Multiple voices in clinical discourse and as clinical intervention

Abstract

Grounded in sociocultural theories of language development and use, this paper explores the concept of dialogic voice. Building on the term 'dialogue', dialogic voice points to the fundamentally social nature of language-in-use. From this perspective, language emerges from specific histories and thus carries the multiple voices of previous speakers. People draw on these voices to think about and represent the world, communicate with others, construct their own identities, and engage in play. Prior (2001) identified three key dimensions of dialogic voicing: typified social voices, re-envoicing others' words and acts, and personalized voice. To present a theoretical framing for dialogic voice; to detail the dimensions of dialogic voice; and to offer a preliminary analysis of dialogic voicing in clinical discourse. Data consisted of ten treatment sessions for a 67-year-old man with amnesia and aphasia, using a collaborative barrier task protocol. Discourse analysis and selective coding were used to identify the three dimensions of dialogic voice in both clinician and client utterances. During this collaborative task, the client and clinician produced an array of voices, including: (1) typified social voices to display professional expertise, family identities, and shared interests; (2) re-envoicing others' words and acts in both task and non-task interactions; and (3) personalized voicing, displayed mostly in the client's discourse. Attention to dialogic voicing offers a way to see and reflect on the heterogeneity of discourse and the multiple identities that clinicians and clients alike can, and do, display in clinical settings. Tracing the complex interplay of multiple voices provides us with insights into rich communicative environments that, from a sociocultural perspective, provide opportunities for initiating change in the communicative practices of clients, their communicative partners, and ultimately clinical practice itself.