定性研究系列 - 与Charlotte Albury博士一起通过对话分析揭示互动背后的机制

欢迎收听《言语的力量》播客，通过更好的沟通提升患者护理质量。

Welcome to the Words Matter podcast, enhancing patient care through better communication.

欢迎收听《言语的力量》播客新一期节目。我是奥利弗·汤普森。首先再次感谢所有通过Patreon支持本节目的听众。正是你们的支持让这些对话成为可能，看到越来越多的研究人员、学生和实践者支持节目并从每期内容中获益，真是太棒了。若您也想支持本播客，只需每期捐赠1英镑即可，访问patreon.com/thewordsmatterpodcast（链接已附在节目说明中）。

Welcome to another episode of the Words Matter podcast. I'm Oliver Thompson. I'll again start by thanking all of you that support the show via Patreon. It really makes these conversations possible, and it's fantastic to see a growing community of researchers, students, and practitioners support the show and find value in the episodes. And if you'd like to show your support for the podcast, you can pledge as little as £1 per episode by visiting patreon.com forward slash the words matter podcast, and I've linked this in the show notes.

现在我们已进行到质性研究系列的中段。带大家回顾下：第一集与佩里·塔特尔曼轻松入门质性研究；第二集与杰伊·米尔斯教授和梅兰妮·伯克斯教授探讨扎根理论；第三集与菲奥娜·韦伯斯特博士讨论民族志研究；上周则与维多利亚·克拉克博士探讨了主题分析法。

So we're halfway into the qualitative research series. And to bring you up to date, episode one eased us in to qualitative research with Perry Tuttleman. In episode two, we explored grounded theory with professor Jay Mills and professor Melanie Berks. In episode three, I spoke about ethnography with doctor Fiona Webster. And in last week's episode, I spoke with doctor Victoria Clark about thematic analysis.

若您尚未收听全部内容，我强烈建议您补听这些精彩的主题入门。各集之间还有前后呼应的小设计，能让您对系列内容形成完整认知。目前系列进展非常顺利，希望能为想了解质性研究理论、方法论及方法的人提供实用资源。本期我将与夏洛特·奥布里博士探讨会话分析。夏洛特是质性研究员，持有健康与疾病社会学基金会颁发的米尔德里德·巴克斯特奖学金，以及牛津大学萨默维尔学院的福特基金会初级研究奖学金。

And if you haven't listened to them all, I strongly urge you to go back and catch up as they're fantastic entrances to their respective topics. And there is also a little cross referencing to previous and future episodes, which will give you a rounded view of the series as it unfolds. So the series is shaping up really nicely, and I hope it will become a useful resource for those wanting to orientate themselves with qualitative research theories, methodologies, and methods. So in this episode, I'm speaking with doctor Charlotte Aubrey about conversation analysis. Charlotte is a qualitative researcher that holds a Mildred Baxter fellowship from the foundation for the sociology of health and illness and a Forford junior research fellowship at Summerville College at the University of Oxford.

夏洛特曾获多项资助，包括来自NIHR初级护理研究学院和英国心脏基金会。她担任牛津质性课程总监，这些是由专家主导的质性方法实践短期课程，涵盖会话分析等多种质性研究方法。这是非常棒的课程项目（链接见节目说明）。夏洛特领导了多个运用会话分析优化临床沟通的研究项目，包括当前利用会话分析研究COVID风险沟通的工作。

Charlotte has held multiple grants, including from the NIHR School for Primary Care Research and the British Heart Foundation. She is the course director for Oxford qualitative courses, which are expert led practical short courses in qualitative methods, including conversation analysis, but also a range of other qualitative approaches. And this is a great program, and I've linked the course in the show notes. And Charlotte has led several research projects which use conversation analysis to identify how to optimize clinical communication, including her current work, which utilizes conversation analysis to investigate COVID risk communication. So in this episode, we speak about conversation analysis or CA as a qualitative method to uncover the machinery and mechanics of social interaction.

