By involving a series of encounters between the same participants, psychotherapy could offer a paradigmatic domain for longitudinal conversation analysis (Deppermann & Pekarek Doehler, 2021; Pekarek-Doehler et al., 2018). The interactional history approach (see Deppermann & Haddington, 2026) has been applied in conversation analysis (CA)studies on psychotherapy for more than a decade (Voutilainen et al., 2011; Peräkylä, 2012; Bercelli et al., 2013; Muntigl, 2013; Voutilainen et al., 2018; Deppermann & Gubina, 2026). Existing studies have a dual focus on topic and sequence: They demonstrate how the participants’ talk on a given topic changes over several sessions in the context of a specific type of sequence. For the present study, we additionally show how the sequential organization of talk about guilt changes over time during the process of couple therapy.

We identified a recurrent sequential context of the talk about guilt. Identifying a recurrent sequence enables us to compare the segments that arise in different sessions (see Schegloff, 1993). Moreover, our work addresses the ways in which the participants index their prior discussion (see, e.g., Betz & Deppermann, 2018) and verbalize their own understanding of the process of change in psychotherapy. As a result, our study contributes to knowledge on interactional histories by discussing both the issue of comparability and the emic perspective of participants (Deppermann & Pekarek Doehler, 2021).

Guilt is a self-oriented negative emotion that emerges when a person perceives his or her behavior as violating moral standards or causing harm to others (Yang et al., 2010; Yu et al., 2020). In contrast to shame, guilt is understood as focusing on a specific behavior, so that it is not generalized as it is when one has a negative image of one’s whole self (Tangney & Dearing, 2002). In perinatal losses, guilt may also intensify grief. For mothers, guilt and grief typically are stronger than for fathers (Duncan & Cacciatore, 2015).

We analyzed the therapy process of a couple who decided to have an abortion after genetic tests. We examined the change of their guilt experience as expressed in their talk. The abortion prompted strong guilt in the wife. Our data are from Poland, a country that has two strongly contrastive, competing social discourses on abortion: prolife (anti-abortion) and prochoice. Owing to these conflicting views in the social context, abortion after medical tests can be considered complicated and ambiguous.

For purposes of the present analysis, ambiguous loss is defined as, “A loss that remains unclear and without resolution” (Boss & Yeats, 2014, p. 2), a loss that results in ambivalence and anxiety (Boss, 2022). This research falls within the realm of ambiguous loss due the complexity of the parents’ decision when they considered abortion after genetic tests and the uncertainty of having made the right choice afterward. The objective of therapeutic work with ambiguous loss is to develop the capacity of the couple to simultaneously be able to harbor two opposing ideas, such as that the loss has occurred as well as their lack of clarity regarding what the loss is. This means that, to understand one’s experience of possible divergent or conflicting mental states requires what is referred to as a mentalizing capacity.

Mentalizing is defined as a person’s active interpretation of his or her own actions as well as those of others in terms of mental states (Allen et al., 2008; Fonagy et al., 2002). This is based on the capacity to observe and reflect on one’s own state of mind and that of another. Effective mentalization helps individuals experience emotionally charged situations without becoming overwhelmed by their emotions or shutting them down (Slade, 2005). For the therapeutic processes we investigated, a key observable change across time was increased mentalization.

As is usual in conversation analytical studies, our research problem was formulated during the data-driven analysis of the research material. This article attempts to determine how talk about guilt changes during the therapy.

Methodology

Participants

The couple who served as our research subjected decided to have an abortion due to a genetic disorder. The spouses were in their 30s and had a three-year-old child. Due to the wife exhibiting symptoms of traumatic stress and experiencing a general crisis, the spouses were referred to the therapeutic center. The couple’s therapy consultations began one month after the wife’s abortion. The couple initially attributed the wife’s symptoms to difficulties they had encountered with medical staff who openly espoused anti-abortion views.

The therapist was a woman in her late 40s. Her approach to grief therapy was based on attachment theory. This theoretical orientation interprets loss-related feelings, including grief, as a form of separation anxiety elicited by the disruption of an attachment bond (Middleton et al., 1993). This therapy aims to enhance the regulation of affect through establishing the relationship with deceased persons as an internalized self-object (Schore, 2015) and to restore mentalization to reduce the activation of both the attachment system and the traumatic response (Allen et al., 2008). The therapist is also the first author of this article. At the clinic, therapy processes are routinely video recorded. The therapist’s analytical distance to the data was facilitated by the short time between the therapy and the research process, as only a few years elapsed between the therapy’s completion and the beginning of the data analysis.

