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Communication and Caring for Someone with Schizophrenia: Intergroup Themes, Strategies, and Communication Accommodation
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Julia Cretchley. - : The University of Queensland, School of Psychology, 2011
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Abstract:
This thesis examines the communication between people living with schizophrenia (PwS) and their family and professional carers, with the aim of identifying behaviours and strategies that are associated with desirable outcomes. Disordered communication is a key symptom in the diagnosis of schizophrenia, and carers identify problems in everyday communication as contributing to their burden of care. Many laboratory-based and clinical studies have investigated formal thought disorder (and other clinical factors) that may cause trouble in conversations with PwS. Few have taken a communication approach, however, and focused on the everyday interactions between carers and PwS. This thesis uses Communication Accommodation Theory (CAT) to identify patterns of behaviour and sociolinguistic strategies that work well in a natural setting. It uses a combination of qualitative and quantitative methods, and has a secondary aim of testing the applicability of text analytics software programs (in particular, Leximancer and NVivo) in the health domain. The first study explored the inter-group dynamics in 17 natural conversations between carers and PwS. Different patterns of behaviour were observed within the sample of PwS: some PwS were highly talkative (introducing and changing topics, and contributing much of the content), and others were reticent (responding minimally and behaving in a reactive manner). Different dynamics were also observed in the conversations between PwS and family versus professional carers, perhaps reflecting the different relationships between the participants. While the carers used a variety of strategies to manage different styles of communication among the PwS, across the board they adopted an accommodative stance in the face of under-accommodation by the PwS. In the second study, 15 carers were interviewed about their daily communication experiences, and the content was coded for emergent themes. Comparisons were made between the concepts identified by hand using NVivo, and those that emerged automatically via the Leximancer software. The carers were asked to describe communication problems, and to explain what strategies they used to overcome these. Most carers were able to describe useful strategies for achieving everyday goals, even if they had no formal training in communication skills. A small set of key strategies was reported to work well across a variety of contexts. The final, questionnaire-based, study explored the experiences of a wider sample of 45 carers. A mixed quantitative/qualitative measure was developed, based on the findings of the interview study. The results revealed some common strategies that worked well across the board. For example, most carers described it as useful to adopt a positive approach in managing conversations with their relative. Most carers also recommended exercising self-restraint, but this strategy was used particularly where the PwS’s conversational tendencies were extreme (whether highly reticent or highly talkative). Such nuances in carers’ usage of strategies suggested that they adjusted their accommodative moves to suit their relative’s individual conversational needs. For example, carers made more effort to improve mutual understanding when interacting with highly reticent PwS. On the other hand, they emphasised reducing the pressure placed upon very talkative PwS. A short list of practical suggestions were devised that may assist new carers to communicate better with their relatives with schizophrenia. Future research could test the success of a training intervention based on these guidelines. This thesis highlights the need for additional informational and training support for family carers of people living with schizophrenia. It demonstrates some opportunities for innovation in clinical assessment by applying new text analytics technologies. It also shows the utility of taking a communication approach, and of Communication Accommodation Theory, in this context. The research is unusual in taking this approach to studying communication in a clinical population, and the results indicate the benefits of doing so.
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Keyword:
1701 Psychology; 20 Language; Australia; communication accommodation theory; Communication and Culture; health; intergroup communication; Leximancer; NVivo; text analytics software
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URL: https://espace.library.uq.edu.au/view/UQ:273884
https://espace.library.uq.edu.au/view/UQ:273884/s33687173_phd_submission.pdf
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