title: Therapists' continuations following I don't know-responses of adolescents in psychotherapy.
abstract: In psychotherapy clients' I don't know-responses (IDK-responses) to therapists' questions are typically considered to be non-cooperating behaviors. How therapists actually handle these behaviors remains unclear. This study therefore aims to assess client-therapist interactions following IDK-responses.
  
  
  
  Data were collected in a Dutch child and adolescent mental healthcare service by observing Dialectical Behavior Therapy aimed at adolescents with severe emotional distress. Eighteen individual psychotherapy sessions involving two therapists with six clients were video-recorded and transcribed. Stand-alone IDK-responses were selected (n=77) and analyzed using conversation analysis.
  
  
  
  Adolescents' IDK-responses led to varying actions of therapists. We identified five categories of continuations after IDK-responses: no IDK-related continuation; redoing of the question; proposing a candidate answer; employing therapy-specific techniques; and meta-talk on the problematic nature of the IDK-response.
  
  
  
  Therapists treat IDK-responses not just as non-cooperative behavior on the part of the client; IDK-responses are also used as a starting point to collaboratively enhance clients' insights in their own thoughts, emotions, and behaviors.
  
  
  
  After IDK-responses therapists can use a variety of continuation strategies with varying therapeutic functions. These strategies can be embedded in training of therapists to deal with potentially non-cooperative behavior.
authors.affiliation: Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands. Electronic address: m.jager02@umcg.nl.
authors.forename: Margot
authors.initials: M
authors.lastname: Jager
authors.affiliation: Center for Language and Cognition Groningen (CLCG), University of Groningen, The Netherlands.
authors.forename: Mike
authors.initials: M
authors.lastname: Huiskes
authors.affiliation: Department of Special Needs Education and Youth Care, University of Groningen,The Netherlands.
authors.forename: Janneke
authors.initials: J
authors.lastname: Metselaar
authors.affiliation: Department of Special Needs Education and Youth Care, University of Groningen,The Netherlands.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Knorth
authors.affiliation: Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Andrea F
authors.initials: AF
authors.lastname: De Winter
authors.affiliation: Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Sijmen A
authors.initials: SA
authors.lastname: Reijneveld
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D001883:Borderline Personality Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000379:methods*; D011795:Surveys and Questionnaires
keywords: Adolescent; Borderline personality disorder; Client-provider interaction; Conversation analysis; Participation; Psychotherapy