Abstract

Service-user groups whose goals include the promotion of self-advocacy for people with an intellectual disability aim, among other things, to encourage service users to identify problems and find solutions. However, service users' contributions to group sessions may not always be full and spontaneous. This presents a dilemma to the facilitator. In two case studies, we identify two ways in which the dilemma is managed. In one case, the facilitator takes an initiating role in each stage of a decision-making cycle. In the other, the facilitator short-circuits the decision-making cycle. The former seems to be closer to the philosophy of self-advocacy, but both nevertheless result in clients not taking the initiative and arguably disempowers them.

The United Kingdom Department of Health's 2001 White Paper “Valuing People” highlighted the fact that people with intellectual disabilities have little control over their lives and outlined a series of objectives to promote choice and empowerment. These include a change to towards person-centred planning approaches, the further development of user consultation, self-advocacy and citizen advocacy plans, staff training, and direct payments. The White Paper endorses the self-advocacy movement, which has been growing in the United Kingdom since the first participation events in the 1970s and the establishment of the People First group in the United Kingdom in 1984 (for a history, see Goodley, 2000). In the intervening 20 years, there has been increasing numbers of independent groups set up as well as groups based in particular services (Crawley, 1988; Simons, 1992; Whittacker, 1996).

Service-user groups aiming to promote self-advocacy have a number of aims and fulfil a number of functions, both at group and individual levels (Goodley, 2000; Simons, 1992; Worrell, 1987). Broadly, the aim is to empower members by giving them opportunities to speak up for themselves, raise issues of concern, and have their voices heard (Aspis, 1997). This is sometimes conceived in developmental terms: Speaking up presumably develops people's skills and confidence, which can be taken outside the group into their personal lives. In this sense, self-advocacy can have an individual focus. Self-advocacy is also about collective action, and many groups become involved in campaigning on national and local disability and service issues, and they act as consultants for government agencies and non-government organizations (for examples, see Blake, 2004). Here, too, there can be a developmental aspect, and in Britain, the National People First organization supports local groups by providing them advice on how to run meetings, mount campaigns, and provide accessible information, among other things (for examples, see Johnson, 2004).

Independent self-advocacy groups vary widely in their membership, in what type of support they seek from people who are not labeled as having intellectual disabilities, in what activities they do, and in what issues they discuss. We note that the term self-advocacy group is best reserved for those meetings specifically set up, independently of official institutions, to actively promote the particular aims of self-advocacy. Many groups do run under that term. The broad ideals of self-advocacy have (at least in Britain), however, permeated a good deal of policy with regard to staff interaction with people who have intellectual disabilities to such a degree, perhaps, that even routine meetings have a strong implicit agenda of empowering the service-users to speak out, assert themselves, and make their needs and wants known. Such meetings between staff and service-users may be labeled self-advocacy groups, service-user groups, client committees, residents' meetings, and so on. To be sure, they are more likely to discuss issues related to the service and are usually facilitated or supported by staff members (Crawley, 1988; Goodley, 2000). Nevertheless, they are imbued with the same policy-orientation to empowerment as are those that are explicitly self-advocacy groups.

Both service-user groups and independent self-advocacy groups aim to empower their members and promote self-advocacy; however, in the former it is hard to avoid conflicts of interests: Group members may be reluctant to voice criticisms of the service (Simons, 1992), and staff members may be compromised by their professional identities. As Goodley (2000) noted, “Conflicting motivations between facilitating self-advocates' independence and maintaining service goals is a common and underlying dilemma of professional advisors in service-based groups” (p. 20). Staff members may exert influence in pursuit of service goals in various ways, some more easily visible than others. This might involve control and subtle influences over the topics discussed, the decisions made, and the activities in which the group engages. For example, in providing relevant information or in attempting to ensure that everyone in the group is encouraged to speak up, advisors may unwittingly introduce boundaries in which decisions are made or issues discussed (for examples, see Jingree, Finlay, & Antaki, 2006; for a discussion of these problems, see Worrell, 1987). Of particular concern in our paper is to show the need for the advisor to accept the time it may take for a group to decide on agendas and come to decisions. In terms of the goals of self-advocacy groups, on which service-user groups might usefully be modeled, “the process of deciding is as important as the outcome of the decision” (Worrell, 1987, p. 32).

Theory and Practice

Although the general philosophy of self-advocacy is clear about what ought to happen, there is a lack of empirical evidence as to what actually happens in service-user groups. There is, however, relevant evidence from elsewhere (e.g., Marková, 1991) to cast doubt on the likelihood that the self-advocacy ideals of full and spontaneous expression will always be achieved. The crucial problems for facilitators are to (a) find a balance between, on the one hand, proceeding with the business of the meeting and, on the other, supporting service users to express themselves freely; and (b) provide support in such a way that the group can become independent. These problems have been documented since Marková's (1991) study. She noted that even giving explicit instructions to tutors failed to prevent them from taking the lead and, to some degree, dominating what were supposed to be ordinary conversations with speakers who had an intellectual disability. Since then, a series of investigations of recordings of interactions between people with an intellectual disability and staff members have brought to light practices that, although certainly helping the interaction to achieve an institutional goal—such as responding to a questionnaire or filling in a form—mitigate against the service-user's spontaneous and unchecked expression (see, for example, Antaki, Young, & Finlay, 2002).

