Subjectivity in Psychotherapy

Social and Personality Psychology Compass 3/5 (2009): 654–670, 10.1111/j.1751-9004.2009.00196.
Narrative and discursive approaches to the analysis of

subjectivity in psychotherapy
Evrinomy Avdi* and Eugenie Georgaca
Aristotle University of Thessaloniki
Abstract
This paper reviews research that utilises language-based analyses (narrative analysis, discourse analy-
sis and conversation analysis) to examine aspects of subjectivity in the context of psychotherapy.
The studies reviewed fall broadly into two main groups. On the one hand, studies which share a
view of subjectivity as the sum of internal ‘voices’ in dialogue adopt a narrative approach, examine
subjectivity in terms of organisation, coherence and self-reflection, and consider psychotherapy a
process of restoring an organised polyphony. On the other hand, studies which conceptualise sub-
jectivity in terms of ‘subject positions’ adopt a discursive approach, emphasise the availability of
subject positions and flexibility in adopting them and examine psychotherapy as a process of facili-
tating the flexible adoption by the client of a variety of subject positions. Theoretical, epistemo-
logical and methodological issues regarding each of the two approaches are discussed, along with
representative studies. We finally examine the implications of these two approaches for under-
standing psychotherapeutic practice and for theorising and researching subjectivity.
In recent years, there has been a flourishing of qualitative research in the study of psycho-
therapy process (Frommer & Rennie, 2000; McLeod, 2001; Toukmanian & Rennie,
1992). In this paper, we focus on a subsection of qualitative research and review studies
that utilise language-based analyses, i.e. conversation, discourse and narrative analysis
(McLeod, 2001), to examine therapy talk. More specifically, we examine and evaluate
how subjectivity has been theorised and analysed in the context of language-based analysis
of psychotherapy. Our aim is twofold: on the one hand, we aim to review and critically
evaluate the contribution of language-based analyses of therapy to our understanding of
the construction of subjectivity in therapy, which we consider to be an important aspect
of therapeutic work, and, on the other hand, to utilise this research to further discussions
regarding subjectivity from a language-based perspective.
In this review, we discuss studies that utilise language-based analyses to study therapy
sessions and that explicitly study aspects of subjectivity. Correspondingly, we have chosen
not to include analyses of psychotherapy which only implicitly deal with issues related to
subjectivity, as well as studies that theorise psychotherapy from a narrative or construc-
tionist perspective but do not analyse actual psychotherapy sessions. We focus on subjec-
tivity here because discussions regarding subjective experience and one’s sense of self are
central both to psychotherapeutic theory and practice and to narrative and constructionist
approaches in psychology. In line with social constructionist views of therapy, we assume
that psychotherapy constitutes an institutional practice, which occupies a significant posi-
tion in late modernity, that both reflects dominant cultural views regarding ‘selfhood’ and
also provides theories that further define these views and practices that implement them
ª 2009 The Authors

Journal Compilation ª 2009 Blackwell Publishing Ltd
Narrative and Discursive Approaches 655
(e.g. Cushman, 1995; Parker, 1999). As such, we view psychotherapy as a particularly

fertile site for the exploration of subjectivity. In addition, the focus of this review reflects
the authors’ longstanding interest in the links between psychotherapy and discursive
approaches (Avdi, 2005, 2008; Avdi & Georgaca, 2007a,b; Georgaca, 2001, 2003; Georg-
aca & Avdi, forthcoming), which often translates into examining the tensions between
social constructionist approaches to understanding human distress and the actual practice
of psychotherapy.
Subjective experience and one’s sense of self have been studied by different disciplines
using a variety of perspectives. In broad terms, mainstream psychological approaches
refer to the ‘person’ or the ‘self’, who they understand in terms of ‘personality’, that is
to say, they assume that a person is an individual, unified, stable and self-contained
entity (Gough & McFadden, 2001). The terms ‘self’ and ‘person’ are also linked to
humanistic approaches, which place emphasis on the wholeness and originality of the
self, and phenomenological approaches, which are concerned with the quality of one’s
experience of oneself (e.g. Schneider, Bugental, & Pierson, 2001). These two terms tend
also to be used in many psychotherapeutic traditions and especially those that draw upon
humanism and phenomenology (e.g. Cain & Seeman, 2002). The term ‘subjectivity’ has
been historically linked to post-structuralism and psychoanalysis and has gained increased
currency as these approaches inform current social constructionist, deconstructive and
discursive approaches. What all of these approaches share is an understanding of identity
and experience as constructed through social processes, which involve power and sys-
tems of meanings, and as lived through by individual subjects. Subjectivity is seen as
complex, distributed and fragmented, permeated by social and discursive processes, yet
intimately personal, as the subject invests these processes with desire and turns them
to the very stuff of his or her being (Blackman, Cromby, & Hook, 2008; Branney,
2008).
Starting from this social constructionist viewpoint, we aim to highlight in this paper
the processes through which subjectivity is constructed both in psychotherapy itself and
in the processes of studying psychotherapy. This view is not shared by many of the psy-
chotherapies and the approaches to psychotherapy research we will be reviewing. Thus,
throughout the paper, we will use the term ‘subjectivity’ when developing our own
arguments, but when presenting the different research trends we will retain the terms
they use to refer to subjective experience and identity.
Subjectivity in narrative and discursive approaches

