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Pädiatrische Gespräche unterscheiden sich gegenüber anderen ärztlichen Gesprächen mit Patienten hinsichtlich der Gesprächsaufgaben und der Beteiligungskonstellationen. In einer triadischen Konstellation mit Arzt, Patient und Eltern(teil) müssen unterschiedliche Kenntnisse und Zuständigkeiten aller Beteiligten ausreichend abgeglichen und Verständigung und Gesprächsergebnisse gesichert werden. In diesem Beitrag wird zunächst die Forschungslage umrissen und das Handlungsschema pädiatrischer Erstkonsultationen kurz dargelegt. Daran anschließend werden anhand einer Fallanalyse die vielschichtigen und komplexen Aufgabenstellungen der Beteiligten bei der Herstellung und Durchführung der körperlichen Untersuchung beleuchtet.
Die Rationale der psychodynamischen Psychotherapie (und anderer Therapieformate) besteht darin, belastende und teils der bewussten Reflexion unzugängliche Erfahrungen der PatientInnen aufzuklären, ihre Ursachen zu identifizieren und alternative Wahrnehmungs- und Handlungsweisen zu ermöglichen. Dazu bedient sie sich eines bestimmten Settings: der Therapie über mehrere Sitzungen hinweg, in denen PatientInnen ihre Beschwerden und Erfahrungen berichten und TherapeutInnen mithilfe kommunikativer Praktiken gemeinsam mit den PatientInnen die Beschwerden aufzuklären, die Erfahrungen zu vertiefen und die Probleme zu lösen suchen. In der konversationsanalytischen Psychotherapieforschung (Peräkylä et al. 2008) werden dazu vier Grundtypen verständigungsbegünstigender kommunikativer Praktiken der Psychotherapie identifiziert: äußerungsfortführende Extensionen, Musterhaftigkeit herstellende Interpretationen, reformulierende formulations und Fragen (Weiste & Peräkylä 2015). Der vorliegende Beitrag widmet sich der Untersuchung von drei Fragetypen: Beispielnachfrage, Kollaborative Erklärungsfindungsfrage und Lösungsorientierte Frage und deren sequenzieller Organisation in psychodiagnostischen Gesprächen. Ziel ist es, deren unterschiedliche produktive Potenziale hinsichtlich der Handlungsrationale diagnostischer und therapeutischer Aufgabenstellungen herauszuarbeiten.
Psychotherapy talk is characterized by epistemic, emotional and professional asymmetries of knowledge, which are continuously adjusted to by the participants in joint process of negotiation. Adjustment is based on structural features of communication: the fundamental sequentiality of verbal interaction, i.e. interrelated succession of utterances of at least two interlocutors, provides for and guarantees the achievement of intersubjectivity and therapeutic efficiency. Solution-oriented questions as a rhetorical practice serve to produce forward-looking awareness, expansion of knowledge and reorganization of knowledge on the patient’s side as well as an increased ability to act. These processes become apparent not only locally in the immediate context of solution-oriented questions but also globally in the course of the interaction as a whole. The data for this research consists of psychodiagnostic interviews conducted according to the concept and manual of the Operationalized Psychodynamic Diagnostics (OPD Task Force 2009).
As part of a larger research paradigm on understanding client change in the helping professions from an interprofessional perspective, this paper applies a conversation analytic approach to investigate therapists’ requesting examples (REs) and their interactional and sequential contribution to clients’ change during the diagnostic evaluation process. The analyzed data comprises 15 videotaped intake interviews that followed the system of Operationalized Psychodynamic Diagnosis. Therapists’ requesting examples in psychodiagnostic interviews explicitly or implicitly criticize the patient’s prior turn as insufficient. They also open a retro-sequence and in the following turns provide for a description that helps clarify meaning and evince psychic or relational aspects of the topic at hand. While the therapist’s prior request initiates the patient’s insufficient presentation, the patient’s example presentation is regularly followed by the therapist’s summarizing comments or by further requests. Requesting examples thus are a particular case of requests that follow expandable responses regarding the sequential organization; yet, given that they make examples conditionally relevant, they are more specific. With the help of this sequential organization, participants co-construct common knowledge which allows the therapist to pursue the overall aim of therapy, which is to increase the patients’ awareness of their distorted perceptions, and thus to pave the way for change.
The goal of the current contribution is to discuss the specific change potential of requesting examples in the helping formats ‘psychotherapy’ and coaching’. Requesting examples are defined as retrospective requests from the therapist/coach to the patient/client to elaborate the latter’s directly preceding utterance via an exemplary concretization. To appropriately reflect upon past events and upon personal experiences is often considered a key for change given that such reflections allows patients/clients to develop alternative and new perspectives on their lives, their relationships, their selves etc. To work with examples or to present concrete experiences thus functions as a central change practice both in psychotherapy and in coaching. While this discursive practice entails an inherent change potential, we still have to empirically unfold the sequential, thematic and action theoretical design of requesting examples as well as their interaction-type specific change function(s). This has already been done in the context of therapy. We now widen the focus and contrast these findings with analyses of requesting examples in executive coaching. Thereby this contribution does not only provide in-depth insight into the change potential of requesting examples, but also adds to further differentiate therapy and coaching as regards their discursive and interactive layout.