Mariana Craciun. The accounted self: Scales, forms, and emotions in psychotherapy

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The accounted self: Scales, forms, and emotions in psychotherapy

How do psychotherapists make sense of mental and emotional difficulties? And how do they do so authoritatively in a field beset by uncertainty? Cognitive behavioral therapists (CBT) meet these challenges through the use of scales and forms I call “ego-inscriptions.” These tools help them convert patients’ subjective states into objective knowledge that can travel beyond the clinical setting to the experimental scene of randomized controlled trials, insurers’ reimbursement practices, and the sphere of self-help. Importantly, ego-inscriptions have helped cognitive behavioral approaches rise to dominance in psychotherapy. Yet this only tells a partial story of how these tools have shaped the field and the construction of psychotherapeutic knowledge. I draw on ethnographic observations in the training program of an outpatient clinic, interviews with psychotherapists, and the writings of mental health researchers and clinicians, to argue that while these standard tools have indeed cemented CBT’s institutional dominance, a different story emerges when we examine their use in clinical work. There, cognitive behavioral therapists fall back on psychoanalytically-informed strategies—what I call “affective-relational knowledge”—to make ego-inscriptions work. In other words, CBT clinicians turn to the very tools they disavow to shore up their expertise and claims to authority. This research has implications for how we theorize the relationship between standards, knowledge, and power in professional domains. It highlights the importance of attending to institutional and individual levels of analysis, integrating the concerns of the sociology of professions with those of science and technology scholars.

Mariana Craciun is a Postdoctoral Fellow in Sociology and Science in Human Culture at Northwestern University. She earned her Ph.D. in Sociology at the University of Michigan, Ann Arbor. Her research spans the sociology of professions and expertise, the sociology of medicine, and science and technology studies. Broadly, she investigates how social actors construct credible knowledge and identities in the face of uncertainty and contestation. Ethnographic, interview, and historical data inform her approach. Her research on psychotherapy has been funded by the National Science Foundation; an article related to this work has been published in Theory and Society,while two others have been accepted for publication at the American Journal of Sociology and Qualitative Sociology. She is writing a book manuscript on the field of talk therapy and is conducting research on a new project about the resurgence of electroconvulsive therapy.