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Formulation and Clients' Agency in Cognitive Behavioral Therapy.

Xueli Yao1, Boyu Dong1, Weining Ji1

  • 1School of Foreign Languages, Qingdao Agricultural University, Qingdao, China.

Frontiers in Psychology
|April 1, 2022
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Summary

Therapists enhance client agency in cognitive behavioral therapy (CBT) by using affirmative and challenging formulations. These interactional techniques help manage epistemic challenges and promote client empowerment during therapy sessions.

Keywords:
agencycognitive behavioral therapyconversation analysisformulationtalk-in-interaction

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Area of Science:

  • Psychology
  • Linguistics
  • Psychotherapy Research

Background:

  • Loss of agency is a key reason clients seek psychotherapy.
  • Enhancing client agency is crucial for successful psychiatric and psychotherapeutic treatment.
  • Limited research exists on how therapists foster agency in real therapy sessions.

Purpose of the Study:

  • To investigate how therapists ascribe agency to clients in authentic cognitive behavioral therapy (CBT) encounters.
  • To analyze the interactional methods therapists use to enhance client agency.
  • To explore the role of formulations in managing epistemic difficulties and promoting client agency.

Main Methods:

  • Conversation analysis of audio-recorded CBT sessions in a Chinese mental health center.
  • Identification and categorization of therapist formulations used to ascribe agency.
  • Analysis of two types of formulations: affirmative and challenging.

Main Results:

  • Therapists use affirmative formulations to highlight positive client experiences and ascribe agency.
  • Therapists use challenging formulations to question implausible client views and non-agentic self-positioning.
  • Formulations effectively manage epistemic challenges in understanding client inner states and feelings.

Conclusions:

  • Therapist formulations are robust interactional tools for promoting client agency in therapy.
  • Affirmative formulations directly ascribe agency by focusing on positive client experiences.
  • Challenging formulations, while promoting agency, risk client resistance due to asserted epistemic authority.