Respecifying ‘worry’: Service and emotion in welfare encounters

Formulating cancer worries: How doctors establish medical expertise and authority to facilitate patients' care choices

Video recordings of oncology interviews reveal how doctors rely on worry to establish medical expertise, facilitate treatment decision-making, and construct worry parameters to help patients understand whether there is a reasonable need for worry or not. Doctors express worry as frequently as cancer patients during oncology interviews, but they face a dilemma: how to provide care for cancer patients without directly stating they are worried about them? Plausible explanations are offered for why doctors do not state personal worries. Conversation analytic methods were employed to identify how doctors rely on worry to achieve distinct social actions. Four worry formulations are examined: (1) variations of "we worry" (and at times, non-specific and second person "you"), (2) hypothetical worry scenarios, (3) dismissing worry and offering assurance, and (4) doctors claiming they are not worried, bothered, or alarmed. Doctors align with and speak for the professionals and institutions they represent, expressing collective worries and claiming the legitimate right to worry (or not). Doctors also avoid abandoning patients to their own decision-making, yet do not formulate worry to coerce deference or dictate patients' choices. In all cases patients agreed and displayed minimal resistance to doctors' worry formulations. These findings contribute to ongoing work across institutional settings where participants have been shown to construct objective, legitimate claims meriting worries about diverse problems. Work is underway to examine when and how patients explicitly raise and doctors respond to cancer worries. Clinical implications are raised for how doctors can use worry to legitimize best treatment options, help patients minimize their worries, rely on hypothetical scenarios allowing patients to compare how other patients managed their cancer, and not dismiss the importance of minimizing the need to worry as a resource for offering reassurance.

The subjective and objective side of helplessness: Navigating between reassurance and risk management when people seek help for suicidal others

Social psychologists interested in interaction have demonstrated that help-seeking is a fruitful area for understanding how people relate to one another, but there is insufficient knowledge on how people navigate emotional involvement in help activities. Drawing on discursive psychology and conversation analysis, this article examines third-party calls to a crisis helpline, with emergency calls as a point of comparison, to see how participants manage emotional involvement related to callers' concerns for others. The analysis unpacks how participants orient to helplessness-callers' uncertainty and inability to move forward-as justifying a focus on the at-risk person or on the caller's emotions. While dispatchers at emergency centres work to get pertinent information to send help, call-takers at the crisis helpline are trained to offer emotional support. In the latter case, a caller's displays of helplessness may be treated as a sign of danger for the person at-risk, but it can also be taken as a disposition to worry, warranting a focus on the caller's emotional state. Showing how participants manage this challenge as they navigate 'whom to help', the paper contributes to research on the accomplishment of subjectivity and objectivity and demonstrates the utility of this framework in suicide prevention.

What affects you? A conversation analysis of exploring emotions during reflection sessions in Dutch general practitioner training

Introduction

In Dutch training for general practitioners (GPs), reflection on professional practice is key to their training. Such reflection is considered beneficial for professional development, especially when it entails discussing the emotional dimension of practice experiences. In the GP context, invitations to share the emotional side of things, such as "how did that make you feel?" are considered functional; yet, they are also sometimes viewed by participants as 'grilling', 'just too much' or 'too intimate'. Put shortly, putting emotions on the table is institutionally embedded in the GP reflection context, but not always straightforward. Thus, we ask: 'how do teachers and GP residents invite talk about emotions in educational reflection sessions?'.

Methods

In this study, we explored the Dutch phrase 'raken, geraakt worden' (being affected) as one interactional practice used to initiate emotion talk. We conducted a conversation analytic collection study of instances of this phenomenon based on 40 video recordings of hour-long 'reflection sessions' at the Dutch GP specialty training. During these sessions, approximately ten GPs in training discuss recent experiences from medical practice under supervision of one or two teachers.

Results

We found that participants orientated to the relevance of 'being affected' as a topic for discussion. Variations of the form 'what affects you now?' may contribute to putting emotions on the table; they can project a stepwise exploration of the emotional dimension of an experience. The 'what affects you now', often done in interrogative format doing a noticing, in combination with a request, is a powerful tool to instigate transformative sequences. The form is less effective to put emotions on the table when the topic shift it initiates is not grounded in previously presented personal stakes or displayed emotion.

Discussion

The study's findings show how detailed interactional analysis of one sequentially structured practice can benefit education and contribute to theory on emotions and reflection. The mobilizing power of 'what affects you' can serve institutional purposes by doing topical work in relation to educational aims, while its power can also be deflated when prior talk does not project the relevance of unpacking the emotional dimension of an experience. Its interactional workings may translate to other helping contexts as well.

"He Won't Pay": The Entanglement of Financial Abuse and Negligence in Swedish Child Maintenance Processes

Since 2016, separated parents in Sweden are expected to pay child maintenance directly to each other unless special reasons, such as intimate partner violence (IPV), can be invoked. Problems with maintenance payments, which may involve expressions of financial abuse, have become a common topic in interactions between parents and the Swedish Social Insurance Agency (SSIA) that handles these cases. This article examines 132 phone calls to the SSIA, and the results show that payment problems are typically framed as relating to inability or negligence and not as possible indications of abuse. This highlights the need for training and capacity building regarding IPV in the Swedish welfare state.

Economic Stressors, COVID-19 Attitudes, Worry, and Behaviors among U.S. Working Adults: A Mixture Analysis

Since the unfolding of the novel coronavirus global pandemic, public health research has increasingly suggested that certain groups of individuals may be more exposed to the virus. The aim of this contribution was to investigate whether workers grouped into several latent classes, based on two perceived economic stressors, would report different levels of enactment of the Centers for Disease Control (CDC) recommended behaviors to prevent the spread of such virus. We also tested propositions regarding the potential differential predictors of compliance behavior, differentiating between cognitive (i.e., attitudes toward the CDC guidelines) and affective (i.e., COVID-specific worry) predictors. Using a longitudinal dataset of 419 U.S. workers, we did not find significant differences among the levels of CDC guidelines enactment across three latent classes, representing a range of economic vulnerability. We found that cognitive attitudes were a significantly stronger predictor of compliance with CDC guidelines for workers in the most economically secure class, whereas worry was a significantly stronger predictor of compliance for the most vulnerable counterpart. We discuss these findings in light of the Conservation of Resources theory and other health behavior theories, being mindful of the need to further understand the differential impact of this health and economic crisis on employees facing economic stressors.