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‘Good’ Communication in Schizophrenia: A Conversation Analytic Definition

  • Laura Thompson
  • Rose McCabe
Chapter

Abstract

Schizophrenia is one of the most serious conditions psychiatrists are likely to encounter. Its complex psychopathology includes changes in thought and perception — delusions and hallucinations. Along with personal distress, this detachment from ‘reality’ (psychosis) brings complexity to psychiatrists’ interviews with patients. Not least, at times, an ontological ‘incompatibility’. The clinician must walk a ‘tightrope’: asking questions of appropriate depth and pace, while maintaining an attitude of non-confrontation and non-collusion around psychotic symptoms (Turkington & Siddle, 1998). Meanwhile, the heterogeneous course and clinical presentation of schizophrenia (Van Os & Kapur, 2009) creates a second delicate balance to achieve. The psychiatrist must understand the individual in their unique psychosocial context: diagnostically disentangling ‘pathological’ behaviour from what may be valid attempts to deal with distress or disturbances caused by particular social circumstances (see BPS, 2014). Achieving this means putting patient experience at the heart of psychiatric communication — a ‘partnership’ paradigm of care (NICE, 2009), removed from psychiatry’s historic reputation of social repression.

Keywords

Therapeutic Alliance Discursive Practice Conversation Analysis Psychotic Experience Discourse Marker 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders (4th edition). Washington, DC.Google Scholar
  2. Antaki, C. (2008). Formulations in psychotherapy. In A. Peräkylä, & C. Antaki, S. Vehviläinen, & I. Leudar (Eds.), Conversation analysis of psychotherapy (pp. 28–42). Cambridge: Cambridge University Press.Google Scholar
  3. Beach, W. A. (1993). Transitional regularities for ‘casual’ ‘okay’ usages. Journal of Pragmatics, 19(4), 325–352.CrossRefGoogle Scholar
  4. ——. (1995). Conversation analysis: ‘Okay’ as a clue for understanding consequentiality. In S. J. Sigman (Ed.), The consequentiality of communication (pp. 121–161). Hillsdale: Erlbaum.Google Scholar
  5. Beach, W. A., & Dixon, C. N. (2001). Revealing moments: Formulating understandings of adverse experiences in a health appraisal interview. Social Science and Medicine, 52(1), 25–44.CrossRefGoogle Scholar
  6. Bercelli, F., Rossano, F., & Viaro, M. (2008). Clients’ responses to therapists’ reinterpreta-tions. In A. Peräkylä, C. Antaki, S. Vehviläinen, & I. Leudar (Eds.), Conversation analysis of psychotherapy (pp. 5–25). Cambridge: Cambridge University Press.Google Scholar
  7. Bergmann, J. R. (1992). Veiled morality: Notes on discretion in psychiatry. In P. Drew & J. Heritage (Eds.), Talk at work (pp. 137–162). Cambridge: Cambridge University Press.Google Scholar
  8. Bolden, G. (2006). Little words that matter: Discourse markers ‘so’ and ‘oh’ and the doing of other-attentiveness in interaction. Journal of Communication, 56(4), 661–688.CrossRefGoogle Scholar
  9. ——. (2009). Implementing incipient actions: The discourse marker ‘so’ in English conversation. Journal of Pragmatics, 41(5), 974–998.CrossRefGoogle Scholar
  10. The British Psychological Society. (2014). Understanding Schizophrenia and Psychosis: A report by the Division of Clinical Psychology. As retrieved at: http://www.bps.org.uk/networks-and-communities/member-microsite/division-clinical-psychology /understanding-psychosis-and-schizophrenia
  11. Buen, R. J. (1990). The recognition of declarative questions in informative dialogues. Tilburg University Press.Google Scholar
  12. Burton, N. (2010). Psychiatry. Oxford: Wiley Blackwell.Google Scholar
  13. Clark, H. H. & Schaefer, E. F. (1989). Contributing to discourse. Cognitive Science, 13(2),259–294.CrossRefGoogle Scholar
