Categories for Classifying Language in Psychotherapy - PsycNET

Psychological Bulletin 1979, Vol. 86, No. 2, 404-419

Categories for Classifying Language in Psychotherapy Robert L. Russell

William B. Stiles University of North Carolina at Chapel Hill

Department of Linguistics University of North Carolina at Chapel Hill

A review of language analysis systems employed in psychotherapy research suggests a typology based on the combination of three category types with two coding strategies. The types are (a) content categories, (b) intersubjective categories, and (c) extralinguistic categories. They are denned by distinct sets of language features. The coding strategies are (a) the classical coding strategy, in which categories describe the text, and (b) the pragmatic coding strategy, in which categories describe the speaker. A review of research results suggests that the content, intersubjective, and extralinguistic features constitute distinct channels of communication and that (a) the content channel carries information pertaining to the speaker's psychodynamic process and personality structure, (b) the intersubjective channel carries information pertaining to the quality of the speaker's relationship with the other, and (c) the extralinguistic channel carries information pertaining to the speaker's transitory emotional state. System consistency criteria are suggested for use in conjunction with the typology to evaluate categories and category systems. If the first stage in the scientific study of a phenomenon is naming and classifying, the study of verbal behavior in psychotherapy is mired in its first stage. Reviews of the psychotherapy content analysis literature (Auld & Murray, 1955; Kiesler, 1973; Marsden, 1965, 1971; Meltzoff & Kornreich, 1970) display an ungainly proliferation of categories and systems of categories to describe the verbal behavior of therapist and client. One reviewer (Kiesler, 1973) put it this way: Psychotherapy process research has to rank near the forefront of research disciplines characterized as chaotic, prolific, unconnected, and disjointed, with researchers unaware of much of the work that has preceded and the individual investigator tending to start anew completely ignorant of closely related previous work. (p. xvii)

The proliferation of categories and category systems and the disorganization of this The authors thank John B. Carroll and Bruce C. Johnson for their comments on a draft of this article. Requests for reprints should be sent to Robert L. Russell, Department of Linguistics, University of North Carolina, Chapel Hill, North Carolina 27514.

area of research reflect the lack of consensus on what are the most significant aspects of verbal interaction. In the absence of a unified theoretical understanding, investigators seem dissatisfied with existing systems, and they continue to search for more illuminating ways to capture the richness of verbal behavior in psychotherapy (Goodman & Dooley, 1976; Kepecs, 1977; Kiesler, 1973; Labov & Fanshel, 1977; Strupp, 1957; Stiles, in press-b). The results of this continuing search—the numerous categories and classification systems—have created a need for an integrated descriptive framework, a framework that would facilitate the comparison and evaluation of alternative categorization schemes (Freedman, Leary, Ossorio, & Coffey, 19511952; Reusch & Bateson, 1949; Rice, 1965; Rice & Wagstaff, 1967). The present article addresses this need; that is, it describes an order we see among existing language analysis categories and suggests guidelines for selecting or creating classification systems appropriate for particular research problems. Our framework is a typology of categories. We use three distinct sets of language features to identify three types of categories.

Copyright 1979 by the American Psychological Association, Inc. 0033-2909/79/8602-0404$00.75 404

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The types we propose subsume the vast majority of the language categories that have been used to study verbal interaction in psychotherapy. In brief, content categories, such as mother or death anxiety, concern denotative or connotative semantic content. Intersubjective categories, such as self-disclosure or question, concern syntactically implied and other relationships between the communicator and recipient. Extralinguistic categories, such as pauses or laughing concern vocal noises, tonal qualities, and temporal patterning of speech, denned independently of semantic content and syntactic structures. Cutting across the three types are two distinct coding strategies, previously described by Berelson (1952) and by Marsden (1965, 1971). In the classical strategy, categories describe characteristics of the text (or some other record of the communication), whereas in the pragmatic strategy, categories describe characteristics of the communicator such as his or her internal state, intentions, socioeconomic class, and so on. For example, the category mother would be classical if it coded instances of maternal references in the text; the category death anxiety would be pragmatic if it coded utterances judged to reflect the communicator's conscious or unconscious concern about death. The classical strategy requires two operational steps from the raw text to inferences about psychological processes: The coder identifies instances of categories in the text, and the researcher later makes inferences based on category frequencies (or indices derived from category frequencies). The classical strategy thus makes explicit the process of inference about the communicator's characteristics. The pragmatic strategy uses only one step; coders make inferences about psychological processes (or other characteristics of the communicator) in the process of coding. These inferences may or may not be based on specified behaviors (e.g., behaviors that instantiate death anxiety may or may not be exhaustively catalogued), but in either case, the specific behaviors are not recorded. Thus the pragmatic strategy permits complex contextual judgments that may be impossible to specify completely (Labov & Fanshel, 1977; Russell, in

