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'Living moments' in dialogical exchanges



In this article, we want to discuss Tom Andersen's focus on the role of certain special kinds of 'arresting', 'moving', 'living', or 'poetic moments' occurring in therapeutic dialogues. In doing this, we see him as exercising a special practice, the practice of a social poetics (Katz and Shotter, 1996). As we s ee it, instead of seeking a universal, cognitive understanding of such events, supposedly revealing of their true nature, a social poetics must 'move' us toward a new way of 'looking over', or participating in, the particular 'play' of unique events unfolding in the conversations between us. It is only by being able continuously to create new links and connections between events within that 'play', in practice, that those involved in a dialogue with each other can reveal both themselves and their 'worlds' to each other. And it is in such living moments between people, in practice, that utterly new possibilities can be created, and people 'live out' solutions to their problems they cannot hope to 'find' in theory, solely in intellectual reflection on them. We explore Bachelard's, Bakhtin's, and Wittgenstein's work in relation to these issues.
In Human Systems, 9, pp.81-93, 1999
John Shotter
Department of Communication, University of New Hampshire,
Durham, NH, U.S.A.
Arlene M. Katz
Department of Social Medicine, Harvard Medical School,
Boston, MA, U.S.A.
Abstract: In this article, we want to discuss Tom Andersen’s focus on the role of certain special
kinds of ‘arresting’, ‘moving’, ‘living’, or ‘poetic moments’ occurring in therapeutic dialogues.
In doing this, we see him as exercising a special practice, the practice of a social poetics (Katz and
Shotter, 1996). As we see it, instead of seeking a universal, cognitive understanding of such
events, supposedly revealing of their true nature, a social poetics must ‘move’ us toward a new
way of ‘looking over’, or participating in, the particular ‘play’ of unique events unfolding in the
conversations between us. It is only by being able continuously to create new links and
connections between events within that ‘play’, in practice, that those involved in a dialogue with
each other can reveal both themselves and their ‘worlds’ to each other. And it is in such living
moments between people, in practice, that utterly new possibilities can be created, and people
‘live out’ solutions to their problems they cannot hope to ‘find’ in theory, solely in intellectual
reflection on them. We explore Bachelard’s, Bakhtin’s, and Wittgenstein’s work in relation to
these issues.
“... the life in which we therapists are particularly interested in comprises meanings and feelings
which shift all the time; they are there for a second and have passed away the next second” (Tom
Andersen, MS in press, p.2).
“... at the still point, there the dance is...” (T.S. Eliot, Four Quartets)
In the Epilogue to his 1991 book “The Reflecting Team: Dialogues and Dialogues about the Dialogues,” Tom
Andersen notes that among the things he would have omitted if he had been writing it now, would have been the
words explain and explanation: “These words belong, as I see it today, to that part of the world where the physical
sciences exist,” he says (p.157). In other words, the activity of explaining things belongs, as Wittgenstein (1953)
would say, to a particular “form of life” with its associated “language-game.” As such, it belongs to a particular
disciplinary sphere of human activity in which one must ‘get things right’: in such spheres, one must act according
to pre-established standards, and talk and/or write about things in accord with procedures for proving one’s
statements true. In this limited sphere “the movements of the inner life are so slow that it looks as though [things are]
dead,” Tom Andersen adds (p.158). In contrast, “the world that we who use dialogue as a ‘method’ for change work
in is composed of living [our emphasis] people and their meanings... If I had written the book today, the words
explain and explanation would have been replaced by understand and understanding,” he [end p.81] writes (p.158).
For, to continue Tom Andersen’s comparison, human problems in psychotherapy are not addressed by seeking new
pieces of information, to solve them by explaining them. They are solved by therapists helping their clients create
new ways of understanding things already known to them, to create new ways of ‘going on’ in their lives by
interconnecting and relating old facts in new ways. In such a process as this, “we want to understand something that
is already in plain view. For this is what we seem in some sense not to understand,” says Wittgenstein (1953, no.89).
We seek a way of talking which leads to “just that understanding which consists in ‘seeing connections’” (no.122),
which can draw a client’s attention to some of the other possibilities open to them that their current forms of talk led
them to overlook.
In this account of Andersen’s work, we want to draw attention to the central value he puts on living
activities and processes. We want to fashion a new way of talking and writing that reflects this same value: that
relates to human phenomena - not as something dead, to be talked about - but as something living that must be
related to in a living way. As we see it, words do not on their own do anything: they do not stand for things, nor
represent ideas. They have a meaning only in those situations in which living human beings make some use of them
in relating themselves to other living human beings. In these situations, living people bodily respond to each other’s
utterances and voicings, and in so doing, not only do they relate themselves to each other, but they also relate
themselves to their surroundings. However, as already completed patterns, representations of such voicings and
utterances risk lying dead on the page (or in the reader?). They lack a living involvement with their surroundings;
they do not point or gesture toward anything outside themselves. But, if we view people’s words in their speaking
as deeds, as actions, as doing something - rather than as already spoken forms or patterns - then we can see people’s
living, voicing of their words as serving “countless different kinds of use” (Wittgenstein, 1953, no.23). Indeed, a
crucial use of words is to ‘move’ or to ‘strike’ others by the saying or the writing of certain words at certain
moments, to use such words to draw their attention and ours to aspects of their own sayings and doings, to unique
details of their lives, that might otherwise passed us both by unnoticed, and particularly, to yet-to-be-created relations
between such details. Indeed, as Andersen says: “Some words touch the speaker such that the listener can see the
talker be moved” (MS in press, p.5). We shall call this way of talking relational-poetic, and, as we shall show, it is
an important aspect of Tom Andersen’s psychotherapeutic practice.
We feel it is important to draw attention to it here, as it is a way of talking that leads to a kind of
understanding that is both extraordinary (in the sense of it is still unfamiliar in our talk and writing ‘about’
understanding) and ordinary (in the sense of it being utterly commonplace) at the same time. To contrast it with the
“representational-referential” form of understanding more well known to us in our intellectual studies, in which,
individually, we ‘picture’ states of affairs, we shall call the kind of understanding to do with us, in a dialogical
situation, ‘seeing connections’, a “relationally-responsive” form of understanding (Katz and Shotter, 1996). It is a
kind of understanding which can begin in just those moments when a speaker pauses after [end p.82] having finished
their utterance, and awaits another’s response to it. For it is in such moments as these - if we are not just to act
routinely and mechanically, according to pre-established demands - that we must responsively bridge a gap or an
opening. And to do that, we must spontaneously create a connection or relation appropriate to the unique
circumstances at hand. Indeed, it is just moments of this kind that Tom Andersen explores when he notices a shift
in a client’s being (in relation both to him and to their circumstances) as they utter a certain word, and he asks the
person: ‘If you looked into that word, what would you see?’ Beginning with such moments, relationally-responsive
understandings can be articulated further:Answers to these kinds of questions have let me learn that there are
always emotions in the words, there are other words in the words, sometimes sounds and music in them, sometimes
whole stories, sometimes whole lives,” he says (MS in press, p.6). Such words can take a grip on our being to such
an extent that we can find ourselves ‘possessed’ by them; our further actions can be ‘rooted’ in them; and as we
continue to respond to their reverberations in us, they can change us in our being.