In approaching the question of how service-user groups reach decisions, then, it would be prudent to keep an open mind about whether the ideals of empowerment will be achieved. Although the ideal is for members to run the group, often, in service-based groups, staff facilitate and guide the business of the group. Facilitators are engaged in the business of running the group and coming away with resolutions to various agenda items; that may mean that they have to use the sort of practices one sees elsewhere (e.g., to get a respondent to fill in a questionnaire) that, because they are directive, go against the philosophy of self-advocacy. On the other hand, the facilitator has the ordinary conversationalist's obligation to help keep the interaction going; this may mean supporting the service-users' possibly problematic contributions and dealing with silences and lack of uptake. The facilitators, then, face a dilemma.

In this paper we describe two styles of dealing with this predicament. In one, which we call a “guidance style,” the facilitator manages the running of the group session so as to bring out, in seemingly natural order, just the rational steps required: statement of a problem, expression or reaction to it, expression of preference for change, and suggestions for action to bring that change about. Nevertheless, we found that it was the facilitator who drove the proceedings, not the group members. In the other style, which we call “short-circuiting,” we found that facilitators who, by paying attention to the merely organizational aspects of the interaction, pre-empt the description of possible problems; reduce the alternative solutions; and move quickly to propose, and to decide on, actions that fit the institutional agenda.

Method

Our interest was qualitative: What it is that facilitators of self-advocacy groups do, and how do they do it? Rather than approach the data with a predetermined category system into which to code behavior, we used conversation analysis to illuminate actions as they occurred.

Conversation analysis is a well-established approach to the study of social action as achieved through talk in interaction. In the 40 years since the pioneering work of the group led by Harvey Sacks (whose lectures were published posthumously as Sacks, 1992), conversation analysis has attracted enormous attention and developed into a multidisciplinary enterprise, attracting sociologists, linguists, and psychologists, among others (for an account of the history of conversation analysis, see Heritage, 1984; for a recent overview of its methods and style, see Hutchby and Wooffitt, 1998; for the difference between conversation analysis and discourse analysis more generally, see Wooffitt, 2005). Its signal characteristics are (a) a reliance on recorded data that can be minutely inspected and (b) an openness to the way the participants in a scene display their own understandings of what they are doing and saying, as evidenced in the exact organization of their talk.

Conversation analysis begins by identifying speakers' turn-taking and how each turn projects a response. Once a conversation has been initiated, every turn a speaker takes is responsive to the previous speaker and, specifically, to what that previous speaker has “set up” for the next speaker. Thus, a summons will set up an acknowledgement, a greeting will set up a reciprocal greeting, a question will set up an answer, and so on. Furthermore, each of these responses will then, in turn, open a space for the first speaker to proceed, and so on. Conversation analysis shows how people design these turns and how they deliver them in sequence to reveal how they forge social actions: instructing; advising; being friendly; diagnosing; complaining; and, indeed, the whole range of resources that, in combination and in context, provide speakers with ways of prosecuting their business in the social world.

Within the field of research on intellectual disability, researchers have used conversation analysis to study the communicative strategies of people with an intellectual disability (e.g., Wootton, 1989), the practices of their assessment (e.g., Antaki, 1999), and the manner in which they manage their identities in interviews (e.g., Rapley, Kiernan, & Antaki, 1998). It has also been used to uncover the working practices of staff members dealing with people who have intellectual disabilities in routine service-user interviews (Antaki et al., 2002) as well as in self-advocacy group meetings (Antaki, Finlay, & Walton, in press).

Our aim in this article, then, is to use conversation analysis to enable a close inspection of recorded talk, thereby illustrating how decisions are reached in a discussion group composed of one or more members of caregivers and a number of residents or service users with an intellectual disability. We note at the outset that what readers will see is a qualitative study of two specific, but routine cases in their interactional detail. We do not mean to say how often the kind of events we record happen; rather, our aim is to use a very narrowly focused beam on two examples of routine work to show what can happen and how it relates to the aspirations of institutional policy.

Data

The extracts come from audio recordings (for which informed consent was secured from all parties) of two meetings, one in a day center and one in a group home; both meetings were supported by staff members. The first is referred to as a self-advocacy group by the day service staff and the group members; the second, as a residents' meeting. Both were designed to provide a forum for group members to express themselves and offer some input into what happens in the respective services. Although examples from only two meetings are presented here, we recorded a total of five meetings in the two sites. Similar patterns to those identified here were observed in all meetings. Personal and place names as well as other identifying details have been changed.

