist generates talk not merely to be funny but also to 'help' his patient an examination of the above utterance might prove rewarding. The f i r s t task i s establishing how the above i s a 'joke', i.e. once recognizable as a 'joke' to explicate how the utterance is constructed so as to constitute a 'joke'. The f i r s t part of the utterance i s important in that the therapist is proposing a state of affairs that does not presently exist between him and the patient, "We w i l l have to schedule daily meetings...". Having more frequent v i s i t s to the therapist is not to be seen by i t s e l f as anything unusual, i.e. therapy sessions can be scheduled 'daily'. The above utterance constitutes a 'joke' not by some criterion of frequency of v i s i t s between patient and therapist but by virtue of the grounds given for increasing the frequency of V i s i t s , "so that you'll run into more people on the elevators". Having more frequent v i s i t s to the therapist is not unusual (indeed such scheduling often implies that the patient needs more 'help' from the therapist than could be accomplished once a week), but the scheduling of such meetings to enable the patient to "meet more people in the eleva-tors" does seem to negate the f i r s t portion of the utterance. The grounds for having daily meetings are not warranted grounds. The second point I would l i k e to consider involves the therapist's 'transformation' of the patient's account, the patient's case h i s t o r y , and the 'joking' comment by the th e r a p i s t . The therapist has implied that the patient had a "pleasant experience" on meeting a former school f r i e n d . The patient has been s u f f e r i n g from extreme states of depression, such that having a "pleasant experience" i s something important f o r t h i s p a r t i c u l a r patient. In U l l , although j o k i n g l y , the therapist allows the patient to r e -f l e c t on t h i s pleasant experience. In therapy s i t u a t i o n s even 'jokes' made by the therapist are not said " j u s t to be funny". As mentioned e a r l i e r much of the 'talk' that occurs be-tween a patient and a therapist concerns the f r i e n d s , events, places, etc., r e l a t e d to the patient. In some sense much of the 'talk' i s concerned with 'others'. Consider the following data: 38. P. She thinks s h e ' l l be happy [reference being made to the patient's roommate] I s a i d to her the other day, you're crazy because she i n -s i s t s that i t ' s not b l i n d (emphasis mine) love thing but of course she i n s i s t s s i t t i n g there t e l l i n g me how wonderful he i s . She hasn't got a bad word to say about him and the only thing the only time she's ever mad at him i s when she gets upset about him not marrying her. You know, I said to her the other day what do you want to do go through the rest of your l i f e supporting t h i s guy? Find out what's going on f i r s t . Cool i t . But she's j u s t so anxious,she 1s j u s t as anxious as he i s to get into bed with him and she's not going to do i t u n t i l she gets a r i n g on her f i n g e r . [laughs] 39. T. Speaking of blind (emphasis mine) You two giving advice to each other i s like the blind leading the blind. In the above piece of data the patient has been discussing the problems of her roommate, i.e. the problems are not those of the patient but constitute the problems of 'others'. It has been suggested that this is a feature of two-person psychotherapy, i.e. patients engage i n talk about, e.g., their friends, relatives, etc. While such talk does occur I speculate that eventually such 'talk 1 must be related to the patient, i.e. i t should be seen to have sig-nificance for the patient. The reader undoubtedly noticed that the therapist i n U39 has 'tied' his utterance to a remark made by the patient during her previous turn at talking. Interactionally, 'tying' i s not a particular feature of psychotherapy but rather a general feature of conversation, i.e. members when taking turns at talking can link their utterance to the last speaker's. Furthermore such 'tying' can but need not coincide with the previous speaker's last statement, but may refer to any utterance produced during the speaker's turn at talking. For the moment I would like to concentrate on the f i r s t portion of U39 namely "Speaking of blind". How I suggest that this utterance is very complicated but i t s examination w i l l reveal some interesting features of interaction. First we notice that i t i s 'tying' to the patient's previous utterance: "...she insists that i t ' s not blind love", and we are able to see this as a 'tying' ut-terance by reference being made to some 'word' used previously by the patient. Thus in some sense the therapist could have initiated a 'tying' remark by say, e.g., "Speaking of being anxious..." where the use of 'anxious' would allow us to see the 'tie' between his and the patient's previous utterance. I suggest that the more interesting feature of this tying utterance is the use of the phrase 'Speaking o f which is then followed by a 'word' which allows us to see the 'tie' between utterances. Interactionally I suggest that one way of being able to introduce a new 'topic' or 'idea' into a conversation is to use a 'tying' utterance employing the following formula: "Speaking of X" where 'X' can be any 'word' or 'phrase' from the previous speaker's turn at talking. The