An investigation into how mutual understanding is established between psychiatrists and outpatients with a diagnosis of schizophrenia; using the mechanism of conversational repair

The therapeutic relationship and quality communication have long been established as
central determinants of therapeutic outcome (Weiss et al, 2002; Drew et al, 2001).
However, these may be more difficult to establish with people diagnosed with psychosis.
This thesis focuses on how psychiatrists and outpatients with a diagnosis of schizophrenia
establish mutual understanding. A newly developed 'repair protocol' was utilised from
within the conversation analytic framework. This takes advantage of the structural
features of language that speakers use to correct misunderstandings; i.e. 'repair'.
Therefore, it was possible to identify when misunderstandings occur and how they were
repaired, then to explore associations between repair and the therapeutic relationship.
This research is novel in psychiatry, as it allows for integration of verbal and non-verbal
behaviour and analyses the function of talk. The findings illustrate that different types of
repair were linked with different patient and psychiatrist outcomes. Repair was utilised to
achieve various actions (e.g. disagreeing) or following certain junctures, (e.g. abrupt topic
shifts). Initially, patients made most effort to make their contribution understandable,
whereas psychiatrists made most effort to repair misunderstandings once they had
occurred. In addition, the more positively the psychiatrists rated the relationship the more
effort they made to understand the patients. Although the psychiatrists' efforts were not
associated with patients overall view of the relationship, they did feel better emotionally,
despite, feeling less understood. Most repairs were successful but they did not always
have to be successful to maintain conversation; effort seems more important than success.
There appeared to be high communicative alignment though some mismatch means there
is scope for improvement. Both parties prioritised understanding the same topics but
psychiatrists' focused more on medication and patients on voices. It seems the concept of
repair can provide a range of relevant information for how psychiatrists and patients
create mutual understanding in their routine meetings.

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