Analysis of Case 1: The facilitator as “directive guide” through the entire cycle from problem-identification to action

In the first of our two case studies, we report on the meeting of a group that was referred to by its members as a self-advocacy group, held in a large day center. The major aim was to help members speak out. Further aims, as compiled by the group, were helping to learn how to talk to staff about problems, giving confidence to say what you feel, not letting others take advantage of you and boss you around, being treated like adults, and listening to what people have to say. The group met weekly and included a single staff advisor. In this meeting, 12 group members and 1 staff advisor were in attendance.

We found that the facilitator prompted the clients through every step of the process: from identifying an appropriate problem through to proposing a specific action to remedy it. Our description begins at the point where the facilitator (“Kevin”) started to specify why a recent event (the vandalizing of the Center's minibuses) was the actual problem for the group members.

In the following transcript, we adhered to the practice in conversation analysis of notating the talk to approximate, as closely as is reasonable, its actual delivery. Past research has shown that such apparently small details as length and placement of pauses can be significant in determining the meaning of an utterance (for a full account of transcription issues, see ten Have, 1999). For our purposes here, however, we have shown only the amount of detail that is appropriate for readers to follow what is said and to give credence to our subsequent analysis. Appendix A is a glossary of the notation symbols. Probably the most significant convention that will need explanation to ease legibility is the use of square brackets ([ ]) and aligned text to indicate that two speakers are talking at once. For example, in Extract 1 below, Lines 2 and 3 show that Helen began saying “I know…” while Kevin was still saying “… didn't have no minibuses,” and the aligned brackets show exactly where this happened. Overlap is an important feature of talk, especially where there is a premium on making one's voice heard, so we have left in all of the occasions in which it happened.

Appendix A Transcription Symbols

Appendix A Transcription Symbols
Appendix A Transcription Symbols

Pursuing a response to generate the ‘right’ problem

 
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The first objective of a decision-making session is to find a, or the, problem that needs solution. Notice three things about what Kevin, the facilitator, did to accomplish this. In each case, he was directive. First, he drew, out of the previous shared outrage about the vandalization of the Center's mini-buses (not shown), the implication that this might be a problem (Lines 1 and 2). Indeed, he drew the implication in a yes/no format. Confirmation is expected in such formats (Houtkoop-Steenstra & Antaki, 1997; Sacks, 1987). Second, he explicitly asked the group members to articulate just what that problem might be (Lines 5 and 6); that is, he did not leave it up to the users themselves to recognize and articulate for the group that the event had consequences; rather, his open-ended question forced the issue by making them accountable for coming up with answers. Third, once 2 users had answered, he chose (Line 19) to ratify “they couldn't go out” as the consequence (of the vandalization of the mini-buses) that was worth elaborating. This directed the talk away from financial matters, which seemed to have been raised by a group member at Line 10 (but which the users may have had little control over and no responsibility for) and on to something that directly affected the users' lives, namely, their excursions. This structure gave us a rather directive way of managing the dilemma of working with people who may not volunteer the required steps in the decision-making process, yet whose voices need to be heard. In each of the succeeding sections, we track how the facilitator pursued the steps of the decision-making agenda of the meeting.

Soliciting suggestions for action

In the next extract, the facilitator again took a directive line by initiating a search for a solution to the problem. Lines 3 to 5 record Ray and another member producing some talk that is difficult to understand (and could not adequately be transcribed).

 
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At Line 6 the facilitator passed on the opportunity to prolong the topic of how the damage was caused. At Line 8 he topicalized, with the distinctive new-topic markers of disfluency and pitch– spike (see, for example, Local, 1996, p. 182), the prospect of doing something about it. He accepted that the minibuses did need to be put somewhere more secure and explicitly solicited suggestions for how “we could stop this happening again.” This was temporarily frustrated, however, by a group member's call for the vandals to be punished:

 
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In the arrowed line (Line 9), Kevin explicitly rejected Scott's contribution as irrelevant to the problem he was moving the group through, and the actions he was moving them towards. In the question-and-answer format that Kevin was using, Scott provided an answer that either applied to locking the vandals up in a cage or locking the buses up in a cage. Kevin assumed that Scott was referring to the vandals and deemed this to be “off track” to the business he was pursuing. Kevin paid no attention to Scott's bid to make a further contribution (Line 16) to bring attention back to the agenda question: Where does the group think the minibuses should go? When no immediate response came, Kevin prompted the group by appealing to what one of the group members said (Lines 20 and 21). This can be seen as a bid to engage the members and acknowledge their contributions. However, that too yielded no immediate further suggestions, and at Line 23 Kevin fell back on a direct restatement of the question.

Piloting to the right answer

In what follows, the facilitator rejected two alternatives sites for secure parking put forward by users. Again, he managed this while maintaining some semblance of encouraging the users to contribute.

