If she had helped me to solve the problem at my workplace, she would have cured me": A critical discourse analysis of a mental health intake (original) (raw)

Concealing and revealing power in therapeutic relationship (PhD Manuscript)

Despite sporadic attention to the issue, the therapeutic professions lack theoretical frameworks and empirical tools to examine the way in which power operates in the therapeutic encounter. This thesis attempts to address this situation, firstly by orienting to the ways in which power is hidden in therapeutic practice, which accounts to some extent for the limited and fragmentary attention given to the issue, and secondly by proposing theoretical and methodological tools to make power visible. In doing so, I develop a view of power based principally on the ideas of Michel Foucault. This approach to power is useful because it not only facilitates an understanding of local therapist-client dynamics, but also promotes investigation of therapy’s function in the overall sociocultural and political context.

Tracing therapeutic discourse in material culture

British Journal of Medical Psychology, 1999

Approaches to language and subjectivity from post-structuralist theory outside psychology and from deconstructiveperspectives within counselling and psychotherapy have questioned the way therapeutic relationships are formed in Western culture. Discourse analysis has been developed as a methodological framework to take this questioning further, and to provide detailed readings of therapeutic patterns of meaning. Foucauldian discourse analytic approaches help us to address how we are made into selves that speak, how we experience the self therapeutically. I will elaborate this methodological framework through an analysis of a piece of text-an item of consumer packaging-tracing the contours of therapeutic discourse through a series of 20 methodological steps. Therapeutic discourse draws the reader in as the kind of subject who must feel a relationship at some depth with the (imagined) authors for the text to work. This paper thus illustrates the value of discourse analytic readings of texts, and helps us to re ect upon our commitment to discourses of counselling and psychotherapy as empowering stories and as culturally-speci c patterns of subjectivity. A variety of arguments from post-structuralist theory outside psychology have been brought to bear in recent years upon the activities of counsellors and psychotherapists (e.g. McNamee & Gergen, 1992). The social construction of therapeutic work in Western culture has been thrown into question, but the 'deconstruction' of therapeutic discourse has been adopted by some practitioners to assist their own critical re ection and to make it possible for counsellors to address patterns of discourse which structure their relationships with clients (e.g. Parker, 1998). The work of Michel Foucault has been particularly helpful to psychologists here (Parker, 1995a), and forms of discourse analysis have been developed in psychology which draw upon Foucault's (1977, 1981) systematic critical analysis of discipline and confession (e.g., Burman et al. 1996; Burman & Parker, 1993). Foucauldian discourse analysis draws our attention to the 'conditions of possibility' for counselling and psychotherapy to work, to the way we experience therapeutic relationships when we are positioned as therapeutic subjects in the texts which comprise this culture. This paper aims to show how Foucauldian discourse analysis may be of relevance to counsellors and psychotherapists, and how this methodological framework functions as part of the broader 'deconstructive' turn in psychology. I will work through a piece of text which looks, at rst glance, to be innocent, but which participates in what Foucault would call a 'regime of truth' that is at one with the 'psy-complex' (Ingleby, 1985; Rose, 1985). It may be thought that the text in question is 577

Discursive Therapies as Institutional Discourse

2018

An institutional discourse perspective is developed and applied to discursive therapies. The perspective focuses on the interactional and interpretive practices that organize therapist-client encounters. Ethnomethodology, conversation analysis, and Foucauldian discourse analyses are discussed as different but related orientations to institutional discourse. Each perspective highlights different aspects of the institutional discourse perspective and discursive therapies. The perspective is applied by reconsidering the concept of collaboration in discursive therapies. Three issues are discussed. They are the value of thinking about collaboration as a shifting achievement in discursive therapy interactions, power relationships that include the potential for client resistance, and sites for the negotiation of multiple—sometimes competing—discourses.

Concealing and revealing power in the therapeutic relationship

2006

Framing, Filtering and Hermeneutical Injustice in the Public Conversation about Mental Health

Journal of Constructivist Psychology, 2020

This article describes how the narrative construct is used in the Power Threat Meaning Framework to refer to personal narratives, cultural narratives and as a metatheoretical language, synthesizing a range of different theoretical perspectives. It identifies ways in which this approach to narrative may differ from its use in a number of therapeutic traditions. Focusing on medicalization and drawing on the concepts of ideological power, framing, filtering and gatekeeping, it discusses the processes which facilitate the dominance of a medical frame in the public conversation about mental health, proposing that such dominance is an example of hermeneutical injustice. The article concludes, firstly, by suggesting some practices which therapists and other professionals could use to broaden and contextualize therapy conversations and, secondly, by making some proposals for how the public conversation about mental health could be re-balanced. Approach to narrative in the Power Threat Meaning Framework This special issue includes an article on each of the two aspects in the 'Meaning and narrative' chapter of the main Power Threat Meaning Framework (PTMF) document (Johnstone & Boyle, 2018). John Cromby's article (this issue) discusses the different facets of meaning: language; feeling; culture; materiality; habit; and memory. The present article focuses on one of the most pervasive sources of linguistic meaningnarrative.

