Emotional interplay and communication with patients diagnosed with schizophrenia

Sammanfattning: Emotional interplay and communication with patients diagnosed with schizophrenia was studied in clinical interviews. Fifty-one video recorded interviews were conducted by two psychologists with nine patients. Qualitative and quantitative methods were used in three successive studies. Study I examined the communicative interplay on an overall level, including verbal and nonverbal means of communication. The interviewer’s willingness to explore and pursue the emotional content in the patient’s narrative was found to be important for establishing well functioning communication. In Study II, the stability over time of facial affective expressions in the emotional interplay was evaluated, using EMFACS. For the patients, no substantial changes in the amount of affects were found across all the interview occasions, although for one interviewer, contempt slightly increased. Whereas previous findings found contempt to be the most frequent affect in patients, in the present material disgust was as common, but depended on the interviewer. Study III investigated gaze behaviour and facial affective expressiveness. The objective was to test whether patients reduced their negative facial affectivity during mutual gaze. The patients were found to not reduce their negative facial affectivity during the state of mutual gaze. This finding was independent of both interview occasion and interviewer and implies that the patients might have intended to communicate negative facial affectivity to the interviewer. The research suggests that the emotional interplay is dominated by the negative facial affective expressions of mainly disgust and contempt. It is proposed that these negative affects may be connected to a patient’s low self-esteem, as the self in schizophrenia may be engrained by self-disgusting and self-contemptive affective experiences. The interviewer’s capacity to respond to these negative facial expressions must therefore be considered as important.