Below, we introduce briefly the main features of each of the language-based methods
with a particular emphasis on how they analyse talk and then we outline how each
method has approached subjectivity in the context of psychotherapy. Although there are
many issues regarding the definition and boundaries between the language-based
approaches, they all assume the centrality of meaning and view meaning as constructive
of human experience and as constructed within interaction (McLeod, 2001; Willig,
2001). Language-based analysis is considered coextensive with the theory and practice of
therapy, and in particular with the recent constructionist and postmodern approaches to
psychotherapy, as they both take place through language, both emphasise the mutual
negotiation and co-construction, between therapist and client, of the client’s problems
and their solution, as well as the role of cultural narratives or discourses in both the pro-
duction and alleviation of human distress (McNamee & Gergen, 1992; Parker, 1999).
On the other hand, there are also significant differences between narrative, discourse and
ª 2009 The Authors Social and Personality Psychology Compass 3/5 (2009): 654–670, 10.1111/j.1751-9004.2009.00196.x
656 Narrative and Discursive Approaches
conversation analysis with regards to epistemology, underlying theory and actual method-
ology (for a discussion of these issues, see Avdi & Georgaca, 2007b).
With regards to the process of analysis, conversation analysis is a detailed examination
of the organisation and regularities of verbal interaction. Its aim is to highlight the rules
of social organisation of everyday and institutional exchanges (Schegloff, 1997). Narrative
analysis focuses on the ways in which people make and use stories to interpret the world
and their self in it, and it examines both the content and the structure or organisation of
the stories people narrate (e.g. Riessman, 1993). Discourse analysis draws upon social
constructionism, which is based on the assumption that reality and experience are socially
constructed through interpersonal processes and by socially available systems of meaning
(discourses). It is a method of tracing the modes through which the phenomena under
study have been constructed, through interactional processes and the deployment of
wider discourses (Willig, 2001).
With regards to the study of subjectivity, most of the language-based analyses of psy-
chotherapy rely on narrative and discursive approaches to analysing language. The lack of
conversation analytic studies on subjectivity reflects its emphasis and epistemological com-
mitments. As already mentioned, conversation analysis aims to detail the processes
through which everyday and institutional practices are interactionally constituted and
makes no claims regarding the speakers’ internal or psychological processes (Antaki, 2004;
Peräkylä & Vehviläinen, 2003; Schegloff, 1997; Silverman, 1997). In contrast, subjectivity
is a notion that has been widely discussed and debated within narrative and discursive
approaches, as we briefly discuss below.
Narrative psychology is a term that includes several approaches, all of which centre on
the notion of narratives, i.e. stories that link events over time and provide a sense of tem-
poral continuity and coherence in one’s life story (Bruner, 1990). Narration is considered
to be intimately linked with one’s sense of self, in the sense that this is continuously
reconstructed through the stories we tell about our life. These stories are shaped by previ-
ous experience, current circumstances and the powerful presuppositions regarding self-
hood and the ‘good life’ provided by specific cultures (McAdams & Janis, 2004). In
narrative psychological approaches, the notions of narrative identity and self-narratives are
central to accounts of the human subject. In general, in narrative psychology, subjectivity
is conceptualised as a reflexive process, sustained by the appraisals of the individual and
others and by the shared meanings that arise from social interaction. Self-narratives or
macro-narratives refer to the main storyline that connects various micro-narratives (or
stories about specific events) in a coherent whole. These function to reconstruct the past
and anticipate the future in such a way as to provide life with meaning and coherence
(McAdams, 2006). Self-narratives also provide the means through which a person’s dis-
rupted sense of self, associated with psychological difficulties or following a traumatic
experience, can be rebuilt (Neimeyer, 2004).
Narrative psychological approaches draw both from social constructionism and from
phenomenology and existentialism (Crossley, 2000). These divergent theoretical alle-
giances create tensions which are reflected in the diversity of approaches to analysing nar-
rative (for a more detailed discussion, see Avdi & Georgaca, 2007b). With regards to
approaching subjectivity, two main trends can be discerned in the narrative research on
therapy. The majority of studies assume a constructivist approach to narrative; that is,
they rely on the assumption that the individual actively constructs their world and attri-
butes meaning to it on the basis of narrative structures. These studies focus on the repre-
sentational aspect of language, whereby narrative characteristics are seen to reflect some
aspect of the client’s inner mental state, and narrative coherence is considered to be a
central aspect of effective or health-promoting narratives. A much smaller group of stud-

