Framing the research setting

First, to help the reader to follow how frames are identified and examined in this study, it may be useful to discuss a specific example of framing that occurs in this data, but which is not typically part of the psychiatric consultation; the framing of participation in a research study. This frame is not considered in detail alongside the eleven discussed later because it is not significant to the conduct of psychiatric consultations more generally. It is important, however, in considering this data, to examine how this frame may influence participants’ talk.

As well as being participants in a psychiatric consultation, the patients and psychiatrists in this study are also participants in an audio-recorded research setting. As with the broader

psychiatric consultation frame, this frame provides participants with an orientation to roles, expectations and behaviours. This type of framing has been identified in previous studies. For example, in introducing her work on framing film narratives, Tannen identifies the layering of research interview onto other contexts:

“the larger context is the one in which the speaker is the subject of an experiment, and the context in which that experiment is being carried out is an interview mode, in which the speaker knows that her voice is being tape-recorded.” (Tannen, 1993: 22)

Keying into a research participation frame alters the footing of the interaction. In addition to being ‘doctor’ and ‘patient’, both are now also ‘research participant’, with the specific rights and expectations associated with that role. Research participants have the right to withdraw

from the study if they wish to, by requesting that the recorder is turned off. Similarly,

participants are expected to continue with the consultation as though the tape were not there, since the study seeks to understand what consultations are like, not simply what research settings are like.

In this data the shift into research participation frame is not generally captured since a significant element of that shift undoubtedly occurs prior to - and at the point of – switching the tape recorder on. This marks a keying of the ‘psychiatric consultation’ frame, into a ‘study of the psychiatric consultation’ frame. As a result, the lamination of the research participation

frame on top of the psychiatric consultation frame is not directly observed. There are,

however, times when this frame slips and keying can be observed, for example, the psychiatrist’s ‘aside to camera’ in extract 4.1 where she describes the activity for the tape.

Extract 4.1 (consultation 63)

Doctor: Which, what‟s the name of the anti-depressant

1

again? Have you got them with you?

2

Patient: No, I I wrote the name

3

Doctor: Oh fantastic that‟s great

4

Patient: They‟re me tablets I take [patient passes note to

5

psychiatrist]

6

Doctor: Thank you very much. ╟ ([talking to tape recorder])

7

[Name]‟s just handed me a piece of paper with er the names

8

of her medication and the dose on, for the sake of the tape

9

heh heh

10

Patient: Yeah right. I‟d forgotten it was there

11

Frame shift: Research Participation

The keying, marked in line 7, does a number of things to the interaction. First, it shifts the footing of the participants. In lines 7-10 the ‘addressed recipient’ becomes the researcher

(mediated through the recording device) and the patient becomes ‘overhearer’ (Potter, 1996: 148). The purpose of the turn is not for the benefit of the patient but the absent, future audience. Second, it draws attention to the broader research setting frame, reminding the patient of the tape’s existence. The patient’s comment at line 11 suggests that she may not have been as attuned to the research setting frame as the psychiatrist appears to have been. Since frames are laminated, orientation to the research participation frame can also be used to create other frame shifts. Some examples of this are seen in the extracts 4.2, 4.3 and 4.4. Using the simple pictorial form suggested in Chapter Three, we might show these by highlighting frames to which participants are explicitly oriented in their talk (figure 4.1). A broader frame may be highlighted in order to facilitate shifts at a narrower level.

In extract 4.2, the patient jokingly asks the doctor not to reveal her weight to the tape (or to the researcher as non-participant audience). Here, rather than orienting to the tape as ‘addressed recipient’, it is oriented to as ‘over-hearer’. In this instance, the frame shift is used light-heartedly to build rapport between the two participants, as indicated by the laugh in line 4. By making reference to the research participation frame, the patient also shifts into an informal frame where light-hearted comments and jokes are legitimate because of the comparative equality of participant roles. The research setting places them both in an equivalent role – that of research participant – in contrast to an absent researcher.

Extract 4.2 (consultation 32)

Doctor: Do you want to jump on the scale for me?

1

Patient: ╟ Don‟t say it out loud when the tape is on

2

Doctor: Do you want me to write it on a piece of paper?

3

(laughs)

4

Patient: No I don‟t mind.