本期我们将讨论作为质性方法的会话分析（CA），如何揭示社会互动的机制原理。我们会简述CA上世纪60年代在美国社会学界的起源，探讨这种兼具量化研究特征（如真理发现观、研究者客观超然立场、数据量化）与质性研究特征（如文本转录分析、社会互动现象研究）的嵌合型方法论。我们会讨论CA试图解决的研究问题类型，以及夏洛特如何运用CA理解医患沟通策略与效果（其博士论文和著作链接见节目说明）。还将介绍CA特有的杰斐逊转录系统，以及生成转录后的数据分析方法。

We briefly talk about the history of CA and its emergence from The US sociology scene in the nineteen sixties. We talk about CA as a chimeric research methodology with features and assumptions which seem to align with quantitative or positivist research, such as notions of the discovery of truth, the somewhat detached objectivity of the researcher, quantifying aspects of the data, but also features which are familiar to qualitative research, such as the analysis of textual data, such as transcripts, and the study of social interaction and phenomena. So a fascinating hybrid. We talk about the sorts of research questions that CA seeks to address, and we discuss how Charlotte has used CA to understand communication between patients and clinicians to uncover the different strategies and outcomes of talk, and I've linked Charlotte's PhD thesis and her papers in the show notes. We talk about the Jeffersonian system of transcription, which is very particular to CA, and we touch on some of the methods of data analysis once these transcriptions have been generated.

最后夏洛特会给考虑开展CA研究或想熟悉该方法的人提供建议。这场关于我原本陌生的质性研究领域的对话极具启发性。夏洛特极其清晰地阐述了CA的目的与方法，真实展现了会话分析的过程。如果您是诠释主义者或社会建构主义者，CA那种近乎还原论的数据分析粒度及其现实主义客观主义观念可能初看不合胃口——但请先别急着下定论。

And finally, Charlotte offers some advice for those considering embarking on a CA study or those just wanting to become more familiar with the methods. So this was such an insightful conversation about an area of qualitative research which was quite unfamiliar to me. Charlotte describes the purpose and methods of CA incredibly clearly, providing a real insight into how conversation analysis proceeds. The granular almost reductionist detail of data analysis and the somewhat realist objectivist notions of CA may initially not be your cup of tea if you're an interpretivist or a social constructionist. But hold your horses.

会话分析对特定词汇、语言及谈话细节的严谨关注，为所有致力于理解和描绘人类互动与社会过程的质性研究者提供了宝贵视角。我确实受益匪浅，这些收获将伴随我当前及未来的质性研究项目。现在有请夏洛特·奥布里博士。

The forensic attention that conversation analysis gives to the specific words, language, and talk offers something valuable to all qualitative researchers who are interested in understanding and portraying human interactions and social processes. And I certainly learned a great deal, which I will take with me into my current and future qualitative projects. So I bring you doctor Charlotte Aubrey.

夏洛特，欢迎来到我们的播客节目。

Charlotte, welcome to the podcast.

嗨，奥利弗。非常感谢你的邀请。

Hi, Oliver. Thank you so much for having me.

鉴于本播客名为《言之有物》，而您又是会话分析领域的专家，您的研究工作让我特别感兴趣。很高兴您能参与这次质性研究系列访谈。

So your work is especially interesting to me given the name of this podcast, Words Matter, and given the expertise that you have in conversation analysis. So it's great for you to contribute to this qualitative series.

谢谢。能在这里讨论会话分析让我非常兴奋，因为随着交流深入我们会发现，这确实是种绝妙的研究方法。我认为它在社会科学领域尚未得到充分利用，尤其在医疗健康领域的应用研究中潜力巨大。今天很期待与您探讨如何让更多人了解会话分析，以及它对应用型医疗研究的重要价值。

Thank you. Yeah, I'm really excited to be here and talk a little bit about conversation analysis, because I think we'll sort of as we chat, we'll sort of realise it is this kind of wonderful method. And I feel quite underused in the social sciences. And it has so much to offer, particularly applied research in healthcare settings. I'm really excited to chat to you about it today and help lots of other people discover conversation analysis and how useful it is, I guess, for applied healthcare research.

在深入讨论前，能否先简单介绍一下您的背景？考虑到这是档质性研究播客，我称您为质性研究者——您认同这个身份标签吗？

So before we launch into that, perhaps you can say a little bit about your background as a I'm calling you a qualitative researcher because this is a qualitative podcast. Do you identify as a qualitative researcher?

是的，完全认同。我既是质性研究方法学者，但首先是位会话分析专家。

Yes, do, definitely. As a qualitative methodologist, but primarily as a conversationalist.

你目前的学术职位在哪里？

And where's your current academic post?

