Therapy as Discourse Practice and Research

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 Olga Smoliak • Tom Strong
Editors

Therapy as Discourse
Practice and Research
Editors
Olga Smoliak Tom Strong
University of Guelph University of Calgary
Guelph, ON, Canada Calgary, AB, Canada

The Language of Mental Health

ISBN 978-3-319-93066-4    ISBN 978-3-319-93067-1 (eBook)
https://doi.org/10.1007/978-3-319-93067-1

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 Contents

1 Introduction to Discursive Research and Discursive

Therapies   1
Tom Strong and Olga Smoliak

2 Discourse in Psychotherapy: Using Words to Create

Therapeutic Practice  19
Jarl Wahlström

3 Researching the Discursive Construction of Subjectivity

in Psychotherapy  45
Evrinomy Avdi and Eugenie Georgaca

4 The Alliance as a Discursive Achievement: A Conversation

Analytical Perspective  71
Adam O. Horvath and Peter Muntigl

5 Discursive Therapies as Institutional Discourse  95

Gale Miller

v
vi Contents

6 Reflexive Questions as Constructive Interventions:

A Discursive Perspective 117
Joaquín Gaete, Olga Smoliak, and Shari Couture

7 Transforming Gender Discourse in Couple Therapy:

Researching Intersections of Societal Discourse, Emotion,
and Interaction 141
Carmen Knudson-Martin, Jessica ChenFeng, Aimee Galick,
Elsie Lobo, Sarah K. Samman, and Kirstee Williams

8 Conversation Analysis, Discourse Analysis

and Psychotherapy Research: Overview
and Methodological Potential 163
Eleftheria Tseliou

9 Discursive Ethics in Therapeutic Encounters 187

Olga Smoliak, Tom Strong, and Robert Elliott

10 Discursive Research from an Assimilation

Model Perspective 219
William B. Stiles

Appendix 231

Index 233
 Notes on Contributors

Evrinomy Avdi, PhD, is an Associate Professor in Clinical Psychology at the

School of Psychology of the Aristotle University of Thessaloniki, Greece. She is
a clinical psychologist, psychodynamic psychotherapist, and drama therapist.
Her research interests lie in applying discursive and narrative research to the
study of the process of psychotherapy, as well as the experience of serious illness.
She is particularly interested in exploring the links between deconstructive
research and actual clinical practice.
Jessica ChenFeng, PhD, is a liberative educator and therapist who focuses on
issues of gender, culture, spirituality, and power in her clinical work and research.
As an Assistant Professor of Marriage and Family Therapy (MFT) in the
Department of Educational Psychology and Counseling at California State
University, Northridge, she enjoys supporting students toward whole-person
development. She is a second-generation Taiwanese American woman residing
in the San Gabriel Valley of Los Angeles, hoping for and working toward cross-
generational/racial/disciplinary transformation.
Shari Couture, PhD, is a psychologist and family therapist working in private
practice in Calgary, Alberta, Canada. She has been a clinical supervisor of family
therapy students at the Family Therapy Centre in Calgary and currently is an
instructor for the Master in Counselling Program at the University of Calgary.
As a researcher, she discursively analyzes the process of therapy.
Robert Elliott, PhD, is a Professor of Counselling at the University of
Strathclyde, Scotland. He received his PhD in Clinical Psychology from the

