Human

Systems: The Journal of Systemic Consultation & Management

Dialogue Is the Change: Understanding Psychotherapy as a Semiotic

Process of Bakhtin, Voloshinov, and Vygotsky

Jaakko Seikkula
University of Jyväskylä and Professor II, Institute of Community Medicine,
University of Tromso

Abstract
Russian linguist Mikhail Bakhtin with his co-worker Valentin Voloshinov as well as psychologist Lev
Vygotsky saw psychological reality thoroughly as social phenomena, in which language is fundamental.
Language is not primarily seen as a medium for an individual to reveal ones inner emotions or thoughts, which
represent the inner core of the psychological structure. Language is a meaning system, which is constructed in
the area between the participants in every conversation.
Dialogical conversation instead of monological language makes it possible to create narratives of restitution
after the crisis. In dialogical dialogue people become agents in their own lives. Dialogue in itself can be seen as
the change, as the aim of psychotherapy. The central ideas of Bakhtin and Voloshinov are summarized and the
open dialogue approach in treatment of psychosis is described from the semiotic point of view.

Introduction
The Russian school of semiotics has especially focussed on the analysis of linguistic meanings
and the dialogical quality of language. In 1931 Roman Jakobson described Valentin Voloshinov
as a perceptive linguist who skilfully used the frames of semiotics in his studies on utterances
and on dialogical exchange in linguistic communication (Matejka & Titinuk, 1996). In general,
semiotics has been most interested in individual psychology and the inner meanings of the
psyche. Julia Kristeva, for one, combines semiotic research with psychoanalytic concepts.
In contrast, Mikhail Bakhtin, Lev Vygotsky, and Valentin Voloshinov view the psyche as a
thoroughly social phenomenon, and language as a meaning system that is constructed in the
space between interlocutors. Drawing on insights from this latter tradition, my paper aims to
describe the primacy of meanings created in the here-and-now in conversational psychotherapy.
My goal is to describe the foundations of dialogical psychotherapy and to demonstrate how the
latter can treat even the most serious psychic problems (psychosis, schizophrenia). By presenting
case examples, I hope to give readers some ideas for using dialogical conversation in their own
clinical practices.
During the last decade, psychotherapy has come to view language as fundamental to
the therapeutic process. This emphasis is not new in itself, since language has long figured
prominently in psychotherapy; for instance, in the work of Jacques Lacan (1981) and Julia
Kristeva. A new surge of interest in language has emerged in the field of family therapy. The
American family therapists, Harlene Anderson and Harry Goolishian (Anderson & Goolishian,
1988; Anderson, 1997; Goolishian, 1990) and a Norwegian, Tom Andersen (1990; 1992; 1995),

© LFTRC & KCC Volume No. 14, issue 2, 2003, pp. 83-94
84 Human Systems Jaakko Seikkula

