Negotiating behavioural change: therapists' proposal turns in cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is an internationally recognised method for treating depression. However, many of the techniques involved in CBT are accomplished within the therapy interaction in diverse ways, and with varying consequences for the trajectory of therapy session. This paper uses conversation analysis to examine some standard ways in which therapists propose suggestions for behavioural change to clients attending CBT sessions for depression in Australia. Therapists' proposal turns displayed their subordinate epistemic authority over the matter at hand, and emphasised a high degree of optionality on behalf of the client in accepting their suggestions. This practice was routinely accomplished via three standard proposal turns: (1) hedged recommendations; (2) interrogatives; and (3) information-giving. These proposal turns will be examined in relation to the negotiation of behavioural change, and the implications for CBT interactions between therapist and client will be discussed. Copyrigh

A brief conversation analytic communication intervention can change history-taking in the seizure clinic

Question design during history-taking has clear implications for patients' ability to share their concerns in general and their seizure experiences in particular. Studies have shown that unusually open questions at the start of the consultation enable patients to display interactional and linguistic markers which may help with the otherwise challenging differentiation of epileptic from nonepileptic seizures (NES). In this study, we compared the problem presentation approach taken by trainee neurologists in outpatient encounters with new patients before and after a one-day conversation analytic training intervention in which doctors were taught to adopt an open format of question design and recognize diagnostically relevant linguistic features. We audio/video-recorded clinical encounters between ten doctors, their patients, and accompanying persons; transcribed the interactions; and carried out quantitative and qualitative analyses. We studied 39 encounters before and 55 after the intervention. Following the intervention, doctors were significantly more likely to use nondirective approaches to soliciting patient accounts of their presenting complaints that invited the patient to describe their problems from their own point of view and gave them better opportunity to determine the initial agenda of the encounter. The time to first interruption by the doctor increased (from 52 to 116 s, p<.001). While patients were given more time to describe their seizure experiences, the overall appointment length did not increase significantly (19 vs 21 min, n.s.). These changes gave patients more conversational space to express their concerns and, potentially, to demonstrate the interactional and linguistic features previously found to help differentiate between epilepsy and NES, without impacting the length of the consultations

A descriptive survey of cancer helplines in the United Kingdom: Who they are, the services offered, and the accessibility of those services

Abstract Background There are more than 1500 UK health helplines in operation, yet we have scant knowledge about the resources in place to support the seeking and delivering of cancer‐related telephone help and support. This research aimed to identify and describe cancer and cancerrelated helpline service provision: the number of helplines available, the variety of services provided, and the accessibility of those services. Method This study used online national questionnaire survey sent to 95 cancer and cancerrelated helplines in the United Kingdom. Results A total of 69 (73%) of 95 surveyed cancer and cancer‐related helplines completed the survey. Most helplines/organizations were registered charities, supported by donations; 73.5% of helplines had national coverage. Most helplines served all age‐groups, ethnic groups, and men and women. Only 13.4% had a number that was free from landlines and most mobile networks, and 56.6% could only be contacted during working hours. More than 50% of helplines reported no provisions for callers with additional needs, and 55% had no clinical staff available to callers. Ongoing support and training for helpline staff was available but variable. Conclusion Although cancer helplines in the United Kingdom offer reasonably broad coverage across the country, there are still potential barriers to accessibility. There are also opportunities to optimize the training of staff/volunteers across the sector. There are further prospects for helplines to enhance services and sustain appropriate and realistic quality standards

Gendering occupations: persistence and resistance of gender presumptions about members of particular healthcare professions

In spite of increasing gender diversity in employment roles, presumptions persist about the gender of people employed in particular occupations. Focusing on healthcare data collected in Australia and the United Kingdom within the past decade, we use Conversation Analysis (CA) to identify how presumptions about gender are displayed within social interaction through the use of gender-specific pronouns. We show how gender-specific pronouns are asymmetrically selected on the basis of a referent’s occupations, with gender-unspecified members of traditionally male occupations (e.g. doctors) referred to with masculine pronouns and gender-unspecified members of traditionally female occupations (e.g. nurses) referred to with feminine pronouns. We also explore ways people avoid making such presumptions. Our analysis therefore reveals a state of flux in contemporary social life, with instances in which gender presumptions persist as well as attempts to employ person references that reflect contemporary social dynamics

