Without a background in psychotherapy, I was attracted to this book for its subtitle relating conversation analysis and Harvey Sacks to therapy. Pain titles her book Not just talking because she aims to show how psychotherapy is different than just talking to a friend; her book shows the value of conversational skill by highlighting features of its organization as they can be applied to the practice of psychotherapy. The book is organized in two parts: the first examines the principles of speech and human social behavior, and the second contains three chapters from the author's dissertation that analyze some of the conversational features of the three phases of the therapeutic dialogue.

In laying out the principles of human social behavior, Pain takes the reader through a historical account of how language has been studied and introduces the conversation-analytic perspective on the study of talk-in-interaction. She then discusses the purpose of conversation, contrasting how it is used for social action in mundane settings with how it is important for the work of psychotherapy. For example, she examines that people use categorization to make sense of their world, and how the work of psychotherapy is to question these generalizations about the world even though they very rarely go challenged in ordinary conversation. Finally, Pain considers the therapeutic relationship; she describes the dialogue between client and therapist as “cooperation for mutual benefit,” but it is the therapist's sense of timing to make interventions that helps clients to make their own discoveries about how to improve their situation.

Part 2 examines the therapeutic dialogue in practice, using transcripts of client-therapist interaction, through three stages of therapy talk: (i) how therapists encourage clients to talk, (ii) how therapists contribute to their clients’ trouble-tellings, and (iii) how therapists’ and clients’ contributions further the identification of the clients’ problem. In the first stage, therapists can gain their client's trust by asking questions and using self-disclosure. In the second stage, as recipients to trouble-telling, therapists need to be mindful of how their responses display alignment or affiliation. Whereas aligning responses are neutral in their recognition of the topic being discussed, affiliative responses are emotional and can be unhelpful in therapy. Once the first two stages of therapy talk are well advanced, the therapist and client may enter the problem-identification stage, which requires cooperation in order to unpack the client's underlying problems.

Pain is inspired by the conversation-analytic insight that talk is jointly produced in the moment. Her book strongly encourages therapists to engage in active listening so that they may make the most of their opportunities to help clients identify their problems and achieve change. By applying conversation-analytic findings to client-therapist interaction, Pain not only gives her readers insights for how to improve their psychotherapy practice, but also how to improve their conversations in all relationships.