Analyzing therapeutic interactions: An exploration of how clinician control is established and maintained.

摘要

This dissertation is intended to answer the following question: How does a clinician establish and maintain control in therapeutic interactions? This is accomplished by focusing on several speech-language therapy sessions to determine how clinicians and clients negotiate control for therapeutic purposes. The strategies, techniques and variables employed to establish and maintain control are detailed as well as the reactions and interactions that are created while control is being manipulated. First, a description of the prior-existing factors that influence and operate upon the eventual mechanisms of clinician control within the targeted social context(s) is provided. Since these factors contribute a general and pre-existing contextual influence, they have been termed variables of control before therapeutic interactions. They include the age and gender of the participants, their cultural values and expectations, perceptions of communicative competence and the environment of the interaction. Next, those behaviors and functions that create the mechanisms of clinician control within the targeted social context(s) themselves are explained. Termed variables of control within therapeutic interactions, this class of variables will be further divided into the dynamic behaviors of control and the complex functions of control. The dynamic behaviors of control include body positioning and proxemics, employment of gestures, focus and shifting of eye gaze, control of communicative space, discourse markers and pronoun choice as well as the synergy between verbal and non-verbal behaviors. The complex functions of control consist of the structuring of therapeutic activities, the directing of specific therapy tasks, monitoring time within the therapeutic context, regulating conversational topics, managing materials, requesting action and information, providing evaluative feedback and applying interpretative dominance. Together, these behaviors and the functions they help establish provide the mechanisms of clinician control and they are consistent with the prior discussion of interactional power in general. This dissertation considers potential implications that this study may have on the profession of speech-language pathology, specifically the practicing speech-language therapist as well as training institutions for students in communication disorders programs.