use of "Speaking of" allows the 'hearer' to see that a 'change' in the conversation is about to occur, e.g., a new piece of information is going to be added, a new topic i s going to be proposed, etc. By supplying the tying word or phrase the speaker is accomplishing two things. First he is showing that the previous speaker's remarks have been 'heard' and second he is i n -troducing a new 'topic' or 'idea'. What we are dealing with is a speaker A, speaker B situ-ation where speaker B ties his utterance to speaker A's using the formula "Speaking of X". While I suggest that such a formula tends to interactionally constitute a chance for a 'new topic', the use of such a formula also allows speaker A to make some inference con-cerning the attentiveness of speaker B to his comments. Consider the following hypothetical examples: 1. A. "Boy, i t was a rotten day today." B. "Speaking of rotten, where did you get that rotten suit you're wearing?" 2. A. "Boy, i t was a rotten day today." B. "Speaking of rotten days, did I t e l l you what happened to me yesterday?" In both examples I suggest that the formula for introduc-ing a new 'topic' or 'idea' into the conversation is adequately demonstrated. Also, I suggest the reader is quite readily able to see the difference i n character between the two 'tying' utterances. The point I wish to make is that "how the tying i s done" carried with i t the consequence that speaker A is able to make some infer-ential judgment concerning speaker B. In example one, we might wish to describe speaker B's comment as being rude, and one way of being able to substantiate such a claim is to note that while 'tying' to the previous speaker's utterance such an utterance does not have any corresponding relevance to the f i r s t speaker's utter-ance. Example two is quite different. While introducing a new 'topic' I suggest speaker A is able to see by the construction of speaker B's utterance that he not only 'heard1 what he said but has adequately attended to i t . That i s , speaker B honors the s i g n i f i -cance of speaker A's -utterance by "sharing" his own trouble with the previous speaker and thereby demonstrating that what he now has to say is "relevant" also. Returning to our data, U39, consider the rather compact nature of the therapist's utterance. By this I mean that the patient has given an elaborate account of her friend's problems, and the therapist's only treatment of this account is to 'tie' to something from the patient's utterance. In some sense this 'tying' does not even attend to most of the patient's comments and tends to discount much of the patient's utterance. Put quite crudely, the therapist, "cuts the patient short" and does not engage in any discussion concerning the affairs of the patient's friend. Rather, I suggest, that the second portion of U39 tends to reinforce the category of 'patient' on the patient. I hear this second portion of U39 as constituting what we might wish to c a l l a "put down". By this I mean that the patient has been t e l l i n g the therapist how 'foolish' her roommate i s and how sha had been giving advice to her roommate. The patient, however, is herself having d i f f i c u l t y with her own relationships. By the use of the personal pronoun 'you' the therapist co-memberships the patient in the same way the patient has been talking about her roommate and I suggest 'maps' the patient into the category 'patient' and not advice giver, i.e. as not one i n any p o s i t i o n to give advice. Furthermore the therapist i n U39 has i n t e r a c t i o n a l l y r e d i r e c t e d the 'talk about the patient's room-mate to 'talk' about the patient. In another p s y c h i a t r i c interview a patient has been d i s -cussing her husband's problems and the f a c t that he i s i n a "good mood" when he i s performing on "stage". Consider the data: 47. P. Well I r e a l l y think t h i s music business i s good for him. I mean I know he needs t h i s [pause] That's when he's happy. Yeah that's when he's happy when everybody's making a fuss over him on the stage. (emphasis mine) He needs that. 48. T. Hmm. [pause] Speaking of being on stage (emphasis mine) How did you do on your assign-ment. [The patient plays i n the same band as her husband and from the continuation of the interview i t seems that the therapist had asked the patient to look at the people i n the audience when she performs.] Again we have an instance of the therapist : t y i n g ' to the patient's previous utterance. The consequentiality of the thera-p i s t ' s comments i s that the patient's 'talk' concerning her husband i s i n t e r a c t i o n a l l y handled by the therapist i n such a way to make i t relevant f o r the patient. While "the music business" may be good for the patient's husband, the patient's husband i s not the concern of the therapist i n that he i s not the person getting 'treatment'. The patient's comments concerning her husband i n some sense are 'dismissed' by the therapist and the 'talk' which follows i s r e l a -ted to the patient, "How did you do on your assignment?" Relating the above discussion to p s y c h i a t r i c theory I would l i k e to o f f e r the following quotation from S u l l i v a n : The interviewer i s also e n t i t l e d to exercise h i s s k i l l i n discouraging t r i v i a , i r r e l e v a n c i e s , graceful gestures f o r h i s amusement, and r e p e t