Methods

By applying CA (Robinson et al., 2024), we describe the sequential organization of action (such as how adjacent utterances are responsive to each other) and the creation of intersubjective understandings. The first author watched all 16 therapy sessions. She collected segments that contained verbal references to the pregnancy, the lost child, and the medical procedure of abortion, and the result was a data set comprising 33 segments, which were then transcribed and translated. These segments were frequent during the first and the second sessions, they then reappeared in Sessions 9–14 as well as in Session 16. In other sessions, the spouses´ talk involved topics such as their families of origin, the wife’s mental health and her professional choices, and the spouses’ relationships with their friends.

After the initial data analysis with the second author, the first author made English subtitles to 26 segments, which were subsequently analyzed intensively by the first and second authors together. The final joint selection of segments to be analyzed was motivated by our analytical focus: the references to a fetus, pregnancy, or a child in the context of blame, punishment, or guilt. As is typical in conversation analytical studies, the analysis was inductive. The final research problem was gradually constructed through the analytic process.

The initial stage of the analysis was longitudinal. To that end, we compared segments that were from different phases of the therapy and discovered that talk about their guilt gradually transformed. During the second stage, the analysis was sequential: We investigated how guilt as a topic emerged and was transformed within each segment. The third stage of the analysis merged the sequential and longitudinal approaches, as we explored how the sequential organization of the talk about guilt was transformed during the therapy alongside its topical content.

Despite the triadic participation framework of couple therapy meetings, the focus of this analysis is on the transformation of the wife’s guilt, because both the intensity of her guilt and her transformation were more profound. We did not, however, analytically differentiate between the two spouses. Thus, when the husband actively contributed to the session (as in Extract 1), we considered the spouses as one unit. This study was approved by the Jagiellonian University Medical College Research Ethics Committee (decision no. 118.0043.1.128.2024). The participants also granted their written informed consent for the use of the data in this study.

Results

We begin by presenting an overview of our results and subsequently move to a detailed analysis of cases that exhibit the dynamics that we summarized in the overview. During therapy, the transformation of the talk about guilt involved both the sequential organization of the talk and its content. We observed that in the first nine sessions (out of 16), the talk regarding guilt followed a pattern that consisted of four sequential steps, which is described in Table 1. After the ninth session, the talk incorporated more diverse sequential forms. In terms of the content of the talk, the couple first spoke of other people blaming them for the abortion and then moved to a strong self-blaming position. Eventually, toward the end of the therapy, the couple adopted a position that they accepted and mentalized the moral and existential conflicts as well as their ensuing guilt for their decision to abort.

In Table 1, we summarize the key aspects of our results: the sequential pattern that facilitated the talk about guilt in the first nine sessions.

In what follows, we will present six extracts from our data that demonstrate how the therapeutic process transforms the representation of guilt. The first three extracts follow the sequential pattern described in Table 1 (Sessions 1–9), whereas the latter three involve more diverse sequential patterns (Sessions 9–16).

Beginning of the process: The blame is externalized

During the first session, the clients discussed how they felt condemned by others for having an abortion. The couple also criticized the medical professionals for not having offered them the help they would have needed. At the beginning of Extract 1, the husband states that he feels that no one considers their decision as justified. In the extract, the four phases of talk about guilt are separated by subheadings. For the transcription, standard Jeffersonian transcription symbols (Jefferson, 2004) are adopted, which are complemented by Mondada’s (2018) annotations of embodied actions. In addition, the target lines are glossed.

Phase 1: A display of distress readable as guilt. In lines 01–06, the husband complains about the pain he experienced caused by the condemnation of their decision and finishes his utterance by claiming: “we haven’t done anything wrong after all” (line 6). Through his negatively formatted assertion, the husband counters possible claims that they have done something wrong. His defense is readable as reflecting his possible guilt.

Phase 2: Therapist’s disambiguating question. Through a question addressed to both spouses in lines 09–11, the therapist cautiously attempts to explore what the distress described by the husband could have involved. She refers to the spouses’ reaction to the social pressures as “such uncertainty” (lines 11–13) and carefully aligns with the husband’s claim of not having done anything wrong (“you not feeling so”; lines 10–11).