我是牛津大学纳菲尔德初级保健健康科学系的米尔德里德·布莱克斯特研究员，同时也是牛津大学萨默维尔学院的富尔福德初级研究员。我的职责主要是将对话分析应用于关注行为改变的临床互动中。除了担任米尔德里德·布莱克斯特研究员外，我还是牛津定性课程的课程主任，这些课程也由牛津大学纳菲尔德初级保健系开设。我们提供定性方法的短期课程，同时我也在牛津大学讲授定性研究方法。

So I'm a Mildred Blackster Fellow in the Nuffield Department of Primary Care Health Sciences at the University of Oxford, and also a Fulford Junior Research Fellow at Somerville College at the University of Oxford. And my role really is to apply conversation analysis to clinical interactions that focus on behaviour change. And in addition to my role as a Mildred Blackster Fellow, I'm also course director for Oxford Qualitative Courses, which also run from the Nuffield Department of Primary Care at the University of Oxford. And we run short courses in qualitative methods. I also teach qualitative research methods across the University of Oxford.

我负责牛津大学的现场实践课程，专注于将定性方法应用于行为改变对话。

I lead Oxford's in vivo courses and specialise in applying qualitative methods to behaviour change conversations.

或许你可以简单谈谈你是如何进入定性研究和对话分析领域的。

So perhaps you could say a little bit about your journey into qualitative research and into conversation analysis.

当然可以。我在杜伦大学学习了人类学和医学人类学。当时这个项目的独特之处在于我们同时学习生物人类学和社会文化人类学。所以我们一半时间思考世界和人类如何共同创造世界，另一半时间则在实验室研究遗传学、骨骼和骨架之类的东西。

Yeah, of course. So I trained in anthropology and medical anthropology at the University of Durham. And what was quite cool and unique about the programme at the time is that we did both biological anthropology and sociocultural anthropology. So we'd spend sort of half of our time thinking about the world and humans and how we create the world together. And the other half the time sort of in the lab looking at genetics and bones and skeletons and things like that.

这是个非常令人兴奋的学位。我真的很享受这两个部分。但我最喜欢的部分是学习叙事和讲故事。这可以说是我进入定性研究的切入点，去理解作为人类，我们如何通过叙述和讲故事来构建周围的世界。所以我攻读了一个医学人类学硕士学位，专门研究叙事和讲故事。

It was a really exciting degree. And I really enjoyed both parts of it. But my favorite bits really were learning about narrative and storytelling. And that was sort of my kind of entry into qualitative research to understand how as humans, the way that we narrate and storytell, we construct the world around us. So I did a Master's in medical anthropology, specifically working on narrative and storytelling.

我在一个灵媒教堂做了民族志研究，观察慢性病患者如何寻求灵性治疗，同时也在接受生物医学治疗。目的是通过民族志方法，以及叙事方法和一些现象学方法，更好地理解这个灵媒教堂中发生的事情。这段经历非常精彩，我在那里待了很长时间，结识了寻求灵性治疗的人和灵媒治疗师。

And I did an ethnography at a spiritualist church, looking at how people who were chronically ill sought spirit healing and were also seeking biomedical care alongside spirit healing. And the aim was to use ethnography, but also narrative approaches and some phenomenological approaches as well, to better understand what was happening here at this spiritualist church. And it was really brilliant. I spent a lot of time there. I got to know the people seeking spirit healing and the spirit healers.

我开始注意到，那些灵魂治疗师本身其实都是退休的英国国民医疗服务体系（NHS）护士。她们都戴着姓名徽章，做着各种动作，试图让这个灵媒教堂更像NHS的诊疗场所而非宗教场所。她们准备了装满患者病历的大文件柜，互相监督佩戴姓名徽章。人们进来时，会像在NHS医院那样受到引导接待。

And what I began to notice was that the spirit healers themselves were all actually retired NHS nurses. And they all wore these name badges and they did all these actions to try and make the spiritualist church much more like sort of an NHS setting than a spiritualist church. So they had big filing cabinets full of patient notes. They made each other wear these name badges. When people came in, they were sort of welcomed and chaperoned in the same way we'd seen at NHS.

