This paper examines how expertise is treated as a separable domain of epistemics by looking at simulated intensive care shift-handovers between resident physicians. In these handovers, medical information about a patient is transferred from an outgoing physician to an incoming physician. These handovers contain different interactional activities, such as discussing the patient identifiers, giving a clinical impression, and discussing tasks and focus points. We found that with respect to knowledge about the patient, the OPs display an orientation to a knowledge (...) imbalance, but with respect to procedures, reasoning, and activities, they display an orientation to a knowledge balance. We use ‘expertise’ to refer to this latter type of knowledge. ‘Expertise’ differs from, and adds to, how knowledge is often treated in epistemics in that it is concerned with professional competence or ‘knowing how’. In terms of epistemics, the participants in the handovers orient to a steep epistemic or knowledge gradient when it concerns the patient, while simultaneously displaying an orientation to a horizontal expertise gradient. (shrink)

Generally, online support groups are viewed as low-threshold services. We challenge this assumption with an investigation, based on Conversation Analysis and Membership Categorization Analysis, of contributions to an online support group on eating disorders. In this analysis we show how a new member interacts with existing members in order to display legitimacy for membership of the group. The group operates as a Community of Practice, since membership is organized as joined participation in a writing practice. It becomes clear that becoming (...) a member involves subscribing to normative requirements, centrally, displaying the insight that you are ill. In the case we focus on, this involves the requirement to leave pro-anorexia as a membership category behind. The novice does not yet seem ready to subscribe to this norm and thus the threshold for seeking support is heightened. (shrink)

Silence has gained a prominent role in the field of psychotherapy because of its potential to facilitate a plethora of therapeutically beneficial processes within patients’ inner dynamics. This study examined the phenomenon from a conversation analytical perspective in order to investigate how silence emerges as an interactional accomplishment and how it attains interactional meaning by the speakers’ adjacent turns. We restricted our attention to one particular sequential context in which a patient’s turn comes to a point of possible completion and (...) receives a continuer by the therapist upon which a substantial silence follows. The data collection consisted of 74 instances of such post-continuer silences. The analysis revealed that silence can retroactively become part of a topic closure sequence, can become shaped as an intra-topic silence, and can be explicitly characterized as an activity in itself that is relevant for the therapy in process. Only in this last case, the absence of talk is actually treated as disruptive to the ongoing talk. Although silence is often seen as a therapeutic instrument that can be implemented intentionally and purposefully, our analysis demonstrated how it is co-constructed by speakers and indexically obtains meaning by adjacent turns of talk. In the ensuing turns, silence indeed shows to facilitate access to the patient’s subjective experience at unconscious levels. (shrink)