Phase 3: The patient’s expression of guilt. In response to the therapist’s question, the wife takes the turn with an in-breath (line 12). The actual utterance begins in line 14, immediately after the therapist completes her question. The husband responds by a click in line 15 but yields the turn. The therapist’s description of such uncertainty (line 13) appears to be readily recognizable as addressed to the wife, as she responds to it through a repetition in line 14 and produces a long account, characterizing the sources of uncertainty (lines 14–39). She juxtaposes people close to them who do not question the couple’s decision (lines 14–17) and the feeling of a threat from many directions that someone might tell her she was a monster (lines 24–27).

The word “monster” emerges after she searches (indicated by the hesitative vocalizations in line 27), and its prosody—a high-low intonation contour and the prolongation of vowels—seems to convey that labeling the wife as monster is but one possible way to describe the unnamed others’ possible message. The wife’s manner of uttering “monster” involves a certain lightness—that she is not taking this accusation seriously when talking about it. The wife then continues her account of being blamed, characterizing it as an enduring pressure of someone all the time sitting on her shoulders (line 38).

Phase 4: Therapist’s mentalizing response. In her third position response, the therapist investigates the dynamics of the wife’s experience by asking in lines 40 and 42 whether she began to feel anxious only after her return to Poland. In this manner, the therapist orients to the clients’ anxiety as a subjective mental state that has its temporal course (Allen et al., 2008).

Intensive self-blame

In Session 2, guilt was constructed differently: An intense self-blame emerged in the wife’s talk. This occurred toward the end of the session, as shown in Extract 2. Her strong exclamation of guilt in line 56 (“I am such a MONSTER”) is an endpoint of her description of the sensual relation between herself and her unborn baby, which was co-constructed by the wife and the therapist. In this extract, the @ sign indicates a teary voice—that is, a voice quality that indexes the person being on the verge of crying; “shih” indicates what Hepburn (2004) referred to as a snorty sniff, and “skuh” constitutes a wet sniff.

Phase 1: A display of distress that is readable as guilt. Immediately before this segment, the participants were in the process of discussing the husband’s intense sadness when their dead fetus was delivered. The wife suggests that the husband said goodbye to the baby then and specifies that she said goodbye earlier, when the baby no longer moved in her womb (line 2).

In response to the therapist’s questions (line 7), the wife confirms that the fetus’s movements ended in the hospital after the abortion-inducing medication was administered. In lines 18–31, the wife again returns to the difference between her own experience and that of her husband’s at the moment of the baby’s delivery, expressing that for her, it was “just about the body,” while for him, “it was about the mind” (line 19).

There seems to be a certain ambiguity in the wife’s description of her own experience. On the one hand, she characterizes it as indifferent (“just about the body,” lines 18–19) and, on the other, she depicts it as overwhelming (“my mind was no longer working then,” lines 21–22). In lines 28 and 30, she points out that the husband did not have physical contact with (that is, did not sense) the baby. In other words, she implies her own experience of sensing the fetus as well as sensing the cessation of the baby’s movements (see line 2) while it was in her womb.

Phase 2: The therapist’s disambiguating question. In line 33, the therapist focuses on the wife’s utterance, shifting the focus from the husband to his wife. By the turn initial “so, you might say,” she portrays her utterance as a formulation, an inference from the wife’s prior talk (cf., Antaki, 2008); subsequently, she points out that the wife sensed “him” (the unborn baby) more (line 33) than her husband did. Through this formulation, the therapist made explicit the implication of the wife’s utterance.

After repeating what the husband stated immediately prior to the extract on “saying goodbye” (lines 34–35), the therapist rather hesitantly (by using the subjunctive construction “it might be”) observes that there might be a connection between the husband’s experience (saying goodbye to someone he did not know) and the wife’s experience of sensing their baby more (line 33). The therapist’s utterance is followed by a long silence (line 38) and the wife’s deep in-breath (line 39), which possibly displays the cognitive or emotional processing of the therapist’s statement.

Phase 3: Patient’s expression of guilt. Eventually, the wife responds in line 40 by saying, “Well yes, well because we sensed each other.” She therefore collaborates with the therapist’s refocusing of the talk on the wife’s sensual experience of the unborn baby; but through the person references “we” and “each other,” she also introduces the baby’s experience into the referential world.

