Explanatory paths, therapeutic directions, conversational destinations: Accountability and authority in therapeutic interaction

While the explanations and vocabulary of psychotherapy have trickled down to everyday accounts of our “mind,” “emotions” and “disorders,” relatively little is known about the conversations in which these accounts are introduced, elaborated and authorized. By means of a synthetic approach to talk in interaction (conversation analysis, discourse analysis, and the ethnography of communication) this study uses accountability as a theoretical framework through which to appreciate the relational dynamic of therapeutic encounters, both in terms of accounts exchanged by therapists and clients and in their respective ability to hold each other accountable. The study comprises a wealth of formal and informal conversational data gathered by participant observation at a family therapy center in Philadelphia: among which, twenty five family therapy sessions observed from behind the mirror, training meetings, and interviews with clients and therapists. By also incorporating non conversational data—for example, testing protocols, training manuals, and the DSM-IV—connections between the sessions\u27 dynamic and the institutional forms and vocabularies of accounting which support psychotherapeutic discourse are elucidated. The framework of accountability is used in the analysis to develop a situated, relationally grounded notion of therapeutic authority. Therapeutic authority is defined as, first, the therapists\u27 execution of discursive strategies to affect the clients\u27 conversational participation and, second, the therapists\u27 access to a third person, conversationally imported discourse of the inner-world from which clients are precluded. Bridging interactions and discourse, the study considers the historical grounding, the underlying logic, and the social consequences of a form of interaction and authoritative discourse that works by unequal accountability of its participants, and for the advantage of some with respect to others