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press), but it obscures the relationships between behaviors and inferred characteristics of the communicator (Marsden, 1971). The classical-pragmatic distinction has been used for distinguishing whole systems of categories or approaches to psychotherapy process research (Berelson, 19S2; Marsden, 1965, 1971), but it is better applied to characterize individual categories: Single systems can (and do) contain both classical and pragmatic categories. Likewise, although the classical-pragmatic distinction has been used primarily for systems that employ content categories, it is useful for intersubjective and extralinguistic categories as well. Previous efforts at organizing language research in psychotherapy have classified studies or systems by criteria other than category types. Auld and Murray (1955) distinguished methodological studies, descriptive studies of cases, and theoretically guided studies of therapy. Kiesler (1973) distinguished "systems of direct psychotherapy process analysis," which focus on therapist and/or patient behavior, from "systems of indirect psychotherapy analysis," which include indirect process analysis, therapist's conceptions, and patient preferences. Marsden (1965, 1971) partitioned studies into three models, the classical, the pragmatic, and the nonquantitative. As noted above, we have adopted the classical-pragmatic distinction to classify categories. Several other authors have made distinctions that parallel aspects of our typology. Mahl and Schulze (1964), Matarazzo and Wiens (1977), and Phillips, Matarazzo, Matarazzo, Saslow, and Kanfer (1961) have distinguished extralinguistic categories and category systems from all other category and category system types. Phillips et al. recognized two controlling frames of reference: one that "directs attention to the communication aspects of verbal behavior, that is, to some symbolic content of the words spoken, using content analysis to define and quantify its variables" and one that "focuses upon the quantitative temporal characteristics of interview interaction, utilizing measures such as number and duration of utterances, duration of silence, etc." (p. 260). Mahl and Schulze (1964) reviewed just those studies

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concerned with the extralinguistic features of speech (e.g., pitch, pauses, rhythm, etc.). Similarly, several investigators (Bollard & Auld, 1959; Murray, 1956; Seeman, 1949; Snyder, 1945, 1963) have implicitly recognized a, distinction between content categories and intersubjective categories by constructing systems of content categories for patient verbal behavior and separate systems of intersubjective categories (called technique categories by Bollard & Auld, 1959) for therapist verbal responses.

Our 3 X 2 typology is not an exhaustive classification of methods used to analyze verbal interaction in psychotherapy. The typology is not intended to cover ratings of verbal behavior, though ratings clearly cut across our typology. Thus, for example, ratings of client "experiencing" (Klein, Mathieu, Gendlin, & Kiesler, 1970; Rogers, 1958, 19S9) or the "immediacy" of therapist or patient responses (Mehrabian, 1972) are not included. Also, the typology is not intended to cover systems that classify language units marked

Table 1 Content Category Systems Murray (1956); patient content categories pragmatic strategy Disturbance of free association Agreement with therapist remarks [intersubjective] Disagreement with therapist remarks [intersubjective] Intellectual discussion General anxiety Sex Sex anxiety Sex frustration Affection Affection anxiety Affection frustration Dependence Dependence anxiety Dependence frustration Independence and self-assertion Independence anxiety Independence frustration Unspecified anxiety Unspecified frustration Stone, Dunphy, Smith, & Ogilvie (1966); Harvard Third Psychosociological Dictionary (partial list); classical strategy Natural realm; psychological processes; emotions Arousal—states of emotional excitement Urge—drive states Affection—incidents of close . . . relationships Pleasure—states of gratification Distress—states of despair, guilt, shame, etc. Anger—forms of aggressive expression Thought Sense—perceptions and awareness Think—cognitive processes If—conditional words Equal—words denoting similarity Not—words denoting negation Cause—words denoting a cause—effect relationship Evaluation Good—synonyms for good Bad—synonyms for bad Ought—words indicating a moral imperative

