Addressing a source of trouble outside of the repair space

A body of research in conversation analysis has identified a range of structurally-provided positions in which sources of trouble in talk-in-interaction can be addressed using repair. These practices are contained within what Schegloff (1992) calls the repair space. In this paper, I examine a rare instance in which a source of trouble is not resolved within the repair space and comes to be addressed outside of it. The practice by which this occurs is a post-completion account; that is, an account that is produced after the possible completion of the sequence containing a source of trouble. Unlike fourth position repair, the final repair position available within the repair space, this account is not made in preparation for a revised response to the trouble-source turn. Its more restrictive aim, rather, is to circumvent an ongoing difference between the parties involved. I argue that because the trouble is addressed in this manner, and in this particular position, the repair space can be considered as being limited to the sequence in which a source of trouble originates

Uncertainty, responsibility, and reassurance in paediatric palliative care: A conversation analytic study of telephone conversations between parents and clinicians

Background: Families play a vital role in the day-to-day medical care of children with life-limiting conditions. Navigating their child’s symptoms, treatments, and the possibility of sudden deteriorations, presents myriad challenges and can be distressing for the family. Paediatric palliative care can provide crucial support for families who are typically responsible for many aspects of their child’s care. Aim: To understand how paediatric palliative care clinicians use reassurance to support families through the uncertainties associated with caring for their children. Methods: One hundred routine telephone conversations between parents and clinicians of a paediatric palliative care service were recorded and analysed using Conversation Analytic methods. Findings: When parents report uncertainty about a specific care task, imply a causal link between this care task and an adverse outcome for their child, and a moral responsibility for the outcome, clinicians respond with reassurance. Clinicians produce reassurance through refuting parents’ accounts and providing an explanation to reframe the potential adverse outcome as independent of parent actions. Parents often agree with the clinicians’ reframings and demonstrate being reassured. Discussion: Specialist paediatric palliative care clinicians routinely foreground support for family members through reassurance. Conclusions: This study demonstrates how family-centred care can be accomplished in clinical practice

Orienting to Emotion in Computer-Mediated Cognitive Behavioral Therapy

Exploring emotions is a defining feature of psychotherapy. This study explores how therapists explore emotions when they cannot see or hear their clients. In analysing 1,279 sessions of online text-based Cognitive Behavioural Therapy (<i>CBT</i>) we focused on therapists’ commiserations (e.g., “I’m sorry to hear that”) and their affective inferences (e.g., “that sounds very scary for you”). Both practices routinely prefaced moves to pursue a range of therapeutic activities, many of which did not prioritise sustained focus on the emotion that had just been oriented to. By separating message composition from message transmission, the modality used for these therapy sessions enabled therapists to combine orientations to emotion with attempts to shift the focus of discussion. Our analysis finds that although physically co-present and computer-mediated psychotherapy share a common focus on emotional experience, the modality used for therapy can be relevant in the design and use of these orientations. Data are in British English

Managing the therapeutic relationship in online cognitive behavioural therapy for depression:Therapists' treatment of clients' contributions

This article examines how therapists and clients manage the therapeutic relationship in online psychotherapy. Our study focuses on early sessions of therapy involving 22 therapist-client pairs participating in online Cognitive Behavioural Therapy (CBT) for depression. Using Conversation Analysis (CA), we examine how therapists can orient to clients’ contributions, while also retaining control of the therapeutic trajectory. We report two practices that therapists can use, at their discretion, following clients’ responses to requests for information. The first, thanking, accepts clients’ responses, orienting to the neutral affective valence of those responses. The second, commiseration, orients to the negative affective valence of clients’ responses. We argue that both practices are a means by which therapists can simultaneously manage developing rapport, while also retaining control of the therapeutic process

Managing clients’ expectations at the outset of online Cognitive Behavioural Therapy (CBT) for depression