  14. Depperman, A. & Fogasy, S. (2011). Doctors’ questions as displays of understanding. Communication and Medicine, 8(2), 111–122.Google Scholar
  15. Drew, P. (2003). Comparative analysis of talk in interaction in different institutional settings: A sketch. In P. Glenn, C. D. LeBaron, & J. Mandelbaum (Eds.), Studies in language and social interaction: In Honor of Robert Hopper (pp. 293–308). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
  16. Epstein, R. M., Franks, P., Fiscella, K., Cleveland, G. S., Meldrum, S. C., Kravitz, R. L., & Duberstein, P. R. (2005). Measuring patient-centred communication in patient-physician consultations: Theoretical and practical issues. Social Science and Medicine, 61(7), 1516–1528.CrossRefGoogle Scholar
  17. Fraser, B. (1999). What are discourse markers? Journal of Pragmatics, 31(7), 931–952.CrossRefGoogle Scholar
  18. Gardner, R. (2001). When listeners talk: Response tokens and listener stance. Philadelphia. PA: John Benjamins.CrossRefGoogle Scholar
  19. Garfinkel, S., & Sacks, H. (1970). On formal structures of practical actions. In J. C. McKinney & E. A. Tiryakian (Eds.), Theoretical sociology (pp. 337–366). New York: Appletoon-Century-Crofts.Google Scholar
  20. Groenendijk, J. & Stokhof, M. (1997). Questions. In J. van Benthem & A. ter Meulen (Eds.), Handbook of logic and language (pp. 1055–1124). Cambridge, MA: MIT Press.CrossRefGoogle Scholar
  21. Gunlogson, C. (2002). Declarative questions. In B. Jackson (Ed.), Proceedings of semantics and linguistic theory XII (pp. 125–143). Ithaca, NY: CLC Publications.Google Scholar
  22. Heritage, J. (2010). Questioning in Medicine. In A. F. Freed & S. Ehrlich (Eds.), Why do you ask? The function of questions in institutional discourse (pp. 42–68). Oxford: Oxford University Press.Google Scholar
  23. ——. (2012). Epistemics in action: Action formation and territories of knowledge. Research on Language and Social Interaction, 45(1), 1–29.CrossRefGoogle Scholar
  24. Heritage, J. & Maynard, D. (2006). Problems and prospects in the study of doctor-patient interaction: 30 years of research in primary care. Annual Review of Sociology. 32, 351–374.CrossRefGoogle Scholar
  25. Heritage, J., & Sefi, S. (1992). Dilemmas of advice: Aspects of the delivery and reception of advice in interactions between health visitors and first time mothers. In P. Drew & J. Heritage (Eds.), Talk at work (pp. 359–417). Cambridge: Cambridge University Press.Google Scholar
  26. Heritage, J. & Watson, R. (1979). Formulations as conversational objects. In G. Psathas (Ed.), Everyday language (pp. 123–162). New York, Irvington Press.Google Scholar
  27. ——. (1980). Aspects of the properties of formulations. Semiotica, 30(3–4), 245–262.Google Scholar
  28. Hopper, R., & Chen, C. H. (1996). Languages, cultures, relationships: Telephone openings in Taiwan. Research on Language and Social Interaction29(4), 291–313.CrossRefGoogle Scholar
  29. Hutchby, I. (2005). Active listening: Formulations and the elicitation of feeling-talk in child counseling. Research on Language and Social Interaction, 38(3), 303–329.CrossRefGoogle Scholar
  30. Jefferson, G. (1983). Issues in the transcription of naturally-occurring talk: Caricature versus capturing pronunciational particulars. Tilburg Papers in Language and Literature, 34, 1–12. Tilburg: Tilburg University.Google Scholar
  31. Johnson, A. J. & Cotterill, J. (2002). So… ? Pragmatic implications of so-prefaced questions in formal police interviews. In J. Cotterill (Ed.), Language in the legal Process (pp. 91–110). Basingstoke: Palgrave.Google Scholar
  32. Labov, W., & Fanshel, D. (1977). Therapeutic discourse: psychotherapy as conversation. Academic Press. Orlando: Academic Press.Google Scholar
