The experience and expression of mental pain can be interpreted in various ways by the mental health nurse and the client during therapeutic interaction. This chapter explores how meanings of mental distress are configured through dialogue between and within the mental health nurse and the person in care. Here, the authors follow Bahktin’s (1981) thesis that meaning making is a dialogical activity, arrived at through engagement with one’s own internal voices and available dialogues and discouses in the surrounding context. Thus the nurses’s understanding or sense making of expressions of mental pain emerges from the interaction between inner (personal, embodied) and outer (professional / therapeutic, social) dialogues. These internal and external ‘voices’ inevitably influence the nurse’s engagement with the client; where these are unquestioned and congruent, the nurse enters into therapeutic engagement with a sense of clarity and purpose and when these dialogues are at variance, the nurse encounters confusion as s / he struggles to find a meaningful interpretation of events so that s / he can engage purposefully with the person in care. The authors ague that while congruent dialogues may facilitate spontaneous knowing and acting, unquestioned interpretations can become habituated knowledge constructions, employing and sustaining professional monologues that dominate the communication process and suppress possible alternative voicings of mental distress. In this chapter we are interested in troubling dialogues in mental health interactions and interventions. We suggest that when inner / outer voices that are perhaps conflictual and somewhat confusing, are met with open curiosity, this approach can promote opportunities for new and transformational dialogue. Further, using vignettes from teaching and research contexts, we offer two interlinked strategies for purposefully engaging with contending dialogues and developing communication about mental pain, thereby enhancing the therapeutic relationship between the nurse and person in care.