This study draws on recent observational research on the intersubjective processes that occur in infant–caregiver interactions. It makes the case that similar methods can be used to develop an observational approach to the dynamics of intersubjectivity in the clinical process using methods from the discipline of pragmatics – the study of human interaction. Following an introduction to the research on intersubjective processes in infant–caregiver dyads and a discussion of the pragmatic approach to the study of talk-in-interaction, we present a detailed analysis of an exchange between a psychotherapist and a patient. Rupture and repair, narrative processes and perspective-taking are observed at the level of the turn-by-turn interactions between the participants. The discussion returns to clinical concerns, discussing the implications of the findings for the study of clinical theory and practice.