  33. Mandelbaum, J. (2003). Interactive methods for constructing relationships. In P. Glenn, C. D. LeBaron, & J. Mandelbaum (Eds.), Studies in language and social interaction: In honor of Robert Hopper (pp. 207–219). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.Google Scholar
  34. McCabe, R., Healey, P., Priebe, S., Bremner, S., Lavelle, M, Dodwell, D., Laugharne, R., & Snell, A. (2013). Shared understanding in psychiatrist-patient communication: Association with treatment adherence in schizophrenia. Patient Education and Counseling, 93(1), 73–79, http://dx.doi.org/10.1016/j.pec.2013.05.015CrossRefGoogle Scholar
  35. McCabe, R., Heath, C., Burns, T., & Priebe, S. (2002). Engagement of patients with psychosis in the consultation: A conversation analytic study. British Medical Journal, 325(7373), 1148–1151.CrossRefGoogle Scholar
  36. McCabe, R., Leuder, I., & Antaki, C. (2009). Do people with Schizophrenia display theory of mind deficits in clinical interactions? Psychological Medicine, 34(3), 401–412.CrossRefGoogle Scholar
  37. The Merck Manual [electronic text book] (2012). Routine Psychiatric Assessment. As retrieved at: http://www.merckmanuals.com/professional/psychiatric_disorders/approach_to_the_patient_with_mental_symptoms/routine_psychiatric_assessment.html
  38. National Institute for Health and Clinical Evidence (NICE). (2009). Schizophrenia: Core interventions in the treatment and management of Schizophrenia in primary and secondary care. Guideline 82. London: NICEGoogle Scholar
  39. ——. (2014). Standards and Indicators. As retrieved at: https://www.nice.org.uk/standards-and-indicators
  40. Palmer, D. (2000). Identifying delusional discourse: Issues of rationality, reality and power. Sociology of Health & Illness, 22(5), 661–678.CrossRefGoogle Scholar
  41. Palmer, B. A., Pankratz, S., & Bostwick, J. M. (2005). The lifetime risk of suicide in schizophrenia. Archives of General Psychiatry, 62(3), 247–253.CrossRefGoogle Scholar
  42. Priebe, S., Dimic, S., Wildgrube, C., Jankovic, J., Cushing, A., & McCabe, R. (2011). Good communication in psychiatry: A conceptual review. European Psychiatry, 26(7), 403–407.CrossRefGoogle Scholar
  43. Priebe, S. & Gruyters, T. (1993). The role of the helping alliance in psychiatric community care: A prospective study. Journal of Nervous and Mental Disease, 181(9), 552–557.CrossRefGoogle Scholar
  44. Priebe, S., & McCabe, R. (2006). The therapeutic relationship in psychiatric settings. Acta Psychiatrica Scandinavica, 113(s429), 69–72.CrossRefGoogle Scholar
  45. Raymond, G. (2003). Grammar and social organization: Yes/no interrogatives and the structure of responding. American Sociological Review, 68, 939–967.CrossRefGoogle Scholar
  46. ——. (2006). Questions at work: Yes/No type interrogatives in institutional contexts. In P. Drew, G. Raymond, & D. Weinberg (Eds.), Talk and interaction in social research methods (pp. 115–134). London: Sage.Google Scholar
  47. ——. (2010). Grammar and social relations: Alternative forms of yes/no type initiating actions in health visitor interaction. In A. F. Freed & S. Ehrlich (Eds.), ‘Why do you ask?’: The function of questions in institutional discourse (pp. 87–107). New York: Oxford University Press.Google Scholar
  48. Robinson, J. D. (2006). Managing trouble responsibility and relationships during conversational repair. Communication Monographs, 73(2), 137–161.CrossRefGoogle Scholar
  49. ——. (2013). Epistemics, action formation, and other-initiation of repair: The case of partial questioning repeats. In M. Hayashi, G. Raymond, & J. Sidnell (Eds.), Conversational repair and human understanding (pp. 261–292). Cambridge: Cambridge University Press.Google Scholar