ies assume a social constructionist approach to narrative, that is to say they assume that
the social and psychological world is produced and reproduced through interactions and
practices, which take place in specific socio-historical contexts. These studies tend to
focus more on the diversity, fluidity and complexity in narrative production rather than
on coherence.
Discursive approaches, on the other hand, draw exclusively upon social construction-
ism. They emphasise the role of language and discourse in constituting reality and identity
and attribute a functional role to language in negotiating reality, agency and accountabil-
ity. In other words, language and discourse are seen as constructive, functional and vari-
able (Wetherell, Taylor, & Yates, 2001a,b). In these approaches, subjectivity is described
as a discursive accomplishment, jointly constructed in specific interactions and within the
broader framework of culturally available systems of meaning. Subjectivity is seen as fluid,
dynamic, reflexive, fragmented, multiple and polyphonous. In line with this, subjectivity
has been described as ‘‘the personal enactments of communal methods of self-accounting,
vocabularies of motive, culturally recognizable emotional performances and available sto-
ries for making sense’’ (Wetherell & Edley, 1999, p. 338).
Over the years, there have been several attempts to examine the links between dis-
course and subjectivity. One of the issues that has been debated relates to the limitations
of discourse determinism, that is the assumption that culturally available discourses define
experience and identity, and therefore shape subjectivity. Discursive approaches have
been criticised for being limited in terms of accounting for continuity, change and resis-
tance to dominant discourses and their associated positions (Henriques, Hollway, Urwin,
Venn, & Walkerdine, 1998). Discursive accounts of subjectivity have also been criticised
for overplaying the disorderly, chaotic, fragmented, variable and flux-like nature of the
self, and for tending to lose touch with the phenomenological and experiential realities of
everyday, practical living, whereby most of us experience ourselves in terms of continuity
and coherence (Crossley, 2000). Moreover, on a theoretical level, it has been argued that
the turn to discourse, which views the self as a category in talk, runs the risk of reverting
to some version of ‘blank’ or ‘uncomplicated subjectivity’ akin to a humanist version of
the person as a reflective and autonomous agent (Georgaca, 2005; Parker, 1994). In this
context, several authors have turned to psychoanalysis, as an approach that may help
explain individuals’ investments in particular discourses and subject positions, reflected in
the observation that we tend to position ourselves in relation to particular discourses and
experience a sense of continuity and coherence over time. This trend has produced
several fruitful, yet contested, attempts to combine psychoanalysis with discursive analysis
(e.g. Branney, 2008; Frosh, Phoenix, & Pattman, 2003; Frosh & Young, 2008; Georgaca,
2005; Gough, 2004; Hollway & Jefferson, 2000; Parker, 2005a,b). Others, however, have
questioned such attempts mainly in terms of issues regarding authorship and the limits of
interpretation (e.g. Frosh & Emerson, 2005; Gavey, 2002; Søndergaard, 2002).
In addition to the different methodologies employed, the studies reviewed here also
adopt different ways of conceptualising subjectivity (see Table A1). More specifically, the
studies that examine the construction of subjectivity in the context of therapy can be
organised in two main groups, according to the main concept they utilise to theorise
and analyse subjectivity. The first group of studies is based on the understanding of
subjectivity as a set of ‘voices’ engaging in ‘dialogue’, while the second approaches
subjectivity through the notion of ‘subject positions’. In addition to these main groups,
there are several studies that utilise versions of language-based analysis and that focus on
specific aspects of subjectivity, using various linguistic and narrative markers of identity
construction. We will start by briefly presenting this more mixed group of studies and
then move to the two main groups.
Linguistic markers of identity construction

Several studies examine therapy sessions from a language-based perspective and focus on
various aspects of the client’s talk, as reflecting aspects of his or her subjectivity. One
feature of the client’s subjectivity that has been examined from a language-based per-
spective relates to the self-analytic or self-reflective function. These studies (Nye, 1994;
Wodak, 1981, 1996) assume that good outcomes in therapy are associated with an
increase in self-reflection, which in turn is analysed in terms of specific linguistic features
of the client’s talk. Self-reflection has also been studied through the Narrative Process
Coding System (NPCS) a systematised method for analysing psychotherapy transcripts
(Angus, Levitt, & Hardtke, 1999). Particular emphasis for positive therapy outcome is
placed in this approach on shifts in the use of reflexive sequences in the clients’ talk and
a number of studies have documented how this takes place in the course of therapy
(Angus et al., 1999; Angus & Bouffard, 2002, cited in Angus, Lewin, Bouffard, &
Rotondi-Trevisan, 2004; Laitila, Aaltonen, Wahlström, & Angus, 2005; Levitt, Korman,
& Angus, 2000). Other studies of therapy focus on the notion of coherence. These share
the assumption that ‘good’ narratives are coherent, that psychological difficulties are asso-
ciated with narrative rupture or disruption and that therapy facilitates and promotes nar-
rative coherence. The studies attempt to demonstrate the ways in which the level of
coherence of the client’s narrative increases in the course of therapy (Kühnlein, 1999;
Meier, 2002; Meier & Boivin, 1997, 1998, 2000; Neimeyer, 2004; Neimeyer, Herrero,
& Botella, 2006).
In brief, the studies presented above are epistemologically constructivist and they focus
exclusively on the client’s talk. In terms of methodology, they employ mainly narrative
approaches to analysis. Although the term subjectivity is not used, they assume that
self-reflection and coherence, respectively, are integral parts of a ‘healthy’ self and set to
demonstrate how this self is promoted through therapy. These studies generally adopt a
traditional psychological perspective on the self, as internal, coherent and reflective, in
line with the culturally dominant perspective of self-contained individualism (Sampson,
2003). As such, they provide an analysis of therapy process which focuses on aspects of
subjectivity and draws upon the notion of narrative, while at the same time the analysis
can be easily assimilated and implemented in clinical practice. On the other hand, by vir-
tue of their assumptions regarding the self, these studies do not make a significant contri-
bution to discussions regarding either subjectivity as constructed in therapy or to wider
contemporary debates regarding subjectivity.
Voices and self-dialogues