have especially opened the way to integrating philosophical theories of language into family
therapy. Social constructionism has provided a sociological and social-psychological basis for
understanding the linguistic foundations of social interaction. To that end, Kenneth Gergen
(1994; 1999) and John Shotter (1993a and b; 1996; 1999) have been building bridges between
psychotherapeutic practice and theoretical research. The basic idea of social constructionism is
that reality is constructed between participants in actual conversations, and it varies according to
the persons involved, the context, and the themes of the conversation.
Lately, Shotter (in press; Katz, Shotter & Seikkula in press) has criticized social constructionism
for not being radical enough in describing this process. In Shotter’s mind social constructionism in
its most popular forms is referring to physical reality as a ready given and stabile surrounding for
us becoming involved in the interaction. In the work of a French philosopher Merleau-Ponty we
come into a chiasmically structured interaction, in which reality has started to be created already
before arriving in any language description of it. And in this chiasmic structure the surroundings
speak back in an active way so that in every social situation the reality is constructed entirely in
the specific connection taking place in this particular situation.
During the last decade the focus on language has come to be the basic feature of psychotherapy
as a whole. According to Anderson and Goolishian (1988), the Parsonian view of social systems
implies that problematic behavior, pathology, and deviance, within components of a system,
represent an inadequacy in social role and structure. The target of treatment is defined by social
structure and role, and the task of therapy within this framework is to repair the social defect. In
one-to-one psychotherapy this means that the individual is first diagnosed as having a specific
defect in psychological structure, then by its resolution the symptoms or problematic behaviors
are eliminated (Tähkä, 1997). The emphasis on social and / or psychological structure has begun
to be replaced by the idea that what is essential in psychotherapeutic practice is the language and
conversation of each participant in the dialogue in which meanings for the behavior is created.
As Voloshinov (1996) noted, psychic experience is the semiotic expression of the contact
between the organism and the outside environment. During his last years, Harry Goolishian
was occupied with psychotherapy as a whole, wondering if it was the best word for describing
the process in which people solve their problems. He started to use the word “meaning” instead
of “psychotherapy”, because the meanings created by each interlocutor become essential to
resolving the problem. Traditional psychotherapy frames the problems as targets to be solved by
cooperation between therapist(s) and client(s). Anderson and Goolishian (1988), instead, noted
that problems are not solved in this collaboration. Rather, they dis-solve in the process of new
meanings being jointly created.
Tom Andersen initiated the reflective-team approach, which has found several applications in
the fields of social care, medicine, and psychiatry (Friedman, 1995). Andersen himself (1997) is
combining the concept of reflective processes with individual work in physiotherapy. The basic
idea is to maintain a reflective relation with your clients in psychotherapy, but also with people
in general with their social relations, with their own psychological experiences and habits, and
with their own body. This process takes place in language, but spoken language is only one
Dialogue Is the Change: Understanding Psychotherapy as a Semiotic Process 85

aspect of it.
The concept of dialogue is now being used in various psychotherapeutic contexts (Anderson
1997; Inger, 1993; Penn & Frankfurt, 1994). The entire psychiatric system has undergone re-
organization, so as to make open dialogue viable in all crisis and problem situations. Originating
in family therapy, open dialogue has become the basic mode of treatment and has made it
possible to integrate different methods of therapy, such as individual psychotherapy, family
therapy, network therapy and the psychotherapeutic community. The results of this integration
have been promising (Haarakangas, 1997; Keränen, 1992; Lehtinen, 1993; Seikkula, 1991 and
1994; Seikkula et al. 1995; Seikkula & Olson, 2003).

Life in language is polyphonic

Dialogue as a scientific concept is an old one, with origins in Platonic thought. More recently,
the philosophy of language received much attention at the beginning of the twentieth century
(Raatikainen, 1997). Though the primacy of language as the subject of philosophical research
appears to be on the wane, it has not lost its importance. The work of Wittgenstein and Gadamer
has been essential to the application of philosophical theories of language in clinical practice.
John Shotter, especially, has helped therapists make use of the central notions of Wittgenstein.
Language creates the boundaries of our reality, within which we inform each other about
ourselves and, at the same time, form ourselves and our social identity. First comes speech, and
in speech the understanding of the spoken subject is generated in the actual, specific context.
In psychology, Mikhail Bakhtin (1981; 1984; 1993; Bakhtin & Medvedev, 1991), Valentin
Voloshinov (1996), and Lev Vygotsky (1970; 1978) opened the most important door to
contemporary research, such as that by Ivanka Markova (Markova & Foppa, 1990; 1992;
Markova et al., 1995) and by James Wertsch (1991) in educational sciences. Bakhtin and
Voloshinov (1996) believe that, in structural theories based on natural sciences, there only exists
one subject of research at each time. Such Cartesian thinking aims to locate the single mind of an
individual and this mind controls that person’s acts, reactions, emotions and responses in different
situations. Shotter (1999) sees this type of situation as monological, such that the human mind
is defined as an entity that operates according to rational laws which are predictable regardless
of the actual context. The task of language is to act within the framework of one mind, to reflect
the picture of reality for the individual or for the social system. Language is a tool for making
observations about and describing the individual or the group as a unit. Within the individual
or the family, the truth guiding the acts serves as a regulatory core for acts and behavior. Such
cores are, for instance, personality, identity, the unconscious, or the family homeostasis as the
motivations for behavior.
For Bakhtin and Voloshinov psychological reality is a semiotic process and theories of human
activity are closely bound up with problems of the philosophy of language. Human activity is
ideological, and everything ideological possesses semiotic value. Every ideological sign is not
only a reflection of reality but also a material segment of that reality. Human ideologies cannot
be located in a single consciousness; rather, understanding comes only by means of signs. These
86 Human Systems Jaakko Seikkula

