Therapeutic conversation is the dialogue between clinician or psychotherapist and client. It differs from social conversation in its rules and in its intent. The therapeutic conversation is meant to help heal the client's suffering. Social conversation is not intended for that purpose. Some like to call therapeutic conversation "therapeutic narrative," focusing on the story-like quality of the clinical dialogue.
Important Parts of Therapeutic Conversation
Therapeutic conversation consists of several areas. Some of these are the same as social conversation, but many are unique to therapy. Not all of these skills will be part of every therapeutic conversation. The first set of skills includes basic listening skills, followed by influencing skills, then confrontation and, finally, resolution. Some features of a good therapeutic alliance, necessary to good therapeutic conversation, include empathy, trustworthiness, caring, genuineness, sincerity and congruence, persuasiveness and, finally, hope or optimism. These essential conditions ensure that the therapeutic conversation is effective and results in positive change.
Rules of Therapeutic Conversation Versus Rules of Social Conversation
One example of a difference between social conversation and therapeutic conversation is the notion of interrupting. In social conversation, interrupting is frowned upon until the speaker has finished speaking. In therapeutic conversation, there are moments when interrupting is necessary to keep one person from dominating the conversation, and so provide an intervention that will result in a more equitable dialogue. Another difference centers around asking questions, and generally, about interest in participants. In social conversation, it is understood that questions will be asked of members about equally. In therapeutic conversation, the majority of questioning is done by the therapist. Self-disclosure by the therapist is kept to a minimum in order for the client to remain at the center of the conversation. Similarly, the therapist will continue to question the client, providing confrontation, in order to receive answers to questions. Glossing over uncomfortable topics is a hallmark of social conversation. In therapeutic conversation, caring confrontation is the norm. In both types of conversation, active listening should be the norm. No conversation should occur where one member does not feel heard. In social conversation, this may happen from time to time. In therapeutic conversation, this is unacceptable.
Example of a Therapeutic Conversation
Clinician: One thought you had was that your son was failing out of school. What led you to have that thought?
Client: Well, he wouldn't show me his report card. It makes me think he failed something.
Clinician: He may have. Does he have a history of failing classes?
Client: No. He usually gets "As" and "Bs."
Clinician: So this is the first time you have suspected that he may have failed a class?
Client: Yes.
Clinician: And what is your definition of "failing out of school?"
Client: I guess it would be someone who has failed several classes so that the person was not asked back to the school.
Clinician: And does that sound like your son?
Client: No, I guess I overreacted when I said he was failing out of school.
Clinician: And what about your thought that you are to blame for his behavior? What led you to think that?
Client: I'm his parent. Aren't I the biggest influence in his life?
Clinician: Yes, your role certainly is an important one. How might you have encouraged your son to fail out of school?
Client: I don't know what you mean.
Clinician: I wonder if you have failed out of school yourself.
Client: No, of course not.
Clinician: Perhaps you condone failure, or didn't try to teach him that school success is important?
Client: No. Just the opposite. I have very strong feelings about the importance of education. I always tried to show my son by example succeed.
Clinician: I'm confused, then, about how you may have caused him to fail.
Client: I guess I was just feeling bad and wanted to find an explanation. But I can see that I certainly never taught him to fail.
Tags: social conversation, therapeutic conversation, Client guess, failing school, social conversation, therapeutic conversation