vii
viii Notes on Contributors

University of California, Los Angeles, where he also studied conversation analy-

sis with Manny Schegloff. Before moving to Scotland in 2006, he was a Professor
of Clinical Psychology at the University of Toledo (Ohio). He is a co-­author of
Facilitating Emotional Change (1993), Learning Emotion-Focused Psychotherapy
(2004), and Research Methods in Clinical Psychology (2014) and in more than
150 journal articles and book chapters. In 2008, he received the Distinguished
Research Career Award from the Society for Psychotherapy Research and the
Carl Rogers Award from the Division of Humanistic Psychology of the American
Psychological Association. Over the years, he has drawn on conversation analysis
(CA) in his research on significant therapy events and in his practice as a psycho-
therapist. He credits CA as one of the influences on the development of emotion-­
focused therapy (EFT).
Joaquín Gaete, PhD, is an Associate Professor, Clinical Supervisor, and
Director of a Clinical Centre (CEAP) at Universidad Adolfo Ibáñez in Viña del
Mar, Chile. His research and writing focus on conversational practices fostering
self-preferred change in counseling, family therapy, and clinical supervision.
Aimee Galick, PhD, earned her doctoral degree in MFT in 2013. She was an
Assistant Professor for three years before moving into a research analyst position
for the Government of Alberta. She conducts research to support decision and
policy making in post-secondary education. She continues to teach as an adjunct
for the University of Louisiana Monroe and City University of Seattle. Her
research interests include gender, couples therapy, and medical family therapy.
Eugenie Georgaca, PhD, is an Associate Professor in Clinical Psychology at
the School of Psychology of the Aristotle University of Thessaloniki, Greece. She
teaches, researches, and publishes in the area of clinical psychology, psycho-
therapy, and mental health and especially qualitative methodology, community
mental health, and critical perspectives on psychopathology. She is a co-author
of Deconstructing Psychopathology (Sage, 1995) and author of papers on psy-
chotic discourse, delusions, discursive approaches to analyzing psychotherapy,
discourse analysis, and social constructionist notions of subjectivity.
Adam O. Horvath, PhD, is a Professor Emeritus at Simon Fraser University.
His research interests include the role and function of the relationship between
­therapist and clients in a variety of therapeutic settings. On the theoretical level,
he is exploring the interactive processes that enable clients to generate new
meaning of their problematic experiences, including the ones that brought them
to therapy.
 Notes on Contributors
   ix

Carmen Knudson-Martin, PhD, is a Professor and Director of the Marital,

Couple, and Family Therapy Program at Lewis & Clark College, Portland,
OR. She has published over 80 articles and book chapters on the influence of
the larger sociocultural context in couple and family relationships and the politi-
cal and ethical implications of therapist actions. She is a founder of Socio-­
Emotional Relationship Therapy, an approach that bridges societal discourse,
power, and couple interaction and a co-author of Socioculturally Attuned Family
Therapy: Guidelines for Equitable Theory and Practice.
Elsie Lobo is a PhD candidate in the Marital and Family Therapy Program at
Loma Linda University. She works primarily with couples and families at the
Loma Linda Behavioral Health Institute where she also directs a clinic mentor-
ing students in couples therapy. Elsie’s research interests include seeking to
understand how couples and families are shaped by social contexts, including
gender, culture, and socio-economic status, and developing practices that attend
to these contexts.
Gale Miller, PhD, is an Emeritus Professor of Sociology, Department of Social
and Cultural Sciences, Marquette University. He has longstanding research
interests in the Sociology of Troubles and Social Problems, Social Theory, and
Social Institutions. His research has focused on how troubles and problems are
defined in human service institutions, such as work to welfare programs and
solution-focused brief therapy. His current research deals with individuals and
families coping with such enduring crises as having a family member impris-
oned for sex offenses in the United States as well as solution-­focused brief
therapy.
Peter Muntigl, PhD, is an Adjunct Professor in the Faculty of Education at
Simon Fraser University, Canada, and a Visiting Research Professor in the
Linguistics Department at Ghent University, Belgium. He is currently exploring
how affiliation, disaffiliation, and re-affiliation are accomplished multi-­modally
during psychotherapy and family therapy interactions. His research is supported
by the Social Sciences and Humanities Research Council of Canada.
Sarah K. Samman, CCRP, PMC-MedFT, PhD, is an Assistant Professor of
Couple and Family Therapy at the California School of Professional Psychology,
Alliant International University, San Diego. She has presented at national and
international conferences on issues of gender and power on couple and family
relationships. Sarah has a strong interdisciplinary background in health psychol-
ogy and medical family therapy and has a deep commitment to social justice.
She is an AAMFT Approved Supervisor.
x Notes on Contributors

Olga Smoliak, PhD, C. Psych., is an Associate Professor in Couple and Family

Therapy at the University of Guelph. She has taken a social constructionist
approach to psychotherapy and has explored the links between discourse and
therapy. Olga has studied linguistic and interactional methods used by therapy
participants to give and receive advice, collaborate, accomplish specific thera-
peutic tasks, and negotiate responsibility for blameworthy conduct. She is cur-
rently examining how therapists request in-session practical actions from clients
and how the authority to direct clients’ actions is interactionally implemented
and negotiated.
William B. Stiles, PhD, is a Professor Emeritus of Psychology, Miami
University, Oxford, Ohio, USA, and Adjunct Professor of Psychology at
Appalachian State University, Boone, North Carolina, USA. He also taught at
the University of North Carolina at Chapel Hill, and he has held visiting posi-
tions at the Universities of Sheffield and Leeds in the United Kingdom, at
Massey University in New Zealand, at the University of Joensuu in Finland, and
at Maia University Institute in Portugal. He received his PhD from UCLA in
1972. He has been President of Division 29 of the American Psychological
Association (Society for the Advancement of Psychotherapy) and of the Society
for Psychotherapy Research. He has served as an editor of Psychotherapy Research
and Person-Centered and Experiential Psychotherapies. He has published more
than 300 journal articles and book chapters, most dealing with psychotherapy,
verbal interaction, and research methods.
Tom Strong, PhD, is a Professor, couple and family therapist, and counselor-­
educator at the University of Calgary who researches and writes on the collab-
orative, critically informed and practical potentials of discursive approaches to
psychotherapy. His most recent book is Medicalizing Counselling: Issues and
Tensions (Palgrave Macmillan). For more details on Tom, please c­ onsult http://
www.ucalgary.ca/strongt or his ResearchGate page https://www.researchgate.
net/profile/Tom_Strong.
Eleftheria Tseliou, PhD, is an Associate Professor of Research Methodology
and Qualitative Methods at the University of Thessaly, Greece, and a systemic
family psychotherapist. She teaches research methodology, qualitative methods,
and family psychology. Her research interests include the development of dis-
cursive research methodologies and the study of psychotherapeutic and educa-
tional processes by discourse analysis methodology. She is an author of articles
and book chapters on methodological aspects of discursive research methodolo-
gies and on family psychotherapy process studies. She is a co-editor (with Maria
 Notes on Contributors
   xi

Borcsa) of a special section on discursive methodologies for couple and family

therapy research (Journal of Marital and Family Therapy).
Jarl Wahlström, PhD, is a Professor Emeritus in Clinical Psychology and
Psychotherapy and former Director of the Psychotherapy Training and Research
Centre at the Department of Psychology, University of Jyväskylä, Finland. He
has served as the head of the national integrative postgraduate specialization
program in psychotherapy for psychologists. He has an advanced training in
family and systems therapy and an extensive experience as a clinical psycholo-
gist, family therapist, trainer, consultant, and university teacher. His main
research interest is in psychotherapy discourse, a topic on which he has pub-
lished in several international journals and books. He is the supervisor of several
doctoral dissertations.
Kirstee Williams, PhD, is a Director and Assistant Professor for the Lee
University Marriage and Family Therapy Program, the first COAMFTE-­
accredited program in the state of Tennessee. Her scholarship focuses on a social
justice approach for infidelity treatment. Kirstee earned her doctorate in Marital
and Family Therapy from Loma Linda University and is an active member in the
American Family Therapy Academy.
 1
Introduction to Discursive Research
and Discursive Therapies
Tom Strong and Olga Smoliak

For more than a century, people have been referring to psychotherapy

as the talking cure, with still vague understandings as to what it is about
talking that is curative or therapeutic. What does talking have to do
with how one understands and experiences reality? Why do therapists
portray clients’ concerns and solutions to them so differently? Such
questions have prompted lots of theorizing by psychotherapists from
often strikingly different orientations to practice. For those who turn to
research for definitive answers, the results can often be similarly dis-
satisfying. The stance taken by discursive therapists and discursive
researchers of therapy can perplex readers, especially if they overlook

T. Strong (*)
Educational Studies in Counselling Psychology, Werklund School of
Education, University of Calgary, Calgary, AB, Canada
e-mail: [email protected]
O. Smoliak
Department of Family Relations and Applied Nutrition, University of Guelph,
Guelph, ON, Canada
e-mail: [email protected]