After an intervening talk in which she reflected on the fetus’s biological inability to sense her (data not shown), the wife returned in line 64 to the theme of sensing each other, now alluding to the traumatic quality (line 66) of that experience. She creates a contrast between physical intimacy (sensing each other) and anticipatory knowledge concerning the consequences of their decision (“he won’t be born”; line 67). The strong negative emotion prompted by this contrast is conveyed, for example, by the wife’s loud voice when uttering, “HE WON’T BE BORN” (line 67), as well as in her rhythmically repeating the expression in line 68 “ALL ALL the time” (cf., Setting, 1994). The wife refers to this experience by stating that it is a “nightmare,” which she utters twice (line 68).

After a short clarifying question (line 72) and a brief answer (“yes,” line 53), the wife concludes by describing her nightmarish experience through the dramatizing expression of guilt, “that I’m such a monster” (line 73). Her voice becomes tearful, and she shakes her head. When she states that she is a monster (line 73), she uses the same noun as a self-categorization that she had stated in Extract 1, when describing how others might categorize her (see Extract 1, line 19). The recycling of the noun indicates the continuity between the two sessions, which involves at least a similarity in emotions and their wording, if not an awareness of the re-invocation of a prior categorization.

Phase 4: The therapist’s mentalizing response. The therapist responds to the wife’s exclamation by asking her to confirm that she felt this way (line 75). This specific request for confirmation appears to be produced to encourage additional talk, yet the question also conveys a shift in epistemic perspective. Thus, as the wife recounts the nightmarish experience that she is a monster (line 73), the therapist foregrounds the subjective character of that experience—that is, the wife having felt something.

The slow pace and low volume in lines 75 and 80 contribute to the impression that the therapist’s talk is calm, possibly conveying an effort to calm down the wife. When responding, the wife adopts the subjectivized epistemic perspective from “being” to “feeling like” (line 76). In lines 80–81, the therapist investigates the origin of the wife’s experience by asking whether that feeling was something that the wife herself began to feel, or did that feeling come from what others were saying?

This question reflects the therapist’s orientation to interactional history: She observably invokes the discussion in the prior session (see Extract 2 at the point when the category monster was presented as originating from the others’ way of assessing the wife. By answering that she is not sure (line 82), the wife appears to adopt a more mentalized not-knowing position; she is open to accepting the possibility that the feeling might arise from herself. This would be indicative of a major change in her experience of guilt—that is, a transformation from her experience of being blamed by others to recognizing her own self-directed blame.

Achieving a more reflective stance toward guilt

During Sessions 3–8, the clients repeatedly speak of their self-accusations and experiences of being blamed by others. However, it was only during Session 9 that the word “guilt” is uttered. Approximately halfway through that session, the wife asks the therapist what being healed might entail. During her long response, the therapist encourages the clients to explore their thoughts and fantasies associated with their choices regarding the abortion by saying, “that may evoke different feelings and I think (…) that you are no longer in the fight with Polish medical doctors or with the Polish state or anyone else who would make you keep on defending your decision.”

By referring to “Polish medical doctors” and “Polish state,” the therapist alludes to the discussion during the first session (Extract 1), during which the spouses complained that they had to defend themselves against those who blamed them. As shown in Extract 3, lines 01–04, the therapist continues her extended utterance by posing a rhetorical question as to whether the wife could achieve a sense of safeness that would allow her the freedom to reflect on her decision.

The therapist’s intervention in lines 01–04 is followed by a 4-second silence in line 0.5. The therapist then continues her intervention (lines 06–08) by saying that it is unknown whether this safeness in sharing thoughts about the wife’s decision might ultimately result in healing, but the main issue is to achieve an internal freedom.

A long silence ensues, with the wife breathing audibly (lines 09–13). Eventually, in line 14, the wife starts a turn. Rather than addressing the internal freedom on a general level, she describes her feelings. Using a somewhat complex utterance, she observes that her anger at her fate has two sides—the first, simpler part concerning the fact that her child was ill, and the second part regarding her needing to decide on abortion (lines 14–21). When describing the other side, the wife halts the progression of her utterance in line 19. After the therapist’s acknowledgment token (line 20) and a gap of 3 seconds (line 21), the wife restarts her utterance by stating that she might also be angry primarily for having had to make the decision (on abortion).

