A fundamental concept in understanding how participants in a conversation support and endorse the storyteller's affective stance or treatment of the events being described is affiliation. It is distinct from alignment, which refers to the listener's support of the structural asymmetry in the storytelling (Stivers, 2008). Affiliation can involve the following two interrelated facets: (i) supporting the affective stance of the previous speaker and (ii) aligning with the action preference set in motion by the initiating action. Affiliative responses are maximally prosocial when they match the prior speaker's evaluative stance, show empathy, and cooperate with the preference of the prior action.

Actions that achieve affiliation in conversation include the use of verbal, prosodic, and visible resources to convey (dis)affiliation. For example, verbal resources such as adding intensifiers to evaluations can show strong agreement and affiliation. Response calls that do not distinguish between the speaker's and the respondent's feelings are affiliative. Verbal resources for affiliative reception, such as claims of understanding and congruent negative evaluations, can be accompanied by prosodic matching or upgrading. However, the same tokens can convey disaffiliation when delivered with prosodic downgrading.

Sequential positions also play a crucial role in the display of affiliation. Resources used to indicate affiliation in mid-flow positions, such as head nods, can be treated as disaffiliative at story completion. Instead, affiliative reception at story completion can be achieved with verbal resources like providing assessments or second stories. The role of sequential position in displaying affiliation is influenced by institutional settings as highly relevant for therapeutic interactions.

Closely related to understanding how participants engage in conversation is the notion of epistemics. As previously discussed, affiliation in CA refers to the ways in which conversation participants establish connections. It involves various actions that signify shared understanding and cooperation. Epistemics in CA refers to how interlocutors display their knowledge, beliefs, or certainty.

Affiliation and epistemic interrelate in (i) sharing epistemic stances and expressing agreement and in (ii) conveying epistemic markers and affiliation strategies.

Firstly, participants often demonstrate affiliation by expressing similar epistemic stances. For example, when one speaker confidently presents information, and another participant responds in a way that supports this confidence, it demonstrates both affiliation and a shared approach to discussing the topic.

Conversely, participants may also show affiliation by expressing agreement or solidarity with each other's expressions of certainty or doubt. This highlights the nuanced interplay between epistemic positioning and affiliation as they contribute to the cooperative nature of the conversation.

Secondly, participants use various linguistic markers to convey their epistemic stance, such as hedging (e.g., “I think,” “maybe”), certainty markers (e.g., “definitely,” “certainly”), or modal verbs (e.g., “must,” “might”). These markers help signal their level of confidence or certainty in their statements.

Affiliation strategies, as discussed earlier, encompass actions like agreement, repair work, and preference organization. These strategies can be intertwined with epistemic markers to achieve affiliative goals. For example, agreeing with someone's statement may involve aligning not only with the content but also with the expressed level of certainty.

Certainly, CA has made significant contributions to our understanding of psychotherapeutic interactions, particularly concerning the concepts of (i) affiliation and (ii) epistemics.

In psychotherapeutic interactions, (i) affiliation has enhanced our insights into psychotherapy by at least three aspects: Firstly, CA studies have highlighted the central role of affiliation in building alignment between therapists and patients. Affiliation is manifested through various conversational actions, such as active listening, empathy, and agreement (Heritage and Maynard, 2006). Researchers have shown how therapists strategically employ affiliative responses, like cues (“mm-hmm”) and empathetic statements, to create a supportive and empathetic therapeutic environment (Heritage, 2011b; Buchholz et al., 2017; Stivers and Timmermans, 2020).

Secondly, CA research has demonstrated how therapists affiliate with the emotional stances of their patients. For instance, Stivers (2015) examined the use of affiliative responses in the context of emotional disclosures by patients. This research revealed that therapists often align with and validate the emotional experiences of their patients through affiliative actions, reinforcing the importance of empathy and understanding in psychotherapy.

Thirdly, managing resistance. CA studies have explored how therapists handle resistance and potentially disaffiliative behaviors from patients (Hutchby, 2002; Guxholli et al., 2007; Vehviläinen, 2008; Kent, 2012; Muntigl, 2013; Ekberg and LeCouteur, 2015; Bergen et al., 2018; Stivers and Timmermans, 2020; Fenner et al., 2022a,b). Peräkylä and Vehviläinen's (2003) research on resistance management in psychotherapy sessions showed that therapists employ affiliative strategies, such as paraphrasing and exploring patient perspectives, to address resistance without escalating conflicts. This nuanced approach helps maintain a positive therapeutic alliance.

