This chapter is a collaboration between academic researchers and psychoanalytic child psychotherapists working in an economically deprived part of a large city in England. We explore the ways in which the psychotherapists' training and experience – what we refer to as their “therapeutic orientation” – are made relevant and consequential in their therapeutic interactions. We argue that such therapeutic orientation needs to be taken on board by analysts of interaction if they are to grasp the relevant sense of therapeutic activities carried out in and through talk.

The chapter presents an ethnomethodological case study. We examine four consecutive group psychoanalytic psychotherapy sessions – how they unfold and how children come to use what the situations afford. Alongside the audiovisual recordings, we scrutinize the therapists' own write-ups of the sessions, which were produced after the event by the trainee sitting in on the sessions. These write-ups display the therapists' professional orientation to the activities in sessions and consequently enable understanding of the interactions in terms of the “schooled experience” of the therapists. Moreover, in preparing this chapter, the “first pass analyses” of the video recordings have been discussed with the authors who acted as therapists. These discussions pinpointed misunderstandings, omissions, and errors, and made it possible to correct and extend the initial analysis and highlight the real differences of opinion among the authors as to what may be happening.

Conversational analysis (CA) has long promised to fill the gaps in psychotherapy theory by conceptualizing and describing the moment-by-moment exchange between therapist and client. Conversation Analysis and Psychotherapy makes a large payment in fulfilment of this ambitious promise. The authors build on continuities with normal conversation to examine therapy's distinctive features.

Though devoutly grounded in observation and sometimes professing to be atheoretical, CA has accumulated a wealth of interlinked theoretical concepts, well illustrated in Chapter 1 in the editors' introductory overview. Each chapter proposes further theoretical categories and distinctions that elaborate the abstractions of therapy theories and the coding categories of psychotherapy process researchers (e.g. Stiles, 1992). The authors place conversational actions in sequences and detail ways that they serve therapists' and clients' purposes. CA's comfort with the complexity and responsiveness of therapeutic conversation often makes psychotherapy theories seem blunt and vague by contrast.

But CA complements rather than competes with psychotherapeutic approaches, such as psychoanalysis, solution-focused therapy, child therapy, or the Minnesota 12-step model. As Streeck (Chapter 10) points out, CA does not attempt an explanation of psychological change or prescriptions for interventions. Instead, CA elaborates therapists' abstractions. Many therapists would agree that each word and inflection is there for a reason; CA actually studies the reasons in relation to the therapeutic approach.

Psychotherapy is an ensemble of techniques the benefit of which is measured by their usefulness to cure or relieve mental disorders and diseases. Psychotherapeutic knowledge is predominantly knowledge of change. The aim of conversation analysis (CA) in psychotherapy is to analyse and document the means and strategies used by patients and therapists to produce talk in interaction happening in the treatment room. In explicating these means and strategies, CA is not primarily concerned whether the treatment is useful at that moment or not, with whether the therapist is acting competently or negligently, or with whether or not the participants perceive the present interaction as therapy at all. Instead, from a conversation analytic perspective the “How” of the present interaction and the interactive production of what is going on between patient and psychotherapist in every moment is in the foreground independent of the kind and quality of the actual events in the treatment room.

In psychotherapeutic theory there is some disagreement regarding the importance of interactive events between patient and therapist. From the very beginning of psychoanalysis, interaction between patient and psychoanalyst has been overshadowed by the suspicion of suggestion (Thomä & Kächele, 1994). For this reason, Freud wanted to create an arrangement that was meant to ensure that the psychoanalytic treatment is nothing else but an “exchange of words” (Freud, 1916/17).

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).

In a recent paper, McGee, Del Vento, and Bavelas (2005) wrote about how therapists' questions constitute a form of intervention. By that, they mean that therapists' questions often carry with them a framework of presuppositions that constrain the client to answer in such a way as to ratify, and hence to affiliate with, the presuppositions informing the questions. Such affiliation involves the co-construction or sharing of the perspective of the therapist. But sometimes clients resist sharing therapists' perspectives, a situation known to even highly experienced therapists: “What therapist is not familiar with the experience of feeling his or her body tense as a client replies with ‘yes, but’ to everything that is discussed?” (Lipchik, 2002, p. 17).