于是我对治疗师群体及其行为愈发感兴趣。其中一位治疗师极力抗拒这种教堂里的NHS氛围——她故意不戴姓名徽章、不写病历，行为方式截然不同。某天我们围站成一圈时，这位治疗师又一次'弄丢'了徽章。另一位治疗师对我使眼色说'哎呀她又忘戴徽章了'，而那位'丢'徽章的治疗师则朝我眨眼道'真是糊涂了'。

So I became more and more interested in the healers themselves and what was happening there. And there was one healer that really resisted this sort of NHS kind of setting that they were creating at the church and would on purpose not wear her name badge, not write the patient notes, and behave in a sort of a completely different way. And one day we were standing in a circle, this healer had just like not won her name badge again. And one of the other healers sort of looked at me and was like, Oh, she's gotten a name badge again. And that healer who'd won a name badge winked at me and she was like, Oh, whoopsie daisy.

'我总是这么丢三落四对吧？'这明显是种抗拒。其他人都试图通过强调姓名徽章来维持NHS式的规范，而那个眨眼瞬间让我意识到：虽然我原本关注叙事，但这个非言语动作传递的信息如此丰富——她什么都没说。

I'm so scatty, aren't I? Clearly resisting. So obviously, this way everyone else was trying to make aware her name badge and create this NHS setting. And that wink was sort of the moment when I was like, Well, I'm interested in narrative, but this wink just told me so much. And she didn't say anything.

这个眨眼动作浓缩了我观察到的所有矛盾：关于佩戴姓名徽章和书写病历的张力。她通过这个动作将我纳入了她的信任圈。事后我专门研读了关于眨眼在社交互动中作用的研究。

This wink sort of embodied all these things that I noticed, these tensions around wearing name badges and patient notes. And she was sort of bringing me into her confidence with this one faction. So I went away, read about sort of winking, what it does in social interaction.

眨眼行为分析。

Winking analysis.

没错。后来我发现，了解人类及其互动方式不能仅依赖叙事研究。有种叫'会话分析'的学科专门研究我们在互动中通过肢体动作等细节构建社会关系的方式。那一刻我恍然大悟：这方法论太棒了。

Yeah. And began to find out, you know what, narrative isn't the be all and end all of finding out about humans and interaction. And there's this whole thing called conversation analysis where we look at embodied action and all these different bits and pieces that we do when we interact with each other to create our social world and our interaction. And really, that was the moment when I thought, gosh, this is really awesome. What an amazing method.

我渴望深入学习。随着在教堂的调研深入，我每天记录田野笔记，回家整理文献时又发现了与会话分析相关的第二波资料——关于灵媒如何与接受过灵魂治疗的人互动。我疯狂记笔记，回家后发现了会话分析学家罗宾·伍芬的著作《灵媒与通灵者的语言》，这成为我接触该领域的第二个契机。

I'd love to learn more. And the more I worked at this church, I would kind of make my field notes and go home every day and write them up and look at the literature. I then found a second sort of conversation analytic bit of literature that was so relevant to my work when I began to look at the mediums and psychics at the church and how they worked with the people after spirit healing. And again, I scribbled my notes, went home and I found this book called The Language of Mediums and Psychics by Robin Woofen, who is a conversation analyst. And that was sort of my second taste.

在一本民族志中它出现了两次，这让我彻底信服了。我当时就觉得，这就是我感兴趣的方向。叙事并非万能。虽然叙事研究很棒，但我真心认为会话分析可能更适合我。从那以后，我开始寻求更多关于这种分析方法的知识，探索如何研究沟通交流，以及如何运用这种方法来解答医疗健康研究中非常具体的问题。

It came up twice in this one ethnography and that really clinched it for me. I was like, this is what I'm interested in. Narrative isn't the be all and end all. It's a wonderful thing to do, but I really think conversation analysis might be for me. And then from there, sort of sought to learn more about the analytic approach and find out more about how we can study communication and how it's a useful approach to take to answer very specific questions in healthcare research.

多么精彩的会话分析入门故事啊。

What a wonderful story into CA.

是啊，谢谢。我总觉得我们每个人都有自己的学术起源故事，这些故事都非常个人化，不是吗？我至今仍清晰记得发现会话分析文献的那两个关键瞬间，那种研究方法与我之前接触过的任何理论都截然不同。

Yeah. Well, thank you. I always think we all have these origin stories and they're very personal, aren't they? I feel that we sort of remember those two key moments where I discovered that conversation analytic literature. And it was just so different from anything that I'd seen before.