Studies of (ii) epistemics in psychotherapeutic interactions have also advanced knowledge in at least three ways: Firstly, CA has highlighted the importance of therapists' epistemic stance in facilitating therapeutic conversations. Epistemic stance refers to how participants represent their knowledge, beliefs, or certainty about the information being discussed (Heritage and Raymond, 2005). Researchers have shown that therapists carefully modulate their epistemic stance, using markers such as hedging (“I think”) or certainty markers (“definitely”) to create a conducive environment for open dialogue (Heritage and Maynard, 2006).

Secondly, eliciting patient perspectives: CA studies have investigated how therapists employ epistemic actions, such as asking exploratory questions, to elicit patients' perspectives and experiences (Heritage, 2011a). This approach allows patients to actively participate in shaping the therapeutic discourse. It promotes a collaborative exploration of their concerns and narratives.

Shared epistemic stance: CA research has explored instances of shared epistemic stances between therapists and patients. By aligning their epistemic positions, therapists convey an understanding of and support for the patients' viewpoints (Muntigl et al., 2013). This shared epistemic stance fosters a sense of validation and trust, contributing to the effectiveness of psychotherapeutic interactions.

In summary, CA has made significant contributions to the understanding of psychotherapeutic interactions, primarily through the concepts of affiliation and epistemics. With regard to affiliation, CA research highlights its crucial role in psychotherapy, emphasizing how therapists strategically use affiliative responses, such as active listening and empathy, to establish rapport and a supportive therapeutic environment. In addition, CA has shed light on how therapists navigate emotional alignment and manage resistance using affiliative strategies, ultimately maintaining a positive therapeutic alliance.

In terms of epistemics, CA emphasizes the importance of therapists' careful modulation of their epistemic stance, using markers such as hedging and expressions of certainty to facilitate open dialogue. CA studies also explore how therapists use epistemic actions, such as asking exploratory questions, to elicit patient perspectives and encourage collaborative exploration of concerns and narratives. In addition, CA research highlights instances of shared epistemic stances between therapists and patients that foster validation and trust within psychotherapeutic interactions, ultimately enhancing their effectiveness.

In this first example, it will be shown how the participants orient to the recording device of a therapy dyad in the 6th min of a second-depth psychological psychotherapy session between a male therapist and a female patient. In the beginning, the patient claims that she does not know what to say today because she might be in such a good mood. The therapist offers to understand this as a fear of losing her good mood by discussing it with the therapist. The patient confirms this and says that she has been feeling bad for a long time. However, she likes to tackle problems directly. Seemingly abruptly, the therapist refers to the recording device.

In the 36th min of the 5th h of a brief modified psychoanalytic therapy of a male therapist and male patient, the therapist points out the initiative competence of the patient by calling him a “fiercely determined young man”. Subsequently, the patient laughs, and the therapist interprets this action as a “vehemence” transformation. The patient elaborates on this interpretation as a “puzzle” (Vehviläinen, 2008), which is the pre-sequence to the following excerpt:

The therapist places a reference to the “tape” (132) and explicitly links possible subsequent actions: “go to the secretary” (129). After a longer pause (134), the patient agrees to the suggestion. When asked by the patient, the therapist specifies that “in a moment afterward” (140) is meant instead of here and now and that he accompanies the patient but will not be part of the follow-up action himself (143). Like in the previous excerpt, the reference to the recording device is explicated by the therapist. After the self-disclosure or explication of the therapeutic intention (152, 157–159), the patient connects that communicatively competent with a mental issue (161, 162), which was not a topic before. The therapist's initiatives of (i) watching the video recording alone after the session (132) and (ii) disclosing the intention of expressing this suggestion (152) can also be understood as offering solutions to the patient's formulations of the problem (123–124 and 148–150). In such a way that “the patient has to find himself in the mind of the clinician […] to experience a mind being changed by a mind” (Bateman and Fonagy, 2016, p. 182). This implies that the therapist takes the patient as the primary actor who can see by himself certain (behavioral) evidence of (certain) psychological issues. And this is certainly a socializing strategy into practices of self-observation and reflexivity. Additionally, the therapist indicates the replay of the video after the session. At the same time, he sees other patients, which would help the patient continue the work beyond the encounter with his therapist.