i t i o n of things he has heard. It i s perhaps harder for the younger interviewer to demonstrate h i s expertness i n this res-pect than i t i s for him. to i n s i s t on the data he must have. But i f you are not an expert i n interpersonal r e l a t i o n s , you are l i k e l y , f o r good reason, to doubt that you have too much l i f e - t i m e ahead of you, and therefore you want to u t i l i z e i t as w e l l as you can. It i s also profoundly impressive to people, i n the l u c i d i n t e r v a l a f t e r they leave you, to r e a l i z e that you have kept them to something that made sense, and that when they started t e l l i n g you things a l l over again, you said ''Yes, yes. Now we want to i n -quire into so-and-so." In other words, the expert does not permit people to t e l l him things so beside the point that only God could guess how they happened to get into the account. And so from h i s f i r s t meeting with the patient u n t i l the end or i n t e r r u p t i o n of an interview or s e r i e s of interviews the p s y c h i a t r i s t handles himself l i k e an expert i n interpersonal r e l a t i o n s who i s genuinely interested i n the problems of the patient. He i s c a r e f u l to get a l l the d e t a i l s necessary to avoid misunderstandings and to c l a r i f y erroneous impressions unin t e n t i o n a l l y given by the patient, yet he i s chary of encouragement toward any r e p e t i t i v e , c i r c u m s t a n t i a l , or inconsequential d e t a i l i n the report and comment of the patient. There i s not time to spare i n a p s y c h i a t r i c interview. If he sees that the patient i s repeating himself, going into circumstances which are i n no sense i l l u m i n a t i n g , or wandering into i n c o n s e q u e n t i a l i t i e s about some fourth, f i f t h , or s i x t h removed person, he may, without unkindness, discourage such moves, t o l e r a t i n g only a minimum of -wasted time, since he knows that there i s plenty to do. A c t u a l l y t h i s i s a kindness to the patient f or i t communicates to him that the p s y c h i a t r i s t seems to know what he i s doing, and with such hope i n mind he w i l l put up very n i c e l y with what the p s y c h i a t r i s t does A The data we have been examining seems to constitute what might be c a l l e d 'discouraging' the patient from discussing, e.g., her roommate's problems, husband's s i t u a t i o n , etc. Unfortunately S u l l i v a n does not e x p l i c a t e how such 'discouraging procedures' are i n s t i t u t e d i n t e r a c t i o n a l l y and whether they are successful. Con-si d e r the patient's reply to U39: 40. P. Right. [laughs] Well that's what's scaring her of course you know i s l i s t e n i n g to me fo r over the l a s t two years over Toin. And she keeps thinking about everytime she thinks w e l l dammit I'm going to then she thinks about me, and she backs out [pause] I t ' s funny. And Tom i s t e l l i n g me what I should t e l l her.... The patient obviously recognizes the character of the therapist's previous utterance, but at the same time she continues to discuss her roommate's d i f f i c u l t i e s . Perhaps t h i s i s some i n -d i c a t i o n of why therapy i s often such a long process compared to other types of medical help. P s y c h i a t r i s t s , I presume, assume that patients contemplate what occurred i n therapy sessions a f t e r the session i s over, i . e . much of the work of the therapist i s accomplished i n what S u l l i v a n could c a l l "the l u c i d i n t e r v a l a f t e r they leave you". As such, 'treatment' i n the p s y c h i a t r i c s i t u a t i o n may be s i m i l a r to "making points" i n which the patient t a l l i e s such points perhaps several hours, days, etc., a f t e r the interview and does not immediately see t h e i r s i g n i f i c a n c e . As such there i s no f u l l scale diagnosis presented to the patient with the appropriate prescription as occurs in other types of medical situations. It has been the purpose of this chapter to demonstrate how 'treatment' is interactionally administered within the psychi-atric interview. While much of the psychiatric literature is concerned with "giving advice" to clinicians on how to successfully manage the psychiatric interview such works f a i l to 'translate' such advice into interactional procedures for the therapist. I have attempted to examine some instances of 'treatment procedures' and describe the interactional techniques used by thera-pists in conducting psychiatric interviews. Again the major con-tention of the thesis is underlined, that while we are dealing with a psychiatric setting the interactional devices available to the psychiatrist are not the result of his possessing any 'special' knowledge by virtue of psychiatric training, but that his expertise lies in his ability to use common-place interactional devices in the service of treatment during the psychiatric interview. FOOTNOTES 1. See the discussion of personal states i n Chapter I I : Opening  the P s y c h i a t r i c Interview. Also Harvey Sacks, Lectures 8, 9, and 10, Spring Quarter, 1967, U.C.L.A. 2o In some cases, indeed, to ask the question would be inappropriate, since the speaker may expect the hearer to understand the account as "obvious". 3. Harvey Sacks, unpublished l e c t u r e s . 