Language use in therapy by phone
The study in a sentence
“The NHS has a fantastic technology that they don’t use - conversation.”
(James Sanderson, Director of Personalised Care NHS England, Creative Health Conference in 2019)Psychological therapy is a 'talking therapy', delivered through in-person meetings and by telephone. This research focusses on language use in telephone interactions between patients and Personal Wellbeing Practitioners (PWPs) in NHS Improving Access to Psychological Therapies (IAPT) calls.
The question
There is some evidence that the quality of interaction in therapy delivered by phone can be just as good as in therapy delivered face-to-face (Irvine et al 2020). However, patients often have misgivings about the prospect of receiving support by phone rather than in person.
What sort of issues might arise when offering therapy by phone and under time pressure?
This research explores two factors: personalisation and patient choice.
Key concept
Conversation Analysis recognises categories of preferred and dispreferred responses, to something that a speaker has said.
In these studies of language use in a workplace setting, we see responses which do not match the patterning of preferred/dispreferred responses in ordinary conversation.
See the case study on Question and Answer Sequences for more background on preferred/dispreferred responses
Does the language used to give patients treatment options really give them a choice?
How personal is the experience of telephone therapy for patients, given the strict protocols that have to be followed?
Methods
These studies use the techniques of Conversation Analysis, which explore in detail:
language as action: what is each speaker trying to achieve?
linguistic design: what linguistic choices has the speaker (unconsciously) made?
the sequence of talk: how does the hearer respond? what happens next?
In a short telephone therapy call: what does the Personal Wellbeing Practitioner want to achieve, what linguistic choices do they make, and how does the patient respond to those choices?
The answer(s)
The main findings of the two studies are:
patients are sometimes offered a 'choice' which does not in fact involve any choice, but is instead an offer of a single option which they must either accept or reject;
there is a tension between the practitioner's need to follow a strict protocol and the stated goal of providing a personalised patient experience.
The evidence for both comes from the patterns of language use by practitioners and patients.
Classroom activities
Lead in task
Understanding the context: how does the IAPT service work and who is it for?
Extension task
Exploring data extracts from telephone therapy calls using the techniques of Conversation Analysis
Appendix
Glossary of transcription conventions used in the transcripts
In more detail
A longer explanation of the research study
Pre-Workshop Talk by Annie Irvine and Paul Drew [11 mins]
Toolkit CPD 2021 Paul Drew + Annie Irvine Pre-Workshop Talk slides.pptxSlides for the Pre-Workshop Talk
Meet the authors
Annie is a researcher at Kings College London, but previously worked for many years at the University of York, where her research focused on ill health, disability and employment in the context of UK social security policy.
Read the papers
Drew, P, Irvine, A. et al. (2021) Telephone delivery of psychological therapies: Balancing protocol with patient-centred care. Social Science & Medicine, 277, 113818. pdf on request