Embodied Expertise: The Science and Affect of Psychotherapy.

Abstract

This project examines the epistemic tools by which psychotherapists in competing orientations understand and treat mental illness. I compare the expert practices of clinicians adopting a psychodynamic (also known as psychoanalytic) approach with those of “evidence-based” therapists (for example, cognitive behavioral and dialectical behavioral). Data from 18 months of ethnographic observations in a psychiatry residency program, and 60 in-depth interviews, inform my argument that these clinicians embody distinct forms of expertise that have both professional and social implications. I show that the former adopt an ‘affective-relational’ orientation that values emotions as sources of knowledge, and the therapeutic relationship as a tool for insight and treatment. In contrast, the latter rely on a ‘techno-scientific’ approach that revolves around inscription, quantification, and time-limited interventions. Drawing on scholarship in social studies of science, medical sociology, the sociology of professions, and the sociology of knowledge, I suggest that these health workers’ practices help illuminate questions about jurisdiction and autonomy, credibility, and the making of social knowledge. First, my data indicates that maintaining autonomy can detract from a group’s ability to succeed in contests of jurisdiction. Second, this project shows that whereas practitioners of psychoanalytic therapy emphasize clinical wisdom and self-reflexivity as legitimating tools, their colleagues in cognitive behavioral approaches assert scientific and institutional credibility. Lastly, this research illuminates the value of subjectivity in the process of knowledge-making by establishing the (spatio-temporally specific) epistemic role of emotions.

My research captures the profession of talk therapy in transition, and argues that this has implications beyond the institutional realm. Drawing on the work of Foucault, I suggest that the therapy room is one important locus for the transformation of ‘modern selves.’ I argue that therapists promote distinct versions of what it means to be a ‘well-functioning’ human being as they take either ‘developmental’ (in psychodynamic therapy) or ‘precipitating’ (in cognitive and behavioral interventions) events as their platform of intervention. This project proposes that whether they construct historical narratives linking past and present, or classify, change and measure parts of selves (behaviors, thoughts, emotions), these therapies promote powerful technologies for shaping the ‘normal.’