Elina Weiste, Sanna Vehviläinen, Timo Leino & Jaana Laitinen

Interactional practices of occupational health checkups: Comparison before and after training intervention

Regular health check-ups are a key tool in occupational health. Their goal is to prevent work-related diseases and symptoms and to promote workers’ health and work ability. To achieve this goal, the counseling skills of occupational health nurses are of great importance. This study is part of a project in which occupational health nurses were provided a short training intervention to increase their skills in counseling interaction. As a part of the project, three nurses video-recorded a total of 16 health checkups prior to and after the training intervention. Using conversation analysis, this paper investigates how plans related to health and the ability to work are discussed prior to and after the training intervention.

Prior to the training, the nurse topicalized a problematic matters potentially worthy of advice by questioning, and following the client’s response, attended to the problem through third-position advice. In many cases such advice was given to a client who had not identified anything problematic when it had been his or her previous turn. After the intervention, the discussions that followed were still mainly constructed around questioning and giving advice, but they displayed more sequential variation: when the client’s response contained any indication of problematic behavior, the nurses, rather than offering advice, formulated or validated the client’s situation. Training counseling skills seems to be beneficial in better targeting advice to the client’s concerns and needs.

Keywords: advice, health checkup, counseling interaction, occupational-health clinic, training intervention

Anni Tiitinen, Elina Weiste, Johanna Ruusuvuori & Jaana Laitinen

Interactional mechanisms explaining the experiences of peer support in group counseling

Peer support has been shown to be an effective counseling technique. In this study, we investigate peer support at the micro level of interaction by conducting a comparative conversation analytic case study. The data consist of five video-recorded processes of group counseling for female small-scale entrepreneurs. The aim of these structured, solution-focused groups was to promote the participants’ work ability and healthy lifestyles. The analysis was based on the participants in one group having reported in a survey that they had experienced less peer support compared to others. We aim to understand the interactional phenomena that could be linked to this difference in the participants’ experiences. We focus on the ways in which participants show empathy with each other.

The results show that a strong orientation towards discussing each group members’ experiences one at a time makes spontaneous commenting on each other’s experiences difficult. Taking a turn to talk in the middle of discussing another participant’s experiences requires extra interactional effort. If the group members are not prepared to be active in breaking the structure of counseling, the possibilities to produce responses that show empathy are limited. This highlights the significance of counselors’ practices of creating opportunities for the participants to share experiences. The results underline the importance of understanding the detailed mechanisms of interaction to be able to evaluate group counseling.

Keywords: conversation analysis, empathy, group counseling, peer support

Sanna Vehviläinen & Kimmo Svinhufvud

Defining the working problem at study psychologists’ consultations

This study examines how the working problem is constructed at study psychologists’ consultations between study psychologists and students. Determining the working problem is a central activity at the first meetings. Shared understanding of the working problem is also viewed as a core element in building a successful alliance. Our analysis shows how this activity is constructed in the study psychologist consultation interaction and how the participants participate in it. Our data consisted of video recorded consultations between individual students and study psychologists, and our method was conversation analysis. Our analysis presents two strategies for arriving at a shared working problem. The problem can be addressed as already having been determined right from the beginning. However, the student has the opportunity to describe the situation during the consultation. A more typical strategy is that the study psychologist presents a ”working problem suggestion”, based on hearing the student’s description of the problematic situation. The student either accepts or evades the suggestion. Those suggestions that get an accepting response present a clear suggestion for the working problem and its focus, and refer to future work together. Also, they are shaped so as to indicate they are based on what the student has said, thus attributing epistemic authority to the student. The suggestion that receives an evasive response differs in terms of the above-mentioned elements.

Keywords: study psychologist’s consultation, counseling interaction, working problem alliance, conversation analysis

Mikko Pohjola, Virpi-Liisa Kykyri & Aarno Laitila

Negotiating responsibility and agency for improving workplace collaboration in a consultation meeting

According to dialogic views of the process consultation the ownership of the problem at hand and its’ solution stays with the client. The consultation events are designed to promote engagement so that the clients could adopt a responsible relationship with respect to their problems and to assume agency in finding ways of resolving them. The empirical studies regarding how this is done in practice are, however, hard to find. The question we focus on in this article concerns positions that the consultees take regarding their responsibility and agency in solving the problem at hand, namely problems in team collaboration. The study data comprised an audio recording of the meeting. Data were analyzed using concepts of positioning analysis. We were able to show that by using these concepts it is possible to study consultation interaction in a meaningful way. We show how the consultant is calling the participants to take responsible and agentic positions regarding the problem at hand and how the responsibility and agency for improving the collaboration at the workplace are negotiated. In this negotiation the participants may seek to avoid taking responsibility and agentic positions in various ways. We show how the ways in which participants talked about the responsibility and agency for improving collaboration at the workplace changed in the meeting. Finally, we discuss the theoretical and practical implications of our findings.

Keywords: process consultation, positioning theory, responsibility, agency, interaction

Melisa Stevanovic, Taina Valkeapää, Elina Weiste & Camilla Lindholm

Participation and the promotion of joint decision making in mental health rehabilitation

In this paper, we analyze the construction of joint decisions in interactions between mental health rehabilitants and their support workers in the context of Clubhouse communal activities. We focus on the ways in which the workers regulate the rehabilitants’ participation in the decisions currently made. On the one hand, the workers aim to promote equal possibilities of participation for the rehabilitants. On the other hand, the workers seek to ascertain that at least some decisions are made during the course of interaction. Our data consist of 30 video-recorded meetings at the Clubhouse. The research method is Conversation Analysis. The interactional practices of the workers examined are located at different phases of the decision-making sequences. Our analysis illustrates how the workers may launch a decision-making sequence by treating a rehabilitant’s turn retrospectively as a proposal for joint action, even if they initially treated the turn differently. In cases where the workers’ own proposals are met with silence, the workers may remind the rehabilitants about their epistemic access to the content of the proposal or pursue agreement or commitment to the proposed plan from the rehabilitants. In these ways, the workers carry more responsibility over the unfolding of interaction and the emergence of decisions than the rehabilitants do. While the workers’ conduct may be justified with reference to various pedagogical notions, it is still in conflict with the recovery-based ideal of consensus decision making that ideologically underlies the practices at the Clubhouse.

Keywords: participation, decision making, mental health, rehabilitation

Mari Wiklund & Melisa Stevanovic

Understanding problems and the teaching of social interaction skills in group therapy sessions of preadolescents with high-functioning autism

Autism is associated with a variety of social interaction problems. This article is based on earlier findings about how the difficulties of social interaction may be seen in authentic group therapy sessions where 11–13-year-old mildly autistic Finnish-speaking boys interact with each other and with their therapists. Drawing on conversation analysis as a method, we consider the problems that the autistic boys have in interpreting the interactional contributions of others, in expressing themselves through linguistic and embodied means, and in using prosody. We examine the management of problems of understanding with the help of repair sequences, while also focusing on the trainers’ professional and pedagogical practices. What we show is that at the same time as the trainers solve problems of intersubjectivity, they also communicate understanding of those general norms of social interaction that the boys are expected to learn to manage. The trainers’ teaching orientation is thus mainly implicit, based on the normal repair practices associated with mundane symmetrical interaction. The teaching of embodied social interaction skills, however, may necessitate the explication of the teaching orientation, while – on the basis of our data – the teaching of prosodic skills tends to elude even this type of explicit teaching orientation.

Keywords: autism, interaction, understanding problems, social skills training, conversation analysis