Matter of discourse

Care is often the topic of media reports, policy and practice
debates. It is also often a part of our own personal lives. Yet
despite its familiarity the term covers diverse, complex and
contested territory. Care is marked by a range of activities, as
well as the number of people who might be thought to deliver or
receive care. The complexity of care is not so much a product of
the tasks, as of the relationships that determine and negotiate
what care will involve. Linked to this is the idea of care as
contested; there is often a mismatch between the ways that carers
and those who are cared for talk about their relationship. We are
all familiar with phrases such as “I’m not a carer, he’s my
husband.”

Being a carer is a different role to a partner and implies
different responsibilities, tasks and relationships. But these
distinctions are not always made in practice. Listening closely to
the ways in which people talk about their care relationships, and
the differences between, say, “wife” and “carer”, can provide
insight into how people make sense of their relationships. This in
turn means that noticing how people talk about difficulties within
relationships has the potential to shed light on how practitioners
might work most helpfully with carers and those they look after. In
order to talk about care, we must also care about talk.

Discourse analysis (DA) is one way of focusing on language and
examining these terms; looking at their function and meaning in
different contexts. DA encompasses a range of approaches, but they
all hold in common theoretical frameworks, vocabularies and methods
for advancing a close examination of language and its use. There
are several key books that introduce DA in broad terms.(1) New work
published in January, however, applies these ideas specifically to
informal care.(2)

Using DA in thinking about care gives us a way of exploring some of
the other ways in which it is talked about, for example, how
care/abuse, abuser/abused, victim/survivor have become understood
as polarised. DA also provides an avenue for working towards less
judgemental articulations of difficulties, and an exploration of
the importance of language. Being attentive to the value judgements
that are contained in the terms above (abuser, victim, survivor)
allows reflection on how we hear and act on conversations where
they are used.

Practitioners may wish to pay special attention to such potentially
emotive words to understand the contexts and consequences of their
use. Consider the use of many inference-rich terms that are
routinely used in health and social care. For example, the word
“disclosure”. It is a familiar expression that is used routinely in
several health and social care contexts such as social work and
clinical/counselling psychology. It tends to be used to refer to
difficulties or events which have not been discussed. It is often
used without much awareness of the assumptions that it
implies.

The difficulties/events referred to by the term “disclosure” are
thought to inform how someone acts, and how the practitioner
responds to, and interacts with, them. Implicit in the use of the
word is an assumption that the difficulty is something that can be
uncovered and worked with therapeutically, for example a disclosure
of sexual trauma. A traditional approach to hearing a disclosure is
to move closer to knowing what the person is really like. The use
of this term therefore suggests that we can know what’s going on
inside someone’s head.

This understanding of disclosure is different from taking a
discourse approach. On some levels this attention to detail in
words can seem misplaced, getting in the way of “the real work” of
helping people move on with their lives and unravelling some of the
more troubled elements of their past or present. However, discourse
analysis can allow us to investigate central issues in care
relationships. For example, how do carers and those they care for
talk about care and difficulties? How do people use stories about
their family history to explain and justify experiences within
care? And how can we use this approach to inform practice and
policy?

In taking account of both sides to the story, one can develop an
understanding of how care and difficulties are spoken about by each
member of the care relationship. It is possible to look at the
intersections and differences between accounts, and consider
differences and overlaps.

Attending to power is an important role of workers in health and
social care. Power and control issues are also important within
informal care relationships. Expressions of power in talk may
indicate abuse or relationship troubles.

For example, in the following extract Barbara* talks to her social
worker Liz* about when her mother is most frequently ill:

Barbara: “…in the summer holidays, at the weekend if we wanted to
go out anywhere, but Christmas was her favourite time of being
ill.”
Liz: “That sounds difficult. Were you doubting whether she was ill
at the time?”

Barbara: “We gave her the benefit of the doubt, maybe she was
suffering all these pains. But there’s nothing wrong with her,
probably hypertension…but maybe that’s a contributory factor. Her
heart’s sound and her blood pressure’s fine, I don’t know.”

Barbara suggests that her mother is saying she is ill to achieve
certain effects within the family (getting more help and time with
relatives). Her mother is treated as being powerful in drawing care
from family members, and while Barbara concedes that there may have
been some physical ailments she simultaneously denies that her
mother was ill. Barbara’s talk indicates that she feels
hypertension is an inappropriate explanation for the subsequent
impact on family life.

DA can be used to look at the accounts of carers and those for whom
they care, and leads to a detailed understanding of how people talk
about care relationships, moving the knowledge base beyond
determining the “who, what, where and when” of care, toward how
inter- and intra-personal factors are constructed in talk. An
awareness of how carers and users account for difficulties has
implications for support services working with people who report
relational difficulties, as well as those who do not. Barbara sees
difficulties in her relationship with her mother which may provide
a starting point for practitioners to work with her around securing
extra support.

Overall, this approach allows us to explore the topics of informal
care and relational difficulties. This includes embracing a
critical view of taken-for-granted terms such as “victim” and
“perpetrator”, looking at the action of such labels in talk, rather
than accepting labels as a perspex cover that allows access to
people’s “disclosed reality”.

Names have been changed

• Talking about Care is published by The Policy Press, available
  from Marston Book Services on 01235 465550 or e-mail: direct.orders@marston.co.uk

Abstract
Caregiving within families is often complex and can be
fraught with relationship difficulties. Paying attention to the way
people speak about care, relationships and difficulties can shed
light on how practitioners can fruitfully work with care-givers and
care-receivers. Discourse analysis, in particular, can be a useful
way for practitioners to explore accounts of care and grapple with
the inherent complex relationships.

References
(1) J Potter, M Wetherell, Discourse and Social
Psychology. Beyond Attitudes and Behaviour, Sage, 1987
(2) L Forbat, Talking about Care: Two Sides to the Story, The
Policy Press, 2005

Contact the author
By e-mail at e.forbat@ed.ac.uk or phone: 0131 650
4055.

BOXTEXT: Liz Forbat is a research fellow at the University of
Edinburgh’s Centre for Research on Families and Relationships. She
is a psychologist with training in family therapy. Current research
interests relate to a variety of areas including learning
difficulties, dementia
and counselling.