signs are not, however, semiotic codes by which the individual interprets reality, as Lotman,
among others, has defined the task of semiosis. Rather, words are agents in themselves. New
understanding does not come about by the single consciousness of an individual but in the
process of interaction between individuals (Peuranen, 1998).
Words are the basic form of signs. A word is not only a means of language, but it also gives
significance to understanding (Bakhtin 1986: 134). The things we encounter obtain their
meaning in words. Each thing occurs only once in such-and-such a place with such-and-such
people present. Instead of having only one mind, individuals live in polyphony, in many voices,
according to the specific contexts and concrete topics of conversation. Each form of behavior is
always a response to a previous act or utterance. In this response to something that went before,
life is realised according to the actual context, and at the same time, meanings are constructed.
In the process, it is impossible to make a distinction between the use of language (speech =
language as a tool) and the language system (Peuranen,1998). To bring forth the word becomes
the ultimate goal of conversation. In building up new understandings, a dialogical form of
conversation is presupposed (Seikkula, 1995), in which topics already spoken about obtain new
meanings.

Case: Two types of schizophrenia

Lars was a severely psychotic young boy. He would sit in a corner of the ward and have no
contact with anyone. After three months without any noticeable improvement in his condition,
the therapeutic team decided to have a joint meeting to discuss the serious situation. The team
invited all the professionals involved in his treatment, both from outpatient and inpatient care,
and his family. At some point in the conversation Lars’ older sister said, “the last two weeks
have been hard on the family”. When asked what was making things so hard, neither she nor
any other family member answered. After a while, Lars’ brother replied that, “after hearing what
the doctor said, it was tough”. He was asked what the doctor had said, and for a second time the
conversation on this subject dried up. After a while, the sister, for a third time, took up the same
issue by saying that “it has been a tough period for the family after hearing the doctors words”.
She was asked to tell the group more about the situation and the doctor’s diagnosis. She said that
the doctor had given his opinion about what was wrong with their brother, and his diagnosis was
hard to bear. She was encouraged to repeat what the doctor had said. After a moment of silence,
she answered in a soft voice, “the doctor said that our brother has schizophrenia”. Upon hearing
this word, all the family members started to cry.
The team responded to this incident by sitting silently, thus making space for the emotional
moment, after which the family members were asked to say what schizophrenia meant to each of
them. They started to tell, at first hesitantly and then more and more straightforwardly, how their
father’s mother was diagnosed as having schizophrenia and that she had been hospitalized for 35
years. The family had tried to have the woman live with them, but this always failed because she
had strong delusions that they would either poison her or take control of her property in some
other way. This history was traumatic for all the family members, and they never talked about it.
Dialogue Is the Change: Understanding Psychotherapy as a Semiotic Process 87

It was a history without words.

The doctor who made the diagnosis was asked to describe the things that led him to view the
problem as schizophrenia. He did so, and said that he wanted to start Lars on the best possible
treatment. He did not think that Lars should stay in the hospital for the rest of his life. At this
point, a new type of conversation emerged: one between the doctor and the family members.
This helped everyone to see the seriousness of the situation. In the same conversation it became
possible to talk in a new way of their experiences with the father’s mother (whom they began to
speak of as “grandmother”) and to supply words for a narrative that previously had none.
Because the meanings of our acts and experiences are constructed in social relations, it is
important for the social network to participate in meetings concerning a crisis. In the meaning-
networks of social relations, the polyphony of life serves as the engine of psychotherapy. At the
same time, this new reality is both experienced jointly, in a way not possible previously, and
new words are created for those difficult experiences that as yet have none. In this way, new
meanings and new understandings are constructed. The shared emotional experience opens up
the monological impasse to dialogical reflection, which in turn obtains its meaning from the
inner dialogue of the patient. The inner and outer dialogues are part of the same language; no
sharp boundary divides them.
Vygotsky (1970) demonstrated that human language originates in social relations and that,
during the first months of life, the mother (or nearest caretaker) constructs the reality in which
the meaning of things around the child takes shape (Leiman, 1995). The child is born into the
language context that her parents have created according to their own voices. In the phase of
egocentric speech, from ages 3 to 7 years, the child starts to incorporate the behavior-guiding
task of language into her own psychological functions. After saying a word aloud, the child
can act according to what she said. Speaking aloud before acting becomes unnecessary in the
phase of inner speech, and an adult can guide her own behavior by means of inner thoughts.
The individual can internalize words and concepts, but the more important aspect of language
remains the actual situations in which the sense of the words is created in each conversation.
Of course one part of this conversation is the inner dialogue, in which different voices seek out
several perspectives and meanings.
In contrast to the Cartesian view, here the function of language is not primarily seen as
reflecting and conveying feelings, thoughts, acts or experiences of the inner reality. Instead,
language is more like an environment in which we all locate ourselves according to our phase of
life, our experiences, our occupation, and our therapeutic approach (Shotter, 1999). We not only
use language, we also live in it.