In summary, the therapist initiates a proposal to go to the secretary (128–129), then attaches the relevant follow-up action again as a proposal via orientation to being recorded: to watch the tape of today's session (130–132). The explicit linking of the orientation to being recorded, plus the affiliative co-creation of the summons-answer sequence, led to the patient's initiation of self-exploration (160f). Affiliation and epistemics are closely linked in this context. Firstly, they are intertwined because gaining access to an epistemic status that is not yet known or balancing epistemic status by explaining future actions can be considered prerequisites for establishing affiliation. This is achieved by aligning one's actions with the preference set by the initial action. Secondly, the summons-answer sequence creates opportunities for affiliative interactions based on shared epistemic perspectives. This can involve acknowledging mutual understanding and agreeing on evaluations, forming a basis for shared epistemic stances.

In this psychoanalytic therapy, we zoom in on the first session at minute 19 with a male therapist and a female patient. Prior to this excerpt, the therapist insinuates that it might be him who hinders her from speaking freely, even though the patient might think of him as her analyst to whom she should be able to talk. The patient imagines “only a tape recorder” as a recipient, claiming the problem of not being able to speak freely lies in her and has nothing to do with the therapist. After self-interrupting her further thoughts about the recording device, she explicitly asks the therapist whether he understands, which makes the answer relevant.

The therapist complies with this request to speak only after a long pause and initiates a repair of the patient. Interestingly, the repair is initiated by means of an orientation to being recorded located in the local environment, which, however, is not “determined” as noticing, i.e., made identifiable (e.g., by certain articles, description of the place, or actually pointing to it). The misunderstanding (Hinnenkamp, 1998) is already indicated by the long pause (187) after the patient's request for understanding. It is cleared up by the patient, who refers to a fantasized situation: “without you—just a tape recorder” (190). In this case, and unlike in excerpt 1.2, the therapist does not enable the subsequent actions of self-exploration by a direct request. The therapist, like in extract 2, responds to the patient's request to speak, thereby initiating the patient's work on redressing the epistemic balance. The patient elaborates that she is “afraid” (199) that “things […] will come out that I have repressed” (201–202). With the help of the mental experiment (only recording device, no resonant therapist), she addresses the problem previously mentioned by the therapist, according to which he is not only a receiver (165) but someone listening.

In summary, in this excerpt, the recording device is initially referenced as a physical object in the local environment by the therapist [“a tape recorder stands here too” (188)], which serves as a reminder of an epistemic balance. However, the recording device is then transformed by the patient into a conversational object [“without you—just a tape recorder” (190)], as the patient uses the recording device as a starting point for her self-exploration. Interestingly, the patient aligns with the therapist by the action preference set in motion by his initiating action—this (at least transformation into) orientation to the recording device differs from the following examples.

In this extract from the session that we have already become familiar with (see last extract 3), the patient makes a disaffiliative, incongruent evaluation. She objects to the therapist's statement about her being not warm-hearted. The therapist gives an example of her being warm-hearted with her partner in order to demonstrate her misunderstanding. However, the two do not reach a shared epistemic status. The patient continued to talk about her irritation about what she understood. The therapist doesn't object. Instead, he addresses the recording of the last session:

Like in the previous extract 3, a misunderstanding is triggered via the therapist's utterance, according to which the patient is warm-hearted in the relationship but cannot live a “lustful sexuality” (198). The patient, however, understands that she is not warm-hearted. The therapist shows the expected dispreference of his following utterance by placing relativizations in the epistemic domain (179–181: “would be,” “i think,” “almost like to suggest,” “take the opportunity”), conveying a rather downgraded epistemic stance, and asks her to “have a look into last sessions video” (182). After a longer pause, the patient clearly refuses (184). The therapist justifies his request by referring to the different memories (186) and introduces watching the recording as a resource for clarifying the indecision. However, watching the recording is not realized further on, insofar as the orientation to being recorded fails as a request to initiate a joint project “clarifying misunderstandings”. No possible follow-up actions are made explicit by the therapist (unlike in PA1 extract 2), which indicates the long pause after the therapist's suggestion (183) as a possible search for implications. The patient's rejection of the action proposal to view the recording of the previous meeting is followed by a justification for the recording by the therapist in the third position. Thus, the therapist makes an unsuccessful attempt here to present a difference between himself and the patient as in need of repair—for which the previously placed proposal for action was made relevant as a solution. The focus on the proposed action is related to a subsequent action. Thus, to be realized, “viewing the recording of the last hour” is proposed as a common solution.