  50. Robinson, J. D., & Kevoe-Feldman, H. (2010). Using full repeats to initiate repair on others’ questions. Research on Language and Social Interaction, 43(3), 232–259.CrossRefGoogle Scholar
  51. Ruusuvuori, J. (2005). Empathy and sympathy in action: Attending to patients’ troubles in Finnish homeopathic and general practice consultations. Social Psychology Quarterly, 68(3), 204–222.CrossRefGoogle Scholar
  52. ——. (2007). Managing affect: Integrating empathy and problem solving in two types of healthcare consultations. Discourse Studies, 9(5), 597–622.CrossRefGoogle Scholar
  53. Sacks, H. (1987). On the preferences for agreement and contiguity in sequences in conversation. In G. Button & J. R. E. Lee (Eds.), Talk and social organisation (pp. 54–69). Clevedon, UK: Multilingual Matters.Google Scholar
  54. —. (1992 [1964–1972]). Lectures on conversation, 2 vols. Oxford: Blackwell.Google Scholar
  55. Schegloff, E. A. (1984). On some questions and ambiguities in conversation. In J. Maxwell Atkinson & J. Heritage (Eds.), Structures of social action (pp. 28–53). Cambridge: Cambridge University Press.Google Scholar
  56. ——. (1993). Reflections on quantification in the study of conversation. Research on Language and Social Interaction, 26(1), 99–128.CrossRefGoogle Scholar
  57. ——. (1996). Confirming allusions: Towards an empirical account of action. American Journal of Sociology, 104, 161–216.CrossRefGoogle Scholar
  58. ——. (2000). When ‘others’ initiate repair. Applied Linguistics, 21(2), 205–243.CrossRefGoogle Scholar
  59. — (2007). Sequence organization in interaction: A primer in conversation analysis Volume 1. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  60. Schegloff, E. A., & Sacks, H. (1973). Open up closings. Semiotica, 8(4), 289–327.CrossRefGoogle Scholar
  61. Schiffrin, D. (1987). Discourse markers. New York: Cambridge University Press.CrossRefGoogle Scholar
  62. Stivers, T. (2015). Coding social interaction: A heretical approach in conversation analysis? Research on Language and Social Interaction, 48(1), 1–19.CrossRefGoogle Scholar
  63. Stivers, T., & Rossano, R. F. (2010). Mobilising response. Research on Language and Social Interaction, 43(1), 3–31.CrossRefGoogle Scholar
  64. Suchman, L., Markakis, K., Beckman, H., & Frankel, R. (1997). A mode of empathic communication in the medical interview. Journal of the American Medical Association, 4, 1680–1681.Google Scholar
  65. Ten Have, P. (1999/2007). Doing conversation analysis: A practical guide. London: Sage.Google Scholar
  66. Thompson, L., Howes, C., & McCabe, R. (2015). The effect of questions used by psychiatrists on therapeutic alliance and adherence. British Journal of Psychiatry. doi:10.1192/bjp.bp.114.151910.Google Scholar
  67. Thompson, L. & McCabe, R. (2012). The effect of clinician-patient communication on treatment adherence in mental health care: A systematic review. BMC Psychiatry, 12(1), 87.CrossRefGoogle Scholar
  68. Turkington, D., & Siddle, R. (1998). Cognitive therapy for the treatment of delusions. Advances in Psychiatric Treatment, 4(4), 235–242.CrossRefGoogle Scholar
  69. Van Os, J., & Kapur, S. (2009). Schizophrenia. Lancet, 374(9690), 635–645.CrossRefGoogle Scholar

Recommended reading

  1. • Antaki, C. (2008). Formulations in psychotherapy. In A. Peräkylä, C. Antaki, S. Vehviläinen, & I. Leudar (Eds.), Conversation analysis of psychotherapy (pp. 28–42). Cambridge: Cambridge University Press.Google Scholar
  2. • Thompson, L., Howes, C, & McCabe, R. (2015). The effect of questions used by psychiatrists on therapeutic alliance and adherence. British Journal of Psychiatry. doi: 10.1192/bjp.bp.114.151910.Google Scholar

Copyright information

© Laura Thompson and Rose McCabe 2016

Authors and Affiliations

  • Laura Thompson
  • Rose McCabe

There are no affiliations available

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