What makes a good conversation?
Communication between doctor and patient is crucial for correct diagnosis and for planning the right treatment. But what constitutes good oral communication, e.g. during a medical consultation? This is the question asked by Christina Fogtmann, Associate Professor in Psychology of Language, who is studying how best to guarantee the mutual understanding that is a prerequisite for good communication.
By combining psychological insight with knowledge from linguistic analyses, Fogtmann shows how GPs, for example, can improve their communications and make patient recovery more effective. She spells out the question of the importance of communication by focusing on psychiatric patients, who do not have any somatic symptoms for the doctor to examine by means of blood tests, scans, etc. Diagnosis and treatment are, quite simply, only possible via the mutual understanding built up between doctor and patient in the course of their dialogue. As part of her research, Fogtmann installed video cameras in general practitioners’ and psychiatrists’ consultation rooms in order to analyse their conversations – with the permission of physicians and patients, of course.
Feelings, thoughts and needs in conversations
Fogtmann draws on the psychological concept of mentalizing – our ability to understand both our own and other people’s mental states: feelings, thoughts and needs. This mutual understanding is severely compromised if we are unable to understand the mental states of others. If the doctor fails to recognise that the patient is frightened or angry, then it may be difficult to work out how best to help him or her.
Mentalizing helps to establish mutually reassuring relationships, which provide the best conditions for communication. It enables the doctor not only to better understand the patient, but also to create a space in which the patient is able to acquire greater insight into their own mental states. For patients suffering from anxiety, stress or depression, this has a therapeutic effect in itself.
Being taught about mentalizing helps doctors and other professionals to develop insight into the nature of the concept, and the conditions for its deployment, in a way that enhances their awareness of the mentalizing process. According to Christina Fogtmann, the interactional analytic method called Conversation Analysis is what is needed in order to convert this awareness into an actual enhancement of mentalizing during conversations.
The structure of the conversation
For decades, Conversation Analysis has been used to study how mutual understanding is generated via dialogue. Studies based on Conversation Analysis have identified a wide variety of structures into which conversations are organised. They have also shown how people engaged in conversation continuously demonstrate and reaffirm their understanding of what has just been said.
Coupling insights from the mentalizing framework with insights from Conversation Analysis facilitates the study of the challenges associated with understanding patients, something which is of vital importance for diagnosis and treatment. These insights, along with the knowledge generated by Christina Fogtmann’s studies, can and is already being used in the training of doctors to make them more aware of what generates understanding during their encounters with patients.
The insights from psychology of language research are relevant in all conversational contexts – both professional and private. Fogtmann has opted to concentrate on the field of medicine, in which effective conversation is vital. Christina Fogtmann’s ambition is to incorporate new knowledge about the psychological mechanisms that enable understanding between conversational partners into the core of communication training on medical study programmes. And she is well on her way: From September 2017, a former master student of Fogtmann is part of the teaching team in the 12th semester course on communication in the medical study programme. Other ambitions include incorporating psychology of language insights into work with young people in residential care, studying communication challenges in institutions that work with neglected young people and teaching mentalizing conversation techniques to staff in these institutions.
Specific examples of the impact of Christina Fogtmann’s work in humanities health research include:
- In collaboration with her colleague, Associate Professor Søren Beck Nielsen, arranging and co-ordinating the interdisciplinary master’s degree programme in Psychology of Language at the University of Copenhagen. Around 40 students per year graduate from the programme, many of whom go on to find employment in the healthcare sector, e.g. in communications posts.
- Teaching on DPU’s master’s programme in Health Education, e.g. for nurses and health visitors
- Acting as a consultant on a national research partnership on over-the-counter advice in Danish pharmacies at the School of Pharmaceutical Sciences, University of Copenhagen
- In co-operation with colleagues on the Psychology of Language programme and staff at the Research Unit for General Practice in Copenhagen, Section for General Practice, establishing the research centre “Intersubjectivity in Medical Communication”
- Participating in an intervention project in an institution for young people in residential care, in collaboration with consultant Poul Lundgaard Bak, Danish Committee for Health Education. Among the topics studied by the project are how high levels of emotional stress in young people affect care professionals and, therefore, their ability to help the young people. Master’s thesis students from the Psychology of Language programme also participate in the project.
- Along with Research Associate Professor Annette Sofie Davidsen, who is a medical specialist in general medicine at the Research Unit for General Practice in Copenhagen, teaching on continuing education courses for doctors under the auspices of the Danish Medical Association. The courses have a dual focus on how conversations work and how we form a picture of the mental state of those with whom we converse.
- Working with psychologist Christian Gaden Jensen, head of the Centre for Mental Health Promotion, on studies of stress-related sick leave in relation to citizens’ understanding and experience of their own disorder, with a view to gathering knowledge to optimise the prevention and treatment of stress. Several master’s thesis students from the Psychology of Language study programme are also involved
- Addressing the annual medical conference Oslo Communication in Healthcare Education and Research, on communication in the healthcare sector in the Nordic Region.
Mirroring patients – or not: A study of general practitioners and psychiatrists and their interactions with patients with depression. Annette Sofie Davidsen and Christina Fogtmann Fosgerau; European Journal of Psychotherapy, Vol. 17, No. 2, 2015, pp. 162-178
Forståelsens psykologi – mentalisering i teori og praksis (The Psychology of Understanding: mentalizing in theory and practice); Forlaget Samfundslitteratur, 2014 (in Danish)
Kommunikationsundervisningen kan nå længere (Communication training can do more); Månedsskrift for almen praksis (General Practice Monthly), January 2017, pp. 273-279 (in Danish)
Mentalisering i samtaler med anbragte unge (Mentalizing in conversations with young people in care); Dansk Pædagogisk Tidsskrift (Journal of Danish Pedagogy), No. 3, 2017 (in Danish)
Christina Fogtmann Fosgerau
Associate Professor, Department of Nordic Studies and Linguistics, Psychology of Language
Tel.: +45 35 32 86 42