Background\ud \ud Engaging clients in psychotherapy by managing their expectations is important for therapeutic success. Initial moments in first sessions of therapy are thought to afford an opportunity to establish a shared understanding of how therapy will proceed. However there is little evidence from analysis of actual sessions of therapy to support this.\ud \ud Objective\ud \ud This study utilised recordings to examine how therapists manage clients’ expectations during the first two sessions of online Cognitive Behavioural Therapy (CBT). \ud Methods Expectation management was investigated through conversation analysis of sessions from 176 client-therapist dyads involved in online CBT. The primary focus of analysis was expectation management during the initial moments of first sessions, with a secondary focus on expectations at subsequent points. \ud \ud Analysis\ud \ud Clients’ expectations for therapy were most commonly managed during the initial moments of first sessions of therapy. At this point, most therapists either outlined the tasks of the first and subsequent sessions (n=36), or the first session only (n=108). On other occasions (n = 32), no attempt was made to manage clients’ expectations by outlining what would happen in therapy. Observations of the interactional consequences of such an absence suggest clients may struggle to engage with the therapeutic process in the absence of appropriate expectation management by therapists. \ud \ud Conclusion\ud \ud Clients may more readily engage from the outset of therapy when provided with an explanation that manages their expectation of what is involved. Therapists can accomplish this by projecting how therapy will proceed, particularly beyond the initial session

Fabriquer un culte ethnique. \uc9criture rituelle et g\ue9n\ue9alogies mythiques dans le sanctuaire des Paliques en Sicile.

The sanctuary of the gods Palikoi in Sicily offers a rich dossier addressing the role of writing in the definition of ethnicity. Although literary evidence attest to the \u201dnative\u201c nature of the gods, the presence of writing, inbedded in local culture through the Greek colonization, plays a curious role. It invites us to reflect upon contact processes and identity changes due to its appearance. The analysis focuses here on the ordeal oath (ritual writing) and on the mythical genealogies (discursive strategies): this set seems to be a "device" in many ways informed by the model of the "Middle Ground."Le sanctuaire des dieux Paliques en Sicile offre un dossier tr\ue8s riche \ue0 questionner pour ce qui concerne le r\uf4le jou\ue9 par l\u2019\ue9criture dans la d\ue9finition de l\u2019ethnicit\ue9. M\ueame si les t\ue9moignages litt\ue9raires reconnaissent la nature \uab indig\ue8ne \ubb des Paliques, la pr\ue9sence de l\u2019\ue9criture, qui a p\ue9n\ue9tr\ue9 dans les cultures locales par le biais de la colonisation grecque, exerce une fonction troublante et nous oblige \ue0 r\ue9fl\ue9chir sur les processus de contact et les changements identitaires que son existence provoque. L\u2019analyse se concentre ici sur le serment ordalique (\ue9criture rituelle) et sur les g\ue9n\ue9alogies mythiques (strat\ue9gies discursives) : cet ensemble semble constituer un \uab dispositif \ubb que le mod\ue8le du \uab Middle Ground \ubb permet d'\ue9clairer \ue0 bien des \ue9gards

Relationship between expectation management and client retention in online cognitive behavioural therapy

Background: Engaging clients from the outset of psychotherapy is important for therapeutic success. However, there is little research evaluating therapists’ initial attempts to engage clients in the therapeutic process. This article reports retrospective analysis of data from a trial of online cognitive behavioural therapy (CBT) for depression. Qualitative and quantitative methods were used to evaluate how therapists manage clients’ expectations at the outset of therapy and its relationship with client retention in the therapeutic intervention. Aims: To develop a system to codify expectation management in initial sessions of online CBT and evaluate its relationship with retention. Method: Initial qualitative research using conversation analysis identified three communication practices used by therapists at the start of first sessions: no expectation management, some expectation management, and comprehensive expectation management. These findings were developed into a coding scheme that enabled substantial inter-rater agreement (weighted Kappa = 0.78; 95% CI: 0.52 to 0.94) and was applied to all trial data. Results: Adjusting for a range of client variables, primary analysis of data from 147 clients found comprehensive expectation management was associated with clients remaining in therapy for 1.4 sessions longer than those who received no expectation management (95% CI: -0.2 to 3.0). This finding was supported by a sensitivity analysis including an additional 21 clients (1.6 sessions, 95% CI: 0.2 to 3.1). Conclusions: Using a combination of qualitative and quantitative methods, this study suggests a relationship between expectation management and client retention in online CBT for depression, which has implications for professional practice. A larger prospective study would enable a more precise estimate of retention

