‘Good’ Communication in Schizophrenia: A Conversation Analytic Definition

Recent work attends seriously to the role of communication in improving the therapeutic value of clinician-patient relationships (Priebe et al., 2011) and, in turn, even multifactorial outcomes such as treatment adherence (Thompson & McCabe, 2012).Nonetheless, 'partnership' constructs deemed essential for service delivery -'shared decision making ' and 'patient-centredness' -remain elusive (Epstein 2005).These are, in the main, abstract ideals, not specific techniques conducive to clinician training. How should we define 'good' psychiatric communication?Conceptualising 'good' communication begins with identification of specific practices and how they advance the values of patients and the therapeutic relationship, or 'alliance' (Thompson et al., 2012).Alliance (a subjectively rated psychological construct) and communication (components of the behavioural exchange, with the capacity for objective analysis) are interrelated, but analytically distinct concepts (Priebe & McCabe, 2006).Starting with the latter 'micro-level' would allow identification of tangible practices from which to explore their relationship with 'higher-level' subjective constructs or behavioural outcomes: treatment adherence.By identifying the systematic practices through which people perform and recognise social action in talk, the method of conversation analysis (CA) shows promise in understanding psychiatric communication at this level (Bergmann, 1992, McCabe, Leuder & Antaki, 2009, McCabe, Heath, Burns & Priebe, 2002).CA researchers use video and audio recordings of naturally occurring psychiatric interaction, and a detailed method of transcription to capture the minutiae of speech and elements of non-verbal behaviour.These provide analytical tools for exposing the underlying structures, or 'rules', that govern how activities are composed and organised.The results are highly descriptive, allowing exploration of topics as dynamic as the tacit skills by which delusional talk is recognised by psychiatrists (Palmer 2000).