A number of studies draw upon the notion of the dialogical self in approaching subjectiv-
ity as evidenced in, and constructed through, therapy talk (Hermans & Dimaggio, 2004;
Hermans & Kempen, 1993). In this framework, the self is assumed to resemble a poly-
phonic novel that contains a multitude of internalised voices engaged in dialogue. In
other words, the self is seen as the product of ongoing conversations both within and
between persons, a dynamic multiplicity of different, and sometimes opposing, voices in
interaction. Central to this conceptualisation of the self are the notions of ‘voice’, ‘self-
dialogue’ and, more recently, ‘self-position’ (Hermans, 2006; Lysaker & Lysaker, 2006).
In this framework, an important assumption regarding the self is that it is multiple, i.e.
that it consists of many voices, rather than one, unitary voice. Therefore, tensions, con-
flicts and contradictions between voices are considered intrinsic features of a well-
functioning multi-voiced self. Also important in this framework is the notion of
organisation; the various voices are considered to be more or less organised in a hierarchi-
cal structure, whereby the stories told in some superordinate voice have more authority
in defining identity than those told by other voices. The experience of coherence and
integrity of the self is seen to result from ongoing conversations (both internal and exter-
nal) and as occurring in an ongoing interplay of competing and contradictory voices
(Lysaker & Lysaker, 2004), rather than the result of a unitary voice that dominates all
others. Finally, another important notion regarding the self in this literature relates to the
presence of a superordinate, reflexive meta-position that can observe and talk about the
other positions; this is a notion closely linked to the psychological notions of meta-
cognition, self reflection and, arguably, mentalisation (e.g. Bateman & Fonagy, 2004). In
the dialogical self model, thus, psychological well-being is associated with the breadth,
fluidity and coherence in the use of various voices and the existence of an organising and
reflexive meta-position. Psychopathology is considered to result from the fragmentation
between the I-positions and ⁄ or the dominance of one I-position over others. The aim of
therapy, accordingly, is to facilitate a reconstruction and reorganisation of the client’s
position repertoire in such a way that the client can move flexibly between positions
(Hermans, 1997).
A considerable number of studies have recently been published that examine subjectiv-
ity explicitly within the framework of the dialogical self, an approach that broadly belongs
to the narrative tradition. The analysis aims to identify the various voices involved in the
narrative and the interactions between them in a rather descriptive way. Moreover, the
analysis relies on examination of both the content (in terms of what the various self-
positions say) as well as the organisation of the client’s talk (in terms of the interactions
between the various self-positions). Epistemologically, the dialogical self approach is based
on both constructivist and social constructionist assumptions (Hermans, 2001). However,
most analyses that employ the notion of voices to study psychotherapy tend to focus on
the clients’ narratives, which are assumed to reflect some underlying internal organisation
or structure with virtually no analysis of the dynamics of actual dialogue as it unfolds in
the therapeutic encounter.
Several themes can be discerned in the research literature that utilises the notion of
voice to analyse subjectivity in therapy talk. Some dialogical self studies of psychotherapy
draw on the assumption that psychological well-being is associated with a multiple or
multi-voiced self and focus on the breadth of self-positions evidenced in the client’s nar-
rative. More specifically, several studies demonstrate how therapy facilitates the articula-
tion of different voices of the self and increased polyphony (Elliott & Greenberg, 1997;
Hermans, 1997, 2001, 2006; Lysaker, Lancaster, & Lysaker, 2003). Other studies analyse
disorganisation in client narratives as a marker of pathology and demonstrate the
increased coherence and organisation in the clients’ narrative as a result of therapy
(Dimaggio & Semerari, 2001, 2004; Lysaker & Lysaker, 2006; Salvatore et al., 2006).
Part of this trend is the formulation of typologies of disorganisation or dissociation
between voices, such as Dimaggio and Semerari’s (2001, 2004) classification of ‘ineffec-
tive’ narratives into impoverished and disorganised narratives and Lysaker and Lysaker’s
(2002, 2004, 2006) typology of narrative disorganisation in schizophrenia, which
includes barren, monological or cacophonous narratives. Another theme in the dialogical
self studies is that of the emergence, through the process of therapy, of a reflexive
meta-position. This theme is explored, for example, in the studies by Dimaggio,