4. Harry Stack S u l l i v a n . The P s y c h i a t r i c Interview. W.W. Norton and Company Inc., New York, 1954, p. 26. At t h i s point I would l i k e to acknowledge my recognition that the r e l a t i o n s h i p between p s y c h i a t r i c theory and p s y c h i a t r i c p r a c t i c e i s an area worthy of i n v e s t i g a t i o n . I have not, however, attempted such an i n v e s t i g a t i o n since such a concern would e n t a i l a work of the same scope as the present report. CHAPTER VI SIGNIFICANCE MARKERS Earlier in this thesis i t was useful to consider the fact that the encounter between therapist and patient i s methodically generated. It is important to note that not only i s the encounter methodically generated but i s initiated on the assumption that more than a "minimal proper conversation" w i l l occur between the parti-cipants. Previously, we have also considered topicality and how 'topics' get interactionally initiated i n the interview. The concern of this chapter is with what might be called the "impor-tance" or "significance" accorded to talk produced by the patient. I w i l l not be concerned with what psychiatrists might wish to re-gard as important i n the sense of patients' talk being seen as "demonstratable" of some psychiatric problem, e.g., the patient i s demonstrating her anxiety. Rather, when referring to "significance" or ''importance" i t seems to be empirically the case that patients during psychiatric interviews use common-sense notions of "signi-ficance" and "importance" and use routine interactional devices to manifest these c r i t e r i a . What we are dealing with is a two-party conversation and I suggest that when members talk to one another they orient to the possible "importance" or "significance" their "hearer" can accord such talk. The analysis presented will deal with the following ex-changes between patient and therapist: Example A: 1. T. I 'm recording this. Is that okay by you? 2. P. Yes. But I don't have much to say today. (emphasis mine) [pause] I had a couple of dreams (( )). It was really vivid.... Example B: 5. T. What's so great? 6. P. Nothing. Just great. [pause] Nothing's great though, everything's the same. [pause] I'm feeling okay. I don't really have too much  to talk about. (emphasis mine). The above pieces of data occurred at the beginnings of psychiatric interviews. I would like to treat the remarks empha-sized in the above utterances as being problematic, despite the fact that they pay seem totally obvious given the fact that the encounter has been methodically generated and both parties are aware that 'talk' is supposed to occur. If the remarks I am emphasizing are treated as obvious then they are presumably explained in the following way. First, the patient has an appointment with the therapist. Second, whil arriving at the appropriate scheduled time the patient discovers that she "does not have anything to talk about". I suggest that such a common sense interpretation will bypass the interactional s i g n i f i c a n c e of the patient's remarks. Consider f o r instance, that on t h i s account the therapist could engage i n some type of "re-scheduling", e.g., "Okay, come back when you have something to t a l k about", or he could i n s t r u c t the patient to c a l l and cancel the appointment should she have nothing to say. In both of the above examples, however, i t i s e m p i r i c a l l y the case that both interviews were not cancelled and that each interview lasted for i t s scheduled duration. This leaves us with two a l t e r n a t i v e s . An obvious s o l u t i o n would be to invoke some c r i t e r i a of accuracy and say that the patient was mistaken, i . e . she d i d have something to t a l k about, despite her claim to the con-t r a r y . However, there seems to be a greater "pay o f f " i n terms of understanding i n t e r a c t i o n a l devices i f wo at least e n t e r t a i n the p o s s i b i l i t y that such a remark as "I don't have much to say today" i s an a r t f u l production and that we can seek to discover what i t i n t e r a c t i o n a l l y accomplishes. In example A the patient and therapist as of yet have not engaged i n any t o p i c a l t a l k , i . e . a topic or more s p e c i f i c a l l y a f i r s t t o p i c has not yet been negotiated between the p a r t i c i p a n t s . The patient does, however, o f f e r as a possible f i r s t 'topic' or at least a f i r s t 'mentionable', "I had a couple of dreams...." Sacks and Schegloff have discussed the importance accorded f i r s t mention-able i n conversations and t h e i r comments are worth noting i n f u l l : If we can r e f e r to what gets talked about i n a con-versation as "mentionables" then we can notice that there are considerations relevant to convers a t i o n a l i s t s ordering and d i s t r i b u t i n g their t a l k about mentionables i n a s i n g l e conversation. There i s s f o r example, a p o s i t i o n i n a s i n g l e conversation f o r ' ' f i r s t t o p i c " . We intend to mark by t h i s term, not the simple s e r i a l f a c t that some topic gets talked of temporally p r i o r to others, but that to make of a topic a " f i r s t topic'' i s to accord i t a c e r t a i n s p e c i a l status i n the conver-sation. Thus, for example, to talk, of a topic as a " f i r s t t o p i c " may provide for i t s a n a l y z a b i l i t y as "the reason f o r " the conversation, that