Negotiating behavioural change: Therapists’ proposal turns in Cognitive Behavioural Therapy


  • Katie Ekberg The University of Queensland
  • Amanda Lecouteur University of Adelaide



conversation analysis, CBT, proposals, epistemics, behavioural activation


Cognitive behavioural therapy (CBT) is an internationally recognised method for treating depression. However, many of the techniques involved in CBT are accomplished within the therapy interaction in diverse ways, and with varying consequences for the trajectory of therapy session. This paper uses conversation analysis to examine some standard ways in which therapists propose suggestions for behavioural change to clients attending CBT sessions for depression in Australia. Therapists’ proposal turns displayed their subordinate epistemic authority over the matter at hand, and emphasised a high degree of optionality on behalf of the client in accepting their suggestions. This practice was routinely accomplished via three standard proposal turns: (1) hedged recommendations; (2) interrogatives; and (3) information-giving. These proposal turns will be examined in relation to the negotiation of behavioural change, and the implications for CBT interactions between therapist and client will be discussed.

Author Biographies

  • Katie Ekberg, The University of Queensland
    Katie Ekberg is a Postdoctoral Research Fellow in the School of Health and Rehabilitation Sciences at The University of Queensland, Australia. Her interests involve conversation analysis, medical interactions, and psychotherapy interactions. Her previous research has involved examining client-practitioner communication in Cognitive Behavioural Therapy sessions for clients diagnosed with depression, calls with specialist nurses on a major UK cancer helpline, consultations with neurologists and patients suffering from seizure disorders (including epilepsy), and most recently audiology consultations with hearing-impaired patients.
  • Amanda Lecouteur, University of Adelaide
    Amanda Lecouteur is Associate Professor in Psychology at the University of Adelaide, Australia, where she is Co- Director of the Discourse and Social Psychology Unit and teaches in the fields of research methods and philosophy of science. She has published in the areas of racism, education, gender and health. She also has a long standing interest in the field of elite achievement and acts as a recruiting and development consultant in the Australian Football League. Her current research involves analysis of real-life interaction in contexts such as help-line, medical and counselling interactions.






How to Cite

Ekberg, K., & Lecouteur, A. (2013). Negotiating behavioural change: Therapists’ proposal turns in Cognitive Behavioural Therapy. Communication and Medicine, 9(3), 229-239.