Talk about what might be helpful:
: Relating meta-therapeutic dialogue to concrete interactions and exploring the relevance for therapeutic practice

  • Sarah Cantwell

Student thesis: Doctoral Thesis


This thesis investigated how clients and therapists discuss the means by which clients can work towards their therapeutic goals. Cooper et al. (2016) termed such discussions meta-therapeutic communication or meta-therapeutic dialogue and Cooper and McLeod (2011) recommend carrying them out since outcomes are robustly related to whether the client accepts the therapeutic strategy as appropriate for their needs (e.g. Horvath et al., 2011). This thesis undertook the first discovery-oriented, Conversation Analysis (CA) study of how clients and therpaists actually carry out meta-therapeutic discussions. It represents a sustained attempt to bridge the practice-research gap and highlights the conceptual and practical challenges in doing so. 42 audio-recorded pluralistic therapy sessions were sampled across seven therapist-client pairs. Before carrying out the CA study proper, it was necessary to conceptually link broad descriptions of meta-therapeutic dialogue to participants’ concrete actions in therapy sessions. This involved a review of related concepts (Chapter Two), as well as a detailed conceptualization of how therapists’ stocks of interactional knowledge (SIKs) (Peräkylä & Vehviläinen, 2003) regarding meta-therapeutic dialogue might demonstrably link with their concrete actions as described by CA findings (Chapters Three through Five). Therapists’ questions to clients about what might be helpful were selected as a likely site for meta-therapeutic dialogue and were subjected to an in-depth CA investigation of the practical issues participants themselves treated as important in their interactions around these questions (Chapters Six through Eight). Findings show how some apparent opportunities for meta-therapeutic dialogue are less facilitative of clients’ independent input, and can sometimes be interactionally coercive. There is evidence that facilitating dialogical opportunities for talking about what might be helpful may require the therapist to move back-and-forth between opposing positions, such as treating the client as potentially unknowing but still also holding open a space for their contribution. These findings extend existing SIKs regarding meta-therapeutic dialogue by specifying some concrete considerations therapists orient to during such endeavours. Some practical similarities between meta-therapeutic dialogue and problem-solving/solution-focused approaches are also highlighted.
Date of Award12 Feb 2018
Original languageEnglish
Awarding Institution
  • University of Roehampton
SupervisorJohn Rae (Supervisor) & Jacqueline Hayes (Supervisor)


  • Pluralistic psychotherapy, Metatherapeutic dialogue, Shared decision-making, Conversation analysis, Personalization therapy process

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