being, f u r t h e r -more a preservable and reportable feature of the conversation (where we mean by "preservable and report-able" that i n a subsequent conversation t h i s feature, having been analyzed out of the e a r l i e r conversation and preserved, may be reported as "he c a l l e d to t e l l me that. .. : i l It i s a feature of telephone conversations that there e x i s t s an "information gap" between the p a r t i c i p a n t s , i . e . , the c a l l e d party does not know who i s c a l l i n g or why the c a l l was i n i -t i a t e d . For th i s reason, much of the "opening work" of telephone conversation i s concerned with overcoming t h i s "inforir_ation gap", 2 i . e . to discover "who i s c a l l i n g and why the c a l l was i n i t i a t e d " . It i s f o r t h i s reason that a " f i r s t t o p i c " c a r r i e s such importance since i t can be seen as the r a t i o n a l e for the i n i t i a t i o n of the en-counter between c a l l e d and c a l l e r . With respect to the notion of "mentioriables" i t seems that members engage i n some process whereby a " f i r s t mentionable" can be seen as char a c t e r i z i n g the possible importance of the con-versation. Extending the a n a l y s i s , I suggest that not only i s the positioning of "mentionables" important but also that members when speaking to one another take into consideration what can constitute a "mentionable" to their fellow interactant. That is, what might be a "mentionable" to one person may not be a "mentionable" to another. Furthermore, the grounds for not "mentioning" something to one per-son while offering the information to another need not be ones of privacy or confidentiality, but rather may be attending to the fact that what would be "mentioned" is of no particular interest to the hearer. Put very crudely, there are some people you t e l l certain things because you assume that they would want to "know" and there are other people you do not t e l l the same things because to do so would be to "bore" them. Earlier i t was made apparent that a therapist can always 'hear' a patient's utterance as being "clinically relevant", e.g., "What's so great" from a previous interview where the therapist treated a patient's "ceremonial" answer to a greeting substitute as a "constructive". Since this is the case I suggest that patients often become aware of this special 'hearing' the therapist uses, i.e. patients are aware that often what they say can be subjected to interaction returns which are not those of common discourse. Such awareness, however, has a double edge to i t . While patients may be in a position to realize that therapists often use a dif-ferent set of criteria than normally used when dealing with patients' utterances, the patient is really never in a position of knowing 'how1 the therapist is going to suspend his interactional return. That is, while therapists often use interactional procedures that are at variance with the way one would normally 'hear' a patient's utterance, the patient is not in a position to be able to "pre-monitor" how the therapist will invoke such a procedure. Just as in routine conversations between the acquainted where the partici-pants screen the introduction of mentionables for their possible "significance" to the "hearer" so patients seem to demonstrate exactly the same concerns in talking to their psychiatrist. It seems to be a matter closely attended to by conversationalists that they do not produce utterances that "go over like a lead balloon" on such grounds that the speaker has misjudged the "hearers'" inter-est or concern. Returning to our discussion of the Sacks and Schegloff quotation, i t was suggested that in telephone conversations a "first topic" can be seen as the rationale for the call. Consider the 3 following hypothetical situation posited by Schegloff: 1. Called: Hello. 2. Caller: Hi! 3. Called: Oh hi, B i l l . 4. Caller: I just called to say hello. The f i r s t point to make concerning the above i s that while two friends may speak on the telephone and one may say "I j u s t c a l l e d to say hello",such a conversation does not expectedly terminate by the pa r t i e s exchanging " h e l l o ' s " , but r e s u l t s i n the two p a r t i e s t a l k i n g about some topi c . Second, where Schegloff ta l k s of the "information gap" i n terms of "who's on the other end of the l i n e and why did they c a l l " , I suggest that by saying "I j u s t c a l l e d to say h e l l o " the c a l l e r i s supplying information concerning the character of the c a l l and i t s r a t i o n a l e for i n i t i a -t i o n , i . e . , nothing important or urgent prompted the c a l l . That i s , we could set up a dummy model such that every time the phone rang i t was something important and that would be the only reason for the phone r i n g i n g (and there are phones l i k e t h i s , e.g., the hot l i n e between Moscow and Washington), i . e . , someone had something urgent to report. Not only does U4 provide a r a t i o n a l e f o r the c a l l but also tends to characterize the t a l k that follows as 'not : urgent', 'important', etc. Returning to our data I would l i k e to consider the i n t e r -a c t i o n a l consequences of the patient prefacing her i n i t i a t i o n of a topic with such a remark as "But I don't have much to say today". I wish to emphasize that I hear the patient's