我认为正是这种差异性让它变得无比迷人，它提供了一种我从未在其他研究方法中见过的视角——尽管我们学过许多不同的社会研究方法。正是这种差异，正是它提供了与我之前所学完全相反的思路，使得这个方法论对理解沟通机制具有极强的吸引力。

And I think because it was different, it was just incredibly interesting and offered an approach that was like no other method that I'd studied, even though we'd been taught a lot of different social research methods. And I think because of that difference and because it offered something that was just kind of the opposite of everything else I've been taught, it was just a very attractive approach to begin to understand better how communication works.

能描述下你目前作为研究者的角色吗？考虑到你做过不少会话分析相关研究——这也是你受邀至此的原因。你显然已经用CA方法完成了博士研究并发表了相关论文。能否谈谈你后来如何运用会话分析法来研究全科医生间的医疗沟通？

And what's your current role as a researcher? Describe it because you've done some work, unsurprisingly, using conversation analysis, which is why you're here. You've obviously completed a PhD using CA and published some papers off the back of that work. So perhaps describe how you subsequently have used conversation analysis to explore communication in healthcare amongst GPs.

确实，我在多个不同项目和研究中都运用了会话分析法。这些研究的共同点在于探索临床医生在不同场景下如何提供患者并未主动寻求的建议——这类建议往往涉及行为改变。我对此感兴趣是因为作为医疗从业者，主动提供建议虽然常常必要，但可能令人不适。这还是个高风险行为，因为多数情况下患者可能不太容易接受未经请求的建议。

So yeah, I've used conversation analysis in a number of different projects, a number of different studies. But what they all have in common really is to find out how clinicians in varying settings give advice when that advice has not been solicited by the patient. And often that advice will be around behaviour change as well. And I'm interested in that because as clinicians, unsolicited advice is something that often it's necessary to give, but it can be quite uncomfortable. And it also is quite a high stakes thing because there's a high likelihood in many cases that patients might not take quite so well to receiving unsolicited advice.

虽然我不是临床医生，但作为患者我确实接收过这类建议，那种体验可能非常尴尬。这正是驱使我研究如何更好地传达非请求建议、如何在临床环境中协同完成建议给予的动力。我主要研究基层医疗中的减重咨询，但也参与过关于戒烟讨论和风险沟通的研究——比如如何传达心血管疾病或癌症风险。最近我正领导一项由英国外交联邦发展部资助的研究，探索如何向即将出行的人群最有效地传达新冠疫情风险，这是个非常应时的课题。

I'm not a clinician, but I am a patient and I've been on the receiving end of unsolicited advice and it can be very uncomfortable. So that's really why I'm driven to find out how we can better deliver things like unsolicited advice and how we work together to achieve advice giving in clinical settings. So I mainly work on weight loss conversations in primary care, but I've also worked on studies of smoking cessation discussions in primary care and on risk communication as well. So how CBD risk or cancer risk is communicated. And most recently, I'm leading a study that's funded by the UK Foreign Commonwealth and Development Office to find out how COVID risk can be communicated best to people about to travel, which is a very relevant thing.

我认为一个非常有用的例子是运用对话分析的时机，因为我们确实不知道如何传达COVID风险。这是个全新的事物。最佳方法就是倾听临床医生实际沟通COVID风险的案例，接收那些未经请求的建议的人们，共同协商对话，出现了哪些问题，临床医生和患者如何协作解决问题，并从这些真实互动的录音中学习哪些方式在特定互动中效果良好，哪些可能效果欠佳。如果问题确实浮出水面，双方如何才能最好地管理和处理，以实现对话的成功解决？因此，我认为所有这些都表明，尽管未经请求的建议可能棘手，但如果我们分析真实互动的录音，我们确实可以发现如何以患者为中心的方式有效且良好地进行。

And I think a really useful example of when to use conversation analysis, because we just don't know how to communicate COVID risk. It's such a new thing. And the best way to find out how to do it is to listen to examples of clinicians actually communicating COVID risk, people receiving that unsolicited advice, negotiating together the conversation, what troubles come up, how clinicians and patients work together to overcome troubles, and learn from those recordings of real interactions what works well in that particular interaction, maybe what works not quite so well. And if troubles do sort of bubble to the surface, how can they best be managed and handled by both parties to have a successful resolution to a conversation essentially? So I think all of these things come together to illustrate that even though unsolicited advice can be tricky, if we analyze recordings of real interaction happening, we can really find out how it can be done well and effectively and in a patient centred way, most importantly.

