Accountability and interactional inequality: the management of problems of interaction as a matter of cultural ideals and ideologies.

In the existing sociological literature, the notion of accountability is seen both as a tool of sense-making (intelligibility side of accountability) and as a way of maintaining larger social order (normativity side of accountability). This paper points to drastically different ways of treating an interactional violation, depending on the precise framework within which the accountabilities associated with the violation are interpreted. The normative side of accountability involves the idea of interactional inequality-that is, the notion that people are not equally held accountable for their interactional violations. I suggest that such inequalities are strengthened by the prevailing cultural ideals and ideologies of interaction according to which a competent participant can solve interactional problems as they emerge. Problems of interaction are therefore commonly let pass, and if addressed, likely to be interpreted within the framework of intelligibility. This means that the violators are likely to get away from being held accountable in the normative sense of the term. As a result, I argue, many interactional problems are commonly beyond effective intervention. In its focus on the intelligibility side of accountability CA has, not only trouble addressing interactional inequalities, but it may also inherently undermine the severity of the inequalities to be addressed. A more critical, socially and societally relevant CA would thus benefit from a more explicit engagement with the normative side of the notion.

Conversation analysis and power: examining the descendants and antecedents of social action.

Conversation Analysis (CA) tends to adopt an ambivalent attitude to the concept of power. The concept is fundamental in sociology but secondary or even disregarded in CA. A closer look at research and the conceptual foundations of CA however demonstrate significant contributions to theories of power. In this paper we aim to demonstrate and discuss these contributions, however, also arguing for an expansion of the CA approach in dialogue with sociological theories to engage in the sociological analysis of power as an essential feature of social relationships and social organization. Based on a general definition of power, as the transformative capacities of social agents in virtue of their social relationships, we discuss how power is interactionally achieved and negotiated, but also conditioned by social institutions and structures that extend beyond the contexts of situated encounters. The paper is divided into two main sections. The first section presents central contributions of CA in relation to the distinctions between power over and power to, authority as a legitimate form of power, and deontics as a key concept in the analysis of power. The second section critically considers the tendency in CA to localize power solely to actions in interaction, and to conflate structure and action, which constraints the analysis and explanations of power. We present examples of how analyses of power, grounded in CA, can be extended to account for the dynamics of social structures and realities beyond the interactional encounters.

Mental health rehabilitees' agency construction and promotion in community-based transitional work programme.

PURPOSE: The integration of mental health rehabilitees into the labour market is an important policy objective everywhere in the world. The international Clubhouse organization is a third-sector actor that offers community-based psychosocial rehabilitation and supports and promotes rehabilitees' state of acting and exerting power over their lives, including their (re)employment. In this article, we adopt the perspective of discursive psychology and ask how mental health rehabilitees' agency is constructed and ideally also promoted in the Clubhouse-based Transitional Employment (TE) programme. METHODS: The data consisted of 26 video-recorded TE meetings in which staff and rehabilitees of one Finnish Clubhouse discussed ways to further their contacts with potential employers. The analysis was informed by discursive psychology, which has been heavily influenced by conversation analysis. RESULTS: The analysis demonstrated how rehabilitees adopt agentic positions in respect to TE-related future activities, and how Clubhouse staff promote and encourage but also discourage and invalidate these agentic positionings. The analysis demonstrated the multifaceted nature of agency and agency promotion in the TE programme. CONCLUSIONS: Although ideally, Clubhouse activities are based on equal opportunities, in everyday interaction practices, the staff exercise significant power over the question whose agency is promoted and validated in the TE programme.

Peer support for accepting distressing reality: Expertise and experience-sharing in psychiatric peer-to-peer group discussions.