 
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In Line 5, the facilitator offered an account for (implicitly) rejecting the site proposed by Rachel: it is where the perpetrators of the vandalism live. This is appreciated by the group; then, in Line 14, Joe suggested “the leisure centre.” The facilitator overlapped this with an outright rejection. However, he did mitigate the brusqueness of this by using a method that is sometimes called “teacher talk” (see, for example, Edwards & Mercer, 1987): setting out a description of the situation so as to make its evaluation obvious (“There's big notices all around saying warning, thieves about; so do you think that's safe?”). Again, then, the facilitator negotiated his way between progressing the decision-making rationally (by dismissing inappropriate suggestions) and promoting the alternative objective to instructing and (in that sense) empowering the group.

In the next extract the facilitator used a more positive directive strategy, namely, hinting that there is a correct answer that has not yet been given.

 
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In Lines 2 to 5, Kevin again dealt with an inappropriate suggestion by questioning its safety. He overlapped Scott's acknowledgement of this, however, to launch a very strong hint that there is a “right” answer (arrowed line). This, again, is a familiar device from teacher talk (Edwards & Mercer, 1987) and strongly implied that the invitations for suggestions so far had been something of a sham. The facilitator (like the teacher who asks for suggestions about an issue to which they hold the solution) had an answer all along. This is a further illustration of the facilitator's management of the dilemma; at some point, if no appropriate answer was forthcoming, the business of the meeting might require the facilitator to provide it. Here, at least, Kevin's hinting did allow the group members one further chance to come up with the answer as if it were spontaneous.

Although one member did recognize what Kevin was alluding to in Lines 7 and 8, he identified the institutional nature of the location only as “the tea bar” (Line 10). Kevin used a set of questions to lead this idea towards a description of the place that had stronger associations with security (“the castle”). Again, Kevin used questions to solicit the information from the users, but it was information that fit the agenda of displaying the rationality and appropriateness of the suggestions.

Proposing action

The facilitator had, to this point, established with and for the group that (a) there was a problem with unwelcome consequences for the users (vandalization of minibuses with the consequence that the users could not go out) and that (b) there was a feasible solution (relocate to a more secure parking area). Now he moved on to find an action that would bring this solution about. In the extract below, the facilitator was directive; he did not wait for this action to be proposed by the group members. On the other hand, he was careful to design his turn so as to make it a question that solicited suggestions:

 
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Kevin repaired his question at the arrowed Line 6 to include a full statement of the issue before relaunching it at Lines 8 and 9. This helpful reorientation to the problem successfully yielded a reply: One of the group members proposed that they write a letter. Kevin received this in an echoing phrase, confirming the suggestion and inviting more to come. Joe did not accept the opportunity to expand his suggestion, and among the other group members, only Scott contributed, merely offering “yeah.” When no elaboration was volunteered, Kevin asked for it explicitly (Line 15). Again, it is important to note that the facilitator was finding his way through the dilemma of attending to the group members' concerns on the one hand and the progress of the meeting on the other: Although Kevin was directive, he did allow an opportunity for the group members to put matters in their own words first.

Personalizing the question

The facilitator had a number of resources at his disposal to encourage the group members to come forward with suggestions or to expand upon what has been said. One of these was what Antaki (2002) called “personalized questions” (i.e., making a specific reference to something from the user's own life to work as a hint or clue to material that is relevant to the current question). In the extract below, Kevin in Lines 1–3 asked how local people might help, but initially did not get informative answers. In Line 19, he asked one of the group members what his sister did, in what are (implicitly) similar circumstances.

 
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Kevin's reference to “what Philip's sister did” did not immediately yield a reply, and the next extract shows how he repaired the question by providing still more prompting, providing the sister's name and the activities for which she needed help.

 
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Although Philip did offer a response in Line 4, Kevin did not deem it adequate and offered yet further details of the scenario from his own and the group's own home circumstances:

 
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At Line 9, Kevin used another test question to yield the information that he had in mind: the local newspaper. This still did not prompt Philip to recall what it was that his sister did to publicize events. Rachel, however, “gets it” at Line 17 in a reference right back to the original question, which Kevin had posed in Line 1 in Extract 7. She proposed that they tell the press. The procedure had been a success. As Antaki (2002) noted, personalizing the issue this way is “as if the interviewer ‘knew better’ than the respondent what the proper answer to the question ought to be, and sets up a scenario that would produce such an answer” (p. 424). In this case, it eventually did, and Kevin rounded it off by casting what emerged as a positive suggestion for the group's approval: “Do you all think it would be a good idea to tell the press? In other words, his long series of attempts to get the group to articulate the solution that he, the facilitator, already had in mind, was deleted, and what remained was a suggestion that appeared to emerge naturally from the group.