Much is at work, then, in these moments when, to use Bachelard’s (1991) terms, a new “poetic image” is
suddenly originated in us, when a new “flare up of being in the imagination” occurs (p.xiv). For, to bestruck’, or
‘arrested’ by another’s words, is not just to understand them in terms of a single kind of connectedness, so to speak,
to fit them into an already well-known, single form of life - thus merely to elaborate its rule over all else - but to find
oneself resonating to a whole multiplicity of other, many quite new possibilities. As Bachelard (1991) puts it with
respect to a poem: “In the resonance we hear the poem, in the reverberations we speak it, it is our own. The
reverberations bring about a change of being. The multiplicity of resonances then issues from the reverberations’
unity of being... The image offered us by reading a poem now becomes really our own... It becomes a new being in
our language, expressing us by making us what it expresses; in other words, it is at once a becoming of expression
and a becoming of our being. Here expression creates being” (pp.xviii-xix). And it is to the special nature of such
poetic images originating in arresting moments - to their possession of a fullness of sense, of seeings and hearings,
of touchings and feelings, of flavors and smells, and so on - that we wish to draw attention.
Three vignettes
In order to have something to think with or through, we would like to begin with three moments that we were
arrested by in practice.
In a halting but increasingly clear voice, in the reverie following a reflecting process consultation (in which
Tom Andersen was in fact the consultant), after the comments of the reflecting team, the wife in a couple offered:
“It’s the tenderness...that’s something that is real easy to lose sight of...It gives me the ability to take a
deeper breath and go back into the world... It’s like hearing English again in a foreign country...” [end p.83]
Another client, at the end of a session in which he had been invited back to reflect on the practice of psychotherapy
as he had experienced it, on how things were currently for him, and on what he was now struck by, said:
Though who I am is nebulous and still emerging, I am no longer confused and lost. The pain that’s part of
my life is now a sense, not a fixed concept... Maybe something has changed in me that I don’t have to
know... there are so many mysteries... like life has so many mysteries...
And in a medical teaching setting, in the course of reflections following an interview, an elderly man - who had been
invited in, not for therapy, but to help medical students learn about interviewing (Katz and Martin, 1994) - shifted
from expressing his sense of despair to being a teacher, to telling the students the meaning of an ordinary, but crucial
experience for him in his life:
“I think that’s true of anyone in a nursing home if there’s no place for them to go, they just begin to wonder,
‘What good am I?,’ I think that’s a natural thing.”
And in the course of its telling, in the change from ‘patient’ to ‘teacher’, his body changed, from that of a man in
pain, withdrawn from the world, to that of an active agent, engaged in the life around him.
There is something special, we feel, in the voicing of utterances such as these. They are voiced by people
who are speaking, not only for themselves, individually - as they had previously - but now also, with others,
dialogically. Instead of merely talking about themselves, what they say is voiced ‘into’ a conversational space
between them and the others around them; their talk is now both relational and responsive. In moments such as these,
rather than simply having to play out a role assigned them in an alien reality, people feel able to play an immediate
and active part in the joint constructing and elaborating of a shared reality. Whereas, previously they had talked
mainly of their own past pain and disorientation, their own past confusion, they are now exploring something that
has become important to them from within the shared moments between them and the others around them. The first
reminds us of how easy it is to lose sight of tenderness - of that special caring way in which one feels valued as a
someone, as who one is, without have to ‘work at it’ - and how she can now take a “deeper breath,” for it feels like
‘coming home’ in a foreign country. The second tells us that his pain has become a part of the background to his
daily life, not a foreground ‘thing’ demanding his continual attention. The third wants to tell doctors an important
fact about the lives of those in nursing homes. And there is now a fluidity and energy in their voicing of their
utterances, a bodying forth of their words into the world that was lacking in their previous demeanor. Why? Because,
we suggest, they have now become participants in a special form of life; they have come to inhabit a new ‘world’
such that they now feel invited or motivated to give these kinds of response - a ‘world’ in which they feel they are
safe, in which they belong and have a rightful place.
But what has occasioned such a change as this? What occurred, moment by moment, such that this form
of life - in which they feel ‘at home’ and are now energized to go on with new options, with a new stance - came to
replace their previous forms of life [end p.84] in which they were ‘stuck’, ‘imprisoned, ‘silenced’, or just otherwise
reduced’ in some way. Indeed, to go further, what is it about the ‘atmosphere’ created in this way of working, of
people interrelating with each other, such that its effects can appear, not only in psychotherapy, but in many other
different domains: in medicine, clinical work, research, teaching, and in ordinary, daily life? How might we get a
grasp, a sense, or a ‘picture’, of this kind of ‘world’? And, is there is something special in Tom Andersen’s style of
relating to those around him thatinvites’ them into such a form of life?
Tom Andersen has, in his writings, of course, discussed the nature of the issues involved here, drawing his
inspirations in the past from Bateson, Maturana, and Goolishian. Stimulated by Harry Goolishan’s turn to
Wittgenstein and to a moreconversational stance - he emphasizes a way of talking with people that is a poetic,
lively, involved form of talk. Thus, rather than metaphors emphasizing a single order of connectedness, Andersen
uses living, moving, feelingful metaphors, such as, exchanges in conversations as the rhythms of inhalation and
exhalation of breath, of words as ‘touches’ or bodily ‘movements’, of them as having a ‘forming’ as well as an
‘informing’ part, and so on. For, as Andersen sees it, “talking is a bodily activity, [and] the whole body is formed
or re-formed in the moment of an utterance... Life is therefore ‘composed’ of small events, which, each of them
happen only once” (MS in press, p.7); and in this process, “language and words are like searching [and shaping]
hands,” he says (MS in press, p.7). Indeed, in our use of language, in our speaking of our words, we embody a way
of proceeding, of ‘going on’, of orchestrating the flow of our energies, a rhythm of acting, shaping, stopping,
reflecting, switching positions, revising, looking back, looking forward and sideways, and so on - we embody ways
or styles of responsively relating to our circumstances, shifting between different activities at different moments.