Peer-based interventions are increasingly used for delivering mental health services to help people with an illness re-examine their situation and accept their illness as part of their life story. The role of the peer supporter in these interventions, known as experts-by-experience (EbE), is situated between mutual peer support and semi-professional service delivery, and they face the challenge of balancing an asymmetric, professional relationship with a reciprocal, mutuality-based, equal relationship. This article investigates how EbEs tackle this challenge when responding to clients' stories about their personal, distressing experiences in peer-based groups in psychiatric services. The results show how the EbEs responded to their clients' experience-sharing with two types of turns of talk. In the first response type, the EbEs highlighted reciprocal experience-sharing, nudging the clients toward accepting their illness. This invoked mutual affiliation and more problem-talk from the clients. In the second response type, the EbEs compromised reciprocal experience-sharing and advised clients on how to accept their illness in their everyday lives. This was considered less affiliative in relation to the client's problem description, and the sequence was brought to a close. Both response types involved epistemic asymmetries that needed to be managed in the interaction. Based on our analysis, semi-professional, experience-based expertise involves constant epistemic tensions, as the participants struggle to retain the mutual orientation toward peer-based experience-sharing and affiliation.

Recognition in interaction: theoretical and empirical observations.

In the current paper we aim to combine the theoretical ideas of recognition theory to conversation analytical, empirical observations. We ask what recognition theories can give to conversation analysis, and vice versa. We operate on a model of recognition that consists of three different modes: respect, esteem, and love/care, and which distinguishes the levels of conversational actions and the attitudes of recognition manifested in such actions. In this study we examine data examples from various conversational settings (institutional, quasi-experimental, family interaction) and activities (decision-making, storytelling), focusing on the more complex cases of (mis)recognition. We show how recognition can appear both explicitly and implicitly in conversational sequences, and demonstrate how the levels of conversational actions and recognition can be either congruent or incongruent with each other. At the end of the article, we discuss the implications of this view for the interface of conversation analysis and sociological theory, arguing that it can inform and promote the development of interactionally based social and societal critique.

Narratives about Negative Healthcare Service Experiences: Reported Events, Positioning, and Normative Discourse of an Active Client.

Narratives about clients' service experiences in healthcare organizations constitute a crucial way for clients to make sense of their illness, its treatment, and their role in the service process. This is important because the client's role has recently changed from that of a passive object of care into an active responsible agent. Utilizing Bamberg's narrative positioning analysis as a method, and 14 thematic interviews of healthcare clients with multiple health-related problems as data, we investigated the expectations of the client's role in their narratives about negative service experiences. All the narratives addressed the question of the clients' "activeness" in some way. We identified three narrative types. In the first, the clients actively sought help, but did not receive it; in the second, the clients positioned themselves as helpless and inactive, left without the care they needed; and in the third, the clients argued against having to fight for their care. In all these narrative types, the clients either demonstrated their own activeness or justified their lack of it, which-despite attempts to resist the ideal of an "active client"-ultimately just reinforced it. Attempts to improve service experiences of clients with considerable service needs require a heightened awareness of clients' moral struggles.

Experiential expertise in the co-development of social and health-care services: Self-promotion and self-dismissal as interactional strategies.

Increasing client involvement in the development of social and health-care services has resulted in clients being invited to present their experiential knowledge in service co-development groups. Nevertheless, research has shown that their opportunities to really contribute to actual decision-making are limited. This article investigates how client representatives initiate turns-at-talk in the decision-making context and the way in which professionals respond to them. Using conversation analysis, we analyzed 15 h of recorded interactions in five co-development workshops. Our data exhibited a systematic pattern that linked client representatives' self-promoting and self-dismissive turns-at-talk to specific types of responses from professionals. When the client representatives highlighted the relevance of their experiential knowledge for making decisions, the professionals disregarded their contributions. However, if instead, the client representatives cast their experiential knowledge as irrelevant to the decision-making activity at hand, the professionals subsequently appreciated this knowledge. Thus, paradoxically, in order to establish the relevance of their views, client representatives diminished their positions as experiential experts.

Self-Disclosure and Non-Communication: Stigma Management in Third-Sector Transitional Employment.

People who are recovering from a mental illness often have difficulties finding and maintaining employment. One of the main reasons for these difficulties is the negative label, or stigma, attached to mental illnesses. People who possess stigmatizing characteristics may use compensatory stigma management strategies to reduce discrimination. Due to mental illnesses' invisible characteristics, information control is an important stigma management strategy. People can often choose whether they disclose or non-communicate their illness. Nevertheless, it might be difficult to decide when and to whom to disclose or non-communicate the stigma. Since stigma management is a dilemmatic process, workers in mental health services play an important role in informing their clients of when it is best to disclose or non-communicate their illness. In this article, we adopt the perspective of discursive social psychology to investigate how workers of one mental health service programme evaluate and construct self-disclosure and non-communication as stigma management strategies. We demonstrate how these workers recommend non-communication and formulate strict stipulations for self-disclosure. At the same time, they differentiate non-communication from lying or providing false information. The study contributes to an improved understanding of stigma management in contemporary mental health services.