Exploring the possible results of the proposed action

Once a proposed action was on the table, a further feature of a full and spontaneous discussion would be for the group members to speculate on what its effects would be. However, in this group, no members volunteered this as a topic. Once again, the facilitator took the lead, as the following extract shows:

 
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At the first arrowed line, the facilitator raised the issue of the effects of the proposed action as an open-ended question. There is no reason to suppose that he himself did not know the answer; it is a test question familiar from classroom settings (see, for example, Edwards and Mercer, 1987, on such teacher devices). This is an economical way for the facilitator to proceed with the business of the meeting: It puts the members in a position where they are expected to reply, but it is the facilitator who arbitrates what will count as a full answer and can keep the question alive (as he did in the subsequent arrowed lines) until it is either answered fully by the group members or a position is reached where it becomes appropriate for him to “reveal” the answer, just as a teacher would if the pupils did not know.

Introducing a Further Proposal for Action

In a free-wheeling discussion, once the group has reached the stage of considering proposals for action, it would be up to anyone to introduce new proposals; in this group, however, none of the members took the opportunity to do so. Once again, then, the facilitator faced the dilemma of direction versus respecting the members' choices. They may be comfortable with the proposal already on the table and to press for more might be inappropriate; on the other hand, he might feel that there is something else that needs to be considered. The next extract shows how he found his way rather delicately though this impasse:

 
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The facilitator introduced Neighborhood Watch as if he wanted to know whether anyone had heard about it. This format is again familiar from classroom talk: it is a “pre-question” (Schegloff, 1980), whose effect here was to nominally allow the respondents to indicate their familiarity with the topic, and yet reserve a place for the questioner to say more about it. He did so at the arrowed line by asking another test question (as can be seen in Extract 10) whose answer he ratified in Line 20. His choice of what to ratify as an answer, namely, “watching people and seeing what they're doing” revealed an aspect of Neighborhood Watch that matched the issue at hand (i.e., how to protect the Center's minibuses. The facilitator managed his dilemma subtly here: He introduced a topic about which the group members would have some information that they could express in their own words; then, when they had done so, he pulled out that aspect, which, in fact, was relevant to the group's decision-making business.

Solicitation of agreement plus action

The final step in the decision-making cycle is for the group to agree on the proposed solution and undertake some specified course of action. Again, it is the facilitator who took the initiative. The extract below comes after a sustained exchange (not shown) in which the facilitator, in Socratic question and answer style, articulated what Neighborhood Watch meant in terms that were directly relevant to the nature of their problem (he described it as involving people looking out of their windows and being alert for suspicious behavior in the street). He then drew out a conclusion of this Socratic dialogue and moved to a decision:

 
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The facilitator's closing-down routine, summarizing the decision-making process they have just gone through, seems to conclude the business of the meeting. However, the group members went on to raise other issues that were irrelevant to the decision being made. We do not have space to describe what happened in detail, but it is worth noting that 2 minutes later, in once again summarizing the business done, the facilitator displayed his concern to make quite sure that all had been agreed. There was more talk and, at the end of the half-hour session before the group broke for refreshment, the facilitator used the expression “that's lovely …that's brilliant so I'll do that,” which is often found in positions of topic termination in interviews (Antaki, Houtkoop-Steenstra, & Rapley, 2000). It marks the topic as closed, but with a positive, successful gloss.

Summary of the “directive guidance” style

Our first case illustrated a style that might be called “directive guidance.” The self-advocacy group did indeed go through all the steps in the decision cycle, but at each step it was the facilitator who directed affairs. In the case we saw, the facilitator “guided” the discussion with the following conversational practices: using yes/no questions, pursuing an answer beyond the first response(s) given by the group members, explicitly nominating a new stage in the cycle, not attending to irrelevant talk, hinting, and using leading questions that strongly point to the required answer, shaping a response in a series of progressively limiting questions, using personalized questions that mobilized information from the members' own lives, and, finally, inviting confirmation of the decision taken as a good one.

Before discussing this style of facilitating the self-advocacy group in our concluding comments, we note two points about it. One, each of the practices of guiding listed above does, in principle, allow the members to voice their concerns, albeit within a limited framework established by the facilitator. Second, there is evidence in the transcript that the facilitator was not unilateral in his proposals or the demands he made of the members: he was, on the whole. responsive to their talk and only occasionally did not attend to what they said. A contrasting case shows a facilitator who used practices that are very different.

Analysis of Case 2: The Facilitator “Short-Circuiting” the Decision-Making Cycle

In the second of our two contrasting case studies, we report on a residents' meeting held in a residential home. According to the manager of the home, the aim of these forums were to empower clients, discuss day-to-day concerns they may have, and offer a social venue to facilitate group interaction and communication. Other staff members saw the meetings as providing an opportunity for residents to have a say in the running of the home, air their grievances, and contribute to planning future activities. There seems the possibility of a conflict between the goals and the practice, in that the agenda is planned beforehand by the staff members and manager, and the meetings are chaired by a staff member. The meetings are attended by the residents of the home and whichever staff members are on duty at the time; thus, staff presence varies from meeting to meeting. Two staff members and 8 residents were present at the meeting discussed here.