Dollard & Auld (1959); patient's signs; pragmatic strategy An internal response-produced stimulus; anxiety, apprehension, distress, tension, or fear Unconscious anxiety or unconscious sense of guilt Anxiety is perceptibly reduced Reduction of unconscious anxiety or guilt Confirmation Dependence Unconscious dependence Patient is aware of and frightened by his dependent motive Conscious dependent motive to which unconscious anxiety is attached Dependent motive is unconscious; anxiety is conscious Both dependent motive and anxiety are unconscious Anxiety component is reduced Unconscious anxiety attached to conscious dependence motive is reduced Dependence motive is unconscious; conscious anxiety component is reduced Unconscious anxiety evoked by unconscious dependence motive is reduced White, Fichtenbaum, & Dollard (1966b); patient's evaluation of self categories; pragmatic strategy Positive self-evaluation Anxiety about self, symptom, dissatisfaction Hostile feelings directed toward others; assertiveness Hostile feelings directed toward self; self-blame Nonsexual love and reduced anxiety about family Anxiety evoked by family members Sex motive, dating, marital relations Anxiety evoked by sex motive Involvement with academic and career motive; social mobility Anxiety evoked by academic/career motive or social mobility


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Table 1 (continued) Kepecs (1977); focal conflict categories; pragmatic strategy Positive human relations Hostility out Mastery Assertion Reactions (reactive motive) Hostility in Masochism Helplessness Other defenses Defensive hostility out Defensive positive human relations Defensive mastery Adaptive activity; relatively nonconflictual solutions Hall & Van de Castle (1966); dream contents (partial list); classical strategy Objects Architecture Household Food Implements Travel Streets Regions Nature Body parts Clothing Communication Money Miscellaneous

Laffal (1968); Cognitive Conceptual Dictionary (partial list); classical strategy Absurd Agree 1 (sympathy) Agree 2 (agreement) Agree 3 (similarity) All 1 (whole) All 2 (much) All 3 (frequent) Animal Art Astronomy 1 (space) Astronomy 2 (weather) Back Bad Begin Big Gottschalk & Gleser (1969); Anxiety Content Analysis Scale; pragmatic strategy Death anxiety Mutilation anxiety Separation anxiety Guilt anxiety Shame anxiety Diffuse or nonspecific anxiety Thibaut & Coules (1952); overt aggression categories; pragmatic strategy Direct aggression Indirect aggression Affective neutrality Friendly statements Self-augmentation Self-reduction Self-neutral

Note. Discrepant category types are listed in brackets.

for some special syntactic feature such as case (Bieber, Patton, & Fuhriman, 1977; Patton, Fuhriman, & Bieber, 1977). The categories we discuss are mainly nominal variables, so indices of intensity or degree are based on frequencies. We think it best to concentrate on the category types that appear most productive and recur most frequently in psychotherapy process research rather than to attempt to include all possible categories. On the other hand, the typology we propose may also be useful for areas other than psychotherapy research (see Berelson, 1952; for an introduction to applications of language analysis categories to other fields in the social sciences, see Gerbner, Holsti, Krippendorf,

Paisley, & Stone, 1969; Holsti, 1968; Pool, 19S9). The category systems shown in Tables 1, 2, and 3 were classified as content, intersubjective, or extralinguistic, respectively, on the basis of predominant category type in the system. Similarly, they were classified as pragmatic or classical on the basis of the predominant coding strategy that was employed to score speech units to the constituent categories. Content Categories Content categories describe the semantic content of words or word groups in the text.

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Table 2 Intersubjective Category Systems Stiles (in press-a); verbal response modes Classical strategy Disclosure form Question form Edification form Acknowledgment form Advisement form Interpretation form Confirmation form Reflection form Pragmatic strategy Disclosure intent Question intent Edification intent Acknowledgment intent Advisement intent Interpretation intent Confirmation intent Reflection intent Murray (1956); therapist content; pragmatic strategy Instructions Labels Strong approvals Disapprovals Demands Directions Mild probes Mild approvals Mm [classical strategy] Not classifiable [residual] Bales (1970); interaction process analysis; pragmatic strategy Seems friendly [mixed] Dramatizes [mixed] Agrees Gives suggestion Gives opinion Gives information Asks for information Asks for opinion Asks for suggestion Disagrees Shows tension [extralinguistic] Seems unfriendly [mixed] Porter (1943); therapist checklist; t pragmatic strategy Defining the interview situation [mixed content and intersubjective] Bringing out and developing the problem situation; leading Developing client's insight and understanding; clarification, interpretation, and problem identification Sponsoring client activity; fostering decision making Note. Discrepant category types are listed in brackets.