Discussing mental health difficulties in a "diagnosis free zone".

Being identified as "mentally ill" is a complicated social process that may be stigmatizing and socially problematic, as a mental illness diagnosis determines the criteria for what is considered normal. This has given rise to a number of anti-stigma campaigns designed to create awareness of the way stigmas affect people with mental health difficulties and to normalize those difficulties in society. One such campaign is the "diagnosis-free zone", which declares that those with mental health difficulties should not be categorized on the basis of their diagnosis; rather, they should be encountered as full individuals. In this paper, we investigate how mental health difficulties are discussed in Clubhouse communities, which adhere to the "diagnosis free zone" programme. The findings are based on conversation analysis of 29 video-recorded rehabilitation group meetings, in one Finnish Clubhouse, intended to advance clients' return to the labour market. The analysis demonstrated that members referred to their mental health difficulties to explain the misfortunes in their lives, especially interruptions and stoppages in their careers. By contrast, staff members disattended members' explanations and normalized their situations as typical of all humans and thus unrelated to their mental health difficulties as such. In this way, the discussion of mental health difficulties at the Clubhouse meetings was implicitly discouraged. We propose that the standards of normality expected of a person not suffering from a mental health difficulty may well be different from the expectations levelled at participants with a history of mental problems. Therefore, instead of considering cultural expectations of normality to be a unified domain, effective anti-stigma work might sometimes benefit from referring to mental-health diagnoses as a means of explicitly tailoring expectations of normality.

Physiological responses to proposals during dyadic decision-making conversations.

A novel conversation-analytically informed paradigm was used to examine how joint decision-making interaction, with its various types of proposal sequences, is reflected in the physiological responses of participants. Two types of dyads-dyads with one depressed and one non-depressed participant (N = 15) and dyads with two non-depressed participants (N = 15)-engaged in a series of conversational joint decision-making tasks, during which we measured their skin conductance (SC) responses. We found that the participants' SC response rates were higher and more synchronized during proposal sequences than elsewhere in the conversation. Furthermore, SC response rates were higher when the participant was in the role of a proposal speaker (vs. a proposal recipient), and making a proposal was associated with higher SC response rates for participants with depression (vs. participants without depression). Moreover, the SC response rates in the proposal speaker were higher when the recipient accepted (vs. not accepted) the proposal. We interpret this finding with reference to accepting responses suggesting a commitment to future action, for which the proposal speaker may feel specifically responsible for. A better understanding of the physiological underpinnings of joint decision-making interaction may help improve democratic practices in contexts where certain individuals experience challenges in this regard.

Being Heard, Exerting Influence, or Knowing How to Play the Game? Expectations of Client Involvement among Social and Health Care Professionals and Clients.

Contemporary social and health care services exhibit a significant movement toward increasing client involvement in their own care and in the development of services. This major cultural change represents a marked shift in the client's role from a passive patient to an active empowered agent. We draw on interaction-oriented focus group research and conversation analysis to study workshop conversations in which social and health care clients and professionals discussed "client involvement". Our analysis focuses on the participants' mutually congruent or discrepant views on the topic. The professionals and clients both saw client involvement as an ideal that should be promoted. Although both participant groups considered the clients' experience of being heard a prerequisite of client involvement, the clients deviated from the professionals in that they also highlighted the need for actual decision-making power. However, when the professionals invoked the clients' responsibility for their own treatment, the clients were not eager to agree with their view. In addition, in analyzing problems of client involvement during the clients' and professionals' meta-talk about client involvement, the paper also shows how the "client involvement" rhetoric itself may, paradoxically, sometimes serve to hinder here-and-now client involvement.

Tensions and Paradoxes of Stigma: Discussing Stigma in Mental Health Rehabilitation.

