This article draws upon an extensive review of narrative, discourse, and conversation analyses of psychotherapy in order to outline, critically discuss, and evaluate claims made by these studies regarding the usefulness of these approaches for psychotherapy assessment. These analytic approaches are seen as compatible with the emphasis on language and meaning that characterises much of contemporary therapy theory. The claims regarding what can be evaluated through language-based analysis vary considerably, ranging from assessing the client's problems and/or psychopathology to assessing the degree of change of the client in the process of therapy, the processes through which therapy is carried out, and finally the therapist's interventions. The studies also vary with regard to the extent to which they subscribe to psychotherapeutic assumptions and practices. Along this continuum, the range extends from claims that language-based analysis can be used by therapists themselves to assess clients as part of their routine clinical work to claims that the role of language-based analysis is primarily to evaluate psychotherapeutic assumptions and practices from a critical deconstructive perspective.

This study aims to further theoretical and clinical discussions regarding the therapy of psychosis from a dialogical perspective and to contribute to the contemporary research literature that works toward developing methods for studying the dialogical processes in therapy. Three videotaped sessions of a therapy with a heterosexual couple, in which both partners had psychotic experiences, were analyzed using the Dialogical Investigations of Happenings of Change, a method developed with an aim to capture the dialogical qualities of multiactor conversations. The analysis illustrated shifts in the dialogical characteristics of the conversation through the sessions and associated shifts in the clients’ positioning, toward increased agency, as well as enrichment of the narratives regarding their difficulties. The gradual development toward more dialogical conversations, evidenced mainly in increased sharing of dominance and therapist responsiveness and participation, seemed to facilitate the joint construction of new words and meanings, the expression of strong feelings, the narration of difficult experiences, and increased agency. The findings support the view that a client's sense of agency, which can be particularly impoverished in psychosis, can be reconstructed in the context of dialogue, in which clients have a central place in telling their story.