Clients’ Practices for Resisting Treatment Recommendations in Japanese Outpatient Psychiatry

What Does “Resistance” Actually Look Like? The Respecification of Resistance as an Interactional Accomplishment

“…Furthermore, given that an FPP makes an SPP conditionally relevant, by remaining silent, the person to whom the FPP is addressed flouts the obligation to respond that is instituted through the initiating action. Resisting by withholding an SPP and remaining silent has been documented, for example, in healthcare interactions, specifically in treatment recommendation sequences in primary care (Koenig, 2011), pediatric (Stivers, 2005a(Stivers, , 2007, and psychiatric consultations (Kushida & Yamakawa, 2020), and in sales encounters, specifically at the sales relevance place (Pinch & Clark, 1986, p. 171), the point where an acceptance of the proposed sale becomes pertinent (Clark, Drew et al, 1994;Clark & Pinch, 2001). Additionally, silence can embody resistance not only in the sequential environment of adjacency pairs, but also in extended tellings, at points where recipients' affiliation would be relevant, such as after tellers deploy idioms to summarize their stances (Kitzinger, 2000).…”

“…Examples of this abound in conversation analytic studies of medical encounters. In the context of diagnosis delivery, patients can exhibit resistance by producing newsmarks such as "really" (Stivers, 2007), by questioning the diagnosis or its underpinning evidence, by bringing up new symptoms, or information (Peräkylä, 2010), and by asserting an alternative diagnosis (Ijäs-Kallio, Ruusuvuori et al, 2010;Koenig, 2011;Kushida & Yamakawa, 2020;Stivers, 2007). Some of these practices are also employed in resisting treatment recommendations.…”

“…Some of these practices are also employed in resisting treatment recommendations. For example, patients resist the doctors' treatment recommendations by describing additional concerns, by questioning the (effectiveness of the) treatment, by invoking negative consequences of the recommended (lack of) treatment, and by asking for specific (other) treatment options (Kushida & Yamakawa, 2020;Stivers, 2007). Finally, still in medical consultations, but in response to recommendations for further tests, patients can exhibit resistance by questioning doctors' decisions, by proposing alternative plans, and by providing additional information (Zhao & Ma, 2020).…”

From Engagement to Disengagement in a Psychiatric Assessment Process

“…Recently, conversation analysis (CA) has offered an interactional perspective to patient involvement in treatment negotiation in psychiatry (Bolden and Angell 2017; Kushida and Yamakawa 2020; Thompson and McCabe 2018; Weiste et al 2020). CA of mental health care has focused especially on the joint decision‐making aspect of patient involvement (Lindholm et al 2020).…”