remark, "But I don't have much to say today", as_ a prefatory remark and not merley occur-r i n g i n some s e r i a l order p r i o r to "I had a couple of dreams...." In U2 I suggest that i n terms of 'topic' or at l e a s t f i r s t mentionable that the patient o f f e r s something that we might wish to c a l l a "dream report". Now assuming that I am correct i n trea t i n g the patient's previous utterance as a prefatory remark, the question becomes what i s the i n t e r a c t i o n a l consequentiality, i f any, of such a preface. I suggest that the patient's prefatory utterance "But I don't have much to say today" functions as what I wish to c a l l a " s i g n i f i c a n c e marker" and serves to i n d i c a t e to the hearer that the speaker does not attach much importance to, e.g., "the dream report". Furthermore I suggest that had the patient wanted to make the opposite claim, i . e . that the "dream report" was e s p e c i a l l y important,an a l t e r n a t i v e marker, e.g., "I have something to t e l l you" could have been used. This would give the patient's utterance 4 the character of an announcement. I would now l i k e to consider another piece of data that adequately demonstrates that members often engage i n i n t e r a c t i o n a l devices to characterize the 'talk' that follows as being, e.g., 'important', 'urgent', ' c o n f i d e n t i a l ' , ' t r i v i a l ' , etc. Consider the data: 47. P. I don't know. How much are sweaters f o r the male sex? 48. T. Twenty to t h i r t y d o l l a r s . 49. P. Yeah. I think I ' l l get him a medical s h i r t , or something l i k e that. [pause] They don't  know my name (emphasis mine) I was going to ask you about something. 50. T. Do you want me to turn i t off ? [pause] As a matter of f a c t , i f there were things you would rather not t a l k about I can turn i t o f f , or I ' l l j u s t simply erase i t . 51. P. Oh, i t ' s okay i f they're not going to know who I am. 52. T. No. He's not. 53. P. Oh. Hmm [laughs] [pause] I was j u s t wondering about b i r t h c o n t r o l , 54. T. You were hey? In the above data, U's 47-49, the patient has been d i s -cussing with the therapist what type of g i f t to get her boyfriend for h i s birthday. One of the noticeable features about U49 i s that i t contains a t h i r d party reference. "They don't know my name", My f i r s t concern i s to account for the reasonableness of t h i s utterance given the empirical s i t u a t i o n of there being only a patient and a therapist present, i . e . who i s the 'they'? As a researcher I am aware of c e r t a i n circumstances con-cerning t h i s interview, i . e . that the interview was being tape recorded f o r the f i r s t time and that the recorder was v i s i b l y l o c a -ted between patient and therapist. With t h i s knowledge the "reason-ableness" of the patient's remark becomes evident. Explaining the reasonableness of such a remark s t i l l does not answer the more i n t e r e s t i n g question of what work such an utterance i s accomplishing i n t e r a c t i o n a l l y . In U49 the patient states that she was going to ask the therapist "about something". I suggest that 'asking' i s an a c t i v i t y that i s done a l l the time and furthermore an a c t i v i t y not needing or r e q u i r i n g an announcement. Given t h i s f a c t , the question of i n t e r e s t i s what i s such an announcement accomplishing i n t e r a c t i o n -a l l y . "I was going to ask you something" i s d i f f e r e n t from a c t u a l l y 'asking', and I suggest that such an utterance constitutes some type of marker which characterizes the question to be asked. Indeed, given the s e t t i n g of a p s y c h i a t r i c interview such an utterance might be heard by a therapist as a patient's concern with the "appropriateness" of a question. In the instance under consideration, however, such a r e -mark i s prefaced by "They don't know my name", and I suggest that this utterance tends to characterize the patient's forthcoming question as being, e.g., c o n f i d e n t i a l , important, for the therapist only. It not only orients to the fac t of the presence of the tape recorder but uses that feature of the encounter to produce an utterance that characterizes her question as being of a "confiden-t i a l " nature. By o r i e n t i n g to the f a c t of the interview being recorded the patient's concern with respect to the " c o n f i d e n t i a l i t y " of the session becomes a warrantable concern. The th e r a p i s t , i n U50, by offering to turn the tape recorder off or "simply erase i t " treats the patient's concern for confidentiality with a reciprocal concern for confidentiality thereby demonstrating that he understood the significance or importance the patient attaches to her question. I suggest that the therapist's action substantiates my analysis of the patient's utterance being one which acts as a marker to char-acterize her question as "confidential", "private", etc. The subject of importance to the patient turns out to be "birth control". Now I do not wish to argue that "birth control" is a subject that patients necessarily always attend to as being confidential. My only contention is that at least in this piece of data the patient has prefaced her questian by what I wish to c a l l a significance marker. The consequentiality of such a marker i s that i t allows