Part III: Interaction Participation
Chapter 6: What is the pattern of participation of patients and their partners in three-
6.2 Conversation role in three-way interactions
6.5.1 Chapter strengths and limitations
A key strength of this study is that it measured the participation of participants in the interaction on three levels; firstly, the percentage of time spent in the active pair, secondly within the active pair, the percentage of time in the roles of speaker and primary recipient and thirdly, the pattern of participation in the active pair over time. By doing so this enabled a more comprehensive picture of the participation of patients and their partners in their three-way interactions. A limiting feature of this study is that head angle is used to approximate conversation role rather than observer rated measures. However, in interactions involving more than two people, head angle is thought to be a good predictor of who the speaker is looking at than eye gaze (Jokinen, Nishida, & Yamamoto, 2010; Loomis, Kelly, Pusch, Bailenson, & Beall, 2008). Furthermore, as both patient and control interactions were subject to the same method of measurement, any errors will be equal between the conditions.
6.5.2 Interpretation of the findings
The results revealed that although patients were no less likely to participate in the active pair, they spent more time as a primary recipient when participating. This suggests that
even though patients’ partners were unaware of the patients’ diagnosis, they were more likely to direct their speech towards the patient (i.e. patient as primary recipient) than towards the other interacting partner. This finding corroborates the results of a previous small study (six patient-clinician interactions) examining patients’ two-way clinical interactions, which reveled that psychiatrist spend a greater proportion of the interaction looking towards the patient compared to when they are interacting with non-patient controls (Fairbanks, McGuire, & Harris, 1982). In the current findings this pattern is seen in the absence of an awareness of the patients’ diagnosis or any overtlay unusal behaviour by the patient. Thus, it appears that others are detecting something unusual in the behaviour of the patient, which demands their increased attention.
This explanation also accounts for the unpredicted association between patients’ poor social functioning and greater time spent in the active pair. The term ‘active-pair’ is somewhat misleading. The speaker is essentially the active participant within this pair, whereas the primary recipient is passively involved as the focus of the speakers’ gaze. The current analysis takes no account of the head orientation of the primary recipient and as such cannot determine if they are reciprocating the speakers’ gaze. Thus, the features of the patient that healthy participants are detecting and responding to makes the patient more likely to be the target of their attention, in the passive role of primary recipient. When the healthy participants’ detection of such features is less pronounced, the patient is less likely to be given the same degree of attention, therefore they spend less time in the active pair. This anomalous feature of the patients’ behaviour influences their social interaction, at least in terms of their participation and others’ behaviour, therefore is feasible that it plays a role in patients’ longer term social functioning. This suggests that the feature that makes patients more likely to be in the active pair also predicts poorer social functioning.
Patients’ increased positive symptoms also predicted patients’ poorer quality of life. Thus, it would appear that the relationship between patients’ active participation in the interaction and their social functioning is mediated by their symptoms. Patients with more negative symptoms spent less time in the role of speaker and patients with more positive symptoms spent more. As discussed in chapter 5, the patients in the current sample had very few positive and negative symptoms therefore this suggests that
patients’ symptoms influence their participation in the three-way interaction, even when symptoms are mild.
126.96.36.199 Patterns of participation over time
Investigating the patterns of patients’ participation in the interaction over time revealed that although patients did not display a direct relationship between their active pair participation and time, the healthy participants did spend less time in the active pair as the interaction progressed. This would suggest that the patient did become more involved in the active pair over time. During the second 30-second (approx) section of the interaction, patients spend more time in the active pair, specifically in the role of primary recipient. This suggests that, as was seen with interpersonal coordination in chapter 4, at this point in the interaction healthy participants are detecting something in the patient making the patient more likely to be the focus of their partners’ attention (i.e. primary recipient). As the interaction progresses, patients spend increasingly more time speaking. Patients’ time speaking reduces in the last quarter of the interaction and they become more likely to be a primary recipient. Again, this pattern is similar to that seen in the pattern of coordination over time in chapter 4, with pairs involving a patient reverting to more atypical coordination patterns in the final quarter of the interaction.
So what is happening in the final quarter of the interaction? In chapter 4 it was suggested that the return to atypical patterns in the final quarter may be indicative of patients’ partners being unable to sustain the interaction with the patient. The results of this chapter demonstrate that patients do not show less participation in the active pair in the final quarter of the interaction. Therefore, healthy participants are not merely focusing their attention away from the patient and towards each other, as was suggested in chapter 4. An alternative suggestion is that it is the patients themselves who are unable to sustain the pattern of adaptation. Over the course of the interaction it is the patients who move from a more atypical display of behaviour to what would be expected in control interactions. Perhaps this more typical pattern is not a natural pattern for the patient (i.e. greater coordination or more time speaking) and they find it difficult to maintain over longer periods of time.
In conclusion, the findings of this chapter build on those of previous chapters demonstrating that healthy participants interacting with a patient give more attention to the patient than the other healthy participant, even though they are unaware of their diagnosis. Patients’ participation in the active pair is mediated by their positive and negative symptoms. However, independent of symptoms, patients who spend more time actively involved in a three-way interaction have a poorer quality of life.
The findings of this chapter reiterate those of chapters 4 and 5, suggesting that healthy participants are detecting and responding to a feature of the patients’ behaviour. Over time this response becomes less pronounced and the patients’ patterns of participation becomes less atypical. In order to understand the nonverbal communication between patients and their partners on a more descriptive level, the nonverbal cues produced by patients and their partners when actively involved in the three-way interaction need to be examined. This will be the focus of the next chapter.