Power Issues in Psychotherapy: Reflections on psychoanalytic theory and clinical cases

2021

The dissertation examines power issues in psychotherapy from different angles of vision and integrates diverse perspectives on power; for example, professional power, transferential power, sociopolitical power, and bureaucratic power. Through topics of the medical record, the patient-therapist relationship, geographical space, minority issues in diagnosis, and clinical challenges involving third parties, I explore unconscious and preconscious power dynamics. The work aims to integrate, and make clinically accessible, some diverse and relatively abstruse writing on power as it may affect the treatment situation. The overarching conclusion of the dissertation is that addressing power in psychotherapy is a subtle, complex, and important ongoing process that has not been fully theorized. It is not a question that can be clarified once and for all. Nor is it a question that is fully separable from the therapist's own subjectivity, internalized norms, or social experiences with privil...

Therapist's use of the disintegrated self : getting lost in power, vulnerability and incoherence

2019

Relational therapies often require the therapist’s wholehearted and conscious use of self as essential to the therapeutic process. I argue that the self I bring to a client is disintegrated and often shattered and that the expectation of integration in the therapist’s self is impossible to meet. This study is aimed mainly towards practitioners as readers, in an attempt to uncover the vulnerability of therapists in light of the complex power relationships we enter into and to deconstruct the myth of the undifferentiated, fixed self of the therapist. I do this by using writing as a method of inquiry, within a post-structural research paradigm, to create a detailed exploration of inter-cultural and inter-gender therapy with a fictional client, written from my perspective as a therapist who assumes a minority identity. The writing is left deliberately disjointed and disconnected to embody this deconstructive stance. From a post-colonial and feminist angle, I explore various themes aroun...

Dialogue and Power: A Critical Analysis of Power in Dialogical Therapy

Family Process, 2003

This article explores the relationship between dialogue and power in the practice of dialogue-orpxtetY, Mnut-knowingn f o m s of therapy. It is argued that pourer of a dyhamic and reuersible kind infuses much ordinary social dialogue, and that the joint processes of power and resistance work togiither to render an interaction dialogical. In. contrast, in dialogical therapy, overt exercises of power threaten the interaction's dialogical status, a d power is deferred and denied by the therapist through not-knowing practices. A case study of Harlene Anderson's (1997) i s used to illustrate that it is precisely power's presence that informs the practices ofnotknowjng and uncertainty that characterize dialogical therapies. It is suggested that the not-knowing therapist withholds aspects-of his or her ooice as a candition for dialogicity. Instead, special $pea king arrangements are required, in which the therapist's not-knowing is continuously communicated to the client, for the therapeutic conversation to remain dialogical. Without these speaking arrangements, 1 argue that therapy moves toward monologue. Tfterapists inherit powerfil speak-* hlichael Guilfoyle ( M A Clin Psych), Lecturer in CIinical Psychology, Psychology Department., Trinity College,,Dublin, Dublin 2, Ireland, "el: 1353-1-2885543, Emnil: rncg@zimmnet.

Navigating Critical Theory and Postmodernism: Social Justice and Therapist Power in Family Therapy

Family Process, 2017

The family therapy field encourages commitment to diversity and social justice, but offers varying ideas about how to attentively consider these issues. Critical informed models advocate activism, whereas postmodern informed models encourage multiple perspectives. It is often not clear how activism and an emphasis on multiple perspectives connect, engendering the sense that critical and postmodern practices may be disparate. To understand how therapists negotiate these perspectives in practice, this qualitative grounded theory analysis drew on interviews with 11 therapists, each known for their work from both critical and postmodern perspectives. We found that these therapists generally engage in a set of shared constructionist practices while also demonstrating two distinct forms of acti-vism: activism through countering and activism through collaborating. Ultimately, decisions made about how to navigate critical and postmodern influences were connected to how therapists viewed ethics and the ways they were comfortable using their therapeutic power. The findings illustrate practice strategies through which therapists apply each approach.

If she had helped me to solve the problem at my workplace, she would have cured me": A critical discourse analysis of a mental health intake (original) (raw)

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