An investigation into how mutual understanding is established between psychiatrists and outpatients with a diagnosis of schizophrenia : using the mechanism of conversational repair

• Main Author: Themistocleous, Myrofora
• Published: University of East London 2006
• Subjects: 150
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.532626

The therapeutic relationship and quality communication have long been established as central determinants of therapeutic outcome (Weiss et al, 2002; Drew et al, 2001). However, these may be more difficult to establish with people diagnosed with psychosis. This thesis focuses on how psychiatrists and outpatients with a diagnosis of schizophrenia establish mutual understanding. A newly developed 'repair protocol' was utilised from within the conversation analytic framework. This takes advantage of the structural features of language that speakers use to correct misunderstandings; i.e. 'repair'. Therefore, it was possible to identify when misunderstandings occur and how they were repaired, then to explore associations between repair and the therapeutic relationship. This research is novel in psychiatry, as it allows for integration of verbal and non-verbal behaviour and analyses the function of talk. The findings illustrate that different types of repair were linked with different patient and psychiatrist outcomes. Repair was utilised to achieve various actions (e.g. disagreeing) or following certain junctures, (e.g. abrupt topic shifts). Initially, patients made most effort to make their contribution understandable, whereas psychiatrists made most effort to repair misunderstandings once they had occurred. In addition, the more positively the psychiatrists rated the relationship the more effort they made to understand the patients. Although the psychiatrists' efforts were not associated with patients overall view of the relationship, they did feel better emotionally, despite, feeling less understood. Most repairs were successful but they did not always have to be successful to maintain conversation; effort seems more important than success. There appeared to be high communicative alignment though some mismatch means there is scope for improvement. Both parties prioritised understanding the same topics but psychiatrists' focused more on medication and patients on voices. It seems the concept of repair can provide a range of relevant information for how psychiatrists and patients create mutual understanding in their routine meetings.