Improving Communication in Mental Health Settings

Evidence-Based Recommendations from Practitioner-led Research

Michelle O'Reilly, Jessica Lester

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000360851
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Improving Communication in Mental Health Settings draws on empirical studies of real-world settings to demonstrate contemporary practice-based evidence, providing effective strategies for communicating with patients/clients in mental health settings.

The book integrates clinical experience and language-based evidence drawn from qualitative research. Drawing on studies that utilize scientific language-based approaches such as discourse and conversation analysis, it focuses on social interaction between professionals and patients/clients to demonstrate effective communication practices. Chapters are led by clinical professionals and feature a range of mental health settings, different mental health conditions and types of patient/client, and evidence-based recommendations.

This book is an essential guide for professionals working in mental health and/or social work, and those training or working in clinical areas of mental health practice.

Chapter 1

Communication, mental health, and how language-based research can help in practice

Jessica Nina Lester and Michelle O’Reilly

Introduction

Communication in the field of mental health is a ubiquitous concept and one that, to some extent, has been taken for granted. However, communicating with individuals in mental health settings requires skills and training to ensure clients/patients are fully engaged in the process. Crucial to effective practice is the relationship between practitioners and their clients/patients, as well as other people involved in their care. These relationships are important at all stages of mental healthcare, including assessment, diagnosis, and treatment. Specifically, communication is important for long-term engagement, and for any required medication adherence to achieve positive outcomes.

In this chapter, we introduce the focus of the book by illuminating a body of literature that contributes significantly to the communication work in mental health. Evidence yielded from research using language-based approaches, such as discourse analytic approaches and conversation analysis, has a great deal to offer those working in practice. Such evidence has the benefit of being grounded in real-world practices due to the use of naturally occurring data, with much of this work involving or led by clinical practitioners. The focus on social interaction and real-world practice means that the findings from such studies have the potential to make a real difference to practitioners seeking to improve their communication skills. Notably, much of the work using language-based approaches fails to reach those working in the field, due to the technical language espoused and the limited nature of many of the outlets of dissemination. Thus, in this chapter, we provide some assistance for practitioners to understand the vocabulary used, while also distilling the core messages into an appropriate and useful discourse. Furthermore, we outline the focus of the book, providing an overall synthesis of the three parts of the book and the chapters within it.

Communication and mental health

Communication is central for those working in mental health, as interacting with patients/clients, families, mental health practitioners, and representatives from other organisations and agencies is fundamental to the work. Engaging others in the consultation, especially the patient/client, is important, and the communication skills of mental health practitioners are crucial for the practice to be effective. Good communication is central for practitioners as they attempt to build a relationship with their patient/client and others involved in their care. This is necessary for longer-term engagement and rapport, but also for medication adherence, attending future appointments, and longer-term outcomes.

Despite this importance, many trainees and practitioners rely on anecdotal evidence, training courses, and experience to inform their social interactions. Often, textbooks used in courses for clinical trainees rely on experience and general approaches to communication, taking a broad approach or using models derived from experimental methods. A good example of this is psychiatry or nursing textbooks that encourage practitioners to use “open questions” without critically addressing what constitutes an open question or in what circumstances they are less effective or how such questions might be asked in a closed way (or how closed questions might be asked in an open way). Many mental health practitioners are reflexively aware of their communication skills and style, and often motivated to maintain and improve their communication competencies, especially within the modern rhetoric of evidence-based practice.

There is a substantial amount of evidence generated from communication studies, specifically from language-based approaches; studies showing the power of a single word, like that of Heritage and Robinson’s (2011) work that showed the significant difference between “some” versus “any”; “Do you have any questions?” versus “Do you have some questions?” in primary care; studies showing the challenging and negative stance that why questions can take (Bolden and Robinson 2011); and studies that have highlighted the usefulness of prefacing questions with “you said x” to encourage children to talk about their problems in mental health assessments (Kiyimba and O’Reilly, 2018). This evidence is often grounded in real-world practices, and more recently, clinical authors are starting to use these approaches. Using qualitative approaches to communication, with a focus on social interaction, actual examples of communication in practice, and identifying ways in which communication works (and fails) in various circumstances, this evidence has the potential to make a real difference to the ways in which clinical practitioners work. Despite its value, and its practice-based approach to examining communication and social interaction, some of this work is written in a way that makes it inaccessible to clinical audiences. Furthermore, because of the difficult-to-access publication outlets that some of these studies appear in, much is hidden from clinical audiences, particularly those individuals who are less resourced to seek them out. However, when written in a clinically relevant and accessible way, this evidence is very useful.

Aims and objectives

Through this book, we propose that an integration of clinical experience and language-based evidence from work using approaches such as discourse and conversation analysis (although not exclusively) can provide an essential source of information for those training or working in mental health settings. Almost all chapters are led by clinical professionals with experience in using these methods, we suggest that what is offered here offers both valid and credible messages for readers. Furthermore, throughout the chapters, the complexity of the methodologies are distilled into practical and understandable messages to help practitioners who want to change or inform their practice, while simultaneously encouraging readers to go beyond the book to seek out how other work may also offer important evidence to support their daily professional lives.

