Laura O’Hara

oharaTitle: Associate Professor of Communication Studies

University: Ball State University

Email: lohara@bsu.edu

Website:

http://cms.bsu.edu/academics/collegesanddepartments/communicationstudies/facultyandstaff/oharalaura

Description of Work:

My current stream of research (shared with colleague Carolyn Shue, who is also attending the conference) employs Leslie Baxter’s Relational Dialectics Theory (RDT) 2.0 (2011) to examine medical interviews in which patients with diabetes and their physicians negotiate the various meanings of “diabetes management.” (sorry, our dept. website is horribly out of date and does not reflect this!)

RDT 2.0 departs from its more well-known predecessor (RDT 1.0) (Baxter & Montgomery, 1996) because it challenges scholars to examine the discursive struggles within an interaction, rather than focusing on conflict between relational partners or the psychological tensions between competing needs. This focus on actual discourse extends researchers’ understanding of RDT findings, which have traditionally been grounded in self-report interview data. However, Baxter laments that the bulk of RTD 2.0 studies continue to rely on analyses of participants’ self-reports. Baxter calls for more RTD 2.0 studies that rely on analyses of enacted speech, arguing that communication scholars can profit greatly by such analytical work because it reveals two important links on the “chain of speech communion” that have been heretofore understudied: The Proximal-Already-Spoken link, (where interactants’ joint history intermingles with their interaction in the present moment) and the Proximal Not-Yet-Spoken link (where interactants acknowledge potential evaluations of their own communication by relational partners).

The formative research presented at this symposium focuses both on these links and relies on enacted speech between two parties, rather than on self-report. However, this work is extremely challenging. It is difficult to capture the complex relational work and history of an ongoing patient/physician relationship using more “traditional” modes of presenting such analyses (e.g., thematic analyses employing illustrative examples). The formative work I share with symposium members is presented a bit differently. I look forward to receiving constructive feedback from peers as I move this project forward.

I believe RDT 2.0 has important application in the health care context because it helps to map competing discourses that may covertly affect chronic disease management (e.g., “rationality” versus “chaos”). Thus, this research carries important implications for training physicians on how to key into subtle discursive struggles that indicate a need for social or resource support that patients either cannot or will not articulate overtly.

Symposium Submission:

Designing to be Thin: Infographics, Fat Studies, and Technical Medical Writing

Baxter and Montgomery’s 1996 articulation of relational dialectics theory (RDT) recognized the existence of seemingly competing relational and communicative tendencies such as integration-separation and expression-nonexpression. At the core of RDT was the assumption that in relationships, there is a dynamic interplay between oppositional demands requiring relational partners to manage the “both/and” –ness of relating (p. 6). A significant outcome of the 1996 iteration of RDT was a proliferation of literature identifying the types of contradictions present in a wide variety of interpersonal relationships, with particular research emphasis placed within family contexts (see Baxter & Braithwaite, 2010, for an extended review of this work). Throughout the past decade however, scholars have begun to use relational dialectics theory as a way to examine health communication contexts. This work focuses on the perspectives of health care providers as they work with patients (e.g., Olufowote, 2011), how health care providers negotiate their various roles as part of a professional team (Martin, O’Brien, Heyworth, & Meyer, 2008), patients’ perception of care (Nebel & Emmers-Sommer, 2009), and how family members cope with the illness of a loved one (Golden, 2010).

In 2011 Baxter introduced an evolved articulation of relational dialectics theory (RDT 2.0), which challenges scholars to examine the discursive struggles within an interaction, rather than focusing on conflict between relational partners or the psychological tensions between competing needs. In RDT 2.0, the “objects of analysis are the discourses not the individuals” (p. 18). RDT 2.0 redirects scholars’ attention from “an isolated sequence of words uttered by a speaker. . . to an utterance chain in which multiple discourses (some already spoken and others not yet spoken but anticipated) can be identified” (p. 18). This focus on actual discourse extends researchers’ understanding of RDT findings, which have traditionally been grounded in self-report interview data. However, even in the nascent RTD 2.0 literature, Baxter laments that the bulk of RTD 2.0 studies continue to rely on analyses of participants’ self-reports. Baxter calls for more RTD 2.0 studies that rely on analyses of enacted speech, arguing that communication scholars can profit greatly by such analytical work because it reveals two important links on the “chain of speech communion” that have been heretofore understudied: The Proximal-Already-Spoken link, (where interactants’ joint history intermingles with their interaction in the present moment) and the Proximal Not-Yet-Spoken link (where interactants acknowledge potential evaluations of their own communication by relational partners).

