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Peer-based interventions are increasingly used for delivering mental health services to help people with an illness re-examine their situation and accept their illness as part of their life story. The role of the peer supporter in these interventions, known as experts-by-experience (EbE), is situated between mutual peer support and semi-professional service delivery, and they face the challenge of balancing an asymmetric, professional relationship with a reciprocal, mutuality-based, equal relationship. This article investigates how EbEs tackle this challenge when responding to clients' stories about their personal, distressing experiences in peer-based groups in psychiatric services. The results show how the EbEs responded to their clients' experience-sharing with two types of turns of talk. In the first response type, the EbEs highlighted reciprocal experience-sharing, nudging the clients toward accepting their illness. This invoked mutual affiliation and more problem-talk from the clients. In the second response type, the EbEs compromised reciprocal experience-sharing and advised clients on how to accept their illness in their everyday lives. This was considered less affiliative in relation to the client's problem description, and the sequence was brought to a close. Both response types involved epistemic asymmetries that needed to be managed in the interaction. Based on our analysis, semi-professional, experience-based expertise involves constant epistemic tensions, as the participants struggle to retain the mutual orientation toward peer-based experience-sharing and affiliation. [ABSTRACT FROM AUTHOR]

In our society, work is generally considered central to citizenship and individual well‐being. However, paid employment is often out of reach for individuals with mental illness. The Clubhouse model is a community‐based rehabilitation programme that therefore offers people with mental illness the possibility to enjoy some social advantages of work. However, the status of the day‐to‐day Clubhouse activities as "work" is a matter of discursive contestation. Drawing on 29 meetings of a Clubhouse rehabilitation group as data, and using conversation analysis and discourse analysis as methods, this study examines two competing interpretive repertoires that are systematically manifested in this context: the capitalist "paid work" repertoire used by Clubhouse clients and the more flexible "productive activity" repertoire used by support workers. The adoption of these two repertoires reflects two competing discursive agendas, which define the scope of mental health rehabilitation and the role of the client in their own rehabilitation process in distinct ways. From this perspective, the support workers' central institutional task is essentially of a discursive and ideological nature—exposing the clients to new ways of talking about their lives with reference to work. [ABSTRACT FROM AUTHOR]

Increasing client involvement in the development of social and health‐care services has resulted in clients being invited to present their experiential knowledge in service co‐development groups. Nevertheless, research has shown that their opportunities to really contribute to actual decision‐making are limited. This article investigates how client representatives initiate turns‐at‐talk in the decision‐making context and the way in which professionals respond to them. Using conversation analysis, we analyzed 15 h of recorded interactions in five co‐development workshops. Our data exhibited a systematic pattern that linked client representatives' self‐promoting and self‐dismissive turns‐at‐talk to specific types of responses from professionals. When the client representatives highlighted the relevance of their experiential knowledge for making decisions, the professionals disregarded their contributions. However, if instead, the client representatives cast their experiential knowledge as irrelevant to the decision‐making activity at hand, the professionals subsequently appreciated this knowledge. Thus, paradoxically, in order to establish the relevance of their views, client representatives diminished their positions as experiential experts. [ABSTRACT FROM AUTHOR]

Using both statistical methods and conversation analysis, we examined how support workers in a mental health rehabilitation community encourage clients to participate in joint decision-making processes. Drawing on video-recordings of 29 community meetings as data, we considered support workers' proposals (N = 449) and clients' responsiveness to them. Support workers' proposals were coded for their linguistic and other features and clients' responsiveness was assessed by three independent raters. Multiple linear regression (MLR) analysis was carried out. A significant regression equation with seven predictor variables accounted for 24% of the variance in the data. Four variables predicted a higher level of client responsiveness: the use of explicit recipient address term, "quasi-open" proposal form, support worker's long work experience, and the average level of client participation during a session. Three variables predicted a lower level of client responsiveness: grammatical complexity of proposal form, modal declarative proposal form, and the presence of only one support worker in a session. The qualitative conversation-analytic investigation highlighted the advantages of the careful fine-tuning of openness vs. closedness of proposal form, the reflexive awareness of which, we argue, may help mental health professionals to encourage clients' responsiveness in joint decision-making processes and thereby their participation in communal life. [ABSTRACT FROM AUTHOR]