How much more stressful, then, might it be for training therapists to manage such resistance? The impetus for the particular study on which this chapter is based was provided by a masters student in a university-based programme in couple and family therapy. As part of their internship, students in this programme work as individual therapists, and sometimes as co-therapists, providing counselling that is supervised by a programme faculty. This student was participating in a research project I was conducting using conversation analysis (CA) to study therapy interactions between training clinicians and their clients.

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.

This chapter is based on a corpus of about a hundred sessions, mainly audio taped, run in Italy by cognitive and relational-systemic therapists. We have identified a type of action, which we call reinterpretation, by which the therapist proposes his or her own version of the client's events and experiences, the therapist's version being grounded in another version of them previously provided by the client. We locate the placement of therapists' reinterpretations in the overall structural organization of the therapies of our corpus. We also briefly compare them to formulations (Antaki, Chapter 2 this volume) and psychoanalytic interpretations (Peräkylä, 2004a;Vehviläinen, 2003a). This leads to the main concern of the chapter, which is clients' responses to reinterpretations. We identify some types of clients' responses and a corresponding array of procedural features, and discuss their importance in the therapeutic process.

In recent conversation analytic research on psychotherapy, clients' responses to therapists' interventions have often been analysed in terms of acceptance vs. rejection or resistance. This has been the case where clients respond to formulations (Antaki, Chapter 2, this volume; Antaki, Barnes & Leudar, 2004; 2005; Hak & de Boer, 1996; Hutchby, 2005) and to psychoanalytic interpretations (Peräkylä, 2005; Vehviläinen, Chapter 7, this volume). The same tack has been followed in research dealing with other similar phenomena, e.g. clients' responses to experts' formulations in medical settings where mental-health talk routinely occurs (Beach & Dixson, 2001).

Interaction as a performance for a viewing or listening audience has had no shortage of attention. Broadcast talk as a field of critical inquiry is reaching maturity, with several recent books in print. The body of work on broadcast talk is now quite substantial. Most of it is on verbal interaction between participants in specific genres of programming, such as news interviews and sports commentary. In the 1980s, early work in the field attended to news, especially interviews with an interest in the design of talk for overhearing audiences; other prominent work in the field examined the dynamics of phone-in talk (these are both topics of subsequent Chapters: Chapters 7 and 8 respectively). Tolson (2006) provides a useful overview of generic developments in media talk on radio and television.

This chapter focuses on broadcast text as spectacle. It deals with issues of participatory structure, power and control in enactments of social relationships offered as spectacle. In it I focus on factual programming, on TV texts depicting TV presenters and non-media people, both professionals of various kinds and ‘Ordinary’ people. I have, of course, had to be highly selective, but the mediatised social identities and relationships that I address have relevance beyond the specific genres and programmes selected. Consumerist lifestyle television is the focus of the first two sections. In them, I look at TV presenters as tourists interacting with locals at holiday destinations, then at TV ‘experts’ and authority, the presenter-expert/novice relationship and sociability.

In Chapter 2, I discussed some shifts and reconfigurations that characterise the modern, media-saturated world. I dealt with issues around the ‘stretching’ of time and space as a consequence of technological developments in communication. Two other interrelated issues were the permeability of public and private social spheres and an increasing tendency towards informalisation in public discourses. I was exploring the way the nature of social interaction in modernity has been transformed. Developing these themes, this chapter looks more closely at attempts to close the gap between producers and audiences and the pervasiveness of ‘chat’ as a broadcast genre.

Three types of interaction

A useful starting point is a conceptual framework devised by a social theorist of the media. Exploring patterns of media action and interaction, John Thompson offers a three-way distinction between modes of communication (Thompson 1995). These are face-to-face interaction, mediated interaction and mediated quasi-interaction. Though he refers to all three as forms of interaction, his qualification for the third (as quasi-) indicates its dubious or, at least, marginal status as interaction. It is this third mode that is the subject of this chapter, but a preliminary exploration of this three-way distinction will be useful.

When two people interact face-to-face, their physical co-presence means that they will generally have a wide range ofverbal and other cues available for understanding one another, among them prosodic features (such as pitch and loudness), facial expressions and gestures. The interaction is two-way.