This issue explores the multifaceted nature of discourse and its relevance to the analysis of clinical activity. Discourse "can be brief like a greeting and thus smaller than a single sentence or lengthy like a novel or narration of personal experience and thus larger than a sentence" (Sherzer, 1987, p. 296). Clinical discourse refers to those contexts of language use that constitute the scope of professional practice. Engaging in assessments and evaluations of communicative ability, delivering diagnostic news, managing therapy encounters with clients, and writing progress reports and even position statements about clinical practice are all relevant to the study of clinical discourse. The purview of clinical discourse is not limited to what professionals produce but also entails the beliefs, values, and concerns that others express about clinical activities.

Because analysis involves the examination of utterances (or texts) in contexts of use (Schiffrin, 1994), there is a concern for the institutional, cultural, and clinical values and ideologies that frame discourse (Wodak, 1996). Here, what remains unsaid can be just as important as what is voiced (Foucault, 1981; Sendbuehler, 1996). In this issue, for example, Kovarsky and Curran describe a missing voice of human subjectivity and experience in the written discourse of evidence-based practice, a discourse that privileges certain kinds of proof while silencing others. Expressing similar concerns for current models of evidence-based practice, Mastergeorge examines how the discourse of maternal belief interviews-where mothers discuss levels of problem-solving assistance needed by their children-can function as proof for the effectiveness of intervention.

To date, much of the existent research on clinical discourse in communication disorders has focused on interactional asymmetries between professionals and clients during therapy. It is the therapist who tends to control the access to the interactional floor, the topics to be discussed, and the manner in which information is evaluated and repaired (Kovarsky, 1990; Simmons-Mackie & Damico, 1999). In short, it is the interpretive framework of the clinician that dominates therapy (Damico & Damico, 1997) and that has the potential to damage the face, or public self-image, and identity of those experiencing communicative impairments (Kovarsky, Shaw, & Adingono-Smith, in press).

Papers in this issue build upon these earlier findings concerning therapeutic interactions in important ways. As an alternative to the discursive practices associated with traditional, impairment-based models of intervention, Simmons-Mackie, Elman, Holland, and Damico examine a number of different discourse management strategies that serve to increase parity between therapists and individuals with aphasia during group therapy. On the other hand, Walsh analyzes the occurrence and function of more symmetrical conversational exchanges, or "small talk," during traditional therapy sessions. She argues that small talk serves an important therapeutic function. Moving beyond the intervention context, Hengst and Duff describe the communicative practices of speech-language pathologists who seek to foster more symmetrical communicative relationships during their assessments of discourse abilities among adults with amnesia.

All these studies focus on discourse practices synchronically or at one point in time. In contrast, the final author in this issue, Duchan, examines written discourse from the 19th century with an eye toward the standard language ideology promoted by elocutionists and the subversive discourse tactics used by some authors who did not agree with these standards. She argues that some of these subversive tactics can be found today in the discourses of those who advocate for a social model approach to disability as a way of contending "with biases resulting from the imposition of narrow standards and norms."

When taken together, the papers in this issue reveal that the critical analysis of clinical discourse has at least two implications. First, it is clear that when language is viewed as discourse, it is neither a transparent nor a neutral means of communication. Rather, it is value laden and reflects beliefs of and relationships between the people who use it in complex ways. Second, it is precisely because discourse is immersed in values and can index relationships that its critical analysis can provide valuable information regarding the nature and effectiveness of our helping practices.

Dana Kovarsky, Issue Editor

Department of Communicative Disorders, University of Rhode Island

REFERENCES