We sought to explore how the process between the counsellor and patient for arriving at a case formulation may predict the outcome of manualized interpersonal counselling (IPC) for depression in primary care. Qualitative content analysis and applied conversation analysis (CA) were used to achieve depth in the understanding of case formulation process among five patients who recovered and five who were unchanged according to quantitative post-treatment change rates derived from Clinical Outcomes in Routine Evaluation– Outcome Measure (CORE-OM). Interaction in the case formulations for the recovered group was generally characterized by a joint construction effort between the counsellor and the patient centred on one problem area. The ability to delimit problems to one area was associated with the patient's role disputes in social relationships. For the unchanged patients, the case formulation typically reflected unilateral construction of the problem area, and more than one problem area was selected as the focus. The problem areas in the unchanged group were associated with complicated grief or loneliness. The process between counsellor and patient of arriving at and agreeing on a case formulation might potentially contribute to recovery, and it deserves greater attention in training counsellors and conducting research. [ABSTRACT FROM AUTHOR]

In many countries, occupational health examinations are considered to have a central role in ensuring that employees' health and work ability are maintained or enhanced. In contemporary Finland, the institutional goal of these examinations is to construct a health plan based on the client's own aims, and in this paper we analyse how occupational health nurses and clients in Finland negotiate what is considered to be a problem. The data consist of 10 video-recorded occupational health examination encounters, analysed by means of conversation analysis. Our analysis focuses on 'no problem' advice, in which the advice giving is initiated in the absence of a problem-indicative response. The client's 'no problem' response was typically followed by the nurse upgrading the problem that she had identified and giving a general reminder of a possible problem. The clients resisted not so much the content of the advice, but the act of advising itself. In a few cases, the client's 'no problem' response was followed by a turn in which the nurse contested the client's knowledge and offered advice that was tailored to the client's situation. The client acknowledged the advice as new information. Our findings indicate that regardless of client-centred ideals, the interaction in occupational health examinations is largely led by nurses, who set up the agenda and raise issues that they consider to be problems for their clients. [ABSTRACT FROM AUTHOR]

Diagnosis is integral part of the way medicine organises illness: it is important for identifying treatment options, predicting outcomes and providing an explanatory framework for clinicians. Previous research has shown that during a medical visit not only the clinician but also patients provide explanations for the causes of their symptoms and health problems. Patients’ lifeworld explanations are often differentiated from the diagnostic explanations provided by clinicians. However, while previous conversation analytic research has elaborated the ways in which diagnostic and lifeworld explanations are interactionally structured in somatic medicine, there is little research on how these explanations are organised in psychiatry. Psychiatric diagnosis is particularly interesting because in mental disorders illness itself is not determined by any objective measurement. Understanding of the patient's problem is constructed in interaction between the patient and clinician. The focus of this research will be patients ' references to diagnosis in psychiatry and the functions of these references. The findings are based on conversation analysis of 29 audio-recorded diagnostic interviews in a psychiatric outpatient clinic. Our results demonstrate that patients can utilise diagnostic categories in several ways: disavowing a category to distance their symptoms from it, accounting for their life experiences being rooted in psychiatric illnesses and explaining their illnesses as being caused by certain life experiences. We argue that these explanations are important in patients' face-work – in constructing and maintaining a coherent and meaningful view of the patient's self. [ABSTRACT FROM AUTHOR]

The relationship between a psychotherapist and a client involves a specific kind of epistemic asymmetry: in therapy sessions the talk mainly concerns the client's experience, which is unavailable, as such, to the therapist. This epistemic asymmetry is understood in different ways within different psychotherapeutic traditions. Drawing on a corpus of 70 audio-recorded sessions of cognitive psychotherapy and psychoanalysis and using the method of conversation analysis, the interactional practices of therapists for dealing with this epistemic asymmetry are investigated. Two types of epistemic practices were found to be employed by therapists while formulating and interpreting the client's inner experience. In the formulations, the therapists and clients co-described the client's experience, demonstrating that the client's inner experience was somewhat similarly available to both participants. In the interpretations, the therapists constructed an evidential foundation for the interpretation by summarising the client's talk and using the same descriptive terms as the client. Clients held therapists accountable for this epistemic work: if they failed to engage in such work, their right to know the client's inner experience was called into question. [ABSTRACT FROM AUTHOR]