“If she had helped me to solve the problem at my workplace, she would have cured me”: A critical discourse analysis of a mental health intake

Critical approaches in psychology and social work criticizing the current mainstream psychotherapy discourse have been gaining more ground in recent decades. Yet, little empirical research has, to date, explored therapy in regular practice to identify the discursive resources employed during the clinical encounter and the way such discourses create and maintain power differences and the boundaries of the therapeutic interaction. This paper is rooted within a post-structural perspective based on Foucauldian analysis which sees power as dispersed throughout the social field and emphasizes the multiple ways in which power differences are created and maintained through accepted forms of discourse and knowledge. Data were drawn from a large study of mental health intakes in clinics in Israel working with culturally diverse populations. We conducted critical discourse analysis on a single dyad including transcription of a recorded intake session and post-intake interviews with the client and the therapist. Based on existing critique of psychotherapeutic discourse for its individualistic and apolitical view, we explored how the hegemonic psychotherapy discourse is negotiated in real practice, the ideology it carries, and the power differences it perpetuates. We shed light on the way this discourse conceals social injustice and contributes to the disempowerment of the client and ultimately to a poorer quality of services.