Listening for the Communicative Signals of Humor, Narratives, and Self-Disclosure in the Family Caregiver Interview

Abstract

During interviews and conversations in health care environments, respondents often convey information in a humorous fashion, self-disclose something very personal, or tell detailed stories containing emotional content that is difficult to decipher and interpret. Words and gestures are composed of ambiguous signals and require interpretation (Sillars, Roberts, Leonard, & Dun, 2000). The humorous delivery of these signals often disguises their importance. Because conversations such as these tend to occur rapidly, and the interviewer may be distracted by the humor, it is easy for the uninformed interviewer to miss information about problems or concerns that should be followed up with additional questions or probes. Our previous work with long-term family caregivers demonstrated the importance of conversational cues, the reliance on humor to convey sensitive information, and the ways in which the interviewer can follow up, with appropriate probes and nonverbal encouragement, to gain necessary insight into the caregiver situation. This article offers specific suggestions for achieving more productive and satisfying interviews with family caregivers who rely on humor to help them tell their stories. THE COMPLEXITY OF COMMUNICATION Bateson (1972) was one of the first theorists to note that communication involves more than simple message translation. The interviewer and interviewee communicate with each other and also communicate about the communication. Each interactant in a conversation plants (humorous anecdotes, for example) to suggest how a message should be handled. To make the puzzle even more complex, the participants are often unaware of the they are sending and may effortlessly present in their talk (du Pre, 1998). What all of this means for health and human services professionals is that the way they were taught to conduct interviews in their educational programs is probably not adequate for the complex interview situations they will find in many settings today. Long-term family caregivers are frequently asked to talk about topics such as bowel movements, loneliness, personal safety, and intimate care. Such socially taboo and sensitive topics can cause periods of awkwardness and embarrassment. When caregivers must share this information with others, and in the process expose their own personal fears and shortcomings about their caregiving abilities, humorous anecdotes and laughter can help them manage a multitude of face-threatening situations. In earlier work on this subject, Bethea (Sparks), Travis, and Pecchioni (2000) described the use of humor or laughter as cues that family caregivers were approaching topics that needed a type of communication safety valve to relieve the stress, tension, or embarrassment associated with discussing the topic. To fully appreciate the subtlety and complexity of this communication strategy, it is important to understand that the humorous anecdote is not the end point. Rather, humor is the cue that sensitive probing may now be in order to fully understand what the caregiver is experiencing, feeling, and shadowing from the interviewer. Social workers, physicians, nurses, and other health and human services providers conduct numerous interviews and historical accounts of their patients' lives, yet often fail to probe for deeper and richer information that may be just beyond the typical interview exchange. How can interviewers make the most of the little time spent with family caregivers in an information-gathering conversation? How can interviewers better understand the communicative that caregivers are using to convey meaning about their personal caregiving situations to the listener? GUIDELINES FOR INTERVIEWERS FACED WITH HUMOROUS CONVERSATIONAL EXCHANGES Several researchers have documented the problems that patients have in trying to express their emotions to their doctors. For example, Suchman and colleagues (1997) discovered that patients are more likely to give that they would like to discuss emotional issues than to directly express their emotions. …