This presentation regards what is achieved in medical and therapeutic conversation as a series of accomplishments. It is the activity involved in these changing accomplishments that is the presentation's primary focus.  Highlighted are how these accomplishments are developed as the conversationalists articulate and negotiate meanings and outcomes with each other, using accessible conversational resources in line with their intentions and preferences.  But what professional discourse makes accessible to the medical or psychotherapy practitioner is also portrayed as constraining the possibilities for collaborative accomplishments with patients and clients.  Further, alongside the common symptomatic focus for health conversations are forms of restrictive or potentially resourceful discourse used by patients/clients. The medical or therapeutic conversation
serves as a nexus for these ways of talking, with the optimal accomplishments
being those that come out of that shared nexus.

     The discussion will explore closely how practitioners can draw from the ideas of discursive psychology to enhance their abilities in hosting helping conversations in ways that foster collaborative outcomes.  Specifically, the presentation will look at the work of collaborative conversation as involving the following accomplishments: constructing shared understandings; negotiating and working from within shared intentions; collaboratively mobilizing meaningful actions; and shared evaluating of outcomes (each to be exemplified in the course of the presentation). Discursive flexibility is put forward as a conversational proficiency, a practitioner's ability to shift to alternative and more resourceful forms of discourse when impasses are experienced in pursuing these accomplishments. This flexibility involves capacities to resourcefully participate in client-presented forms of conversation and flexibly negotiate passage to other, more resourceful, forms of conversation should a particular line of talk be unproductive for the participants involved.  Implications for practice in highly medicalized contexts will be discussed.