Salvatore, Azzara, and Catania (2003) and by Georgaca (2001), concerning cognitive
constructivist and long-term psychodynamic therapy respectively. Finally, a systematic
approach to identifying and analysing voices in therapy talk is the Dialogical Sequence
Analysis, which draws upon cognitive analytic therapy and Bakhtin’s theory (Leiman,
1997, 2002). This approach is interesting, as it focuses on the interaction between thera-
pist and client and is not restricted to the client’s talk, although published studies to date
have focused mostly on illustrating the system rather than making claims regarding the
process of therapy.
In summary, there exists a growing body of research that focuses on the dialogical
aspects of the clients’ narrative. These studies generally suggest that the process of change
in therapy can be evidenced in the development of richer dialogues between the main
characters in the client’s narrative, a decrease in disorganisation or dissociation, as well as
in the development of a reflexive, observing meta-position. In other words, the aspects of
subjectivity studied in this literature relate to narrative multiplicity, coherence, integration
and self-reflection. The dialogical self approach provides a clear system for conceptualising
and studying subjectivity, as well as changes in the client’s sense of self, in the process of
therapy. The notion of voice provides a way of approaching and describing complexity
in the client’s subjectivity, which can fairly easily be assimilated into cognitive construc-
tivist, psychodynamic, narrative and humanistic approaches to therapy. As such, it is a
notion that ostensibly makes intuitive sense to many practitioners and may thus be useful
to clinicians. On the other hand, in most of this work, narrative is analysed as primarily
an individual construction. This individualised and decontextualised view of narrative
ignores the interpersonal nature of narrative production as well as the role of the wider
sociocultural context in the content and form that narratives take. Despite their theoreti-
cal commitment to dialogism, in practice many of these studies risk collapsing into a tra-
ditional psychological conceptualisation of subjectivity as an internal entity, expressed
through and reflected in a variety of voices. As such, although we believe that the notion
of the dialogical self provides a useful perspective in approaching subjectivity, which has
the potential to highlight both its constructed and experienced aspects, most of the
research on therapy to date has failed to fully exploit its potential with regards to either
the study of shifts in subjectivity through therapy or to wider contemporary debates
regarding subjectivity.
Subject positions
The second main way in which subjectivity has been studied in language-based analyses
of therapy is through the notion of subject position (Davies & Harré, 1990), a notion that
refers both to how a speaker is positioned in particular interactions and to how he or she
is positioned through particular discourses. Importantly, subject positions exist in a net-
work of power relations that allow certain experiences and actions to take place, while
prohibiting others (Willig, 1999). Most of the studies in this section draw on social con-
structionism and mostly, although not exclusively, employ versions of discourse analysis.
This is not surprising, as the very notion of subject position is closely related to social
constructionist attempts to formulate subjectivity (Burr, 1995).
The studies in this section are presented according to the main theme they address.
Initially, we discuss studies that examine the breadth of the subject position repertoire
available to individuals as well as the flexibility with which these positions are taken up.
Then, we turn to studies that employ the notion of subject positions to discuss issues
relating to agency. Finally, we present studies that examine the role of wider discourses,
including discourses created and maintained through psychotherapy itself, in constructing
versions of subjectivity in the process of therapy.
There are a number of discourse analytic studies that focus on the flexibility with
which clients employ a diverse range of discourses and subject positions in the course of
therapy (Avdi, 2005; Frosh, Burck, Strickland-Clark, & Morgan, 1996; Madill &
Barkham, 1997). These studies assume that psychological difficulties are established and
maintained through a recursive process which involves a narrowing of the repertoire of
available discourses and subject positions. Accordingly, it is assumed that therapeutic
change is related to an enhancement of the clients’ ability to flexibly adopt a wider range
of discourses on the same theme, to hold more complex views and to accept others’ per-
spectives. Indeed, it has been claimed that the flexibility with which clients position
themselves can provide an outcome variable in psychotherapy research (Frosh, Burck,
Strickland-Clark, & Morgan, 1996). This view is compatible with the emphasis of the
dialogical self-approach on the significance of fluid interchange between multiple voices
of the self.
Another issue regarding subjectivity that has been examined is that of agency. Agency
is a thorny issue in social constructionist accounts, given its theoretical affinity with the
humanist tradition and the ‘modernist psychological subject’, a subject which is ahistori-
cal, decontextualised, over-psychologised, self-contained and over-controlled (Bayer,
2002; Henriques, Hollway, Urwin, Venn, & Walkerdine, 1998). Consequently, the vari-
ous studies that examine the negotiation of agency in therapy talk assume different posi-
tions with regards to agency. More specifically, some assume that agentic subject
positions are indeed associated with psychological well-being and, as such, the emergence
of such positions in the client’s talk is used as evidence of therapeutic change (Burck,
Frosh, Strickland-Clark, & Morgan, 1998). Other studies note the promotion of agency
in therapy and make reference to the set of sociocultural assumptions regarding subjectiv-
ity thus evoked, without, however, discussing the implications, on an ideological or polit-
ical level, of therapy furthering such assumptions (Avdi, 2005; Madill & Barkham, 1997;
Madill & Doherty, 1994). Finally, a small number of studies approach therapy as part of
the ‘psy-complex’ (Ingleby, 1985; Rose, 1985), an institution that promotes certain ideals
regarding subjectivity, and assume a critical stance towards the promotion of agency
through therapy talk. For example, Guilfoyle (2001, 2002) persuasively demonstrates how
psychotherapy functions to promote specific, culturally sanctioned modes of subjectivity,
in line with the ideal of self-contained individualism. This brings us to the next group of
studies that explore the role that systems of knowledge play in constructing subjectivity
in therapy.
This group of studies uses the notion of positioning in relation to specific discourses
and studies the role of these discourses in the construction of particular versions of sub-
jectivity in the clinical dialogue. Many of these studies employ post-structuralist discourse
analysis (Willig, 2001), although other analytic approaches such as constructionist
grounded theory (Hook, 2001, 2003), Foucauldian analysis (Hodges, 2002) and construc-
tionist narrative analysis (McLeod & Lynch, 2000) have also been used. They examine
the ‘lay’ and ‘expert’ discourses participants employ in constructing their accounts and
pursuing their respective discursive agendas and note the subject positions associated with
these discourses. Some of these studies also explicitly examine the implications these dis-
courses have for the clients’ subjectivity.
The medical discourse is one of the hegemonic discourses examined in this literature
(Avdi, 2005; Dallos & Hamilton-Brown, 2000; Dallos, Neale, & Strouthos, 1997). These
studies are generally critical towards the medical discourse, as it is seen to define con-
straining subject positions for the ‘patient’, which function to individualise and patholog-
ise human distress and to limit possibilities for action. Subjectivity here is studied in
relation to the subject positions of ‘expert’ and ‘patient’ and the emergence of nonpatho-
logical, nonmedical accounts is generally seen to be associated with well-being. Another
discourse relating to subjectivity that has been examined in several studies relates to gen-
der and gender roles (Burman, 1992, 1995; Foreman & Dallos, 1992; Kogan, 1998;
Kogan & Gale, 1997; Madill & Barkham, 1997; Madill & Doherty, 1994; Soal & Kottler,
1996). Other systems of knowledge that have been examined include ‘moral’ discourses
regarding what constitutes a ‘good life’ (McLeod & Lynch, 2000) as well as discourses
regarding family and culture (Roy-Chowdhury, 2003; Soal & Kottler, 1996).
Psychotherapeutic discourses are systems of meaning which contain ideals regarding
‘healthy’ or ideal selves that have been constructed by psychotherapy as an institution and
are maintained through its practices. These ideals are not explicitly stated in many psy-
chotherapeutic traditions and most often are not consciously acknowledged by therapists.
However, they function as reference points, with respect to which therapists organise
their interventions and direct the therapeutic process. The final group of studies we
review examines the role played by psychotherapeutic discourses in the construction of
the clients’ problems and their subjectivity. Again, studies differ with regards to the
position they take with regards to psychotherapy. Some assume a neutral stance towards
psychotherapeutic discourses, often in an attempt to attain ‘ethnomethodological
indifference’, and aim to describe in detail how therapy gets done in practice. These tend
to use conversation analysis to describe in detail the linguistic and interactional practices
that make up the institution of psychotherapy. In a series of papers (Davis, 1986; Miller
& Silverman, 1995; Peräkylä, 2004, 2005; Peräkylä & Silverman, 1991; Peräkylä &
Vehviläinen, 2003; Vehviläinen, 2003) and a recent edited volume on conversation
analysis and psychotherapy (Peräkylä, Antaki, Vehviläinen, & Leudar, 2008), several
authors have attempted to link the theory of psychotherapy with the way it is actually
practiced. It has been argued that such conversation analyses can help clinicians examine
how the therapeutic theories (or discourses) they adhere to are put into practice, as well
as situations where practice involves aspects of interaction not theorised or interactions
that clearly diverge from that which theory advocates (Peräkylä, Antaki, Vehviläinen, &
Leudar, 2008). These studies do not make explicit claims with regards to subjectivity,
given the focus of conversation analysis on interaction, but assume that participants in
therapy actively and competently engage in their respective institutionally defined tasks.
Another set of studies investigate the role of psychotherapeutic discourses from a more
critical position, and many rely on Foucault’s view that versions of the self are produced
through institutional complexes of power and knowledge and are subsequently internalised
by individual subjects through professionally induced processes of talking about, examining
and understanding oneself (Foucault, 1980). In this framework, psychotherapy is approached
as an institutional practice that produces certain types of subjectivity through inviting partic-
ipants to talk about themselves in particular ways (Kogan & Brown, 1998). Moreover,
therapists are shown to selectively attend to and mould the issues brought by the client,
reformulating them and transforming them into ‘psychological problems’ in need of expert
intervention. This process usually entails the reframing of difficulties as psychological, inter-
nal, individual and pathological and at the same time decontextualises them from the
interactional and social context of the client’s life (Hook, 2001). Accordingly, therapy
produces a ‘psychological subject’, which most often complies to the ideal of the self-con-
tained individual (Sampson, 2003). This ‘psychological subject’ is considered a prerequisite
for therapy to be rendered relevant and necessary, while it is also arguably necessary for
therapy to be effective (Guilfoyle, 2001). A number of discourse analytic studies explore the
ways in which psychotherapeutic discourses regarding the source of client difficulties and
ideal subjectivity are implicated in therapy sessions (Burman, 1992, 1995; Guilfoyle, 2001;
Hak & de Boer, 1995; Hodges, 2002; Hook, 2001; Kogan, 1998; Roy-Chowdhury, 2003;
Soal & Kottler, 1996; Stancombe & White, 1997).
In summary, the considerable body of research which analyses the construction of sub-
jectivity in psychotherapy using the notion of subject positioning assumes a social con-
structionist view of subjectivity as constituted through interactions and shaped by
discourses. Correspondingly, most studies employ discursive forms of analysis of therapy
sessions. Client problems are seen in this approach as arising from the use of a limited
range of discourses, usually culturally dominant pathologising discourses, which restrict
the range of subject positions that can be adopted and as a result the client experience
and understanding of themselves. Therapy is seen as a process of shifting the dominance
of these discourses in a double move of replacing them with more empowering discourses
and enabling the client to move flexibly, drawing upon a variety of discourses. This
results in the adoption of more varied and empowering subject positions and therefore
the enrichment of the client’s experience and self-understanding. While all studies agree
that the above is what takes place in therapy, they vary widely regarding the extent to
which this process is seen as neutral, positive and effective. Some studies on the critical
edge of the spectrum, for example, view the replacement of pathologising discourses with
more empowering ones as effectively the installation of psychotherapeutic discourse and
the enhancement of the client’s agency in adopting a variety of discourses as the turning
of the client to a psychotherapeutic self-contained individualist subject. The majority of
these studies, consistent with their theoretical, epistemological and methodological alle-
giances, demonstrate the construction of subjectivity through the interactions between
client and therapist and show how discourses of various kinds shape the understanding of
the client’s self and problem throughout therapy.
The construction of subjectivity in psychotherapy