Snyder (194S); counselor categories; pragmatic strategy Structuring Forcing client to choose and develop topic Directive questions Nondirective leads and questions Simple acceptance Restatement of content or problem Clarification or recognition of feeling Interpretation Approval and encouragement Giving information or explanation Proposing client activity Disapproval and criticism Lennard & Bernstein (1960); therapist informational specificity categories; pragmatic strategy Passive encouragement Active encouragement Limits to subjective matter area Limits to specific old proposition Interpretation Limits to specific answer Excludes discussion Introduces specific new proposition Strupp (1957); type of therapeutic activity; pragmatic strategy Facilitating communication Exploratory operations Clarification Interpretive operations Structuring [content] Direct guidance Activity not clearly related to the task of therapy [content] Unclassifiable [residual] Bandura, Lipsher, & Miller (1960); therapist activity; pragmatic strategy Reflection Labeling Exploration Approval Ignoring Topical transition [content] Silence [classical extralinguistic] Mislabeling Goodman & Dooley (1976); listener response modes; pragmatic strategy Question [classical strategy] Advisement Interpretation Reflection Disclosure Silence [classical extralinguistic]


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Table 3 Extralinguistic Category Systems Dibner (1956); speech characteristics; classical strategy Unfinished sentence Breaking in with a new thought, generally by breaking into another sentence [mixed] Interrupted sentence Repeating words or phrases Stuttering I don't know [content] Sighing Laughing Voice change Questioning the interviewer [intersubjective] Blocking Rice & Wagstaff (1967); voice quality; pragmatic strategy Emotional Focused Externalizing Limited Matarazzo, Wiens, Matarazzo, & Saslow (1968); interaction chronograph; classical strategy Mean speech duration Mean speech latency Percentage of interruption

Mahl (1956); speech disturbance categories; classical strategy "Ah" Sentence correction Sentence incompletion Repetition Stutter Intruding incoherent sound Tongue slip Omission Eldred & Price (1958); voice categories; classical strategy Alterations of pitch: overhigh and overlow Alterations of volume: overloud and oversoft Alterations of rate: overfast and overslow Breakup Lasswell (1935); speech categories; pragmatic strategy Slower speech rate; increase of unconscious tension Faster speech rate; decrease of unconscious tension Fairbanks & Pronovost (1939); pitch categories; classical strategy Pitch level Pitch range Extent of pitch shifts

Note. Discrepant category types are listed in brackets.

(Examples of content category systems are given in Table 1.) The categories describe manifest or latent content: Denotative meaning and connotative meaning constitute manifest content; referential-contextual, symbolic, or metaphorical meanings constitute latent content. For example, Lasswell (quoted in Kaplan, 1943) wrote, '"I love my husband more than anyone in the whole world' may be taken at its face value; or we may decide that the wife 'doth protest too much.' In the first instance we describe manifest content, and in the second, we interpret according to latent content" (p. 234). Manifest content is identified by the classical coding strategy, in which the coder makes inferences about the characteristics of the communicator. Classical content categories describe the manifest content of the text; that is, either the dictionary meanings of the words or word groups that occur in the text or the connotative or constituent meanings normally ascribed to them, regardless of the context in

which they occur. Thus classical content categories serve "as a conceptual grid to be laid upon a language sample in order to reveal the density of the various concepts in the sample" (Laffal, 1968, p. 280). Classical content categories vary in abstractness. The following is an example of a concrete category (also see Table 1): Implements: Three subclasses of implements are scored. The first letter of the scoring symbol is I to which a second letter is attached to indicate the subclass. Tools (Scoring symbol: IT). This subclass includes tools, and machinery parts. Objects that are used in vocational activities are generally included here, although some such as typewriter are scored in the communication class. Examples of the IT subclass are hammer, nail, saw, screwdriver, wrench, pliers, shovel, rake, lawn mower, lathe, X-ray machine, jack, level, and starting button of a machine. Household appliances are scored in the household class and parts of conveyances are scored in the travel class. (Hall & Van de Castle, 1966, p. 46)

