Therapists’ responses to young people’s anger: a Conversation Analysis approach

Objective: The exploration of negative feelings is one of the core principles of psychoanalytic psychotherapy, yet anger experienced towards the therapist may lead to increased risk, ruptures in the therapeutic relationship and dropout. This study aimed to investigate the therapists’ immediate responses to patients’ anger in Short Term Psychoanalytic Psychotherapy (STPP) Method: This study used Conversation Analysis (CA) to analyse 10 patient-therapist conversations in extracts extrapolated from 4 different patient-therapist couples. The four treatments were audio-recorded as part of the STPP arm of the IMPACT study, a randomised controlled trial, investigating the efficacy of three types of therapy in the treatment of adolescent depression. Results: The CA analysis found six patterns of response that were produced following patients’ expressed anger. Therapists responded in highly emotion-laden ways, they created space from addressing anger in the here-and-now interaction, they used their epistemic authority to support their point of view, they asked questions about patients’ anger and they shifted their focus to moments of agreement. In one case, the therapist named the patient’s annoyance and anger towards her. In all other three cases latent feelings of anger were named but evaded when those became explicit in the therapeutic interaction. Conclusions: Expressions of anger can be seen as moments of increased emotionality which temporarily affect the therapist’s reflective stance and neutrality. Whilst anger indicates misalignment in the patients’ and therapists’ views and goals, strong emotional alignment on a non-verbal, procedural level seems to be at play. Pragmatic research in naturally-occurring data can inform psychoanalytic technique for STPP and bring awareness of factors likely to impact upon the therapeutic alliance.