Andersen’s noticing of ‘moving moments’ in dialogue.
Central to our whole account of Tom Andersen’s style of psychotherapy here, then, is our noting of his focus on
certain phenomena rather than others: those to do with the fact that we are living. And, just as Wittgenstein (1981)
claims that “only in the stream of thought and life do words have meaning” (1981, no.173), so Andersen also claims
that “every word is part of the moving of the body. Spoken words and bodily activity cannot be separated” (MS in
press, p.5). Or, to put it another way, “language lives only in the dialogic interaction of those who make use of it”
(Bakhtin, 1984, p.183). And there are two points that he especially emphasizes that we would also like to mention:
One is, that he attends to the relations between bodily rhythms of breathing and the rhythm of people’s shifts between
listening, thinking, and talking, the small pauses before the start of inhaling and the start of exhaling, and so on.
Indeed,there are so many similarities between the exchanges of conversation of a fellowship and the exchanges
of breathing of an individual that I let the understanding of one,” he says (p.32), “inspire the understanding of the
other... During the cycle of conversation one also [as in breathing] needs a small pause before talking (acting) and
a small pause before listening [end p.85] (sensing)... Conversations needs pauses, enough for the thinking about the
process of the conversation to take place.” About such pauses Bakhtin (1986) remarks, “these pauses differ
essentially from both grammatical and stylistic pauses... One expects them to be followed by a response or
responsive understanding on the part of another speaker” (p.74). Indeed, without such pauses, without others
responding to details and nuances, without participants taking the time needed to let each other’s utterances resonate
within them, the conversation between them cannot be a caring conversation. Witness in this connection the words
of the first woman mentioned above: for her too, the ability to ‘go back into the world’ is associated with the ability
to take a deep breath again, to pause, to able again to take time to ‘take in’ what is around her.
Tom Andersen also notes the fact that “the body works without the mind’s noticing it” (p.26); or, to put it
another way, that “an interesting overall discovery [over the years] has been that practical changes occurred first...
[and are] followed by attempts to understand the changes...” (p.167). Indeed, Andersen quotes Harry Goolishian as
saying: “We don’t know what we think before we have said it” (MS in press, pp.7-8) - and here we can add
Wittgenstein’s (1953) comment: “Let the use of words teach you their meaning” (p.220). In this respect, not only
the remarks of the second client are noteworthy - that something has changed in him that he’s not wholly aware of -
but also his attitude toward his lack of knowledge: it doesn’t upset or disturb him. In fact, as we shall see, he’s
‘intrigued’ by it; it opens a door to new possibilities. To put it briefly: In this sphere, our practices of a new life often
seem to precede the theory of them. Indeed, as we shall suggest, once we understand how to reflect on our life’s
practices... in practice... we can then reflect on our living of our lives... as we live them... moment by moment...
rather than, as it were, having to take ‘time out’ from them, and to view them as if from afar, in terms of a theory.
In making such observations as these, Tom Andersen, we feel, has drawn the attention of all of us to
something very crucial in the therapeutic process that has not yet been sufficiently articulated or elaborated: the
momentary, bodily ‘moving’, not-easily-picturable, ‘living’ nature of our conversational practices. He emphasizes
the momentary, shifting nature of our responsive-relational understandings. For, as living beings, we cannot be
indifferent to the world around us. We must continuously react and respond to it directly and immediately, whether
we like it or not, without having ‘to work it out’, and in so doing, we connect and relate ourselves spontaneously
to our surroundings in one way or another. Indeed, it is this that gives the human voice its power: As we give voice
to our words into the world, it is not just the static form or the picturable patterns of our words that is important; but
our unfolding bodily movement in their production. The others around us cannot not respond to our voicings, to our
utterances. Thus others, in our presence as individual, active “I’s,” do not move independently of us; their
movements are not wholly their own; they are ‘colored’ by our, individual movements - but our individual
movements are also colored’ by theirs. Thus, the momentary movement between us is not individually ours or theirs
alone, but ours as a “we.” Activity of this shared, dialogical kind - which elsewhere called “joint action” (Shotter,
1993a and 1993b) - always gives rise to the experience that [end p.86] what is created within it, is experienced as
an ‘it’, as an external, objective entity - as not yours nor mine, but as ours. Thus, not only is a reality with its own
kind of existence constructed between us, but also, as a result of our involvements in such moments, we come to
embody a certain selective sensitivity, a sensibility, a certain way of reacting and responding to our surroundings
from within the relations between us constituting them. And these jointly shared backgrounds are the “seen but
unnoticed” (Garfinkel, 1967, p.41) backgrounds to all else that happens between us.
Andersen’s talk of such bodily inter-activities is indicative, we feel, of the fact that all changes in the being
of an individual, in their sensibilities, originate in joint, social, or dialogical exchanges, in processes that go on, not
first as ideas in one or another person’s head, but are woven into the fabric of activities between them, in their
practices. Indeed, what constitutes a life with a living flow to it, a life in which one does not feel ‘stuck’ or
‘imprisoned’ within a stagnant backwater, is a life in which one feels one understands what is occurring as it occurs,
a life in which one can continually creatively respond to the novel and unique features of one’s circumstances in an
ongoing, shifting manner. Such a form of life seems to involve in its practical conduct just that kind of ‘orchestrated’
understanding which, as we have already noted, that consists in ‘seeing connections’, first in one way and then
another, which we have called a ‘responsive-relational understanding’.
The nature of this kind of ‘shifting’, ‘mobile’, relational form of understanding maybe unfamiliar to us -
at least against the traditional theoretical and philosophical background of what the nature of our understanding is
usually taken to be, i.e., as some thing ‘in’ our individual heads or minds, rather than something ‘in’ our social
practices. Thus we must try to point out its singular, but nonetheless, everyday ‘living’ nature straightaway: Consider,
for example, living in a city. After a while, we can develop such a ‘sense’ of the relations between its streets and
squares, and so on, that we can ‘move around’ in it with a degree of comfort. That is, we can ‘go on’ from where we
are to where we want to get to, without it ever being necessary for us to be able to bring to mind a single, overall,
fixed picture of it. Our use of language is somewhat similar: we are confident in our interrelating of its parts, and
in relating our use of it to our current circumstances, but we cannot say in any simple sense what its nature as a
unitary whole is. As ‘in’ our journeys through our city so in our talk: we just simply and continually show that we
‘know’ it in our continual use of it. Indeed, we can exhibit such relational forms of understanding in the same
‘moment-by-moment’, practical way - i.e., in practice - for instance, our knowings of what a person is, a society, a
self, a mind, or a relationship; the style of an artist’s paintings, a genre of writing, our grasp of a philosophy or a
theory, etc, and so on.