Mental illness remains as one of the most stigmatizing conditions in contemporary western societies. This study sheds light on how mental health professionals and rehabilitants perceive stigmatization. The qualitative study is based on stimulated focus group interviews conducted in five Finnish mental health rehabilitation centers that follow the Clubhouse model. The findings were analyzed through inductive content analysis. Both the mental health rehabilitants and the professionals perceived stigmatization as a phenomenon that concerns the majority of rehabilitants. However, whereas the professionals viewed stigma as something that is inflicted upon the mentally ill from the outside, the rehabilitants perceived stigma as something that the mentally ill themselves can influence by advancing their own confidence, shame management, and recovery. Improvements in treatment, along with media coverage, were seen as the factors that reduce stigmatization, but the same conceptualization did not hold for serious mental illnesses. As the average Clubhouse client was thought to be a person with serious mental illness, the rehabilitation context designed to normalize attitudes toward mental health problems was paradoxically perceived to enforce the concept of inevitable stigma. Therefore, it is important for professionals in rehabilitation communities to be reflexively aware of these tensions when supporting the rehabilitants.

Physiological responses to affiliation during conversation: Comparing neurotypical males and males with Asperger syndrome.

We examined the emotional and psychophysiological underpinnings of social interaction in the context of autism spectrum disorder, more specifically, involving participants diagnosed with Asperger syndrome (AS). We recorded participants' autonomic nervous system (ANS) activation (electrodermal activity, heart rate, and heart rate variability) and facial muscle activation during conversations in two different types of male dyads: (1) ten dyads where one participant has been diagnosed with AS (AS/NT dyads) and (2) nine dyads where both participants are neurotypical (NT/NT dyads). Afterwards, three independent raters assessed continuously each participant's affiliative and dominant behaviors during the first and last 10 minutes of the conversations. The relationship between the assessed data and ANS responses was examined. We found that, in the NT/NT dyads, a high level of affiliation displayed by the conversational partner calms down the participant when they are actively dominating the interaction. In contrast, when the participants themselves expressed affiliation, their psychophysiological responses indicated increase in arousal, which suggests that the giving of affiliation is physiologically "hard work." The affiliation-related ANS responses were similar in those NT participants whose conversational partner had AS, while some differences in facial muscle activation did occur in comparison to NT/NT dyads. In the AS participants, in contrast, a high level of affiliation provided by the conversational partner was associated with increase in arousal, suggesting heightened alertness and stress. As for their own affiliative behavior, the AS participants exhibited similar indicators of alertness and stress as the NT participants, but only when their own level of dominance was low. Our results increase understanding of how individuals with AS experience social interaction at the physiological level, and how this experience differs from that in NT individuals. Moreover, our results confirm and further specify our earlier results, where we proposed that affiliation involves the type of "sharing of the burden" that also reverberates in the participants' bodies.

The co-creation of meaningful action: bridging enaction and interactional sociology.

What makes possible the co-creation of meaningful action? In this paper, we go in search of an answer to this question by combining insights from interactional sociology and enaction. Both research schools investigate social interactions as such, and conceptualize their organization in terms of autonomy. We ask what it could mean for an interaction to be autonomous, and discuss the structures and processes that contribute to and are maintained in the so-called interaction order. We also discuss the role played by individual vulnerability as well as the vulnerability of social interaction processes in the co-creation of meaningful action. Finally, we outline some implications of this interdisciplinary fraternization for the empirical study of social understanding, in particular in social neuroscience and psychology, pointing out the need for studies based on dynamic systems approaches on origins and references of coordination, and experimental designs to help understand human co-presence.

Experience sharing, emotional reciprocity, and turn-taking.

In this perspective article, we consider the relationship between experience sharing and turn-taking. There is much evidence suggesting that human social interaction is permeated by two temporal organizations: (1) the sequential framework of turn-taking and (2) the concurrent framework of emotional reciprocity. From this perspective, we introduce two alternative hypotheses about how the relationship between experience sharing and turn-taking could be viewed. According to the first hypothesis, the home environment of experience sharing is in the concurrent framework of emotional reciprocity, while the motivation to share experiences is in tension with the sequential framework of turn-taking. According to the second hypothesis, people's inclination to coordinate their actions in terms of turn-taking is motivated precisely by their propensity to share experiences. We consider theoretical and empirical ideas in favor of both of these hypotheses and discuss their implications for future research.