We hope to have shown in this review the complexity and range of studies that address
issues pertaining to subjectivity in the context of psychotherapy. This review has been
comprehensive, including studies which explicitly address aspects of subjectivity in their
analysis of psychotherapy sessions, although we would not claim it is exhaustive. More-
over, the diversity in both the methodologies used and analytic notions employed in these
studies makes it difficult for this body of work to be neatly organised. Our aim has been
primarily to show how qualitative language-based analyses can be used, and have been
used, to examine the processes through which subjectivity is articulated and understood in
psychotherapeutic practice. The implications of this are twofold. On the one hand, the
arguments developed and conclusions reached have implications for the practice of psy-
chotherapy, as these approaches carry assumptions regarding the characteristics of the
‘healthy’ self, the nature of pathology or client problems and consequently the direction,
aim and effectiveness of therapy. On the other hand, the issues raised by these studies have
wider implications for theorising and researching subjectivity, beyond the therapeutic set-
ting. The nature of subjectivity has been extensively theorised and debated (see Blackman,
Cromby, & Hook, 2008) and the study of psychotherapy, which explicitly focuses on the
reshaping of the understanding and experience of the client’s self, can be the field par
excellence of studying the processes of the construction and reconstruction of subjectivity.
In this section, we would like to draw the reader’s attention to the links already made
between the theoretical, epistemological and methodological approaches adopted by the
groups of studies presented above, and the repercussions these have for understanding
psychotherapy and subjectivity. The studies presented above fall broadly into two theoret-
ical ⁄ epistemological perspectives, the narrative and the discursive approaches respectively.
Notwithstanding the variability within each approach, the narrative approach includes
both social constructionist and constructivist epistemologies, but, as also evidenced in this
review, the constructivist epistemology tends to dominate the field, while the discursive
approach is on the whole epistemologically social constructionist. This is turn has reper-
cussions for the way in which language is approached – as a reflection of internal individ-
ual processes or as an interactional accomplishment – and for the focus of analysis – client
narratives versus interaction between client and therapist. In the two main approaches we
described, subjectivity is conceptualised as voices in internal dialogue or as a set of subject
positions. In the former approach, subjectivity is viewed as internalised by the client and
expressed in the client’s speech, while in the latter as constituted in the course of thera-
peutic interaction and shaped by culturally available discourses. In both approaches, sub-
jectivity is seen as fluid, multiple and contradictory. In the former approach, however,
more emphasis is placed on organisation, coherence and self-reflection, while in the latter
the emphasis is on the availability of multiple subject positions and flexibility in adopting
them. Pathology is described by the first group of studies in terms of disorganisation
of the internal dialogues or domination of the dialogue by a dominant voice. The aim of
therapy, correspondingly, is to facilitate the development of richer internal dialogues
through supporting an organised polyphony of voices and the emergence of a reflexive
stance. For the second group of studies, pathology results from restricted availability of
subject positions, mainly because of the dominance of particular pathologising discourses.
The aim of therapy, thus, is to open up spaces for the introduction of other discourses
and to enhance the client’s ability to adopt various subject positions.
Overall, the narrative approaches, as they have been utilised in the analysis of therapy
sessions, have tended to be more focused on the client, to promote a more individualist
view of subjectivity and to be either neutral with regard to the assumptions of psycho-
therapy and its power as a social institution or supportive of it. The discursive approaches,
on the contrary, tend to focus on the co-construction of subjectivity in the therapeutic
encounter, to highlight the interpersonal and sociocultural aspects of both subjectivity and
psychotherapeutic practice, and to be more critical of psychotherapy, viewing it as an
institution entrusted with the construction of dominant forms of subjectivity. The value
of each of these approaches for psychotherapy and its usefulness for psychotherapy practi-
tioners is a matter of debate (see Avdi & Georgaca, 2007a,b; Georgaca & Avdi, forthcom-
ing). We consider, however, that reviewing the literature which analyses the ways in
which subjectivity is constructed in psychotherapy can provide very useful insights into
theorising and researching subjectivity, and most importantly into the ways in which the-
oretical, epistemological and methodological approaches intersect into producing and
maintaining specific versions of subjectivity.
Short Biography
Evrinomy Avdi is a Clinical Psychologist and Senior Lecturer in Clinical Psychology at
the Psychology Department of the Aristotle University of Thessaloniki, Greece. Her
research interests lie in the application of discourse and narrative analytic approaches to
the study of various domains of clinical psychology practice, in particular psychotherapy
and health psychology. She is interested in exploring the links between deconstructive
research and actual clinical practice. She is author of articles on discourse analysis on clin-
ical issues, such as diagnosis and psychotherapy, as well as narrative research on issues
relating to health psychology, in the British Journal of Medical Psychology, the Journal
of Health Psychology, Psychology and Psychotherapy: Theory, Research and Practice, European
Psychotherapy, Qualitative Research in Psychology, the European Journal of Psychotherapy,
Counselling and Health, the Hellenic Journal of Psychology and other Greek publications.
Eugenie Georgaca is a Lecturer in Clinical Psychology at the Psychology Department
of the Aristotle University of Thessaloniki, Greece. She teaches, researches and publishes
in the area of social and clinical psychology, and especially qualitative methodology,
psychoanalysis and critiques of psychopathology. She is coauthor of Deconstructing
Psychopathology (Sage, 1995) and author of articles on discursive and narrative analyses of
psychotherapy, psychotic discourse, delusions, subjectivity in psychotherapy and social
constructionist notions of subjectivity in Psychology and Psychotherapy: Theory, Research,
Practice, the British Journal of Medical Psychology, Theory and Psychology, Qualitative Research
in Psychology, the European Journal of Psychotherapy, Counselling and Health, Philosophy,
Psychiatry and Psychology, the Hellenic Journal of Psychology and the International Journal of
Critical Psychology.
Endnote
* Correspondence address: Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki 541 24,
Greece. Email: avdie@psy.auth.gr
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Appendix
Table A1 Table of studies reviewed in the order they appear in the document, the aspect of subjec-
tivity they examine and the method of analysis they employ
Author(s) Aspect of subjectivity studied Analysis employed
Studies examining linguistic markers of identity construction

