Time,Knowledge, and Power in Psychotherapy: A Comparison of Psychodynamic and Cognitive Behavioral Practices

Time has long been recognized as a marker of professional control and a tool for the organization of work. Yet we know less about how temporality intersects with experts’ epistemic goals. This article illustrates how the patterning of time in psychotherapy shapes the construction of knowledge about mental illness and how this relationship is mediated by patients’ own interventions. I focus on psychodynamic and cognitive behavioral therapeutic practices and draw on data from ethnographic observations in an outpatient psychiatry clinic and in-depth interviews with psychotherapists. The article details the constitutive relationship between two dimensions of temporality: first, clock time, namely the length of treatment, the length and frequency of sessions, and the flow of the therapy hour, and second, the temporal epistemics of illness, its construction as a phenomenon with a past, present, and future. Clinicians in the two orientations attempt to construct particular temporal landscapes by integrating these two facets of their work. Yet they must always do so in response to patients’ own temporal interventions. By attending both to the organization of professional work and the temporality of illness, this article brings together two largely distinct literatures within medical sociology, namely scholarship on the profession of medicine and social scientific understandings of the temporal dimensions of illness. It shows that temporality is constitutive of how knowledge and power are negotiated in expert work.