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At the other end of the range, words or word groups are coded according to their underlying associative or conceptual communality. For example, "We will start the project shortly" and "He was born on July second" have a common constituent meaning: beginning" (Laffal, 1968, p. 279). The coder in scoring the units start and born in the category begin (see Table 1) employs the classical coding strategy—the semantic feature beginning is marked for words like start and born regardless of the context of their use. Scoring depends only on the capability of the coder to recognize semantically similar words or word groups. Pragmatic content categories describe some characteristic or condition of the communicator. Thus, instead of locating particular words or word groups with similar meanings the coder "now directly scores resistance, tension, adjustment" (Dittes, 19S9, p. 329). For example, Murray's (1956; see Table 1) pragmatic content category, generalized anxiety, was denned as follows: Generalized Anxiety: Included all psychological and somatic expressions of anxiety which are not related to a drive nor related to any specific person or object ; general "free floating" anxiety and guilt. a. "I feel panicky about the thought of death." b. "I tremble and then it would ease off, then I start again . . . in waves." c. "I feel tense as if there's some force inside of me trying to get out." (p. 27)

Similarly, White, Fichtenbaum, and Bollard's (1966a, 1966b) pragmatic content category positive self-evaluation (see Table 1) would be scored for each sentence judged to reflect, by virtue of its content, a favorable attitude toward the speaker. Thus, "I'm getting a broader idea of myself as an entity and full person" (White et al, 1966a, p. 108) is scored to the category positive self-evaluation. This scoring procedure typifies the pragmatic scoring strategy employed by those pragmatic content category systems enumerated in Table 1. As the examples above illustrate, many of the pragmatic content categories of interest to researchers of psychotherapy are used as theoretical constructs by clinicians. A review of published research suggests that content categories have been most suc-

cessfully employed to investigate internal psychodynamic processes, motives, drive conditions, characterological traits, and changes in these client characteristics in therapy. The focus on internal psychodynamic processes was made explicit by Murray (1954): "We propose to study the content of verbal behavior in psychotherapy with respect to underlying motives and defenses" (p. 305). Murray (1956) also wrote, "The categories of the content analyses were defined in terms of motivation and conflict, influenced by psychoanalytic and learning theories, and formulated in such a way as to be most relevant to an eventual understanding of the underlying processes of psychotherapy" (p. 23). Auld and Bollard (1966) enumerated the key psychological phenomena that they felt were amenable to investigation with content categories: resistance, transference, unconscious motive, inhibition, dependence, hostility, and interpretation. Bollard and Mowrer (1947), Raimy (1948), Kauffman and Raimy (1949, Murray, Auld, and White (1954), Leary and Gill (1959), Freedman et al. (1951-1952), Lennard and Bernstein (1960, 1969), Auld and White (1959), White et al. (1966a, 1966b), Hall and Van de Castle (1966), and Thibaut and Coules (1952) have carried out investigations that embrace similar assumptions. As an example of the use of content categories to investigate psychodynamic processes; Murray (1954) found that the frequency of hostility statements in psychotherapy increased as the frequency of defensive statements decreased; he interpreted this as evidence that the client's anxiety had decreased as therapy progressed. Thibaut and Coules (1952), focusing on the relative frequency of hostility statements, reported that residual hostility lessened for subjects who directly communicated their hostile feelings after being provoked. White et al. (1966a) were able to determine that "the therapist focused more than the patient did during the active period of therapy on the areas of sex and evaluation of self" (p. 47) by the high proportion of statements scored to these content categories. By considering sex and evaluation of self as the therapist's target area, the authors were