These are all concepts with “blurred edges” (as Wittgenstein (1953, no.71) put it in discussing our
knowledge of games); they are ‘things’ or ‘styles’ that we know in practice, without the practice yielding up to us,
any single, fixed and distinct picture upon which it is seemingly based. Thus, if we do have to explain to someone
what “games” are, we cannot do it by giving a simple definition or single example; we give a whole range of
examples. As Wittgenstein (1953) remarked: “One gives examples and intends [end p.87] them to be taken in a
particular way. - I do not, however, mean by this that he is supposed to see in those examples that common thing
which I - for some reason - was unable to express; but that he is now to employ those examples in a particular way”
(no.71). And the fact is, there are many living human activities, practices, of this kind, in which never seem to come
to possess a single, overall, final, fixed, God’s-eye-picture’ of their overall character. Yet, we can often become
fairly sure of the kinds of phenomena that nonetheless will ‘belong together’ to make up a whole. So, although we
cannot form a simple, describable image - for there is always something else any such a image always fails to capture
- we are nonetheless able to continually and confidentlymake connections’ in various spheres of activity as required
in practice. In other words, what we grasp in our living involvements with cities, language, with a collection of
paintings, with a friend’s behavior, with all human phenomena that are in some sense in a living relation to each
other, is an embodied way of acting in relation to them, i.e., what we have already called either a form of life, or a
This is why the differences that make a difference (Bateson, 1972, p.453) are so hard to locate and to
identify in such forms of understanding. For the differences are not to be found in static pictures, nor in fixed inner
mental representations or ideas, but in the moving, momentary, dialogic, living relationships that occur in the streams
of life between us. Or, to put it another way, the new ideas, or thoughts, or images that we think of as coming to
guide our ways of acting in the world do not just spring into our heads ‘out of the blue’; they originate in differences
(in relations) which have a sensed connection: whose origins are to be found in our spontaneous, unnoticed,
responsive or dialogic bodily reactions and relations to our surroundings. Where, as Andersen (1991) says, a idea
has the character of a “glimpse,” a momentary noticing of an aspect of a “moving picture,” containing “all the
qualities that correspond to the senses of seeing, smelling, tasting, touching and also sensations frominside’ the
body...” (p.23). So how can we capture what is meant by such a kind of momentary understanding if we cannot
capture it in a single, fixed and comprehensive picture?
Paradoxically, we can still do it by the giving of pictures, but now we must do it by the giving of two or
more pictures, with the hope that the kind of understanding “which consists in ‘seeing connections’” will emerge in
us ‘seeing’ the relations or connections, the ‘movement’, between them. As Andersen comments: “Many people have
not grasped Bateson’s idea. They believe that there is one correct history and one correct picture... [But] those
following Bateson’s idea might be intrigued by what they heard that another person saw or heard or smelled or tasted
or touched in the situation - things which s/he did not notice. These new aspects of the moving ‘picture’ of the
situation could stimulate differences in his/her own evolving ‘picture’.. And these differences contribute to the
person’s shading his/her moving picture” (p.17). Hence his additional comment that “questions that often clarify
problematic situations are those that comprise comparisons and relationships” (p.17).
Putting Bateson’s ‘idea’ in the language of ideas, however, still too easily invites, we feel, the language of
static pictures; we move too easily back into talk of things hidden inside the heads of individuals, and fail once again
to take notice of events happening [end p.88] out in the space between them. Thus, we would like to try to steer a
course toward a language of momentary doings, of changing activities, of practices and movements. For if, as
Andersen remarks, the meanings and feelings in which we are interested are there for a second and have passed away
the next, then one of the tasks of a therapist is to say something that that will help people both recollect what they
already know, but now re-arranged so as to reveal new connections and relations not before grasped or even
glimpsed... at the moment it will help! To do that, we must say something about the special nature of such moments.
So let us begin to move in that direction by introducing the notion of dialogic, living relationships - and the idea of
reflecting on our practices in the practice of them - through some examples.
Reflecting on practices in practice
“... And do not call it fixity
Where past and future are gathered...” (T.S. Eliot)
An example of the kind of momentary, ongoing circumstance that intrigues us, is mentioned in Tom Andersen’s
(1991) book. He writes of a meeting with a family, in which the teenage daughter of the mother’s first marriage often
ran away, and also did some shoplifting. The mother had had two new babies, and the stepfather seemed more
attentive to his own two children than to his stepdaughter. As Andersen puts it, the nature of the crucial event is as
follows: “One of the team members, feeling that the teenager had been excluded from the new family, talked about
how he thought the girl might feel. When he reached the words, “Maybe she feels she is excluded,” he had difficulty
continuing. The feelings in the team member were so strong that he had to take several breaks to be able to finish.
The family was stunned, and the runaway and shoplifting disappeared overnight” (p.62).
How should we understand the family’s understanding of such an event? What is it to be momentarily
‘stunned’, to be ‘struck’, ‘arrested’, or ‘moved’, by another person’s words? What is occurring in such a moment?
How is it, that the crucial change seemed to emerge from out of the exchange without any problem-solving thought,
argument, deliberation, reasoning, persuading, etc., having to take place?
With these questions in mind, we return to the second client mentioned above: after finishing therapy, he was
invited in to reflect on how things are now, as well as affording us another vantage point from which to articulate
our practice in practice - another form of reflecting process that adds the voice of the client (Katz, 1991). In the
course of these reflections, this young man talked of his initial sense of alarm and loss of intuition: “When I first
came in, I was suffocating, now its changed in intensity and in proportion to the rest of myself. Though who I am
is nebulous and still emerging, I am no longer confused and lost. The pain that’s part of my life is now a sense, not
a fixed concept. A lot of the time, its just normal... It may be there but the sense of alarm is gone.” This alarm -
about the sudden onset of strange, involuntary, bodily movements that had at times been accompanied by shaking,
screaming, and even striking himself – had been [end p.89] increased by the range of explanations of those he
consulted with previously: a meditation teacher, body workers, a psychic, a Jungian analyst and two past-lives
therapists. In contrast, he now described the recent clinical work... as “just talk,” but of a particular sort: “ was
different because we just talked... we could like bite off what we could chew or something. And so we just focused
on my family and things like that mostly, which was really helpful, and sort of stabilizing in a way, you know”... “It
opened up new ideas... the kind of talk we have here; on the way here I may have a thought, and it opens a new door
- it just seems to fit.”