Nye (1994) Self-reflective function Discourse analysis
Wodak (1981, 1996) Self-reflective function Discourse analysis
Angus, Levitt, and Hardtke Self-reflection (reflexive Narrative Process Coding
(1999) sequences) System, narrative approach
Angus and Bouffard (2002) Self-reflection (reflexive Narrative Process Coding
sequences) System, narrative approach
Laitila, Aaltonen, Wahlström, Self-reflection (reflexive Narrative Process Coding
and Angus (2005) sequences) System, narrative approach
Levitt, Korman, and Angus Self-reflection (reflexive Narrative Process Coding
(2000) sequences) System, narrative approach
Kühnlein (1999) Biographical continuity, narrative Narrative approach
coherence
Meier (2002) Narrative coherence Theme analysis, narrative
approach
Meier and Boivin (1997, Narrative coherence Theme analysis, narrative
1998, 2000) approach
Neimeyer (2004) Narrative coherence Narrative approach
Neimeyer, Herrero, and Narrative coherence Narrative approach
Botella (2006)
Studies employing the notion of ‘voices’
Elliott and Greenberg (1997) Breadth of self-positions, polyphony Narrative approach
Hermans (1997, 2001, 2006) Breadth of self-positions, Dialogical Self, narrative
polyphony approach
Lysaker, Lancaster, and Breadth of self-positions, Dialogical Self, narrative
Lysaker (2003) polyphony approach
Dimaggio and Semerari Coherence and organisation ⁄ Dialogical Self, narrative
(2001, 2004) disorganisation approach
Salvatore et al. (2006) Coherence and organisation ⁄ Dialogical Self, narrative
disorganisation approach
Lysaker and Lysaker (2002, Coherence and organisation ⁄ Dialogical Self, narrative
2004, 2006) disorganisation approach
Dimaggio, Salvatore, Azzara, Reflexive meta-position Dialogical Self, narrative
and Catania (2003) approach
Georgaca (2001) Reflexive meta-position Discourse analysis
Studies employing the notion of subject positions
Avdi (2005) Flexibility in subject positions and agency Discourse analysis
The role of the medical discourse
in shaping subjectivity
Frosh, Burck, Strickland-Clark, Flexibility in subject positions Discourse analysis
and Morgan (1996)
Madill and Barkham (1997) Flexibility in subject positions and agency Discourse analysis
The role of discourses regarding
gender in shaping subjectivity
Burck, Frosh, Strickland-Clark, Agency Discourse analysis
and Morgan (1998)
Table A1 Continued
Author(s) Aspect of subjectivity studied Analysis employed
Madill and Doherty (1994) Agency Discourse analysis