In the following extracts, the two facilitators did at times solicit information from the residents; but they also intervened much more directively, and more unilaterally, at many junctures in the decision-making cycle; they also did not attend to the residents' concerns more markedly.

Intervention right at the start of the cycle

At the start of the session, the facilitators in this group (“Melanie” and “Andy”) introduced a forthcoming event unilaterally (Line 6).

 
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The nature of the event, then, was already decided (“We're all going out to lunch”), and residents were involved only in having their approval solicited, in a yes/nor format that is strongly associated with a yes answer (Houtkoop-Steenstra & Antaki 1997). Moreover, in Line 15, Mel checked the qualification (that the residents will have to pay half) as if it were a matter of positive confirmation (“You're happy about that”). This, according to Houtkoop-Steenstra (2000, pp. 144–151) is a distinctive no-problem way of posing questions, making it hard for the respondent to disagree. However, after this the facilitators did ask for suggestions of where to go.

 
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After uninformative answers to the first invitation, Mel restated the question (Line 13), which yielded an ambiguous response from one of the residents, which the other staff member present asserted is the garden center …Tadworth Hall. However, at Line 23 Tim attempted what may have been a dissenting voice: his I wouldn't, which might have gone on to go back there is lost in overlap as Mel addressed another resident. This possibility of dissent was not taken up for clarification, and, indeed, Mel issued a bid to terminate discussion using two formulations that would result in yes responses: “So that's where you'd like to go?” followed by the more directive “And are you all in favour of that, come on speak now (or ‘speak out,” delivered fast and emphatically (see Line 33).

How does this advance the business of the meeting? In the next extract, which follows immediately after, staff members express an attitude towards the progress made:

 
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At Line 45 the facilitator observed (“Well that was easy wasn't it?”). Indeed it was—from the facilitators' point of view. In this opening episode of the advocacy group, the staff set a preplanned activity on the agenda (going out to lunch); solicited agreement by a yes/no question; paid no attention to a possible dissenting voice; and, in bringing the discussion to an immediate end with a hurried request for agreement, made no (visible) attempt to incorporate all the members present. If the business of the advocacy group was to empower residents to take the initiative, voice their concerns, and actively prosecute their own business, this little episode, in the first 2 minutes of the recording of the session, did not bode well; on the other hand, if the business was to get through the meeting and achieve recordable decisions, it has the virtue of being time-efficient. We found that the facilitators tended toward this latter orientation throughout the whole session.

Topic introduction

The next decision-making item on the agenda was introduced in what we might consider, again, to be a rather disempowering fashion, although the arrowed lines below may have been intended to introduce the item in a jocular or ironic way:

 
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Mel's introduction of the menu as a discussion topic was framed as a matter that caused her trouble: she “gets GBH of the ear for it.” The initials GBH, in British English usage, refer to the legal offense of causing grievous bodily harm, a step or two step down from manslaughter. Mel would be heard by fellow members of her speech community as making a semi-serious joke to the effect that she gets grievously assaulted verbally over the menu business. This seems to privilege her own concerns as a staff member above the interests and complaints of the residents; moreover, when invited to speak, they are given the opportunity to “speak now or forever hold your peace.” This, too, is a jocular expression, borrowed from the old-fashioned church wedding ceremony. Possibly, as we noted above, the intention was to give a light-hearted touch to the proceedings; but, equally, it did not promote an atmosphere of respectful solicitation of residents' views. When the residents expressed dissatisfaction with the menu (Lines 11 and 12), but did not elaborate, these staff members (unlike Kevin in the first case-study) chose not to use cooperative (or cooperative-seeming) teacher talk. Instead they resorted to direct challenge: “Come on what's the matter with the menu?”

Dealing with “off-topic” talk

After a period of talk in which the residents aired negative views about the food, one resident voiced an objection about staff behavior at mealtimes:

 
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What Nat says at Line 5 could be heard as a complaint about staff behavior related to the issue of food currently being discussed. According to one reading of the purposes of a self-advocacy group, it would have been in order for the facilitator to have followed this up as an issue of resident's concerns. The facilitator might have asked for clarification, invited other members to comment, or have taken responsibility for looking into the matter. Mel did none of these things; rather, she did a “pass,” echoing Nat's words, as if to make her accountable for what she had just said (see Schenkein, 1978, on what passes can do to imply something deficient in the previous speaker's turn). Nat's no (Line 9) is met by Mel signaling (with “well,” a marker of some trouble (see Hutchby & Wooffitt, 1998, pp. 43–47) that this is irrelevant to the business at hand. The tone is playful, perhaps, but the effect is to sideline the issue. As before, this way of proceeding is certainly time-efficient, but it has the effect of dismissing concerns brought up by the residents.

