Highlights Patients' opportunities to reveal their subjective experiences were investigated. Dialogical sequence analysis DSA and usual psychiatric AAU interviews were compared. Clinicians facilitated the patients' subjective experiences significantly more in DSA. In AAU, the patients needed to make an extra effort to reveal subjective experiences. Working on patients' subjective experiences may promote individual care planning.
This paper investigates how two ideologies of mental health rehabilitation-recovery ideology and communal approach-are realized in interactional practices associated with psychosocial rehabilitation. More spesifically, the paper discusses employee selection in the context of the Clubhousecreated Transitional Employment (TE) programme, which offers employment opportunities for rehabilitants. The paper describes how joint decisions are established during the moment-by-moment interactional processes at the Clubhouse. Drawing from the data set of 29 video-recorded rehabilitation group meetings, and Conversation Analysis as a method, the paper analyzes two questions: (1) How do the participants talk about the decision-making process associated with the TE on a ''meta'' level? And (2) how are the TE employees actually selected in the turn-by-turn sequential unfolding of interaction? When discussing the TE employee selection procedure on a ''meta'' level, the values of recovery ideology focusing on client empowerment and selfdetermination are prevalent. Also, the central ideals of the communal approach-openness and collaboration-are defended as decision-making guidelines. However, in the meetings where decisions on the TE employees are concretely made, there is a mismatch between the two ideological approaches to rehabilitation and the actual practices observable in the relevant interactional encounters. Keywords Rehabilitation Á Professional ideology Á Joint decision-making Á Conversation analysis Á Social interaction ''We made a democratic selection with the members who were interested in the job. It was a joint decision and the selection process went really well.''-Support worker evaluates a selection process of a transitional employment worker.
The chapter analyses practices by which support workers promote client participation in mental health rehabilitation meetings at the Clubhouse. While promoting client participation, the support workers also need to ascertain that at least some decisions get constructed during the meetings. This combination of goalspromoting participation and constructing decisionsleads to a series of dilemmatic practices, the dynamics of which the chapter focuses on analyzing. The support workers may treat a client's turn retrospectively as a proposal, even if the status of the client's turn as such is ambiguous. In the face of a lack of recipient uptake, the support workers may remind the clients about their epistemic access to the content of the proposal or pursue their agreement or commitment to the proposed plan. These practices involve the support workers carrying primary responsibility over the unfolding of interaction, which is argued to compromise the jointness of the decisionmaking outcome.
Using both statistical methods and conversation analysis, we examined how support workers in a mental health rehabilitation community encourage clients to participate in joint decision-making processes. Drawing on video-recordings of 29 community meetings as data, we considered support workers' proposals (N = 449) and clients' responsiveness to them. Support workers' proposals were coded for their linguistic and other features and clients' responsiveness was assessed by three independent raters. Multiple linear regression (MLR) analysis was carried out. A significant regression equation with seven predictor variables accounted for 24% of the variance in the data. Four variables predicted a higher level of client responsiveness: the use of explicit recipient address term, "quasiopen" proposal form, support worker's long work experience, and the average level of client participation during a session. Three variables predicted a lower level of client responsiveness: grammatical complexity of proposal form, modal declarative proposal form, and the presence of only one support worker in a session. The qualitative conversation-analytic investigation highlighted the advantages of the careful fine-tuning of openness vs. closedness of proposal form, the reflexive awareness of which, we argue, may help mental health professionals to encourage clients' responsiveness in joint decision-making processes and thereby their participation in communal life.
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