The misunderstanding seems to have been clarified, and the therapist is probably more interested in being right and showing the patient that she presented the misunderstanding as if he should have corrected it. One could speculate that the therapist wants the conflict to be resolved for him, but this could be the starting point for the patient to reflect on her misperception and her response to the therapist's comments. Clinically formulated, this could be a revealing of unconscious acting. However, the therapist shifts the topic from the sexual relationship in the patient's partnership to the therapeutic relationship in the here and now—and the video serves to “clarify” her behavior or to make it accessible to her self-exploration. Therefore, the video serves to observe the performative level of the patient's and therapist's actions (Deppermann et al., 2020) in order to make these invisible insights viewable and hearable.

This results in opposing courses of action in the epistemic domain: (i) Retrospectively through the thematization of different memories (“clarification of misunderstanding”), whereby what was previously said can potentially be given a new meaning. (ii) Projectively through the design of a potentially subsequent action “watching the recording of the last hour”. In this respect, the orientation to being recorded is placed in a projective sequence. However, only after the patient's rejection the sequence is extended but not taken up by the patient.

In summary, the therapist embeds the reference to the recorder in a request to replay the video (180–182). Even though he anticipates the other's dispreferred answer, he leaves out an explicit reason. The patient rejects the request (184). The therapist treats the rejection as OIR and formulates an account for his request (185–186). The patient stays silent after her rejection—what is sequentially understandable as silencing (Thiesmeyer, 2003; Dimitrijević and Buchholz, 2021). The therapist then continues formulating the patient's potential thoughts (191ff) but does not evoke an answer. All in all, it becomes clear that the unresolved misunderstanding affects not only the epistemic domain in terms of different epistemic statuses but also the level of cooperation as disaffiliative. The orientation to being recorded as a resource fails. Even a further self-exploration of the patient does not take place. The sequence illustrates how the orientation to being recorded silences the patient's subsequent utterances, which is also evident in the fact that after the patient's contradiction (“look into last sessions video” 182), no further utterance signals are placed by her. Using the recording as evidence for therapist's reasoning or as a resource to convict the patient does not seem to be effective in furthering the pragmatic therapeutic goal of patient's self-exploration and results in the reference to the recorder as disaffiliation.

In this interaction between a male dyad in a modified long-term psychoanalysis in their 22nd session in minute 9, the therapist initiates by proposing a shared project and offers his perspective on what has been discussed so far. The patient initially accepts this offer but later seeks clarification. Eventually, the patient uses the opportunity to introduce his perspective, leading to a mismatch in conversational projects as the therapist attempts to redirect the conversation. This exchange demonstrates a misalignment in the conversational projects of the therapist and the patient within the psychoanalytic context. The different projects are being explicated in the following excerpt.

After the indirect rejection of the therapist's request, the patient places an argumentative reference (Sacks, 1995 [1992])—by pointing to the video recorder and asking him to watch the recording (144). Subsequently, the patient explicates that he has signaled to the therapist's listenership in order not to interrupt him (155), nurturing the plan to formulate a reproach. He accuses the therapist of telling the patient something instead of asking (159). Only after the patient's orientation to being recorded (144–145), the interactional history is rearranged (153) from a claim of listening into a reproach (159).

The request to focus on the recording refers to a reference potentially perceptible to both. The patient uses the reference as a resource to reinterpret the interaction history in the conflict context (as in PA2 extract 4) and to place potentially delicate utterances in the conversation. This form of retrospective reference enables the connection to the previous interactional history in such a way that a new meaning is produced. The retrospective negative reevaluation of putative listener signals calls into question mutual trust in the participants' activities as reliable and positively intended. From a psychotherapy research perspective, this is a possible alliance rupture that presses for repair as therapy progresses.