Getting a message across

The next episode is a further demonstration of the staff members' orientation to institutional goals other than open solicitation of residents' views. In the dialogue below, the facilitators used the advocacy-group session to instruct, or coach, in institution-relevant information. The house management had introduced an item onto the agenda to check whether residents know the fire procedure. This put staff members in the position of both teacher and quiz-master and group members as students whose competence was questionable and reinforced a model of interaction that is not consistent with empowering the group members.

 
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Notice that the facilitator at first used a test-question format to solicit answers about the fire-drill. When a resident did volunteer to provide an account of what to do in a fire, however, Mel quickly intervened at Line 12 to direct her to “start from the beginning.” When this seemed to hinder the resident's flow, the facilitator turned to another resident, Nat, who gave what seems to be a plausible if incomplete account (“If you're upstairs and can't open the door you have to wait for the fire engine to come”). What is striking is that the facilitator responded to this with a notably sarcastic comment (Line 25 arrowed). This, as in Extracts 16 and 17 above, may have been intended light-heartedly, but it seems inappropriate to the self-advocacy philosophy of respect for residents. It may be a further example of the staff member pursuing institutional objectives: here, perhaps, “getting the message across” by whatever means.

This orientation to getting the message across is also visible in the following extract, where, again, the staff's objectives seem to be instructional, rather than supporting residents' decision-making.

 
formula

The format of this exchange is the classical teacher–pupil test question format, in which the student is meant to supply a known answer. The facilitator rejected the residents' first attempt and prompted a correction at Line 10, with a sentence that is formatted for the residents to complete with a given word: “What do you always say? She is my ___.” In other words, rather than enquiring freely into the resident's feelings towards the night caregiver, the facilitator shepherded them into providing the single word (friend), which counted as an acceptable answer to her question. Indeed, Mel's formulation had clear overtones of instruction, as if telling the group members what they ought to think. As before, this might be seen as eliciting statements to meet institutional objectives of obtaining and reinforcing favorable views on the group members' relationships with staff, though at the expense of an open enquiry into their feelings.

Working through the agenda

The staff's main agenda in the meeting was to expedite institutional business they raised and dealt with, a lunch outing, suggestions for the home's menu, and fire drill procedures in terms that de-emphasized residents' contributions. in the last substantive set of extracts, the facilitators brought up and dealt with the institutional business of arranging the residents' Christmas party. There is a telling indication, on Line 5, of the facilitators' approach to the matter as an agenda item:

 
formula

In the lines above, the two staff members exchanged comments between themselves, within the group's hearing. Mel read from what seemed to be a printed list of questions meant for the residents: “and it says how do you feel about the dates?” This way of introducing the topic of the residents' preferences casts it as something to be “got through” with in the session. It can be compared with a more conversational-sounding introduction that does not refer so explicitly to the institutional nature of the topic (see, for example, how the facilitator in Case 1 introduced new topics in a more endogenous manner). Once again, the facilitators' practices here are oriented towards the management of the interaction as a meeting whose agenda must be gone through efficiently.

In pursuing the resident's preferred Christmas activities, the staff members dealt dismissively with the first suggestion:

 
formula

In Line 19, Mel's repeated nos, and in Line 22, her idiomatic complaint “patience is a virtue,” both contribute to a sense that she considers Kat and Tim's contributions to be off-agenda. Later in the same episode of discussion on Christmas activities, a resident informed the group that another resident had gone to bed. Mel betrayed what seems to be a strongly disciplinarian orientation to the meeting's progress:

 
formula

Possibly, Mel's strongly worded response was meant to correct Kat's mistaken claim by showing it to be a serious accusation that would merit serious (physical) retribution. Nevertheless, it is another example of discourse that is hard to reconcile with the philosophy of respect that is at the heart of self-advocacy. Space precludes us giving further examples, but such apparently scolding talk was not anisolated incident.

We conclude our examination of the short-circuiting style by seeing how the Christmas activity episode was terminated by the staff. We pass over the bulk of the discussion to reach the conclusion in the following extract, at which point the two staff members have been commenting on the contributions of the residents in the group.

 
formula

In Line 4, Andy overlapped Mel's observation that they have had no other suggestions and that not all the group was well enough to participate, with a comic proposal. This engendered some banter from Mel and from 2 of the residents. What we note is that although the talk was apparently good-humored, the staff glossed over the residents' lack of participation as due to their “not feeling well,” when, arguably, the staff's own practices of moving things along may have been at least partly a factor.

Summary of the short-circuit style

In this second case from a residents' meeting, the facilitators employed a markedly more directive style, which short-circuited the business at hand. The practices they used included the following: They proposed topics unilaterally; used yes/no questions; disambiguated unclear answers in a way that progressed the meeting's business; overrode residents' suggestions; deferred problem-raising to other times and other personnel; oriented to the interaction as fulfilling preplanned agenda items from a script; and solicited final confirmation of the meeting's achievements from each other, not the residents.