© The Author(s) 2018 1

O. Smoliak, T. Strong (eds.), Therapy as Discourse, The Language of Mental Health,
https://doi.org/10.1007/978-3-319-93067-1_1
2 T. Strong and O. Smoliak

how language is used when representing and intervening in therapeutic

realities.
Some of the perplexity might relate to therapeutic models’ root meta-
phors (Pepper, 1942; Turnbull, 2003) for the foci and processes of thera-
peutic discourse in the first place. Are the concerns clients present, for
example, about faulty information processing, ids needing taming, aver-
sive childhood experiences, or dysfunctional patterns of relationships?
What about therapeutic discourse or the talking between clients and
therapists itself: are therapists doing forms of conversational surgery, can
they administer conversational interventions in dosages, can good thera-
pists engineer transformational experiences? These can seem silly ques-
tions to therapists and researchers who have taken up a discursive turn.
For them, and for the authors of this volume, discourse is how humans
negotiate and navigate socially constructed experiences, processes, con-
cerns, and aspirations with each other. As for how all of this pertains to
discursive researchers and therapists, their metaphors of interest relate to
discourse as linguistically constructed meaning, and discourse as lan-
guage use in human interactions.
If you are feeling uncomfortable reading about this language of meta-
phors as accounting for what is real, welcome to the club, but get used to
it. Experiences and things do not name themselves; humans do and hold
each other to account regarding the “right” or best ways to use language
in describing those things and objects. To discursively informed practitio-
ners and researchers, language use involves more than passive exchanges
of information computed for accuracy and algorithmic decision-making
(Ortega & Vidal, 2011). Important things are at stake over how language
gets used, as debates over psychiatric diagnoses (e.g., Frances, 2013)
underscore at a big picture level, but also in how therapists and clients
wordsmith their ways forward in therapeutic conversation. Some see a
more deferential thing occurring between client and therapist, where
authoritative roles and expertise are to govern what gets talked about and
how that talking is to occur (Rose, 1990). Beyond the consulting room,
therapeutic discourse has found its way into people’s everyday conversa-
tions and understandings—enough to have become a default discourse of
self-understanding for many (Illouz, 2008).
 Introduction to Discursive Research and Discursive Therapies 3

Discourse, in the sense that most authors here will use the term, refers
to conversational processes and meanings, without a sense that there is a
“right” or more-real-than-others way to understand and humanly ­interact.
Discourse, down to words, gestures, tones of voice (etc.), and their con-
versational use, is the focus of the work of psychotherapy. For discursive
therapists, conversational work is needed to respond to the ways of
understanding and communicating that clients bring in related to their
concerns and aspirations, while negotiating changes to client problem or
aspirational discourse. That work for discursive researchers is analyzable
for what gets used in and is seen to result from therapeutic discourse.
Discursive approaches to therapy came into vogue in the 1980s. They
drew on the linguistic insights of philosophers of science, like Wittgenstein
(1953), Gadamer (1988), and Foucault (1973), but also the socio-­
political concerns of feminist (e.g., Weisstein, 1971) and postcolonial
critics (e.g., Fanon, 1967). Inherent to the discursive approaches to ther-
apy (primarily narrative, solution-focused, and collaborative therapy) is a
view that meaning is socially constructed and that therapy itself is as a
meaning-making/changing endeavor (McNamee & Gergen, 1992).
Differences in approach between therapists occur over the relevance of
macro-political influences, such as cultural and institutional discourses,
over the micro-dynamics of therapeutic dialogue, as the focus of therapy
(Monk & Gehart, 2003). One finds similar differences in discursive
forms of research where the focus can be macro, as in the case of critical
discourse analysis, or micro, as in the case of conversational analysis
(Gale, Lawless, & Roulston, 2004). Regardless, the focus of discursive
therapists is to converse with help clients change their problem-­sustaining
or problem-saturated discourse, be that from problem talk to solution
talk, bad to better stories, or hosting collaborative dialogues focused on
client preference and resourcefulness (Friedman, 1993). Thus, discursive
therapists have been particularly interested in conversational practices
helpful in deconstructing problem meanings while co-constructing more
client-preferred meanings and directions (Paré, 2013).
While discursive therapists (Lock & Strong, 2012) borrow from dis-
course theory, their models do so quite differently. Narrative therapists
(White & Epston, 1990; White, 2007), for example, draw heavily from
Foucault, using questions to externalize and make explicit the workings
4 T. Strong and O. Smoliak