As he looked back, he recounted that early on in the work the movements began to die away gradually. Though
he now had a different sense, or understanding of these movements, he still could not explain them. “And maybe
that’s something changed in me, that I don’t have to - like there’s so many mysteries... “ As he now spoke, this sense
of ‘mystery’ seemed very different from the bewildering nature of his initial alarm: “You don’t have to be threatened
by a mystery. And before I’d felt threatened. It was like a... darkness... I was petrified by it. Now I sense a lot of
depth in myself or something; somehow it’s not so threatening.” And when asked what he thought had got the
movements to die away, there was a long, long pause; he took deep breaths, and answered:
Well... (long pause)... I’m not sure, but, maybe - though this is just a thought - it was something that was
trying to draw my attention to certain things, like my relationship to my family, and once I’d started paying
attention - and I know there’s a lot more work, and a lot’s been done - that maybe that was... kinda like a
message... although I don’t know, to tell you the truth... But I’m not sure how important it is to know... (our
And, as he talked of his past experiences, he ‘re-experienced’ the alarm of the ‘movements’ and loss of his intuition
‘in’ his talking of them. He ‘showed’ in his embodied gesturing of his words how the sense of ease in his body had
been previously replaced by a fixed sense of disconnection. He recounted how his need to know, or sense of ‘not
knowing’, had previously ‘arrested’ him, how back then, it had felt like choking - a fixed sense of terror. As he spoke
now, in direct contrast, there was a sense of movement, that he could ‘go on’ with his life. What he was struck by
at this moment had a very different character to it: rather than fixity or stuckness, there was a shifting, moving stance,
a coinciding of both stillness and movement. As he moved back and forth from being in the experience to reflecting
on it, new possibilities emerged, and with it a new “sense of his own agency” (Goolishian, pers. comm). In his words,
he described a journey of how his initial sense had changed from ‘alarm’ to ‘mystery’, and then to ‘just one of those
things’: “One thing is that it’s over and it doesn’t really matter... Its not like arresting my life the way it was before..
it was really choking...Coming to psychotherapy was really healing... now a different thing I’m dealing with - a new
day, a new problem.”
Let us underscore this: the energetic way he spoke embodied a new ability to reflect on his living of his life, not
just with us, but with and for himself, in the course of his [end p.90] living of it. His utterances contained multiple
stances, and as he spoke, his movements were now fluid and responsive rather than static and repetitive. In coming
to embody these poetic-relational forms of talk (as is clear from the transcripts above), rather than his body being
alien to him, he became re-embodied: that is, as Andersen notes (see above), he was ‘struck’ or ‘moved’ to reflect
on his own words by his own very speaking of them. He shifts continually, moment by moment, between different
ways of being, different ‘worlds’. In such shifting moments, as we have said, there is a simultaneity of both stillness
and motion. His talk is now rooted in his life’s experiences - “though who I am is nebulous and still emerging, I am
no longer confused and lost” - and he now speaks from within each experience, moving back and forth from the past
to his present sensibility, and to possibilities for the future. And as he does so, he shifts from reflecting on new
possibilities from within a past experience, to looking back on it from the present... all the time navigating in these
shifts, between the past alarm, the equanimity of the present, to the possibilities he now saw in the future. In his
utterances, he seems to fluctuate, moment by moment, between participating in a number of different dialogues that
all, however, seem to have a similar focus... within the ‘movement’ of his talk. There now seems to be a “still point,”
a sense of where for him “the dance is.” He seems to possess, not a single “poetic image” of his life’s course, but
a way of creating such images as and when required: “... the pain that is a part of my life is now a sense, not a fixed
concept,” he says. The move to this state of affairs seemed to have been occasioned by a “something that was trying
to draw my attention to certain things, like my relationship to my family...” (see note three). He has become the
beneficiary of a new, dialogical way of being, a new relational practice, that was created jointly, by him and his
therapist, as the openings (the gaps and pauses) unfolding in the dialogue between them were spontaneously bridged.
Thus now, it is as if this client has come to incorporate within himself a variation of the kind of dialogue
involved in the reflecting process. And so doing, he can move from talking with the therapist (reflecting on her
practice), to a similar dialogue within himself, and from being within it to reflecting on it, and so on. In this shifting
dialogicality, he can move among and be responsive to a whole range of situated realities, and in speaking and
recognizing all the different voices arising from them, he shows that he now knows his ‘way about’ in his own life;
he has come to feel ‘at home’ in it. So, although he cannot predict all his life ahead of time, he is only alarmed about
not knowing how to ‘go on’ when it arrests his life, if there were to be a fixity, a stuckness... if the ‘shifting
movement’ in his life were to get stuck...
Above, then, we have focused on the importance Tom Andersen attaches to the special, living moments in people’s
talk when they are ‘moved’,struck’, orarrested’ by what they say, when a shift in their (and our) being occurs. As
he himself remarks, “the words that prompt these movements are the ones that particularly attract my interest”
(Andersen, MS in press, p.5). Such moments can only occur between living human beings, in [end p.91] reacting
and responding to each other’s speech, as they spontaneously bridge the gaps opened up between each other in a
dialogue. They are of crucial importance because it is in these fleeting moments that something utterly extraordinary,
utterly new and unique, spontaneously occurs: new “poetic images” (Bachelard) are created in the dialogical spaces
between people... that can, perhaps, if responded to appropriately, become incorporated into people’s ways of being
in the world. The essence of a poetic image, as Bachelard (1991) notes, is its “fullness,” it is “essentially variational,
and not, as in the case of the concept, constitutive” (p.xv); it has a sensed, complex, mobile ‘shape’ to it rather than
a stable, fixed structure. Thus, instead of specifying a single order or dimension of connectedness, they seem to
awaken indefinitely many forms of connectedness that afford unending exploration. Again, as Bachelard (1991) puts
it, they take “root in us,” they “become a new being in our language, expressing us by making us what it expresses”
(p.xix); they originate new forms of life in us.
These open, poetic forms of talk can appear, however, in many contexts, not only therapeutic ones. Indeed,
because they are originating forms of talk, they can be carried outside the consultation room - witness the evidence
from our second client above. For they involve ways of talking, the use of words, that gesture toward something in
one’s circumstances at the moment of their use. Let us finally, return to a glimpse of the old man in our third vignette
above. In the initial medical interview his despair was palpable as he recounted his past experiences of being in a
rehab center following surgery, and his sons came to him to inform him that he was going to a nursing home. His
life had become more and more narrow and unfamiliar to him. Unfamiliarity turned to loneliness and loneliness to
isolation. A shift in his whole demeanor came, however, when, after the interview, he was included in the reflections
on the interview. He began to participate in a quite different way; he shifted from being the object of their concern,
to being there with them, in the moment, with something of worth to tell them. From being a patient, he shifted to
being a teacher, as he, among other things offered, “Well, I would have liked to have been asked [about going to the
nursing home]. I would have liked to have a try on my own. The outcome probably would have been the same, but
I would have liked to try a bit on my own.” The change in the old man’s ‘energy’ and sense of connection was
striking; he sat up, became active and alert, his attention now fluctuating between what the others were saying and
what he wanted to say himself. Now, the momentary space between all present was open to a multiplicity of
possibilities, to other ways the old man could ‘be’. He became someone with dignity and self-worth.