her co-participant to attend to the importance she wishes her comments to be accorded, e.g., i n this case with respect to their confidentiality. This chapter has been concerned with a general feature of conversation, i.e. when members talk to each other they orient to the possible significance they expect their hearers to accord their talk. The psychiatric interview, however, poses a d i f f i c u l t problem for the patient since i t is a feature of such occasions that therapists are entitled to treat patient's utterances i n ways which are at variance with the way such utterances would normally be t reated i n everyday l i f e . While i t was suggested that p a t i e n t s e v e n t u a l l y become aware of t h i s enti t lement they are not i n a p o s i t i o n to know 'how* the t h e r a p i s t w i l l g ive t h e i r comments such a h e a r i n g , and they therefore employ standard c o n v e r s a t i o n a l r e -sources to i n d i c a t e to t h e i r c o - p a r t i c i p a n t what s i g n i f i c a n c e to a t tach to t h e i r t a l k . Thus I have demonstrated the use of what have been c a l l e d " s i g n i f i c a n c e markers" to preface t o p i c i n i t i a -t i o n s , t o p i c changes, e t c . It i s a b a s i c assumption of t h i s report that whatever theory the p s y c h i a t r i s t subscribes t o , he must neces-s a r i l y share With the p a t i e n t the vocabulary of speech acts which form the r e p e t o i r e of r o u t i n e d i s c o u r s e . FOOTNOTES 1. Emanuel A. Schegloff and Harvey Sacks. "Opening Up Closings". Paper presented at the A.S.A. meetings, San Francisco, Septem-ber, 1969, p. 7. 2. Emanuel A. Schegloff. "Sequencing In Conversational Openings". American Anthropologist, Vol. 70, No. 6, December, 1968. 3. Ibid. 4. David Sudnow. Passing On: The Social Organization of Dying. Prentice-Hall, Inc., Englev7ood C l i f f s , Nev7 Jersey, 1967. Particularly chapter 5. CHAPTER VII CONCLUSION This thesis has been concerned with the social organiza-tion of the psychiatric interview and how that organization is pro-duced and manifested via the talk that occurs during the interview. Most psychiatric research in this area is concerned with the effec-tiveness cf the psychiatric interview and with the training of clinicians. The sociological liaterature which deals with the psychiatric interview, while not necessarily related to psychiatric problems, is often concerned with the interview from the standpoint of some pre-adopted theory of interaction. Thus such works are often concerned with, e.g., content analysis, scoring procedures, and attempts at quantification, directed at establishing typologies of interviews or participants. While I have not examined the inter-view in terms of any psychiatric theory I have also not adopted any explicit theory of interaction. Rather my concern has been with examining pieces of interaction for their "performative" character. In this connection, one of the problems considered in this report was how topics become interactionally negotiated in the interview. It was suggested that settings typically place constraints on topicality by providing for the accomplishment of "core activities". The therapy situation, however, seems to be one i n which the "core activity" and hence c r i t e r i a for identifying "main topic," are not obvious. Thus with respect to topical talk, what w i l l become topics for discussion between patient and therapist is something that has to be negotiated between the participants, and i t is apparent that such negotiation is accomplished by both members using natural language. This presumably legitimates analysis into speech acts. Using some of the ideas and concepts developed with res-pect to topicality,chapter IV was concerned with the special charac-ter of the relationship between doctor and patient. It was shown that much of the talk that occurs i n the interview involves the "sharing of news" on the part of the patient, i.e. some "resuming" behavior occurs i n psychotherapy. It was suggested, however, that informational rights with respect to the sharing of news were not symmetrical and that (1) the "resuming" behavior exhibited by the therapist was concerned with producing talk on the part of the patient for possible topical development, and (2) such talk con-stitutes the data from which he does his work. That i s , patients' personal biography also constitutes for the therapist patients' medical history. In the data and analysis presented i t would appear that the psychiatric interview is composed of the same "interactional stuff" of other settings and encounters, i.e. the members of the psychiatric interview use the same repetoire of "speech acts" for producing the social organization of the settings, e.g., asking questions, telling stories, etc.,that would be available for use in other settings and occasions. Given this fact i t would seem that while a large amount of the psychological literature is concerned with psychiatric practice in "theoretical" terms, i n order to under-stand the interactional processes occurring in the interview one is entitled to make use of the resources available to any competent member of the society. The problems are of sociological interest in that they require explicit examination of such resources. This approach suggests further areas of research. Thus, after a discussion of topic construction and greeting