In summary, in this sequence, the patient initially demonstrates affiliation by providing listener signals (line 155) that indicate active listening. These signals are essential for maintaining the flow of the conversation and ensuring a supportive environment or affiliation. As the conversation progresses, the patient interprets the therapist's actions and places a reproach (line 159) that reinterprets his benign display of affiliation into a hostile calculation. This shift from signaling active listening to reproach illustrates how affiliation can be challenged within a conversation. The patient's reproach implies a breakdown in the therapist-patient affiliation, which is crucial for a productive therapeutic interaction.

Also, in terms of epistemics, the patient introduces an argumentative reference by mentioning the recorder (line 144). This reference functions as evidence to support the patient's perspective, reflecting his epistemic stance. The patient seeks to establish a basis for his argument by invoking the potential evidence provided by the recorder. The patient engages in retrospective reinterpretation (lines 153 and onwards) of the interaction history, using the reference to the recorder as a resource for disaffiliation. This reinterpretation involves attributing new meanings to past actions and statements, emphasizing the role of epistemics in shaping the patient's understanding of the therapy session. The negative reevaluation of putative listener signals calls into question mutual trust in the therapeutic relationship. This aspect highlights how epistemic elements, such as trust and reliability, play a crucial role in the therapeutic context. The mention of a potential alliance rupture underscores the significance of maintaining a positive epistemic stance to ensure effective therapy (Safran et al., 2001).

The patient's use of retrospective reference and argumentation serves to assert his epistemic position while influencing the affiliative dynamics of the interaction, ultimately shaping the course of the therapy session.

The following sequence is of the same dyad as the previous one. In the 29th h, in minute 15, the therapist initially attempts to build affiliation by suggesting that they should reflect on something together. He acknowledges the patient's way of speaking, demonstrating attentiveness and an attempt to align with the patient's communication style. The therapist then shares his observation with the patient about the latter. This itself is a delicate issue because it entails other attributions. He suggests that sometimes, probably contrary to the patient's intention, he may express himself in a very devaluing way. This reflects an epistemic stance, where the therapist judges the patient's communication. He points out the patient's perception and the need to take it seriously, emphasizing the epistemic dimension of understanding the patient's viewpoint. The therapist further addresses the patient's critics of the therapist's lack of empathy and lack of authenticity. Moreover, he expresses uncertainty about the sincerity of the patient's devaluating utterances. The therapist works to balance affiliative and epistemic dimensions of the therapeutic relationship. He fosters understanding and collaboration while addressing potential issues in the therapeutic relationship. While the patient clears his throat, the therapist concludes:

After this intensification of the conflict, the patient interprets the therapist (as “too emotional”, 370), places an ironic preface (371) and then leads over to his emotional mood (“annoyed”, 372) before using the recording device as a resource for the placement of a reproach (376) by means of argumentative reference.

That this is a misunderstanding (regarding what the patient remembers having said and what the therapist says he heard from the patient), which is commented on by the patient (361) and not the content of the therapist's confrontation (341–42), becomes clear retrospectively, as the patient says: “i didn't say you are not empathic” (377–78).

However, as in the previous excerpt of the same dyad (PA3 extract 5), the patient's reference to the interaction history of the patient's utterance (361) becomes retrospectively the first part of a reproach sequence—with the current sequence as the second part (376).

The confrontational moment (as in the previous excerpt), in which the therapist questions the alliance with the patient, again serves as a starting point for the patient to introduce the recording device as an argumentative counter-weapon. This thus placed orientation to being recorded indicates that it has a fundamental quality of authentication—it functions like evidence in court and thus, in turn, reflexively indicates the severity of the rupture.

In summary, the patient interprets the therapist as “too emotional” emphasizing his epistemic stance (evaluative judgment). The patient then uses the recording device as an argumentative reference, highlighting the role of epistemics in supporting his perspective and shifting the interaction's dynamics. Retrospectively, it becomes clear that there was a misunderstanding, emphasizing the importance of shared epistemic understanding for affiliation. The confrontational moment becomes a starting point for the patient to introduce the recording device as evidence, reflecting its authentication function. Overall, this interaction illustrates how affiliation and epistemics interplay in shaping the therapeutic discourse and dealing with conflicts and misunderstandings (s. also extract 5).