Andersen (Ms in press) discusses precisely this circumstance as he talks about the shift from professional
language to ordinary language, to the words of the client: “Neither individuals nor families is a certain way. They
change all the time. In periods a family is enmeshed, in others disconnected. In some contexts social... Being a
therapist it is most easy to make a family that appears happy to feel guilty and ashamed and angry... And it is not the
most difficult to make a family that appears sad to feel happy. The therapist I try to be myself is not to concentrate
on what the family is, but to find out, together with them, how they might live their lives differently” (MS in press,
p.10). But to [end p.92] do this, he must help to set a certain scene, to stage a certain form of life, one of an open,
creative, conversational kind that invites or affords the clients the opportunities to entertain (to play with) different
meanings that are meaningful to them. How he does this, the nuances and details of it, is what we have tried to
celebrate in what we have written here: how people can be afforded the dignity to explore possibilities for living their
lives differently, and more fully.
Andersen, T. (1991) The Reflecting Team: Dialogues and Dialogues about the Dialogues. New York: Norton.
Andersen, T. (MS in press) Language is not innocent. In F. Kaslow (Ed.) The Handbook of Relational Diagnosis.
New York: John Wiley and Sons.
Bachelard, G. (1991) The Poetics of Space, trans. by M. Jolas. Beacon Press: Boston.
Bakhtin, M.M. (1984) Problems of Dostoyevsky’s Poetics. Edited and trans. by Caryl Emerson. Minneapolis:
University of Minnesota Press.
Bakhtin, M.M. (1986) Speech Genres and Other Late Essays. Trans. by Vern W. McGee. Austin, Tx: University
of Texas Press.
Goolishian, H. (pers. comm to AMK)
Katz, A.M. (1991) Afterwords: continuing the dialogue. In T. Andersen (Ed.) The Reflecting Team: Dialogues and
Dialogues about the Dialogues. New York: W.W. Norton.
Katz, A.M. and Martin, M. (1994) The Patient as Teacher: Multiple Perspectives on the Interview Process,
(instructional videotape), Boston, Harvard Medical School.
Katz, A.M. and Shotter, J. (1996) Hearing the patient’s ‘voice’: toward a social poetics in diagnostic interviews.
Social Science and Medicine, 43, pp.919-931.
Shotter, J. (1993a) Cultural Politics of Everyday Life: Social Constructionism, Rhetoric, and Knowing of the Third
Kind. Milton Keynes: Open University Press.
Shotter, J. (1993b) Conversational Realities: the Construction of Life through Language. London: Sage.
Wittgenstein, L. (1953) Philosophical Investigations. Oxford: Blackwell.
Biographical notes:
John Shotter is a professor of interpersonal relations in the Department of Communication, University of New
Hampshire. He is the author of Cultural Politics of Everyday Life: Social Constructionism, Rhetoric, and Knowing
of the Third Kind (Open University, 1993), and Conversational Realities: the Construction of Life through Language
(Sage, 1993). Currently, he is Senior Faculty Fellow in the Center for the Humanities, University of New Hampshire.
Arlene Katz is an instructor in the Department of Social Medicine at Harvard Medical School and is a psychologist
with a specialty in family therapy and consultation. She has created two video productions, The Patientas Teacher:
Multiple perspectives on the Interview Procecess (Harvard Medical School, 1994) and the other honoring Harry
Goolishian (1992). Her research interests include cultural responses to illness and a dialogical approach to the
patient-doctor relationship.
... We can look at their schedule during the day of the event, or the day before, or even the day after etc. I trust the conversation and start" living moments" in dialogical exchanges Shotter and Katz (1999). ...
All aspects of our life are ruled by the concept of „fast society” - from fast food to „fast (on-line) relationships” and, in turn, to „fast therapy”. Clients and counsellors alike are in a rush to find a quick way to solve the problem. This approach to „panic attack” problems could sometimes lead to a dead end. What is more, this dynamic of the therapeutic process could increase the client’s confusion and let the sensation of fear unexplained. The following paper puts forward three case studies, where the „not-knowing” position of the therapists unlocks the situation, helping the clients become aware of the elements from context that are connected to their fear. The meanings behind the attacks are revealed in the conversational field when the therapist stops their search for explanations and becomes patient enough to be curios and invite the client to explore detailed stories of their daily life.
... Trata-se de uma linguagem alusiva, e não objetiva ou "referencial". Não é um modo de fala que busca explicar ou solucionar os dilemas humanos, mas construir entendimento conjuntamente, tecendo novas relações entre eventos e conectando velhos fatos de novas maneiras (Shotter & Katz, 1998;Shotter, 2017). ...
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“Este livro é fruto de um precioso percurso de comprometimento e dedicação dos autores, que se envolveram na aventura de atenção às famílias no contexto de tratamento de pessoas com graves transtornos psiquiátricos. Um trabalho de fundamental relevância buscando responder às complexas necessidades, questionamentos e dificuldades próprias do desafio de qualificar a atenção psicossocial. O texto apresenta um diferenciado rigor metodológico e aprofundada fundamentação teórica, articulados por uma criativa capacidade reflexiva, diante das demandas que emergiram do trabalho clínico. Desta forma, se constitui como uma valiosa contribuição para o campo da assistência, do ensino e da pesquisa, iluminando com esperança e entusiasmo aqueles que se dedicam à construção de saberes e ao exercício do cuidado. Uma generosa oferta, que nos cabe acolher e agradecer”. Sergio Ishara Médico psiquiatra, mestre e doutor em Saúde Mental pela Faculdade de Medicina de Ribeirão Preto – USP. Coordenador Clínico do Hospital Dia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – USP. “Resultado de muitos anos de prática comprometida e pesquisa dedicada, esse livro explora como é possível promover uma ‘comunicação dialógica’ em contextos de saúde mental. A partir de vários exemplos e ilustrações de práticas situadas, Carla Guanaes-Lorenzi e Pedro Martins ensinam uma visão de comunicação que combina aspectos contextuais e responsivo-relacionais, mostrando como o diálogo não se reduz a uma relação imediata entre falantes, mas é atravessado por várias relações institucionais ao longo do tempo. Este é um livro empolgante que pode interessar a estudantes, pesquisadores, profissionais e todos aqueles que buscam democratizar e humanizar o cuidado em saúde mental” Emerson F. Rasera Professor Titular da Universidade Federal de Uberlândia (UFU), onde atua no Programa de Pós-graduação em Psicologia. Foi Presidente da Associação Brasileira de Psicologia Social. É Bolsista de Produtividade em Pesquisa (CNPQ).