exchanges i t was pointed out that therapists are often able to treat patients' utterances in ways which are at variance with "normal interactional routines" and thereby suspend conventional conversational practices. Since the conversational resources available to both patient and therapist are the same as those available to any member of the soc-iety, i t may be that an area worth further investigation is how therapists are "taught" to suspend such interactional routines. I suggest that therapists have to "learn" how to interactionally "undercut" patients' comments and perhaps some insight into the social organization of the therapy situation might be gained by an examination of the training procedures cf clinicians. Further, since i t has been established that the interac-tional resources are normally shared by both participants of the psychiatric interview, i t might prove interesting to examine those encounters between patient and therapist where such interactional knowledge is not reciprocal. I am thinking of child therapy where i t is either assumed by the therapist that (1) the child has not developed interactional competence and the therapist must contend with this fact as part of the psychiatric interview or (2) the child is operating using a different system of interactional rules for conversational encounters. In conclusion, in recommending such further research, I would like to emphasize that the findings of this report are to be regarded as tentative. In so far as I make a claim i t is that alternative (and perhaps more satisfactory) findings must be dis-covered by the employment of an approach best described as a "nat-ural history" of interaction. I have tried here to show what such a natural history looks like. BIBLIOGRAPHY Bitt n e r , Egon. "The Police on Skid Row; A Study of Peace Keeping", American Sociological Review, Vol. 32, No. 5, October 1967. Flew, Anthony (ed.). Logic and Language. Oxford: B a s i l Blackwell, 1966. Garfinkel, Harold. Studies i n Ethnomethodology. Englewood C l i f f s , New Jersey: Prentice-Hali, 1967. G i l l , Merton, Richard Newman, and Fredrick C. Redlich. The I n i t i a l  Interview i n Psychiatric Practice. New York: International Universities Press Inc., 1954. Goffman, Efving. Stigma. Englewood C l i f f s , New Jersey: Prentice-H a l l , 1963. Kuhn, Thomas S. The Structure of S c i e n t i f i c Revolutions. Chicago: University of Chicago Press, 1962. Orne, Martin T. "On the Social Psychology of the Psychological Experiment". American Psychologist, November 1962. Pittenger, Robert E., Charles P. Hockett, and John J . Danehy. The  F i r s t Five Minutes. New York: Paul Martineau, 1960. Sacks, Harvey. Unpublished Lectures. Spring Quarter 1967, Uni-versity of C a l i f o r n i a , Los Angeles. Schegloff. Emanuel A., and Harvey Sacks. "Opening Up Closings", paper presented to the American Sociological Association, San Francisco, September 1 9 6 9 . Schegloff, Emanuel A. "Sequencing i n Conversational Openings", American Anthropologist, Vol. 70, No. 6 , December 1968. Schutz, A l f r e d . Collected Papers I: The Problem of Social Reality. The Hague: Martinus Nijhoff, 1967. Searle, John. "What i s a Speech Act", i n Max Black (ed.), Philosophy  i n America. London: George Al l e n and Unwin Ltd., 1966. Speier, Matthew. "The Everyday World of the C h i l d " , i n Jack Douglas (ed.), Understanding Everyday L i f e . Aldine Press, 1970. . "The Organization of Talk and S o c i a l i z a t i o n Prac-t i c e s i n Family Household Interaction", unpublished Ph.D. d i s s e r t a t i o n , Department of Sociology, University of C a l i f o r n i a , Berkeley, 1969. . "Procedures for,Speaking and Hearing: The Inter-a c t i o n a l Display of S o c i a l Organization", i n David Sudnow (ed.), Papers i n Interaction (forthcoming). . "Some Conversational Sequencing Problems for Inter-a c t i o n a l A n a l y s i s : Findings on the Child's Methods f or Opening and Carrying on Conversational Interaction", paper presented at John Gumperz's Summer Workshop, Group IV of "Language, Society, and the C h i l d " , University of C a l i f o r n i a , Berkeley, Summer Quarter, June 19-September 7, 1968. Sudnow, David. Passing On: The S o c i a l Organization of Dying. Englewood C l i f f s , New Jersey: P r e n t i c e - H a l l , 1969. S u l l i v a n , Harry Stack. The P s y c h i a t r i c Interview. New York: W.W. Norton and Company Inc., 1954. Turner, Roy. "The Ethnography of Experiment", The American Behavioral S c i e n t i s t , A p r i l 1967. . "Occupational Routines: Some Demand C h a r a c t e r i s t i c s of P o l i c e Work", paper presented to the Canadian S o c i o l o g i c a l and Anthropological A s s o c i a t i o n , Toronto, June 1969. . "Some Features of the Construction of Conversation", paper presented to the American S o c i o l o g i c a l A s s o c i a t i o n , San Francisco 1969. . "Some Formal Properties of Therapy Talk", i n David Sudnow (ed.), Papers i n Interaction (forthcoming). . "Talk and Troubles : Contact Problems of Former Mental Patients", unpublished Ph.D. d i s s e r t a t i o n , Department of Soc-iology, University of C a l i f o r n i a , Berkeley, 1968. . "Words, Utterances and A c t i v i t i e s " , i n Jack Douglas (ed.), Understanding Everyday L i f e , Aldine Press, 1970. 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0302455/manifest

Comment

Related Items