Reality is created on the boundary

Although we would supposed that each of us has an inner core that guides our behavior, we must
also note that the meaning of our psychological acts is created on the boundary between inside
and out, in social relations with other individuals or in our inner dialogue between different
voices, which have their origins in our life experiences. If we start to look at the psychological
88 Human Systems Jaakko Seikkula

reality as meanings created in language, the search for an inner psychological structure becomes
secondary. If we try to find a cause to a problem in the inner structure or in the social system, we
aim at finding some rule behind the evident behavior and, after defining the rule, to correct the
way of acting which led to the problem. Only one explanation is best, and after it has been found,
interest in other possible explanations ceases (Shotter, 1996). As Bakhtin noted, “structuralism
has only one subject – the subject of the research himself” (1986: 169).
In the previous example, the doctor perhaps aimed to find the rule – the right diagnosis,
“schizophrenia” – governing the boy’s behavior. This one and correct diagnosis meant an end
to the interest of this research problem for the doctor. But in the joint meeting, this definition
triggered an avalanche of new meanings, which opened up in the shared conversation and
prompted new understanding between the discussants. In the meaning-network constructed
between these individuals, the diagnosis of schizophrenia of course had its place, since it
formed the theme of conversation. The talk, however, no longer focussed on the meaning of
schizophrenia to the inner psychological or biological structure of the patient, but on the actual
conversation then and there, on what “schizophrenia” meant to every participant. This led to a
polyphonic deliberation of each one’s own experiences of schizophrenia and of matters related to
the grandmother and to Lars’ future. Originally one-voiced, monological words started to receive
multi-voiced, dialogical aspects.
In defining the difference between the meanings generated from structuralism and those
derived from contextual meaning, Bakhtin says the following (1986: 169-170): “Contextual
meaning is personalistic; it always includes a question, and address, and the anticipation of a
response; it always includes two as a dialogical minimum. This personalism is not psychological,
but semantic.”
By contrast, structuralism seeks to describe the research problem by one exact
definition, as is the case in the natural sciences. In the contextual definition of the psychological
reality, on the other hand, conversation creates each research problem. Shotter (1993) calls this
“knowing of the third kind”, and the observer him/herself is always included.

New understanding presupposes dialogical conversation

Reality is constructed between the participants in a conversation, in a space that is empty that,
in a way, waits to be filled with new words. Understanding is an active process of uttering and
responding. The starting point for understanding can be the recognition of a thing as representing
something, but mere recognition is not understanding, because the latter always presupposes
dialogical conversation about the recognised things. The diagnosis of “schizophrenia” is to
recognise some symptoms and behaviours as belonging to that illness, but the transformation of
this recognition into understanding takes place in a dialogical conversation (Voloshinov, 1996).
Dialogue is the basic quality of language, which is not located inside an individual, but on
the borderlines between individuals in actual conversation. Differences promote exchange
of meanings, and treatment becomes richer the more that different views are voiced. The
therapeutic resources in the polyphony become evident if the team-members have professional
Dialogue Is the Change: Understanding Psychotherapy as a Semiotic Process 89

enough skills to hear these different voices as a part of the joint narrative, and can build bridges
across the boundaries between the different voices. In a way, language is always dialogical:
even monological utterances contain dialogue, in the sense that they are said to someone. But
monological utterances are closed in the sense that they do not demand answers. Dialogical
conversation (Seikkula, 1993; 1995), instead, is one in which answers are more important than
questions. Yet this new utterance, with its answers, is not an end of the conversation, but a
new question aimed at promoting the theme under discussion. It is the theme itself – not the
individuals participating in the conversation – that guides the dialogue.
Therapists no longer attempt to control dialogue by their questions or interventions. Therapists
must instead constantly adapt to the utterances of the clients in order for the dialogue to take on
life, since the dialogue itself generates new meanings. As Bakhtin notes:

