Interviewing and specific communication access techniques The nature of each individual’s difficulty with language, compounded with the

anticipated difficulty of articulating views about a topic not generally discussed required that we gave advanced thought to ways of supporting conversations about friends and friendships. Four of the Research Group members with aphasia are experienced communication skills trainers and I also drew on my expertise as a Speech and Language therapist and communication access trainer. Prior to the interviews we determined a range of regular and more innovative ways to enable respondents to participate as equally as possible in conversation and the co-construction of knowledge. For example, the interviews drew on the use of coloured stones to externalise thoughts about friends, pre-prepared communication props and, resulting from the first six interviews with Research Group members, a series of ‘some people say…’ interview probes.

5.3.1 Stones

In the research interviews, after probing the general impact of stroke and aphasia I reiterated the main purpose of the interview to explore experiences of friendship and aphasia post-stroke. At this point, I offered participants a selection of stones differing in shape, size, texture and colour and asked them to select one stone to represent themselves and various stones to represent people whom they thought of as their friends. Participants were asked to think about the characteristics of the different stones and where they might spatially position their friends in relation to themselves. This is in line with use of creative and visual methods to support discussion of interpersonal issues within counselling and psychotherapeutic practice (Bradley, 2008). Visualization techniques are well recognised within PAR studies as providing opportunities for participants to initiate discussions about complex topics and explore and represent personal perspectives (Cornwall and Jewkes, 1995).

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No guidance was given to interviewees concerning which people to include because the aim was to elicit personal and individual understandings. For example, if an individual asked for clarification about whether they were expected to select family or friends, I would say ‘Whomever you think of as your friends’. I employed probe questions asking why interviewees had chosen specific individuals, what they perceived as important qualities of specific friendships, and reasons for suggesting more proximal or distant relationships by the way they located different stones.

Selections were placed on a piece of A4 paper on which were printed two faint concentric circles to convey a sense of increasing distance from the self- stone. The use of circles is similar to a technique used in social network analysis (Antonnuci and Akiyama, 1987) and adapted by Cruice et al (2006) for exploring the social network size of older adults. Unlike these studies however, no instruction was given regarding whether the circles represented particular categories of people, frequencies of contact or strengths of relationship. My intention was for respondents to determine how they defined friendship rather than impose pre-determined categorisation. With the permission of resondents, a digital photograph was taken at the end of the interview as a record of each individual’s friendship circle.

During the interview the stones acted as a point of reference and as a tool for probing perceptions of different relationships and reactions of friends. For example, if a respondent located a friend stone very close to the stone representing themselves I might ask ‘Can you tell me a little more about this person? What is it you like about them? How is this person different from this one? Sometimes the manner in which a person non-verbally manipulated or moved stones presented opportunities for follow up probes. For example, some respondents located a friend stone and then moved it closer or more distant from their own stone while talking about the friend. I would comment on this behaviour saying ‘I notice you are moving that stone closer …why is that? Can you tell me more about how it is now? Has that changed?’

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Another function of the stones was as a way to refer back to issues raised earlier in the interview. Referring back to topics when respondents have limited expressive language can be a particular challenge in interviews (Swinburn et al, 2007). The stones again provided a more concrete reference point. For example, I might say ‘When you were talking about this person earlier (points to stone) you said … Can you tell me a little more about why you felt that way?’

5.3.2 Supported conversation and conversation props

The coloured stones represented a versatile communication prop to support the in-depth interviews. Other communication props used in interviews included pen and paper, on-line drawing (constructing drawing as part of the emergent conversation), writing of key words, use of photographs and artefacts within the person’s home environment or notes which participants had selected to bring to the interview. Kagan and colleagues (Kagan,1998; Kagan et al, 2001) have pioneered the use of ‘supported conversation’ techniques aimed at revealing and acknowledging the competence of people with aphasia. A combination of the skills of the person with aphasia, techniques employed by their non-aphasic conversation partner and relevant communication props enable the person with aphasia to engage more meaningfully in conversation. Techniques used by the researcher included additional time and use of silence, frequent clarification and summarising, attending closely to the non-verbal aspects of communication (also captured on video) and occasional use of individual and co-generated diagrams and drawings.

For the second group of six interviewees, several of whom had marked expressive language difficulty, I developed a series of visual and verbal props to have available in case of struggle in the second wave of interviews. These materials reflected the ideas and insights shared by the first six interviewees and included:

 A diagram demonstrating types of people whom other respondents had selected as friends

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 A list of barriers and facilitators to friendship mentioned by the first six interviewees

 A list of issues raised as important in friendship by the first six interviewees

Examples of these communication props are provided in Appendix C. Within interviews where respondents struggled to respond to open-ended questions I would frequently offer suggestions drawn from issues raised by the Research Group. For example I might tentatively offer a probe: ‘Some people with aphasia say that …they feel closer to good friends now. Is that something that you have experienced?’ These prompts were not aimed to shape or constrain new respondents’ answers but to give them ideas to acknowledge, develop or reject, acting as a facilitative springboard to expressing their own thoughts and experiences. Importantly, in probing responses to what others with aphasia had mentioned in written format, there was always an item marked ‘other’ or a list backed up with question marks signalling that this was not an exhaustive list of possibilities. Chapter 10 will discuss further the strengths and limitations of using these methods to co-construct understandings with people with severe aphasia.