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

Findings from a feasibility study to improve GP elicitation of patient concerns in UK General Practice consultations

Objectives To establish: a) feasibility of training GPs in a communication intervention to solicit additional patient concerns early in the consultation, using specific lexical formulations (“do you have ‘any’ vs. ‘some’ other concerns?”) noting the impact on consultation length, and b) whether patients attend with multiple concerns and whether they voiced them in the consultation. Methods A mixed-methods three arm RCT feasibility study to assess the feasibility of the communication intervention. Results Intervention fidelity was high. GPs can be trained to solicit additional concerns early in the consultation (once patients have presented their first concern). Whilst feasible the particular lexical variation of ‘any’ vs ‘some’ seemed to have no bearing on the number of patient concerns elicited, on consultation length or on patient satisfaction. The level of missing questionnaire data was low, suggesting patients found completion of questionnaires acceptable. Conclusion GPs can solicit for additional concerns without increasing consultation length, but the particular wording, specifically ‘any’ vs. ‘some’ may not be as important as the placement of the GP solicitation

Making Arrangements : Remote proposal sequences and attendant structural phenomena in social interaction

In this thesis, I contribute to the study of how arrangements are made in social interaction. Using conversation analysis, I examine a corpus of 375 telephone calls between employees and clients of three Community Home Care (CHC) service agencies in metropolitan Adelaide, South Australia. My analysis of the CHC data corpus draws upon existing empirical findings within conversation analysis in order to generate novel findings about how people make arrangements with one another, and some of the attendant considerations that parties to such an activity can engage in: Prospective informings as remote proposals for a future arrangement – Focusing on how employees make arrangements with clients, I show how the employees in the CHC data corpus use ‘prospective informings’ to detail a future course of action that will involve the recipient of that informing. These informings routinely occasion a double-paired sequence, where informers pursue a response to their informing. This pursuit often occurs even after recipients have provided an initial response. This practice for making arrangements has been previously described by Houtkoop (1987) as ‘remote proposing.’ I develop Houtkoop’s analysis to show how an informing of a future arrangement can be recompleted, with response solicitation, as a proposal that is contingent upon a recipient’s acceptance. Participants’ understanding of references to non-present third parties – In the process of making arrangements, references are routinely made to non-present third parties. In the CHC data corpus, these third parties are usually care workers. Prior research (e.g., Sacks & Schegloff, 1979; Schegloff, 1996b) explains how the use of ‘recognitional references’ (such as the bare name ‘Kerry’), conveys to recipients that they should be able to locate the referent from amongst their acquaintances. Conversely, the use of ‘non-recognitional references’ (such as the description ‘a lady called Kerry’), conveys that recipients are unacquainted with the referent. I examine instances where the selection of a recognitional or non-recognitional reference form is followed by a recipient initiating repair on that reference. My analysis provides further evidence thatthe existing analytic account of these references corresponds to the way in which participants themselves make sense of them. My analysis also advances an understanding of how repair can be used, by recipients, to indicate the inappositeness of a prior turn. Post-possible-completion accounts – In a case study of a problematic interaction, I examine a misunderstanding that is not resolved within the repair space, the usual defence of intersubjectivity in interaction (cf. Schegloff, 1992b). Rather, I explore how the source of trouble is addressed, outside of the sequence of its production, with a ‘post-possible-completion account.’ This account specifies the basis of a misunderstanding and yet, unlike repair, does so without occasioning a revised response to a trouble-source turn. By considering various aspects of making arrangements in social interaction, I highlight some of the rich order that underpins the maintenance of human relationships across time. In the concluding section of this thesis I review this order, while also discussing practical implications of this analysis for CHC practice