COVID-19 and paediatric palliative care consultations with Dr Katie Ekberg

A collection of interviews with experts from around the globe discussing communication in healthcare during COVID-19. Interviews by Dr Sarah White, Ms Christelle Pagonis, and Mr Jesse Vanzino

Three is not a crowd! Involving family members in audiology appointments

Hearing loss in older adults not only affects the patients themselves, but also their family members. This article outlines the findings of recent research into how family members are typically being involved in current audiology practice, and how audiologists might move towards a more family-centred approach to clinical practice

Identifying clients’ readiness for hearing rehabilitation within initial audiology appointments: a pilot intervention study

Objective: The current study sought to explore audiologists’ use of the Ida Institute Motivation Tools to help them identify clients’ readiness for change within initial assessment appointments. Design: The study involved a mixed methods intervention design. Data were collected pre- and post-training audiologists to use the Ida Motivation tools in their appointments. Appointments were video-recorded and analysed using conversation analysis. Clients and audiologists also completed questionnaires within each appointment to measure clients’ readiness-for-change. Study sample: Participants included 5 audiologists and 22 adult clients from two Audiology clinics. Results: Audiologists incorporated the Ida Motivation tools into the post-training appointments without a significant increase in appointment time. The Ida tools solicited responses from clients that displayed their ambivalence regarding hearing rehabilitation/aids within their talk. Post‐training, audiologists’ perceptions of clients’ stage of readiness were not significantly more likely to match clients’ self-reported stage on the URICA. Conclusions: The Ida Motivation tools may be useful to solicit clients’ ambivalent feelings towards hearing rehabilitation/aids, however, it is important for audiologists to actively listen for ambivalence within clients’ interactional responses to the tools in order judge clients’ readiness

Historical seismometry database project: A comprehensive relational database for historical seismic records

The recovery and preservation of the patrimony made of the instrumental registrations regarding the historical earthquakes is with no doubt a subject of great interest. This attention, besides being purely historical, must necessarily be also scientific. In fact, the availability of a great amount of parametric information on the seismic activity in a given area is a doubtless help to the seismologic researcher’s activities. In this article the project of the Sismos group of the National Institute of Geophysics and Volcanology of Rome new database is presented. In the structure of the new scheme the matured experience of five years of activity is summarized. We consider it useful for those who are approaching to ‘‘recovery and reprocess’’ computer based facilities. In the past years several attempts on Italian seismicity have followed each other. It has almost never been real databases. Some of them have had positive success because they were well considered and organized. In others it was limited in supplying lists of events with their relative hypocentral standards. What makes this project more interesting compared to the previous work is the completeness and the generality of the managed information. For example, it will be possible to view the hypocentral information regarding a given historical earthquake; it will be possible to research the seismograms in raster, digital or digitalized format, the information on times of arrival of the phases in the various stations, the instrumental standards and so on. The relational modern logic on which the archive is based, allows the carrying out of all these operations with little effort. The database described below will completely substitute Sismos’ current data bank. Some of the organizational principles of this work are similar to those that inspire the database for the real-time monitoring of the seismicity in use in the principal offices of international research. A modern planning logic in a distinctly historical context is introduced. Following are the descriptions of the various planning phases, from the conceptual level to the physical implementation of the scheme. Each time principle instructions, rules, considerations of technical–scientific nature are highlighted that take to the final result: a vanguard relational scheme for historical data

Co-implicating and re-shaping clients' suggestions for behavioural change in cognitive behavioural therapy practice

This article uses conversation analysis to examine Cognitive Behavioural Therapy (CBT) interactions with clients diagnosed with depression. The analysis explicates some routine conversational practices used by therapists in CBT to involve or co-implicate clients in the decision-making process regarding behavioural change. The article illustrates how the co-implication of clients in plans for behavioural change involves complex, therapist-guided sequences of interaction. Instances of co-implication are compared to those where therapists propose their own suggestions for change, resulting in different interactional consequences. The demonstration of therapists' use of systematic turn structures to co-implicate clients in the therapeutic process offers an interactional specification of the therapeutic relationship of collaborative empiricism that is encouraged in CBT practice and also shows how this relationship unfolds in the moment-to-moment interaction of therapy