The therapist receives the wife’s reflections with a continuer (line 24) and again, a long silence occurs. This silence is broken by the wife’s inbreath (line 26) and outbreath (line 28). These extended and excessive perturbations in the wife’s talk indicate both the struggle as well as the laboriousness of dealing with the sensitive issue of her decisions (Lerner, 2013). Finally, in line 30, the wife asserts that she possibly harbors “some sense of guilt” for having made the decision. The therapist receives the wife’s disclosure of guilt with a softly spoken, “mm-hm” (line 31; the voice quality is indicated by @ signs) and the wife then continues by asserting that the guilt might provoke her anxiety regarding her possibly having a second child (line 33–35).

The segment above is the first point in the therapeutic process when the theme of guilt is explicitly stated. This emerges during the wife’s multi-unit turn, self-reflective yet emotional and laborious talk, which sequentially occurs as a response to the therapist’s long intervention, during which she encourages the wife to reflect freely about her thoughts related to her decision. After the disclosure of guilt, the wife continues on the topic of a possible subsequent pregnancy, alluding to the possibility that her next child would not be healthy. The end part of that talk is presented in lines 01–02 in Extract 4.

Phase 1: A display of distress readable as guilt. In the context of the prior talk, the wife’s idiomatic expression—which is translated here as, “you cannot escape your destiny” (line 1)—alludes to the possibility of their having another child with a congenital disorder. The wife continues in line 2 by articulating resignation (“what’s the point”). Her turn ends with a prolonged sound and a flat intonation contour, suggesting continuation. After the therapist’s continuer (line 3), the wife sniffs, utters “but,” and sniffs again but does not continue her utterance (line 4).

After the therapist uses another continuer (line 6), the wife remains silent and then sighs audibly (line 8). Her distress or struggle in finding the words to express her concerns are conveyed by her discontinuation of her utterance, sighing, and sniffing. The wife expresses a concern that things will not go well with a possible next pregnancy. Although she does not articulate the reasons for the anticipation of something bad happening, she says that against the backdrop of her prior reflections on her guilt that produces her anxiety concerning her becoming pregnant again (Extract 3, lines 31–33).

Phase 2: The therapist’s disambiguating question. By posing a question that conveys both a formulation (e.g., Antaki, 2008; Weiste & Peräkylä, 2013) and an interpretation (see Bercelli et al., 2008), the therapist returns to what the wife stated in line 1, first by suggesting that the wife’s fatalism may be a result of her feeling guilty (lines 10–11) and then by proposing that the wife may expect to be punished (line 13). By connecting guilt and destiny, the therapist thus re-invokes the themes of guilt and anxiety for pregnancy that were disclosed by the wife some moments before (Extract 3, lines 31–33). The therapist also intensifies the themes by introducing the idea of punishment.

Phase 3: The patient’s expression of guilt. The wife begins to nod intensely when the therapist has reached the end of her first question clause with the word “guilty” (winna, line 11). The wife’s nodding continues throughout the therapist’s elaboration (line 12), her reformulating the question (line 14), and the silence that follows (line 15). During this silence, the corners of the wife’s mouth and brows exhibit crying features, which begin with the word “punishment” (kara) in line 13. The wife’s continuous nodding conveys confirmation of what the therapist suggested regarding guilt and punishment (lines 10 to 13). Through the wife’s confirmation by nodding emphatically rather than verbally or vocally, she appears to consider the topic under discussion as something unspeakable.

In line 18, the wife takes the turn. Through her utterance, produced in an exceedingly high pitch and crying voice, she confirms and elaborates what the therapist suggested between lines 10 and 14, disclosing that she cannot stop the feelings that the therapist described. By characterizing her relation to her feelings (she cannot stop them), as a speaker, the wife distances herself from her actual feelings. This distance constitutes an incipient mentalizing stance toward guilt.

After the therapist’s acknowledgment tokens (lines 19 and 20), the wife expands her utterance by an increment in lines 22 and 23 in which she formulates the feelings (being a “terrible person” who did a “terrible thing”). Her voice quality remains teary; the words expressing her self-blame are marked by a high pitch (lines 22 and 23). The wife now formulates the sources for her guilt and expected punishment: her extreme deficiencies. Yet, on the other hand, by the hedge jakimś, jaka, (“kind of”) in lines 22 and 23, she expresses that the categories terrible person and terrible thing might not be fully applicable but instead be approximations of what she experiences.