The proposed project evolves from an existing stream of research, which employs RDT 2.0 to examine medical interviews in which patients with diabetes and their physicians negotiate the various meanings of “diabetes management.” Specifically, the research team from which the proposed project derives has examined the counterpoints of various discourses embedded overtly or implicitly within the chain of speech communion. Such analysis is an important application of RDT 2.0 in the health care context because it helps to map competing discourses that may covertly, but negatively affect chronic disease management (e.g., discourses of family members that may compete with physicians’ advice). This research also carries important implications for training physicians on how to key into subtle discursive struggles that indicate a need for social or resource support that patients either cannot or will not articulate overtly.

One serious limitation in the work done by our research team and by other scholars employing the RDT 2.0 framework has been the method of reporting findings–particularly given the contextual complexity of relationships between patient and physician as they are enacted over time. Conventional modes of scholarly writing have not generally privileged the sort of in-depth discussion that an RTD 2.0 analysis of enacted speech requires. Examining the intricate discursive enactments across the chain of speech communion as patients and physicians negotiate the meaning of diabetes management during appointments and over the course of multiple appointments is extraordinarily challenging. Traditional modes of presenting such analyses (e.g., thematic analysis employing illustrative examples) fail to capture the complex relational work and history in these relationships.

I propose to expand existing approaches to RDT 2.0 by using it as a framework to analyze the case of a single patient-physician dyad over the course of three visits. Such an approach allows for a much more empirically rich, nuanced, and detailed reading of the speech culture the patient and physician co-create as they discursively make sense of “diabetes management.” Similarly, such an analysis permits a more careful examination of how the patient-physician dyad discursively performs identity work within the two links that have been, to date, understudied: the Proximal-Already-Spoken and the Proximal Not-Yet-Spoken (Baxter, 2011). An in-depth understanding of the discourse that occurs at these sites can help us move from continual repetition of unproductive conversations between patients who struggle with diabetes and their physicians to understanding how physicians might best intervene in the moment and because of the utterance.
References
Baxter, L. A. (2011). Voicing relationships: A dialogic perspective. Thousand Oaks, CA: Sage Publications Inc.

Baxter, L. A. & Braithwaite, D. O. (2010). Relational dialectics theory, applied. In S. W. Smith & S. R. Wilson (Eds.), New directions in interpersonal communication research (pp. 48-66). Thousand Oaks, CA: Sage Publications Inc.

Baxter, L. A. & Montgomery, B. M. (1996). Relating: Dialogues & dialectics. New York, NY: The Guilford Press.

Golden, M. A. (2010). Dialectical contradictions experienced when placing a spouse with dementia in a residential care facility. Qualitative Research Reports in Communication, 11, 14-20. doi: 10.1080/17459430903413440

Martin, D. R., O’Brien, J. L., Heyworth, J. A., Meyer, N. R. (2008). Point counterpoint: The function of contradictions on an interdisciplinary health care team. Qualitative Health Research, 18, 369-379.

Nebel, S. & Emmers-Sommer, T. (2009). The good patient: Competing discourses of the “paternalistic patient” and the hospice patient.” Paper presented at the National Communication Association convention, Chicago, IL.

Olufowote, J. O. (2011). A dialectical perspective on informed consent to treatment: An examination of radiologists’ dilemmas and negotiations. Qualitative Health Research, 21, 839-852. doi: 10.1177/1049732311402097