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able to report that the therapist had ap- are somewhat equivocal, Mahl's (1956) theparently been successful: The scored content oretical assessment that "the most valid meaof the patient's talk about these areas in- sures [of transitory states] will be based on creased from the first to last quarter of ther- the expressive [i.e., extralinguistic] aspects of apy and was judged to be adaptive. Lennard speech rather than on the manifest content and Bernstein (1960) reported that in the measures" (p. 13) is still most compelling, data collected from four therapists and two empirically and theoretically (see Mahl, 1959, patients who interacted in a total of 500 ses- for a theoretical discussion of this issue; see sions, "the therapists as a group led the pa- Cook, 1969; Markel & Roblin, 1965, for some tients slightly in the proportion of communica- empirical evidence). tion dealing with affect" (p. 85). In comparing the early with the later sessions, they Intersubjective Categories found that "the proportion of both therapist and patient references devoted to feelings inIntersubjective categories are descriptive of creased—almost doubled—for the sample as syntactically implied and other relationships a whole" (p. 85). between the communicator and recipient. For Content categories also reflect personality example, self-disclosure implies that the comvariables, as well as trends or focal points in municator reveals something to the recipient, the communicated content. Sarason, Ganzer, question implies that the communicator seeks and Singer (1972) found that high- and low- information from the recipient, and so forth. defensive subjects used different content cate- (Examples of intersubjective category sysgories to describe themselves, after having tems are given in Table 2.) In contrast to conlistened to models that differed in self-dis- tent categories, intersubjective categories can closure style. Kepecs (1977) used content typically be denned without reference to the categories to locate the focal conflict of the semantic content (or extralinguistic features) client. Auld and White (1959) found that ex- of the communication. perienced therapists are more likely to interMany intersubjective categories can be devene than are apprentice therapists following fined by syntactic features alone (Goodman a patient's utterance scored as resistance. & Dooley, 1976; Stiles, 1978, in press-b). For They also reported that the patient's talk example, question has a well-attested set of seemed to hang together: Categories on a syntactic features associated with it; selfspecific topic were more likely to follow one disclosure can be defined as a first-person another than to be followed by a category on declarative sentence. Since these syntactic a different topic. Although content categories features are characteristics of the text, speech have been used most consistently to investi- units are scored to such categories by means gate internal psychodynamics and charactero- of the classical coding strategy. For example, logical traits, one group of researchers (Gotts- in Stiles's (1978, in press-a, in press-b) claschalk & Frank, 1967; Gottschalk & Gleser, sical intersubjective system (see Table 2), 1969; Gottschalk, Winget, & Gleser, 1969) sentences such as "I'd really like to talk about have concluded that "the relative magnitude my feelings of being an experimental subof an affect can be validly estimated from ject" and "I can't stand needles" would be the typescript of the speech of an individual scored to the category disclosure form because using solely content variables and not includ- of their first-person subjects. ing paralariguage variables" (Gottschalk & The intersubjective categories used in psyGleser, 1969, p. 96). A number of studies chotherapy research are more often descriphave been carried out that directly or indi- tive of interpersonal intentions, which may rectly address this issue (Cook, 1969; Gotts- or may not be expressed using the correspondchalk & Frank, 1967; Hart & Brown, 1974; ing syntactic form. For example, an utterance Mahl, 1956, 1959; Markel, Meisels, & Houck, identified as a question by syntactic criteria 1964; Markel & Roblin, 1965; Mehrabian & may express the interpersonal intention "asks Ferris, 1967). Though the empirical findings for information," but it may also express the

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interpersonal intention "gives suggestion," as in "Don't you think you should lock the door?" In Goodman and Dooley's (1976) system, such utterances as "I had the same problem and solved it with . . . " or "Do you think it would work better if you tried . . . " (p. 109) would be scored to the pragmatic content category advisement (see Table 2). To judge whether a communicator is giving a suggestion or is asking for information, the coder must infer the communicator's intent and thus employs the pragmatic coding strategy. Pragmatic intersubjective categories are used frequently in interaction research, though they require the coder to make more complicated inferences than their classical counterparts. For instance, confrontation is defined by Barnabei, Cormier, and Nye (1974) as "a response indicating some sort of discrepancy in the client's message . . . a 'you said but look' condition" (p. 356). Or, similarly, direct guidance (see Table 2) is denned by Strupp and Wallach (1965) as "suggestions for activity either within or outside of the therapeutic framework; giving information, stating an opinion, answering direction questions, speaking as an authority" (p. 118). In published research, intersubjective categories have been most consistently and successfully employed to measure psychotherapeutic technique, interpersonal roles and relationships in therapy, and therapy process. Intersubjective categories have long been used to describe and teach psychotherapeutic technique. Freud (1912/1958) explicitly argued in favor of using interpretation while he condemned suggestion and disclosure. Rogers (1