... Exemplar 3: 'keeping on task' (Cl3 = client, Cr3 = counsellor) Shotter and Katz (1999) described, as utterances calling forth a response from us, because there seems something incomplete about them seeking further articulation. This aspect of relationally responsive talk sees speakers do such things as attempt benevolent completions of each other's utterances or hear invitations to ask about matters that seem emotionally incomplete for another. ...
The starting point for many counselling approaches is a goal both clients and counsellors agree upon. This is particularly the case in the social constructionist approaches (solution-focused, narrative, and collaborative language systems) to counselling where particular emphasis is given to language use and conversational practice. In this study, 12 clients were seen by counsellors trained in these counselling approaches for single session lifestyle (i.e. non-clinical) consultations. The consultations were videotaped and passages where goal-articulation occurred were analysed using conversation analysis. As well, both clients and counsellors were independently asked to review such passages in which they had participated, to retrospectively comment on their experiences in these passages. The results speak to often taken-for-granted conversational practices and conversational resources used that can help in optimising the goalarticulation process in ways that satisfy both counsellors and clients
... De todas las estructuras y determinaciones que, si la cosa funciona, deben abrir esta circulación, abrirse a ella. A través del ritmo, dicen, del acuerdo en la expresión, del ajuste de afectos se permite que surja algo de sentido que empalabrar luego (Andersen 2012, Shotter, Katz 1999, Fuchs 2007, 2019. ...
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El artículo expone las condiciones de posibilidad de una comprensión de la psicoterapia que de cuenta de la similitud de resultados de técnicas diferentes. La psicoterapia no consiste en la aplicación de técnicas derivadas de teorías causales empíricas, sino que pertenece a la tradición del cuidado de la vida, sobre la que se diferencia en un aspecto esencial. Donde el cuidado de la vida ha supuesto la adopción de valores prudenciales o morales fundamentados en la naturaleza de lo ente, el cuidado de la vida entendido desde la fenomenología no estándar supone preparar el acaecimiento de un sentido nuevo. En tanto el sentido se incuba en un estrato afectivo impersonal, la psicoterapia procede a preparar este sentido nuevo mediante el trabajo de remoción sobre lo instituido simbólica o habitudinalmente, hasta que la circulación afectiva en interfacticidad pueda dar lugar a un sentido nuevo que recoger, poner en palabras e incorporar, literalmente.
... Hence, the epistemological belief is guided by interpretivism. This implies that one must firstly engage in interactions with the people of study in order for knowledge creation to be enabled (Shotter & Katz, 1999). This is well aligned with the qualitative approach that this study applies, because it allows for exploring how the people under investigation account for their experiences, beliefs and viewpoints (Gergen, 1985). ...
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In recent years, the increasing environmental problems have put mounting pressure on consumers to change behavior to reduce the negative environmental impact of current lifestyles. This applies to a clothing context in which there is an urgent need for more sustainable consumption practices. Despite the reported increasing environmental concerns among young people, secondhand clothing consumption struggles to gain momentum in the Danish market. Therefore, the purpose of this paper is to investigate young Danish consumers’ perception of secondhand clothing consumption. To pursue this purpose, the aim of this paper is to illuminate how young mainstream consumers co-constructively account for their current clothing consumption, and how symbolic meanings of secondhand clothing may refrain them from adopting such consumption practices. Taking point of departure in Consumer Culture Theory, this study employs an exploratory qualitative approach with an empirical outset in four focus groups with a sample of twenty-two young Danish consumers. This is done in order to gain an in-depth perspective that can add to the accumulated pool of knowledge within the academic field of secondhand clothing consumption. Arising from a systematic qualitative thematic analysis, findings point to a highly complex set of personal and social needs that current clothing consumption practices play in the construction of identity for young consumers. This complexity poses challenges towards the young consumers’ adoption of secondhand clothing consumption, when coupled with the diverse set of symbolic meanings and barriers identified in this body of work. Although the findings are highly context-bound, the managerial implications pertain to the role of communication in appealing to young consumers with secondhand clothing and highlights the importance of understanding the symbolic meanings in this market to shape the desired brand image.
... Conceptual starting points * Additional literature to that cited in the text -an incomplete list ** Joint, Interdependence , Mutuality Blumer (1966), Buber (1947), Corcoran and Cromby (2016), Ford, Mattsson, and Snehota (2017), Gergen (1997), Grönroos (2012), Lowe (2022), Shotter (1995a), Shotter (1999a), Shotter and Cunliffe (2003) Times/temporalities, Episodes, Periods, Events Adam (2010), Araujo and Easton (2012), Bluedorn (2002), da Silva and Vieira (2020), Dawson (2013), Halinen and Törnroos (1995), Hall (1983), Hedaa and Törnroos (2002), Langley, Smallman, Tsoukas, and Van de Ven (2013), Zerubavel (1981) Social individuals, Collective actors, Actor, Sensemaking *** Cunliffe and Coupland (2012), Donati (2011), Lowe and Rod (2019), Snehota (2003), Yamauchi (2015), Zerbini and Castaldo (2007) Interaction, Intra-action Blumer (1986), Cunningham (1980), Czarniawska (2006), Goffman (1983), La Rocca (2013), La Rocca, Snehota, and Trabattoni (2015), Turnbull, Ford, and Cunningham (1996) Processes, Relativities according to processes Browning and Myers (1998), Chia (1996), Chou and Zolkiewski (2012), Cova, Pardo, Salle, and Spencer (2015), Ingold (2015), Langley (1999), Nayak andChia (2011), Tsoukas (2017) Dialogic/dialogical, In-between Linell (2009), Medlin and Törnroos (2007), Medlin and Törnroos (2008), Shotter and Katz (1999), Snehota (2014) * There is no order to the list and the concepts are not mutually exclusive even though grouped. The groupings and concepts can be rearranged according to different constructivist ontologies. ...
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Researchers socially accepted understandings, including those embraced from specific academic communities, are critical in how they conduct research and in the way their intuition leads to research questions and methods. An issue is that understandings are often based on unknown and unsuspected presuppositions inculcated in academic communities. This paper presents a meta position of changing viewing points and understandings from which to approach B2B research. The shade vine metaphor is introduced to open a set of different understandings concerning research viewing points as being braided with an entity and temporal process path of development. The ideas are developed by re-appraising the Cartesian epigram and approach, and by presenting an exemplar ‘business interaction’, as understood within the business and industrial network approach. The exposition of possible researcher understandings and presuppositions against the background of research development paths provides a capability to B2B researchers that enhances opportunities for future research, and does so within a frame that encompasses constructivist studies of processes and dynamics. Guidance is provided for research that adopts a temporal rather than a mechanistic process approach. The research viewing points presented, by fore fronting temporality, are likely to aid investigation of sustainability and biodiversity for future generations.