Phase 4: The therapist’s mentalizing response. In ordinary conversation, self-blaming would make relevant an agreement or disagreement, the latter being the preferred option (Speer, 2019). The therapist, however, receives the wife’s self-blaming statement in line 24 by requesting a confirmation. Nonetheless, instead of agreeing or disagreeing, the therapist’s confirmation focuses explicitly on how the wife thinks about herself. The therapist strengthens the mentalizing stance that had emerged in the wife’s prior turn by reformulating “being kind of a terrible person” (the wife’s self-description in line 22) as “having such thoughts about yourself” (line 24). When the therapist does not reformulate the actual content of the wife’s self-accusatory feelings but refers to them as “such thoughts,” the question then no longer concerns whether or not the wife is a monster but focuses on her thoughts. The wife confirms by nodding (lines 24–25), after which the therapist asks whether the thoughts have now become more intensive (line 26). The wife first answers negatively—thereby implying that she has had feeling of being a monster for some time—and thereafter formulates her unwillingness to talk about these thoughts because they are “so totally pointless” (line 28)

The transformation of guilt, as observed in the three extracts, is summarized in Figure 1—especially row 3, which reveals the clients’ transformation in their expression of guilt over time. During Extract 1, the accusation is ascribed to others; Extract 2 has self-blame expressed in an unmitigated and emotional manner; Extract 4 features strong self-blame expressed in the frame of incipient mentalization. Furthermore, the clients’ expressions of guilt are rooted in their sequential contexts. The expression of guilt is a response to the therapist’s disambiguating questions (row 2 in Table 1), which in turn are responsive to the clients’ prior talk concerning the distress they feel due to abortion (row 1 in Table 1).

It is important to note that the talk about distress is different in the three extracts. In Extract 1, the husband defends himself against blame he perceived that others addressed to them, whereas in Extract 2, the wife describes the husband’s lack of a sensual relationship to the aborted fetus, contrasting it with her own experience in carrying it. Finally, in Extract 4, the wife alludes to the scary “destiny” that casts an ominous shadow over her potential future pregnancy.

The therapist’s disambiguating questions treat the prior tellings as having implied three factors that remain unexplicated. The first is the feeling of uncertainty caused by others’ attitudes (Extract 1). The second is the wife’s close sensual connection to the unborn child (Extract 2). The third is their expectation to be punished (Extract 4). By articulating and explaining these matters, the therapist invites the clients to reflect on their guilt-related experiences. The clients respond to her invitation by directly expressing their experience of being blamed or being guilty. Through her mentalizing interventions (row 4), the therapist transforms the client’s assertions into ascriptions of mental processes or states to the client. We have demonstrated how the client adopted the mentalized the perspective offered by the therapist. In Extract 2, this occurrs by allowing the spouses to assume an ignorant stance, whereas in Extract 4, the mentalizing perspective is reflected by her expressing her preference not to talk about omnipresent guilt. Summarizing the interactional organization represented in Figure 1, the descriptions of guilt-related experiences can be seen to be transformed both locally, within the sequence, as well as longitudinally, across sessions (cf., Peräkylä, 2019).

Guilt recognized and accepted

A turning point in the talk on guilt occurrs in Session 9, from which Extract 4 was taken. After the wife admits the omnipresence of guilt in her mental realm (see Extract 4), her guilt is addressed openly and straightforwardly so that the cautious and stepwise entry into talk concerning guilt is no longer needed. The participants likewise change their manner of talking about guilt as they increasingly display their acceptance of its inevitability. This change can indeed be considered to be an outcome of the therapeutic interaction.

Below, we present three extracts that illustrate the change that occurred during their couples therapy. The change involves new perceptions, understandings, and emotional processes associated with guilt, as expressed in the patients’ talk. In these extracts, the participants also demonstrate their knowledge concerning the process of their change.

Extract 5 is part of the concluding discussion of Session 9, from which Extract 4 was taken. The summary involves the therapist’s encouragement, which is primarily directed to the wife, to acknowledge and accept her feelings of guilt. The therapist emphasizes the universality of guilt and its weight in this family. As the wife eventually responds, she conveys that the therapist’s comment has given her a new understanding.

