The results are presented similarly for both patients. First, a baseline formulation of the problematic experience is presented, generated by the analysis of the recorded data of the first interview. Next, vignettes from the pre-therapy interview are presented to illustrate the baseline formulation. Third, based on the analysis of follow-up interviews, we describe any noticeable changes in the patient’s problematic experiences and present illustrative vignettes.

In the baseline formulation and in the vignettes, utterances indicating the relevant semantic positions in the formulation are in angle brackets, and the referential objects are in square brackets. In some cases, the reference object and its semantic position appear in the same expression. Usually, the stance then appears in the structure of the expression, in the form of certain word choices or metaphorical expressions. In this case, the referential object is enclosed in both brackets, i.e., the hybrid notation is applied.

Case 1: “Helen”Baseline Formulation

In her pre-therapy interview, Helen described social anxiety and very distressing [thoughts about dying]. Her problematic stance was < alarmed and helpless > in relation to overwhelming and dominant idea of death. Helen [tried to cope with her anxious helplessness] by trying to be as < brave and capable > as possible. Another coping strategy was to block the painful and frightening thoughts and avoid thinking about them by focusing on something else. Helen’s stance towards her [difficult emotions] was therefore < avoidant and repressive>, but it was exhausting.

The Assessment Interviews

At the beginning of the first interview, Helen describes the emotion she calls the fear of death. In the following excerpt Helen describes her experience, expressing both her helpless and brave and capable stance.

Excerpt 1

68. H: So last week was such that I (holding back tears) that I thought that < from where do I get the power to [continue]>. When [nothing] < seems to have any meani-> (almost cries). So < how do I get motivated> [to continue every day] and < try to> [be happy] when I, I mean when [it] < has not any>, I mean that I feel such a way that [this] < makes no difference at all>.

As the interview continues, she further describes her experience and her actions.

Excerpt 2

78. H: So that [it] is, [it’s something < quite awful>], but [it went past then] as I walked around the house and of course < tried to think of, like, anything else>.

79. I: So, [this limitation of life] and then [such rather desperate thoughts] that [life, that life has no meaning]?

80. H: Yes, and I as a kind of as an adult now, or I realize as an adult that [it happens] and - <what does it matter after all, does it matter at all> - but it’s like < how can I, like, continue > like that, so that <[I wouldn’t think about it] all the time>.

An evasive and repressive pattern of action appears repeatedly as the interview progresses.

7- and 12-Month Follow-Ups

Analyzes of the first and second follow-up interviews showed that Helen’s difficult emotional experiences and her efforts to resolve them were largely unchanged. The idea of dying still appeared to be frightening, overwhelming and dominant; in relation to it she was alarmed and helpless. Nor had her understanding of the problem broadened or been accompanied by alternative ways of dealing with difficult emotions.

Excerpt 1 (12-Month Follow-Up)

345. H: That < it is so terribly difficult for me to accept>, [even though I know, I know that we’re all going to die] so < why can’t I accept > it as such. So, [it’s like this state of pain instead].

346. I: Mm, so < it’s difficult to get out of> [it]?

347. H: Yes, yes, but then again, [I do get out of it], even though like in the evening, [by bed it often comes], so then < I, like, [can get out of it] > again. And I can fall asleep, but then [< I wake up, like, at night>].

The fear is there, and the excerpt suggests that her habitual coping mode remains unchanged. It seems that ‘but then again, [I do get out of it]’ is a truncated statement of attempting to escape the anxiety by thinking of something else.

Case 2: “Annie”Baseline Formulation

In the pre-therapy interview it appeared that, amid [challenging life events], Annie believed that she must < cope alone>. When trying to [express her needs and rely on others], she quickly adopted a < supporting and concerned > stance. Others seemed somehow fragile, which prevented Annie from expressing openly her own distress. This made it difficult to ask for help. Annie tried to cope by [performing inflexibly until she felt exhausted] and became < needy and helpless>. As a result, she perceived herself a failure and lonely. No other options were in sight but trying to keep coping alone, which had led to her exhaustion.

The Assessment Interviews

At the beginning of the interview, Annie describes recent emotionally distressing events in her close relationships. Despite the feelings and thoughts associated with the events, she describes that she has tried to concentrate on her studies and work as before.

Excerpt 1

32. A: And [then I started to feel] < like if, like>, if I < should already think > a little about [all things] and [what has been]. And so, [I was thinking in the fall] < that in the springtime, when there will be less of everything>, so then < I will have time to think about> [what has happened] and < mourn and be angry and everything>, and [then I felt, like, that I was] < stretched to the point of snapping>, [I didn’t have the energy]. Somehow, <I just couldn’t>, [I felt that] < crying wasn’t enough>.

The interview soon proceeded to discuss experiences of expressing difficult emotions, especially to those close to her, and asking for help. Annie further refines her experience by describing her expectations regarding the other.

Excerpt 2

75. A: Because then, at that point, <I can’t push myself forward > and [tell things]. But altogether, like, with [anyone who is a close person]. But [if there is someone, who is < just someone more distant>] or [someone you < only meet every now and then>], then < you don’t need to worry>, [if she] < has a vested interest> [with this matter].

76. I: mm-hh?

77. A: <how she deals with> [this], or [does she] < feel bad>, [if I say that I feel] < like something>. Will it come to her like, [does she see it so differently that it] < makes her feel bad>, or something else.

It may be that the pattern played out with people close to her has also interfered with her attempts to get professional help. This is suggested by the following excerpt.

Excerpt 3

34. A: I [felt like a < rubber band stretched too thin>] < to be able to>, like, [alone], <to flex backwards>. Then I went to the psychiatrist. Before that, [I had talked couple of times with ordinary doctors], but even though [some of them] were pretty < good to talk to>, but then, [there were < those stupid ones>] who < couldn’t really discuss>. And I just needed.

35. I: mm?

36. A: <[the kind of an outsider who] could>, [who] < would know how to discuss>.

Turn 36 summarizes Annie’s quest to find an “outsider” who would understand her and endure her helplessness without collapsing.

7- and 12-Month Follow-Ups

Analysis of the first follow-up interview showed that Annie’s repetitive pattern of coping alone and adopting a supportive and concerned attitude in closer relationships was dealt with in her therapy. Moreover, she became aware of its relationship to her demanding attitude toward herself, leading to a more empathic internal dialogue. Annie’s altered relationship to herself constitutes the central outcome of psychotherapy. In the following excerpt, the discussion focuses on her current relationship with herself.

Excerpt 1 (7-Month Follow-Up)

162. A: Yes, [I kind of feel like] < I’ve tried as somehow a little more> [to get to know who I am] and [what I < really want to do>]. And then, [what is something] that just for some reason feels like < I should want to do>.

163. I: mm-h?

164. A: <I can’t say that> [it would have changed radically], but < maybe a little more familiar with it>.

165. I: Mm, [< slightly turn more towards you>]?

166. A: Yeah, <a little more friend to> [myself] than just….

167. I: Mm, [than just what]?

168. A: [< A boss>].

The analysis of the second follow-up interview showed that the positive change was further strengthened. Annie’s expression of negative emotions had become easier during therapy, but this change was still in progress.