The emergence and management of embodied dilemmas in psychotherapeutic interaction: a qualitative study


  • Sarah Bro Trasmundi University of Southern Denmark, Denmark & Oslo University, Norway
  • Thomas Wiben Jensen University of Southern Denmark, Denmark
  • Henriette Bruun Psychiatric Hospital Middelfart, Denmark
  • Katharina Kjølbye Wrist Brønderslev Psychiatric Outpatient Clinic, Denmark
  • Sune Vork Steffensen University of Southern Denmark, Denmark, South China Agricultural University, China & Southwest University, China



Cognitive Event Analysis, embodied ethics, embodied interaction, ethical dilemma management, psychotherapy


In this article we take an embodied and interactional perspective on how ethical dilemmas are being managed in situated interaction. Accordingly, we aim at linking ethical principles to real-life clinical practices in order to show how ethical dilemmas are less about abstract decision-making, and more about reasoning constrained by inter-bodily dynamics, affect and adaptive behaviour in situated interaction. We present two real-life cases of ethical dilemma management in a psychotherapeutic setting. We use the innovative method, Cognitive Event Analysis, to investigate the interaction in which the dilemmas emerge. The analytical findings, we claim, pave the way for a more embodied code of ethics, which, in turn, has consequences for the theoretical assumptions that inform the models and guide­lines for action in practice.



Barnett, J. E. (2019). The ethical practice of psychotherapy: Clearly within our reach. Psychotherapy, 56(4), 431–440.

Beauchamp, T. L., & Childress, J. F. (1979) Principles of biomedical ethics. Oxford: Oxford University Press.

Bruun, H., Lystbaek, S. G., Stenager, E., Huniche, L., & Pedersen, R. (2018). Ethical challenges assessed in the clinical ethics Committee of Psychiatry in the region of Southern Denmark in 2010–2015: a qualitative content analysis. BMC Medical Ethics, 19(62).

Cowley, S. J. (2014). Human Language and Sensorimotor Contingency. In J. M. Bishop & A. O. Martin (Eds.), Contemporary Sensorimotor Theory (pp. 235-255). Dordrecht: Springer.

Giere, R. N. (2004). The Problem of Agency in Scientific Distributed Cognitive Systems. Journal of Cognition and Culture, 4(3/4), 759-774.

Goodwin, C. (1994). Professional vision. American anthropologist, 96(3), 606-633.

Goodwin, C. (2017). Co-operative action: Cambridge University Press.

Hem, M. H., Molewijk, B., & Pedersen, R. (2014). Ethical challenges in connection with the use of coercion: a focus group study of health care personnel in mental health care. BMC Medical Ethics, 15(82).

Hollan, J., Hutchins, E. and Kirsch, D. (2000) Distributed cognition: Toward a new foundation for human-computer interaction. In J. Carroll (ed.), Human-Computer Interaction in the New Millenium (pp. 75-94). New York: Addison-Wesley.

Hutchins, E. (1995). Cognition in the Wild. Cambridge MA: MIT Press.

Knapp, S. J., Gottlieb, M. C., & Handelsman, M. M. (2015). Ethical dilemmas in psychotherapy: Positive approaches to decision making. American Psychological Association.

Musschenga, A. W. (2005). Emperical ethics, context-sensitivity and contextualism. Journal of Medicine and Philosophy, 30(5), 467-90.

Peräkylä, A., Antaki, C., Vehviläinen, S., & Leudar, I. (Eds.). (2008). Conversation analysis and psychotherapy. Cambridge: Cambridge University Press.

Steffensen, S. V. (2013). Human interactivity: Problem-solving, solution-probing, and verbal patterns in the wild. In S. J. Cowley and F. Vallée-Tourangeau (Eds.), Cognition beyond the brain: Computation, interactivity and human artifice (pp. 195–221). Dordrecht: Springer.

Steffensen, S. V., Vallée-Tourangeau, F., & Vallée-Tourangeau, G. (2016). Cognitive events in a problem-solving task: a qualitative method for investigating interactivity in the 17 Animals problem. Journal of Cognitive Psychology, 28(1), 79-105.

Trasmundi, S. B. (2016) Distribueret kognition og distribueret sprog: analyse af kognitive events i en akutmedicinsk social praksis. NyS 50, 55–85.

Trasmundi, S. B. (2020). Errors and Interaction: A cognitive ethnography of emergency medicine. Amsterdam: John Benjamins.

Trasmundi, S. B., & Linell, P. (2017). Interactivity, extended dialogism and cognitive event analysis: finding problems to solutions in emergency medicine. Pragmatics & Cognition.




How to Cite

Trasmundi, S. B., Jensen, T. W., Bruun, H., Wrist, K. K., & Steffensen, S. V. (2023). The emergence and management of embodied dilemmas in psychotherapeutic interaction: a qualitative study. Qualitative Health Communication, 2(1), 41–57.