In lines 01–04, the therapist refers to “us” as those who become guilty. By implying that everyone is guilty, the therapist invites the wife to include herself in those who are guilty. The tag nie is translatable in this context as “yes” in line 04, and this makes it unequivocal that the therapist seeks the wife’s response. Nonetheless, the wife remains silent (see line 05) and sighs audibly (line 06); during her silence and sigh, she gazes at the therapist. The therapist responds to the wife’s lack of verbal uptake by offering a disclaimer in lines 07–09 (data not shown). During the wife’s extended response (lines 11–18), she hesitantly agrees and elaborates on the therapist’s comment. The wife conveys that the understanding of guilt that the therapist has suggested is different from her understanding thus far: To her, guilt has been something of a judicial matter (line 14), whereas the therapist has now suggested a different perspective, guilt that is in contrast to innocence and involves many aspects and choices in life (lines 14–15, 18). The wife points out that this new understanding of guilt does not underestimate its seriousness, but it changes the burden that the feeling of guilt imposes on her. She concludes her elaboration in line 23 by returning to what she started from in line 11: she had not conceived of guilt in this manner before.

Extract 6, taken from Session 10, further exhibits this new way of talking. At the beginning of the session, the wife states that the talk about guilt during the prior session had remained on her mind. Shortly before the extract, the therapist inquired whether guilt could still fuel the wife’s fear of a next pregnancy. After the wife’s confirmation, the therapist asks whether the spouses share a sense of guilt or whether only the wife feels guilt. The wife points out rather firmly that only she feels it. Thereafter, she embarks on a reflective description of her guilt, the main part of which is presented below. The participants can now talk about guilt in a matter-of-fact manner without the cautious preparatory sequence described in Extracts 1, 2, and 4.

The wife depicts her two entirely different experiences: an acceptance of her decision to abort as well as her guilt as a mother. In building up the conflict between the two experiences, the wife emphasizes both poles—although she is “fully aware” (line 01) of her agreement with her decision, the “mother’s guilt” is there po prostu (“simply,” line 03).

After the therapist’s acknowledgment tokens (lines 04, 05), the wife continues to reflect (data not shown). In lines 30–32, the wife summarizes these reflections, again formulating the grounds for her guilt: “something has happened against this natural course and I was an agent in this.” Thus, the wife defines the specific grounds for her guilt (see Tangney & Dearing, 2002), no longer extending it to her entire self (as she did in Extracts 2 and stating that she is “a monster” and “a terrible person”).

After her acknowledgment token and a silence of 10 seconds, the therapist produces an upbeat assessment of the wife’s prior talk, appreciating her ability to name and describe how she experiences guilt (lines 35–36). The therapist thus conveys acceptance and even encouragement, which are observably responsive to the self-critical stance conveyed by the wife’s prior talk. The wife receives the therapist’s appreciation by nods (lines 36 and 37) and by uttering “mm-hm” (line 38). Yet, as shown in Extract 7, only after an additional silence of 10 seconds does the wife in line 40 take the turn and elaborate on her response to the therapist’s assessment. She describes the gradual transformation of her guilt, not only by creating her own metaphoric description of this process but also illustrating it by her gesticulation.

In lines 40–41 and 43–44, the wife responds to the therapist’s appreciation of her guilt-related reflection by stating that she has “only now” begun to recognize it (line 40), even though it has been developing in her “over time” (line 41) and “slowly: (line 43). The wife then metaphorically depicts this process in lines 43 and 44 as one in which “these layered lids of it are opening.” Through her gestures, she depicts the process (Figures 2–5); while uttering the word “these layered” (te kolejne), she shows with her hands a type of cover or lid (Figure 2) and opens it (Figure 3). She repeats this opening gesture with a greater amplitude while uttering the word lids (Figures 4 and 5). In line 49, she reformulates her description of the change in her by observing, “it is becoming slowly somewhere in me named.” Although the wife’s utterance is indicative of her mental perception of change and her ability to verbalize it, it also describes her experience throughout the therapy process, which is an interactional history through which guilt became perceived, named, and tolerated.

Conclusion

This analysis has presented a transformation in the participants’ talk about guilt during the process of couples therapy after an abortion. Our analysis highlights three facets of this change: the referential context of guilt, the interactional expression of guilt, and the sequence in which the talk about guilt occurs. The results are summarized in Table 2.