“In reality, practical intercourse is constantly generating, although slowly and in a

narrow sphere. The interrelationships between speakers are always changing, even if the
degree of change is hardly noticeable. In the process of this generation, the content being
generated also generates [author’s italics]. Practical interchange carries the nature of
the event, and the most insignificant philological exchange participates in this incessant
generation of the event. The word lives its most intense life in this generation, although
one different from its life in artistic creation.” (Ibid.: 95)

The utterances of the participants in the conversation unavoidably construct new types of
meaning for the problem. Conversation, already and in itself, creates new meanings. Language
itself becomes the power that generates this new economy of meanings. The therapist’s goal
becomes dialogue itself, how in this “once-occurring event of being” all the participants in the
treatment meeting can jointly create new and more constructive meanings and, by doing so,
incorporate them into each other’s inner dialogue. The things making the difference become how
to listen, how to hear, and, what is most important, how to answer each utterance of our clients.
Answering comes first. After answering what the clients said, we have the possibility of learning
if we heard and understood correctly.
Listening attentively aims at hearing what our clients are saying. Hearing is witnessed in our
answering words. We do not plan in advance our next question, or even the interview as a whole,
but, instead, the next question is created in the answer of the clients. In this way, everyone, even
the patient with his/her psychotic ideas, can experience how to become agent in the new story of
their suffering (Seikkula, 2002).
The therapy team would prevent this kind of exchange by acting in a monological way; for
instance, by asking questions which the discussants have to answer by defending their own
viewpoints. If the questions are monological, in “one voice”, such that the answer to them takes
place in one voice, then no new understanding emerges. These are questions which are answered
by merely agreeing or denying. In this way, monological speaking is generated.
90 Human Systems Jaakko Seikkula

The basic elements of dialogue in psychotherapy

Based on the semiotic theory described above, a psychotherapeutic approach can be conducted
that no longer focuses on changing the psychological or social structure by interventions nor by
using questions as interventions. Rather, it focuses on constructing a joint dialogue between the
participants in a treatment meeting in order to generate a new understanding of the circumstances
related to the actual crisis. The basic elements of this procedure include the following:
(1) The therapeutic conversation should start with as little preplanning as possible, to
guarantee that each participant has the same history in speaking of the actual issues.
(2) All courses of treatment should be organized when everyone is present – the patient, those
nearest him/her, and all the professionals involved.
(3) Therapists should not be considered as experts who know all the answers to questions, and
they should avoid giving ready-made responses and solutions to those in a “non-expert”
position. Rather, therapeutic expertise should consist primarily in skill at generating
dialogue (Anderson, 1997; Haarakangas, 1997; Seikkula, 1995; 2002).
(4) The best results in the most serious psychiatric crisis seem to presuppose immediate
help, where the social network around the patient can, in a safe enough form, tolerate
uncertainty and avoid premature conclusions and decisions. This includes especially the
avoidance of starting the patient on large doses of anti-psychotic medication rapidly or
impulsively, but only after several discussions of such medication and, if it is started, then
in small doses.
(5) Promoting conversation is primary. Therapeutic “work” is to generate dialogue, not to
draw conclusions and make decisions. All the participants should be heard, since being
heard always improves one’s understanding of oneself.
(6) Open dialogue is a key factor. This includes openness in integrating different therapeutic
methods as parts of the entire treatment process, since the patients can start to construct
new words, and in many different ways, for experiences that till then they had none.

Requests for reprints should be addressed to: Jaakko Seikkula, Ph.D. Department of Psychology,
University of Jyväskylä, Department of Psychology, University of Jyväskylä, Box 35, 40014
Jyväskylä, Finland Email: seikkula@psyka.jyu.fi

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