This chapter provides the problems of how subjectivity, consciousness and selfhood are understood in psychotherapy and the implications of these understandings for practice. It suggests that Mikhail Bakhtin has a considerable amount to offer to the practice of psychotherapy beyond the idea of the dialogical self, but as his potential contribution comes from very different perspectives to mainstream psychological thinking, potentially making psychotherapy a truly multi-or cross-disciplinary undertaking. The introduction of Bakhtin into psychotherapy also raises philosophical questions about the nature of the knowledge base in psychotherapy. Bakhtin's historical moment gave rise to both a desire for redemption and the circumstances which frustrate it, a search for philosophical meaning in history and a dawning awareness of the contingency of history itself. A Bakhtinian socio-historical self with a dialogical consciousness is in direct conflict with the monadic self of traditional cognitive therapy and partially in conflict with psychoanalytic models.