What are psychotherapies?

The Oxford English Dictionary defines modern psychotherapy as “the treatment of disorders of the mind or personality by psychological or psychophysiological methods.” Administering electroconvulsive shocks would, however, hardly count as psychotherapy; the common assumption is that, in psychotherapies, the means of healing is talk. Not all talk is therapeutic, and the history of psychotherapy involves not just formulating new psychological theories but evolving new and distinct ways of talking with clients. This book is an effort to describe and to understand these distinct ways of talking.

Many psychoanalytic historiographies locate the invention of psychotherapy in Breuer's work with a patient they called Anna O. (described in Freud and Breuer's Studies on Hysteria, 1991/1895) at the end of the nineteenth century. Anna O. found that narrating her worries and fantasies helped to relieve her symptoms and she coined the phrase “the talking cure” to describe what she was doing. Freud used her case retrospectively to document the invention of psychoanalysis, which became the first form of psychotherapy. Rather soon, however, there emerged other ways of doing and thinking about “the talking cure,” and at least since the 1950s, the field of psychotherapy has been characterized by the multitude of (often rival) approaches. In psychotherapy with individual patients, client-centred psychotherapy gained influence in the 1950s (see e.g. Rogers, 1951), and cognitive-behavioural therapies have been increasingly popular since the 1970s (see e.g. Dryden, 2007).

The aim of this chapter is to present a systematic overview of some of the research results presented in this book. An overview like this cannot cover all that was important in the preceding chapters, but it will bring out something from each. We present the key results in Table 11.1. We then unpack the contents of the table, and, by setting them against earlier conversation analytic research on psychotherapy, set the contributions of this book in context.

In order to summarize the research findings in a meaningful way, we have had to choose one analytic dimension from which to consider them. We have chosen one that is the cornerstone of all conversation analytic research: sequence organization (see Schegloff, 2007). We have chosen, from the wealth of material in each chapter, to emphasize what we learn about the ways in which the utterances of one participant are linked to utterances of the other(s) in the interaction. The apparently simple conjunction of one person's utterance with another's is a site at which many therapy-relevant phenomena happen.

There are two distinctions that we have made in organizing the research results of the book on the basis of the conjunction of utterances. One is the distinction between initiatory and responsive actions. An initiatory action is one that calls for, or makes relevant, a response from the co-participants. Responsive action is, of course, such a response.

Discursive psychology's interests in respecifying the traditional phenomena of psychology is well exemplified, we think, in the way that conversation analysis (which is a mainstay of discursive psychology) can illuminate psychotherapy. This chapter is about two things: what conversation analysis has to say about psychotherapy as an interaction, and what it has to say about psychotherapy as psychotherapy. We want to see what we can say about what therapists are up to: how they achieve what seem (to us) to be their therapeutic objectives.

In looking at therapy that way, we are in what is sometimes called ‘applied CA’. That is to say, we are certainly going to be looking very closely at the exact exchange of talk, and relying on the accumulated insights of CA to see how it works. But, unlike the utterly unmotivated looking of ‘basic’ CA, we do have our eyes open to the institutional work that the talk is likely to be carrying out. Moreover, we are conscious that, in therapy talk, we have something about which institutional representatives themselves have stories to tell: what Peräkylä and Vehviläinen call ‘stocks of interactional knowledge’ (Peräkylä and Vehviläinen (2003). In these circumstances, a CA account can be corrective (it may prove the therapists' account wrong, even on their own terms), or it might be illuminating (it might show they are right, and provide detail), or it might reveal something unsuspected but meaningful to the therapists (again, in their own terms; we leave aside those things that CA reveals about the interaction as an interaction as such, and in which a therapist would have no special interest).

This chapter is about how interviewees go about using absurdity in their expressions of their own views and their descriptions of others'. Expressing one's own views absurdly gets them registered, yet protected against the potential accusation that one “really meant it.” It is a way of doing what the discursive psychologists Edwards and Potter call “attending to stake and interest” (Edwards and Potter 1992). Absurdity can also feature in descriptions of others' views. That is a riskier proposition, but it can be done if you cloak it in a certain kind of concessionary form (the “show concession,)” Antaki and Wetherell 1999). If you do, the absurdity damages the opposition's case while seeming fairmindedly to yield something to it.

Views and attitudes

Why approach these data with an interest in looking into speakers' expressed views at all, let alone “absurd” ones, and why look into them, as I shall be doing, by close examination of exactly how those views are delivered in talk?

The first question is easy. For one thing, it is hard to read the interviews, or listen to them, and not get a feeling that at least one thing the speakers are doing, at least sometimes, is expressing what we would say in shorthand are “deeply held” or “powerful” opinions; just the sort of thing that Michael Billig's pioneering work on arguing (1989, 1991) encouraged us to linger over as “strong views.”