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Este artigo visa compreender o processo de produção de sentidos sobre a mudança em terapia familiar sob a perspectiva construcionista social. A análise do processo terapêutico de uma família apontou que a construção conversacional da mudança terapêutica foi marcada pelo deslocamento do discurso inicial do problema de saúde da mãe, oriundo do trabalho, para o discurso do agenciamento com o cuidado da vida. Tal construção foi analisada em relação a três aspectos centrais: (a) a desconstrução do sentido do trabalho; (b) a redefinição da relação mãe-filha; (c) a reconstrução da vida. A análise permitiu ainda compreender um importante processo subjacente, o agenciamento como forma de promover a mudança terapêutica em terapia familiar. Concluímos que a postura aberta, ativa e engajada da terapeuta com o fluxo da conversa favoreceu a emergência desses sentidos de mudança.DOI
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Based on the paradigm of social constructionism, this study includes a team of nine leaders who are involved as co-researchers in a narratively inspired action research project, with the aim of co-creating new opportunities within the notion of relational leading (Cunliffe and Eriksen 2011; Hersted and Gergen 2013; Hosking 2010). The article examines transcribed excerpts from a dialogical process in the “start-up phase” and discusses how the action researcher’s (the author’s) attention – inspired by relational ethical approaches (McNamee 2019) – can support future processes of co-creation Through empirical analysis, the author focuses on action research in her own organization and highlights the attention paid to the insider action researcher’s ethical approach, as well as how to co-create dialogue. The study emphasizes how attention paid to ethical concerns in the dialogical process can expand the knowledge-building process through co-creation and help understand how a curious and exploratory approach to the facilitation of dialogues could support future processes of developing leadership in practice.
Supply Ontology is the knowledge about the meaning of supply for performative Enterprises. We discuss the importance of supply and no-supply events and use the power of Spencer–Brown notation of the Laws of Form for conceptualising meaningful supply chains. We show how through drawing distinctions, the development of concepts regarding the form of the modern Enterprise is possible, illustrating the approach’s heuristic value. The chapter includes three sections. First, we address the fundamental elements of what is known as the performatives of supply, the injunctions that perform the Enterprise. The second section addresses the meaning of the supply world. Using Heidegger’s radical ontology, we explore phenomena as part of the Enterprise world and discuss its hermeneutics. Finally, in the third section, we present two supply chain cases; the electricity supply chain and the logistic chain of events.
What happens when the barriers between therapists and clients are removed, when they all participate in a dialogue about change, and when therapists and clients even trade places? Operating within the reflecting team format, professionals meet clients without preexisting hypotheses. Together they engage in a conversation that becomes a search for the not-yet-seen and the not-yet-thought-of, as well as for alternative understandings of what has been defined as problematic. As clients and therapists trade places and various members of the entire group participate in conversations, the possibilities for change open wide. This book describes the evolution of this radical strategy in Tromsø, Norway, and its adaptation by various family therapists in the United States. It begins in Part I with a description of the setting in which the reflecting team developed and its history and evolution. Then basic concepts, practical considerations, and guidelines for practice are detailed. Part II contains Dialogues About the Dialogues, that is, reflections on the client-therapist-consultant-team dialogues that distinguish this innovative approach to therapy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
John Shotter argues that it is not in the writings of philosophers, sociologists, or other 'theorists' that we discover our 'ways of knowing.' He asserts that knowledge is founded in, and relevant to, the everyday civil life of ordinary people in society. In conversations and in practical knowledge people create the basic reality in which social institutions have their life. Shotter connects such 'theoretical' topics as 'realism' and 'foundations' to social concerns such as rights, citizenship, and access to public debate. He is concerned with human culture in the widest sense, with ideas of personal relationships, civil society, social ecology, identity, and belonging. "Cultural Politics of Everyday Life" is an important contribution to debates in social and cultural theory. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In this article we introduce a special practice that we have called the practice of a "social poetics", and explore its nature. The setting is a Primary Care Clinic at a large urban teaching hospital in the northeast of the U.S. As we describe it, the practice is at first conducted by a third person who occupies the position of a "cultural go-between" and who mediates between doctors and their patients in diagnostic interviews. Her task is to be open to being 'arrested', or 'moved' by, certain fleeting, momentary occurrences in what patients do or say. For sometimes in such moments, in our responding to the unfolding motions of their whole body and voice-as they respond to the circumstances in which they find themselves-we can begin to sense that the unique nature of their 'inner world of pain and suffering' is like for them. The practice of a social poetics entails a new relational attitude to the patient's use of words, an attitude that invites a creative, poetic sensibility, as well as a 'boundary crossing' stance that creates comparisons useful in relating what patients say to the rest of their lives. In elucidating the nature of such a practice further, we draw on the work of Wittgenstein, Bachelard, and Bakhtin. Together, these can lead to a new diagnostic practice that enables those involved in it to create, within the practice itself, both ways of talking that draw attention to the new possibilities for interaction the practice itself momentarily makes available, and ways of talking relevant to realizing these possibilities.
The Poetics of Space, trans. by M. Jolas Problems of Dostoyevsky's Poetics. Edited and trans. by Caryl Emerson Speech Genres and Other Late Essays. Trans
  • G Bachelard
Bachelard, G. (1991) The Poetics of Space, trans. by M. Jolas. Beacon Press: Boston. Bakhtin, M.M. (1984) Problems of Dostoyevsky's Poetics. Edited and trans. by Caryl Emerson. Minneapolis: University of Minnesota Press. Bakhtin, M.M. (1986) Speech Genres and Other Late Essays. Trans. by Vern W. McGee. Austin, Tx: University of Texas Press.
The Patient as Teacher: Multiple Perspectives on the Interview Process
  • A M Katz
  • M Martin
Katz, A.M. and Martin, M. (1994) The Patient as Teacher: Multiple Perspectives on the Interview Process, (instructional videotape), Boston, Harvard Medical School.
Problems of Dostoyevsky's Poetics. Edited and trans. by Caryl Emerson
  • M M Bakhtin
Bakhtin, M.M. (1984) Problems of Dostoyevsky's Poetics. Edited and trans. by Caryl Emerson. Minneapolis: University of Minnesota Press.