The role of discourses regarding
Guilfoyle (2001) The role of psychotherapeutic Discourse analysis
discourses in shaping subjectivity
Hook (2001) The role of psychotherapeutic Grounded theory
Hodges (2002) The role of psychotherapeutic Discourse analysis
McLeod and Lynch (2000) The role of discourses regarding the Narrative analysis
‘good life’ in shaping subjectivity
Dallos and Hamilton-Brown The role of the medical discourse in Discourse analysis and
(2000) shaping subjectivity Grounded theory
Dallos, Neale, and Strouthos The role of the medical discourse in Discourse analysis and
(1997) shaping subjectivity Grounded theory
Burman (1992, 1995) The role of discourses regarding Discourse analysis
gender and psychotherapeutic
Foreman and Dallos (1992) The role of discourses regarding Discourse analysis
Kogan (1998) The role of discourses regarding Discourse analysis and
gender and psychotherapeutic Conversation analysis
Kogan and Gale (1997) The role of discourses regarding Discourse analysis and
gender in shaping subjectivity Conversation analysis
Soal and Kottler (1996) The role of discourses regarding Discourse analysis
gender, family and culture and of
psychotherapeutic discourses in
shaping subjectivity
Roy-Chowdhury (2003) The role of discourses regarding Discourse analysis
family and culture and of
psychotherapeutic discourses in
shaping subjectivity
Davis (1986) Engagement of clients in Conversation analysis
institutionally defined tasks
Miller and Silverman (1995) Engagement of clients in Conversation analysis
Peräkylä (2004) Engagement of clients in Conversation analysis
Peräkylä (2005) Engagement of clients in Conversation analysis
Peräkylä and Silverman (1991) Engagement of clients in Conversation analysis
Peräkylä and Vehviläinen Engagement of clients in Conversation analysis
(2003) institutionally defined tasks
Vehviläinen (2003) Engagement of clients in Conversation analysis
Hak and de Boer (1995) The role of psychotherapeutic Discourse analysis
Stancombe and White (1997) The role of psychotherapeutic Discourse analysis
Kogan and Brown (1998) The role of psychotherapeutic Discourse analysis

Subjectivity in Psychotherapy

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Subjectivity in Psychotherapy

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Social and Personality Psychology Compass 3/5 (2009): 654–670, 10.1111/j.1751-9004.2009.00196.

Narrative and discursive approaches to the analysis of

ª 2009 The Authors

(e.g. Cushman, 1995; Parker, 1999). As such, we view psychotherapy as a particularly

Subjectivity in narrative and discursive approaches

central aspect of effective or health-promoting narratives. A much smaller group of stud-

Linguistic markers of identity construction

Voices and self-dialogues

meta-position. This theme is explored, for example, in the studies by Dimaggio,

The construction of subjectivity in psychotherapy

Author(s) Aspect of subjectivity studied Analysis employed

Studies examining linguistic markers of identity construction

Author(s) Aspect of subjectivity studied Analysis employed

Madill and Doherty (1994) Agency Discourse analysis

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