5

Frame shift: Research participation / Informal

Here the effect of orienting to the research frame and shifting the footing accordingly is to create a form of light-hearted collusion that allows them both to ‘put one over’ on the researcher. This kind of collusion is possible because of the frame shift, but the effect of creating a friendly and relaxed relationship may have longer-lasting benefits for the interaction and for the ongoing relationship. Throughout this chapter, we will see other examples of how framing is used to create a positive relationship between psychiatrist and patient.

Extract 4.3 demonstrates how attuning to the research study frame is used by the participant to legitimise introducing a topic shift. In this case, the participant makes explicit reference to the purpose of the original research in exploring how changes in medication are negotiated and decided upon. The ‘out of character’ (Goffman, 1959: 167) reference to the tape

recording, in which the patient openly refers to the performed activity, is used to draw attention to the study as a frame which makes discussion of his medication preference relevant to the interaction and facilitates a shift into a Negotiation frame (discussed below, section 4.2.2, page 135).

Extract 4.3 (consultation 83)

Patient: ╟ This tape recording it‟s about initiations and

1

changes and non-changes in medication isn‟t it, you were

2

explaining to me? And I hope and when I mentioned this to

3

[Name] yesterday, she hopes too that there will be no

4

change. I‟m very happy on what I‟m on.

5

Doctor: Well that‟s fine.

6

Frame shift: Research Participation / Negotiation

This same technique is seen in extract 4.4. Using an ‘aside to camera’ similar to that in extract 4.1, the patient creates the space to bring up medication issues.

Extract 4.4 (consultation 33)

Patient: I know that and I appreciate that, and I have got halfway

1

down the road a few times, and I‟ve turned round and not bothered.

2

But it is reassuring that you‟re, someone or yourself is going to be

3

there. ╔ Shall I say for the sake of the tape medication‟s fine?

4

Doctor: ╦ I was going to ask you that. Any medication issues?

5

Patient: No, it‟s fine.

6

Doctor: With the Olanzapine.

7 Frame shift: Research Participation / Disclosure Frame shift: Interview

In extract 4.4, the footing of the participants is again shifted. Ostensibly, the psychiatrist remains the addressee, while the researcher becomes the target of the message although a non-participant in the interaction - what Levinson (1988) described as a ‘targeted overhearer’.

Footing is further complicated, however, when we consider the purpose of the patient’s statement. In fact, the patient has already met with the researcher, as described in section 3.6, and explained his preferences in relation to medication to him. Although the researcher is the explicit target of the statement, the psychiatrist, I would argue, remains the actual intended recipient of the talk. The patient again uses ‘communication out of character’ (Goffman 1959: 167) to disclose information not requested by the psychiatrist (see below re Disclosure frame). The psychiatrist responds accordingly in line 5 by ratifying the topic shift. Instead of orienting himself to the Disclosure frame, however, the psychiatrist is prompted to re-frame the interaction again in order to explore the medication topic further in an interview frame. The patients’ decisions to shift the footing in this way suggest that they might not consider their statements concerning the medication as legitimate in their footing as patient. The change in alignment to the speech recipients allows the speaker to make different statements. In this way, participants deliberately use the frame shifts available to them to meet their own goals in the interaction.

This brief overview of the research participation frame highlights key premises discussed in this chapter. First, these extracts demonstrate how frames are laminated and attuned to. In each case participants refer to the research participation, and in doing so also manoeuvre other frame shifts. Additional frames are placed on top of the research participation frame: in extract 4.1 orientation is to the Research Participation frame itself; in extract 4.2 talk shifts to an Informal frame; in extract 4.3 the shift is to a Negotiation frame; in extract 4.4 the patient prompts a shift into a Disclosure frame. The shifts do not replace the existing frames but are layered on top of them and interact with them. These frames are each discussed in more detail below.

Secondly, frame shifts adjust the expectations and rights of participants, but participants should not be assumed to be at the mercy of these frame shifts. Speakers build up and shift

frames precisely because they result in these changing expectations. As in extracts 4.1 and 4.2 the shift can allow participants to adopt a different footing to one another, changing the relationship and dynamics between them. Equally, as in extracts 4.3 and 4.4 frame shifts can facilitate the participant in addressing a new goal in the interaction by providing space to make statements that may otherwise be rejected as inappropriate or irrelevant.