In addition, we were surprised to see these facilitators use practices, which, although they could be understood to move the business of the meeting along, implied a certain disrespect of core self-advocacy values of respect and encouragement. They were sarcastic (jocularly or not) to the residents; ignored an audible complaint about staff behavior; overtly coached institutionally preferred forms of address; made critical asides about the residents; and referred to residents, or addressed them, in what could be seen as an infantilizing way.

Discussion

Our aim in this article was to look at the interactional details of two styles of conducting service-users' groups, in order to bring out how they achieved their institutional objectives. We started with an overview of what these service-based group meetings professed to do, in general: Drawing on the philosophy of self-advocacy, they aim to empower members by giving them opportunities to speak up for themselves, to raise issues of concern, and to have their voices heard (Aspis, 1997).

We report on an empirical investigation into two cases that seemed to contradict this ideal in routine everyday work. We do not want to single out these particular care staff personnel. Our intent, rather, was to use them to illustrate a standing dilemma for any institutional personnel who have to realize, in everyday interaction, the aspirations of official discourse. That is the promise of case studies of routine practice, which provides insight into the workings and the effects of ways of working that are embedded in institutional procedures, but might be contradictory to institutional policy. This article was not based on a survey. We do not know how often this practice happens nor whether it varies according to standard sociological or psychological factors. We can say, however, that when it happened in these cases, it came off as routine; and it had the effect of privileging the facilitators' interests over those of the service-users contrary to the official ideal.

The two styles of management that we found departed from the ideal in the following ways. In what we called the directive guidance style, the staff facilitator respected the general aim of making the meeting a decision-making one, but taking the initiative in each step of the decision-making process. The other style was still further away from the normative ideal of what groups aiming to encourage empowerment should do. In short-circuit style, the staff facilitators left little room for the residents to propose topics or contribute to the discussion on their own terms.

The goal of service-users' groups (certainly those that are meant to promote empowerment) should be that the role of the advisor decreases over time as the group becomes more confident and competent in running itself. The role of advisors, then, should be to help the members run the group rather than running it themselves (Goodley, 2000). Although this certainly applies to independent groups, there is no reason why the same goals should not apply to groups based in services. Our examples show staff taking responsibility for the effectiveness of the meeting, running through the agenda, and producing decisions that can be taken out of the meeting. Although these products ostensibly fit into the goals of the meeting, the process itself disempowers the group in both cases. In neither case is the supporter intervening in such a way that the group can begin to run itself. Advisors/ facilitators do have power in user groups; it would make no sense to deny it. The question, as Worrell (1987) stated is “How do they use that power to empower the members?” (p. 35).

The sequences we have described can be understood in terms of the continuum of intervention discussed by Goodley (2000), who showed how different disability discourses (individual pathology models vs. social models) might be seen in different types of supporter intervention in service-user groups. Both styles of interventions here fit firmly into individual pathology models of disability, where the staff member is the one treated as competent and the members are treated as incompetent. In both sequences, the staff assume responsibility for getting the business of the meeting achieved, deciding what utterances are reasonable, and having the answers that members must work towards. In Goodley's terminology, these are examples of “deficit” interventions (which presume incompetence on the part of members) because the staff opened no space for the residents to run the meeting themselves. The second sequence particularly provides examples of taking over and missing the point, where the staff shut down spaces in which issues of members' concerns might have been aired and explicitly evaluated and reformulated members' utterances. In this sequence, institutional goals obstructed any space for group members to express themselves. Although the institution administrators might be able to point to the existence of residents' meetings as an example of service-user empowerment, in practice the forum can become a further tool in the disempowerment of the residents.

We chose examples of disempowering staff interventions to discuss in this paper because we believe these are common problems that need to be highlighted. At other points in the meeting, and at other meetings, the same groups did provide opportunities for members to express themselves, and members do support each other in speaking up (Antaki et al., in press). For examples of interventions that fit more closely with social models (e.g., capacity, talking with, and addressing the point interventions) and for further examples of self-advocates supporting each other, see Goodley (2000, chapter 8). Nevertheless, we feel that the practices that we have identified in this paper point to a source of trouble that should be addressed. All participants in service-user groups face a dilemma in conducting meetings so that voices can be heard and yet achieve the meeting's institutional objectives; the question is, How is this dilemma to be solved?

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Author notes

Authors: Charles Antaki, PhD, Department of Social Sciences, Loughborough University, Loughborough, LE11 3TU, UK (c.antaki@Lboro.ac.uk). W. M. L. Finlay, PhD, Emma Sheridan, BSc, Treena Jingree, BSc, and Chris Walton, PhD, Department of Psychology, School of Human Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK