Problem Construction in Initial Sessions of Psychotherapy: A Meta-Synthesis of Existing Literature and a Critical Discourse Analysis

This thesis consists of a literature review and a research study. The review used a meta-synthesis to integrate the findings of existing literature on problem construction in initial sessions of psychotherapy. Five main themes were constructed from the studies reviewed: Problems are defined by therapists, Therapists employ rhetorical strategies, Therapists’ use of power and clients’ resistance, Problems are structured and ordered through language, and Problems exist in socio-historical context. A new explanatory model for problem construction in psychotherapy was proposed. Therapists’ problem schemas that were shaped by socio-historical factors and rhetorical strategies involved in realising these schemas were central to the process of problem construction. Epistemological differences in research methodologies generated difficulties in the synthesis of existing research.
For the research study, a critical discourse analysis was used to analyse therapist-client problem construction in first sessions of therapy in a trial comparing two psychotherapies for depression. Four stages of analysis were conducted, with the following findings: (1) discursive constructs included how problems were experienced and made sense of; (2) rhetorical strategies were used to pursue agendas by both clients and therapists; (3) subject positions were interactive and could be contradictory for both therapists and clients, they were generally more problem focused for clients and powerful for therapists; (4) therapists and clients reproduced normative discourses from institutions and ideologies shaping their subjectivity. Methodological limitations and recommendations for practice were outlined.