Discourse and conversation analysis

Most (although not all) of the chapters draw specifically on discourse or conversation analysis to demonstrate the central role of language, the focus of social interaction, and the meaning of communication in mental health practice. While the authors of each chapter provide a short overview of their specific language-based approach in research and explain the relevant aspects of that process, we provide a brief introduction here. This description is not intended to be a full or detailed description of these approaches, but merely a brief introductory overview.

Discourse analysis

Discourse analysis is an umbrella term that refers to a range of approaches that examine the use of language in social interaction. Discourse analysis spans several disciplines and there is variability in how discourse is conceptualised and analysed (Georgaca, 2014). However, all discourse approaches focus on language and meaning in talk and text. That is, there is agreement across the various approaches to discourse analysis that language is central to the meanings of the human world (Spong, 2010) and that it is through language that social life is performed.

There are different theoretical strands of discourse analysis. Those that focus on the macro-processes of social interaction and those that focus on the micro-processes of social interaction is a common distinction that has been made. Those that focus on the macro-processes include approaches like critical discourse analysis, critical discursive psychology, and Foucauldian discourse analysis (see Wooffitt, 2005 for an overview). These macro-focused discourse approaches examine the socially available discourses that people draw upon when presenting their views and experiences and tend to be concerned with power, social domination, and inequality (Georgaca, 2014). These types of discourse analysis are concerned with the role of discourse in the production of power within certain social structures to see how discourses might sustain and legitimise social inequality (Wooffitt, 2005). In so doing, these discourse analysts take an explicit socio-political position and focus on the production of the dominance of elite groups or organisations and consider how these are reproduced by the talk or text (van Dijk, 2008). Those discourse analysis types that focus on micro-processes of social interaction include approaches like discursive psychology (Edwards and Potter 1992). This type of discourse approach tends to have a closer alignment with conversation analysis and focuses more on how meaning is co-created between interlocutors. These discourse analysts prefer to collect data that represents real-world interactions and argue that any speech act can only be analysed in a meaningful way by reference to the situated nature of the talk (Edwards and Potter, 1992).

Conversation analysis

Conversation analysis, as a distinct qualitative methodology, is designed to examine language in interaction in terms of how the turns of talk are designed to perform certain social actions (Antaki, 2011). To put it simply, conversation analysts study social interactions, attending to the ordered and patterned nature of the talk itself. Indeed, those practicing conversation analysis study “talk-in-interaction” (Drew and Heritage, 1992). Although conversation analysis is interested in language, the main object of its study is the interactional organisation of social activities; that is, the production of talk and sense obtained through a sequential structure in terms of the practical social accomplishment (Hutchby and Wooffitt, 2008). To achieve its analytical goals, conversation analysts collect data from the real world, referred to as naturally occurring data. Naturally occurring data are those recordings (or natural texts) of actual practices, such as classroom interactions, therapy conversations, or police-witness interviews (see Kiyimba, Lester, and O’Reilly, 2019). In so doing, conversation analysts focus on what people actually say and do, rather than what they report they say and do (McCabe, 2006).

More recently, conversation analysts have turned significant attention to talk and interaction within institutional settings, and more scholars have begun to consider the value and application of their findings to practitioners. Therefore, a distinction has been drawn between basic and applied conversation analysis (Antaki, 2011). Basic (sometimes referred to as pure) conversation analysis examines mundane and commonplace interactions (McCabe, 2006), whereas applied conversation analysis tends to (although not exclusively) focus on interactions within institutional settings (Lester and O’Reilly, 2019). Notably, the application of conversation analysis to institutional talk is not necessarily related to solving problems of institutions, but instead focuses on how those institutions carry out their institutional business successfully (Antaki, 2011; O’Reilly et al., 2020).

Relevance of discourse and conversation analysis to mental health

We argue that language-based approaches are useful approaches to examine mental health. This is because mental states and psychiatric categories are produced through and within language (Harper, 1995), as the very idea of “normality” or “sanity”, “pathology”, and “insanity” are typifications that start with observation and social interaction (Roca-Cuberes, 2008). The focus on language therefore has worked to reframe conceptualisations of mental health and mental ill health, as well as its management, shifting the emphasis away from biomedical explanations to interpersonal and social-cultural ones (Georgaca, 2014).

Importantly, discourse and conversation analytic approaches are also important in understanding the institutional business related to mental health. For example, by using these approaches new perspectives have been brought to the fore on therapy, counselling, and psychiatric care. This is especially useful as a focus on language for analysis is congruent with therapeutic practice as both take place through language and focus on meaning-making (McLeod, 2001). Notably, this is not to say that these approaches tell practitioners how to conduct therapy effectively; rather, they highlight how client...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Acknowledgements
• Editor Biographies
• List of Contributors
• 1 Communication, mental health, and how language-based research can help in practice
• PART I: Communication with children and families
• PART II: Communication with adults
• PART III: Learning Journeys: From theory to practice
• Index