of dominant discourses and stories in clients’ lives, so that clients can

consider and possibly enact more preferred alternatives. Solution-focused
therapists (e.g., deShazer, 1994) negotiate clients’ ways of t­ alking/under-
standing from problem-focused language games to solution-focused,
strengths-informed language games. Collaborative therapists (Anderson,
1997) see conversation as the means by which problems organize people’s
thinking and interacting, needed are pragmatic conversations that dis-­
solve the problem-organized conversations, so that more preferred con-
versations can occur. Reflexive questions as conversational interventions
are central to these meaning-focused therapies (Tomm, 1987); that is,
questions are used intentionally, to invite from clients deconstructive
conversations associated with problem meaning, or to invite conversa-
tions that construct preferred meanings, such as solutions. Common
across these discursive therapies is a socially constructed view that mean-
ing is revisable, though not correctly knowable in some general way. It
would be wrong, however, to regard discursive therapies as only those just
described. Increasingly, therapist-researchers are attending to emergent
meanings in therapy, focusing on “responsiveness,” pointing to a reflexive
or discursive dimension of an otherwise normally practiced therapy
(Kramer & Stiles, 2015).
Discourse analysts have largely approached psychotherapy critically, as
a suspect institutional activity focused on “helping” clients adjust to nor-
mative societal expectations. This line of critique has been most evident
in the “psy-complex” program of research of Nikolas Rose (1985) and
influenced by Foucault’s writing on discourse and “biopower” (1962,
2006). While discursive therapists have often had backgrounds in psy-
chology, these discursive researchers more typically have brought a socio-
logical focus to their examinations of therapy. Family therapy has been
somewhat unique for owing some of its origins to communicationally
focused research at the Mental Research Institute in Palo Alto, California
(e.g., Watzlawick, Bevan Bavelas, & Jackson, 1967). A common socio-
logical derivation for many discourse analysts is Garfinkel’s (1967) ethno-
methodological studies where the focus is on social orders and their tacit
performance in socially situated, yet accountable ways. This focus more
specifically tends to be on the micro-interactional features of therapeutic
discourse as they occur between client and therapist moment-by-moment,
 Introduction to Discursive Research and Discursive Therapies 5

turn by conversational turn. Most commonly, this focus is associated

with conversation analysis (e.g., Peräkylã, Antaki, Vehviläinen, & Leudar,
2008), and rarely is it found in mainstream therapy research journals.
More often, such studies appear in sociology and discourse analysis jour-
nals. Regardless of the kind of discursive research done of therapeutic
discourse, very little of it currently influences the practice of discursive
therapy.
Perhaps this psychological/sociological divide can help to explain why
discursive therapists and discursive researchers are working apart.
Psychology has tended to focus on individual behaviors, cognitions, and
emotions largely bracketing off social influences, whereas sociology turns
to cultural, institutional, and social influences when accounting for the
same things psychologists attribute to the individual. In some respects,
discourse or language use complicates things further, cutting across both
individuals and social entities. People’s words are not determined socially,
even in face-to-face encounters Goffman (1967) saw as being “where the
action is,” though socially derived “involvement obligations” may influ-
ence what gets said. Individuals, as phenomenology has shown, bring
their subjectivities to such conversations, and that means differences in
their interpretive histories, habits, and preferences. Such differences can
make for interesting conversational interactions, particularly in therapy.
Whether one refers to such interactions as micro-social or inter-­subjective,
there is much worth studying as clients and therapists use discourse to
transcend differences and make differences in clients’ lives.
Critical discourse analysts have helped to expose the professional con-
versations of therapists with clients, as sites of societal reproduction
(Rose, 1990). A related and derogatory term from a few decades ago was
that therapists were “reality adjusters.” This can seem a heavy-handed
critique for therapists steeped in the understandings and aims of the
human potential movement. For them, therapy aimed to be liberating, a
means to optimizing oneself and becoming more real. Concerns about
institutionalized “therapy” go back decades, as movies like “The Snake
Pit” (Litvak, 1948) or “One Flew Over the Cuckoo’s Nest” (Forman,
1975) attest. Concern about “treatment” for “mental health concerns”
also focused Michel Foucault’s PhD thesis, published in a revised form
as “Madness and Civilization” (1962). How the concerns of therapy’s