Academic journal article Journal of Marital and Family Therapy

Conversational Evidence in Therapeutic Dialogue

Academic journal article Journal of Marital and Family Therapy

Conversational Evidence in Therapeutic Dialogue

Article excerpt

Family therapists' participation in therapeutic dialogue with clients is typically informed by evidence of how such dialogue is developing. In this article, we propose that conversational evidence, the kind that can be empirically analyzed using discourse analyses, be considered a contribution to widening psychotherapy's evidence base. After some preliminaries about what we mean by conversational evidence, we provide a genealogy of evaluative practice in psychotherapy, and examine qualitative evaluation methods for their theoretical compatibilities with social constructionist approaches to family therapy. We then move on to examine the notion of accomplishment in therapeutic dialogue given how such accomplishments can be evaluated using conversation analysis. We conclude by considering a number of research and pedagogical implications we associate with conversational evidence.


In family therapy, conversation is usually seen as part of the therapeutic process and evidence is viewed as outcome. Process (conversation) affects outcome (evidence); both are intertwined and inseparable. Yet, one usually characterizes evidence in outcome research as being something far more measurable and tangible than the unquantifiable properties of conversation and discourse. In psychotherapy research, evidence of successful outcome is predominantly defined by test scores usually employed after and outside of the therapeutic conversation. Still, the nature of conversation is valued by therapists as facilitating outcomes by establishing and maintaining a therapeutic alliance (Bordin, 1994; Horvath & Symonds, 1991; Luborsky, 1994). In this article, we meld together two key process-outcome concepts, conversation and evidence, into "conversational evidence" for evaluating outcomes in psychotherapy. Larner (2004) recently pointed out that in family therapy, there are significant politics around what should constitute the evidence guiding practice. For us, conversational evidence is a tangible, empirical, and justifiable form of outcome evidence useful for examining therapeutic change. Accordingly, we present the case that family therapy outcome evaluation could involve conversational evidence as one form of evidence among other forms.


We share a view with a number of social constructionist practitioners and researchers; that, to be helpful, therapeutic dialogue needs to elicit meaningful change clients prefer (Andersen, 1991; Bird, 2000; Ferrara, 1994; Gale, 1991). For dialogue to be meaningful speakers need a sense that they are understood, if not influential and mutual with each other. Such dialogue typically occurs in relationally responsive ways that speakers take for granted-that is, unless they feel misunderstood or at odds with each other. At such points speakers have conversational work to do. They turn to each other's responses for evidence that this work is creating shared understanding and perceived forward movement for them. In this sense, speakers are practical interpreters of each other, deriving what they say and do from what was said and done by their conversational partners as the dialogues they contribute to develop. Such dialogues typically occur without much need for conversational and interpretive work because history, cultural, and relational experiences have already created a common ground of understanding. But, through dialogue, speakers work out new understandings and ways of going forward together, and this is especially the case in rhetorical endeavors like family therapy.

Depicting therapy as a rhetorical endeavor may, for some readers, seem repugnant. Such a depiction places therapists in the same league as salespeople or politicians, but therapy has long been depicted this way by researchers and therapists (Frank, 1973; Maranhào, 1986; Roy-Chowdhury, 2003). seen as a practice where an aim is to put language to effective use vis-à-vis clients' presenting concerns, however, we feel rhetorical can be an apt word to reflect therapists' mindful awareness and use of talk. …

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