“I think you are struggling with this very much”: Formulating therapy-relevant matters in psychosomatic therapy sessions

Psychosocial ascriptions in psychosomatic therapy invite the patient not only to confirm and elaborate on their mental feelings, but also make relevant certain therapy goals. Establishing a shared understanding, or “common ground” regarding therapy-relevant topics are appointed by therapist and patient as prerequisites for the success of psychosomatic therapy. We analyzed those specific moments in the conversation where therapists address a possible therapy-relevant topic, and analyzed the social actions conveyed by patients in their uptake. We used conversation analysis to analyze 54 audio-recorded conversations between psychosomatic exercise and physical therapists and patients with persistent somatic symptoms (PSS). Therapists raise possible therapy-relevant issues by ascribing psychosocial feelings or mental states to the patient. These psychosocial ascriptions have two functions, namely (1) highlighting an underlying factor of the patient's PSS and (2) providing a psychosomatic explanation for the patient's PSS. Ascribing mental states to patients can be a precarious action, as therapists enter the epistemic domain of the patient. However, our analysis showed that the ascriptions in our dataset are unproblematic for the continuation of the interaction and set the agenda to further explore therapy-relevant topics. This implicates that therapists could use psychosocial ascriptions as conversational strategy to further explore patients' problems.