Trouble in agreeing on a client’s problem in a cognitive behavioural therapy session

In this article we would like to demonstrate what conversation analysis can contribute to the understanding of psychotherapy as a joint social practice. We will concentrate on analysing one extended example of proposing a problem for consideration, the kind of thing that tends to happen at early stages of (many kinds of) psychotherapy sessions. What is interesting about this particular example is that the client and therapist have a battle over what the problem is, and whether it merits attention. We will try to bring out how the therapist brings off her formulation of the client’s complaint, and about how the client resists it. We speculate on whether the conversational turbulence is indicative of a mis-match between client’s and therapist’s understanding of how therapy should proceed. The therapist’s institutional objective of making a provisional list of problems may conflict with the client’s objective of explaining fully the problem she is currently ex- pressing. We can’t say how often this kind of sequence of proposal-reformulation-resist- ance happens in therapy as a whole, but by revealing how this particular example works, we hope the paper says something about one feature of cognitive-behaviour therapy, and stands as an advertisement for CA as a useful way of approaching therapy data more generally.