Communication & Medicine, Vol 6, No 1 (2009)

How the therapist does authority: Six strategies for substituting client accounts in the session

Mariaelena Bartesaghi
Issued Date: 13 Jul 2009


Combining talk and textual data from a family therapy clinic, this paper examines six discourse strategies therapists employ during first sessions of therapy to reframe and ultimately substitute client accounts with a therapeutic version of the problem. These are: metalinguistic actions; institutional positioning; speaking for the client; speaking through the client; re-authoring emotions; invoking a notion of ‘communication’ as a technological skill. Arguing that asymmetry is both a resource and a co-participatory dynamic of therapeutic interaction, I analyse therapeutic asymmetry in terms of unequal accountability between therapist and client and tie session strategies to a larger institutional praxis of un-authorization of client accounts and ways of accounting. Thus, while clients may go to therapy expecting to be heard on their own, first-person terms, therapy works by exchanging those terms in favour of an expert, third person vocabulary of institutional accounting that clients cannot claim. I define therapeutic authority as the ability of the therapist, but not the client, to strategically intervene in the session in order to put forth versions of problems for which the therapist is not directly accountable, and to which the client has no access.

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DOI: 10.1558/cam.v6i1.15


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