Exploring first conversations with children and families: responsive, pivoting improvisation within systemically-informed practice
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AbstractThe first conversation between clinician and family is a complex, crucial encounter. This practice-based research used video recordings of my first conversations with children and families attending a specialist child and adolescent mental health service (CAMHs) for people who had already been given, or who sought, a diagnosis of an Autism Spectrum Condition, to examine systemically informed practice. The objectives of the research were to explore: what happens when I subject my everyday practice to systematic research, how I move with my words and my body between different domains of action in conversation with families, and how moment-to-moment interactions with words and body contribute to the unfolding of the conversation. Working from an onto-epistemological position of knowing-in-being, I used ethnographically and auto-ethnographically inspired methods of creating material, and used multiple analyses with videos of 10 first conversations. Reflexive Thematic Analysis of transcripts was used to explore patterns across the material. I created ten themes, grouped under three thematic territories: creating a space for all voices; talking about the presenting concern; therapist as an active conductor. These thematic territories serve as a systemic processual guide to the first session. Within the themes identified, the use of tailored self-stories to build the therapeutic relationship was particularly striking. Experimental analysis to picture the flow of conversation through domains of action highlighted a unique and fluid path of actions through each conversation. This demonstrates how the flow of the conversation is jointly, responsively constructed and how the themes of the conversation are performed in an improvisational way. Applied Video Conversation Analysis together with a Systemic-Diffractive analysis demonstrated the responsive complexity of moment-to-moment actions and how epistemic status and stance are navigated, particularly in creating space for the young person to share their knowledge and understanding about matters of concern. I conclude that the overall conduct of a systemically-informed first conversation is based on a process of responsive pivoting improvisation, whereby the conversation is patterned in an improvisationally fluid, intra-active and relationally-responsive way. My findings have tentative implications for how clinicians might help families know more about what to expect when they come to CAMHs. My findings also have tentative implications for the practice and training and supervision of systemically-influenced practitioners, whereby the microanalytic techniques of applied conversation analysis can be combined with a systemic diffractive analysis to notice and improve practice. Keywords: CAMHs, first sessions, applied video conversation analysis, reflexive thematic analysis, flow mapping, autism spectrum condition, systemic practice, diffraction.
CitationHelps, S. (2019) 'Exploring first conversations with children and families: Responsive, pivoting improvisation within systemically-informed practice'. PhD thesis. University of Bedfordshire.
PublisherUniversity of Bedfordshire
TypeThesis or dissertation
Description"A thesis submitted to the University of Bedfordshire, in partial fulfilment of the requirements for the degree of Professional Doctorate".
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