In this study, as in earlier studies on interactional histories in psychotherapy (see Voutilainen et al., 2018), we followed a topical thread (Schegloff, 2007) through a number of therapeutic sessions. We explored the transformation of the patient’s understanding of an emotionally significant topic during therapy. In earlier studies, the type of sequential context under which the topical evolvement occurred remained the same (Voutilainen et al., 2011). By contrast, in our work, we demonstrated a change in the sequential organization of talking about the same topic from a stepwise cautious approach of guilt to the open topicalization of it. In the first half of the therapeutic process, the trajectory of the talk about guilt was initiated by clients’ talk, which was readable as related to guilt but did not openly express or address it. The therapist responded to this talk by posing disambiguating questions, inviting answers when the guilt-related experience surfaced. These answers involved the release of intense emotions; during the latter part of the therapeutic process, participants addressed their guilt more directly. The therapist could then introduce the topic of guilt in her questions without preparatory work, and the wife tended to talk about it on her own initiative. It appears that the sequential structure that facilitated the talk about guilt in the first half of the therapy sessions was no longer needed.

For the interactional history we described, the therapist facilitated the expression of guilt, first through her cautious interventions leading to disambiguating guilt, and toward the end of the process, through opening up discussion on the different dimensions of the loss and the parents’ relation to their decision. Therefore, a key part of the therapeutic project encouraged guilt not only to be more openly expressed, but also enabled the clients to acknowledge the different, conflictual aspects of their experience.

This analysis has also demonstrated how the therapist’s mentalizing responses to clients’ expressions of guilt calmed the patient down and consequently enabled her to adopt a more reflective stance on her guilt. The stepwise organization of talk about guilt appears to contribute to what Asen and Fonagy (2021) referred to as “balanced mentalizing.” They considered as important the shifting between cognitive and emotional mentalizing. At the beginning part of the interactional history, the balanced mentalizing of guilt was achieved in two shifts. The first shift was from emotionally charged general claims regarding the world and/or the self (the client’s display of distress readable as guilt) to openly named emotions (the client’s expression of guilt). The second shift was from emotions to reflections (from the client’s expression of guilt to the therapist’s mentalizing response and the client’s talk prompted by it). This stepwise organization of the talk on guilt facilitated dynamic shifts between emotions and cognition. As a consequence, a more integrated way of coping with guilt was achieved.

The sequential structure of talk and longitudinal changes are inseparably interwoven. From a more general interactional history perspective, we suggest that establishing a topic, which may be delicate or frightening, as relevant for a particular set of participants in a specific type of encounter makes it possible to address that topic more directly and less cautiously during subsequent interactions.

Even though the couples therapy involved two clients, our data analysis focused predominantly on one client—the wife. This was due to the wife’s expression of her guilt and grief being clearly more pronounced than those by the husband. In general, a mother’s grief response, owing to her physical bond with the lost child (Watson et al., 2019), is considered to be more intense than the father’s grief (cf., Duncan & Cacciatore, 2015). Nevertheless, in future studies, we hope to follow the coordination of both spouses’ interactional performance in a longitudinal way.

Our study also contributes to the analysis of emotions in conversation. Previous studies on emotion in interaction (see Robles & Weatherall, 2021) have typically adopted a “synchronic” design: exploring the interactional organization of emotion displays as they emerge at particular moments. Like Heritage and Lindström (2012), we adopted the interactional history perspective to describe change in an emotion over time.

It is also important to acknowledge that guilt has not been addressed in earlier CA studies on emotions. Through CA, we revealed that the clients’ expression of guilt changed during the interactional history. At the beginning of the therapeutic process, what they expressed was closer to shame than guilt in that the couple harbored a generalized negative image of their whole self, encoded in self-attributions as a monster and terrible person. Toward the end of the process, the focus of the negative self-attribution shifted to a specific action (cf., Tangney & Dearing, 2002)—the abortion decision—which the wife considered to be both justified and bad. It is intriguing that the full acknowledgment of guilt and relativization of it went hand in hand. It is also interesting to observe that the gradual shifting from a sense of being blamed and shame to a more direct and free emotional expression of guilt was accompanied by the clients adopting a mentalizing stance toward it.

Through their actions, the participants displayed that they understood the therapy to be a process of change that would span over several encounters. The therapist’s questions were informed by the previous interactions and, after having undergone a major change in her understanding of guilt, the wife contrasted her earlier understanding with her newly achieved realization of guilt, and eventually characterized the entire process of change. According to Deppermann and Pekarek Doehler (2021), a key challenge for longitudinal conversation analysis is achieving an emic perspective to change in interaction. This change can remain hidden, as “people usually do not display that they or others are doing something ‘differently’ at a given moment than they did before” (Deppermann & Pekarek Doehler, 2021, p. 134). Psychotherapy may constitute one environment in which patients sometimes manifestly orient to changes that would otherwise remain hidden in other contexts. This certainly happened in our study.