我想在此提醒，我会为那些想阅读关于对话分析的博士论文的人提供链接。但更易获取的是，我也会链接你基于此发表的关于全科医生在减肥方面沟通的论文，对吧？是的。因此，无论是戒烟还是减肥，作为临床医生，这些都是我们常常笨拙地进行的尴尬对话，怀着提供建议的最佳意图，希望患者做得好、茁壮成长并保持健康。但考虑到我们作为临床医生的良好意图，我们在对话中哪些做得好或不好？对话分析告诉了你关于临床医生进行的这些对话的什么？

And I think at this point I'll signpost that I'll link for those that want to read a PhD thesis on conversation analysis, I'll link that. But probably more accessibly, I'll also link the papers that you published off the back of that about GP communication around weight loss, wasn't it? Yep. So these are really both the smoking cessation and the weight loss, as a clinician myself, these are the kind of awkward conversations that we often clumsily stumble through with the best intentions of giving advice and wanting the patient to to do well and to thrive and to be healthy. But so thinking about our good intentions as clinicians, what is it that is within our conversation in which we're doing badly or doing well, or what has conversation analysis told you about these conversations that clinicians are having?

这是个非常好的观点。我想说的是，没有人会故意沟通得很差。但我们通过对话分析真正找到的是那些处理得非常巧妙的例子，其中有些棘手的情况，有人以我们可能从未想过的方式处理，事情进行得非常顺利。这往往非常反直觉。

That's such a good point. And I guess it's never I would say that no one ever communicates badly. But what we do with conversation analysis really is find those absolute brilliant examples where there's been something tricky and someone has just handled it in a way that maybe we never would have imagined. And things are just run really smoothly. And often that can be very counterintuitive.

我认为你提到的关于人们出于好意和最佳意图的观点非常重要，因为在大多数情况下，当我听临床医生与患者互动的录音时，临床医生会遵循指南，尽力进行指南推荐的沟通。但棘手之处在于，沟通指南很少是由研究沟通的人编写的。因此，有时指南推荐的做法并不奏效，而真正有效的方法对临床医生来说往往非常反直觉。我认为一个很好的例子来自我关于减肥讨论的研究。

And I think what you said about people meaning well and having the best intentions is so important because in most cases, when I listen to recordings of clinicians interacting with patients, clinicians will be following guidelines and doing their very best to do guideline recommended communication. But where the tricky thing comes up is that guidelines on how to communicate are very rarely actually written by anyone who studied communication. And because of that, sometimes guideline recommended practices just don't work. And what does work well is actually very counterintuitive for clinicians. And I think a really neat example is from my work looking at weight loss discussions.

我听过的大多数录音中，临床医生都遵循NICE指南，并以培训和指南推荐的方式进行沟通。但指南和培训的问题在于，它们很少基于有效沟通的实际证据。这在实践中可能导致问题。因此，尽管人们尽力遵循指南，做指南认为对患者有益的一切，但在实践中，效果可能适得其反。以我自己的研究为例，分析全科医生关于减肥的讨论，我分析了200多段录音，其中全科医生机会性地向患有肥胖症但未寻求减肥帮助的患者提供免费转介到体重管理服务（如Weight Watchers或Slimming World）的推荐。

So most of the recordings I listen to, clinicians are following NICE guidelines and communicating in ways that they are recommended to communicate by training as well. But the problem with guidelines and training is that it is very rarely based in evidence of what effective communication actually is. And that can cause problems in practise. So even though people are doing their best to follow guidelines and do everything the guidelines say will be good for patients, when it happens in practise, the effect might be the opposite. So an example from my own work, looking at discussions about weight loss in general practice, what I did was analyze over 200 recordings of GPs opportunistically offering free referrals to weight management services like Weight Watchers or Slimming World to their patients who were living with obesity, but hadn't been attending to seek help for weight loss.

在这种情况下，指南建议临床医生将减肥的积极价值与患者现有的或潜在的健康问题联系起来。比如说：‘你今天来这里是因为关节炎。你知道你膝盖的关节炎吗？我知道它很严重，但如果你减掉一些体重，它会好很多。’这就是指南推荐的沟通方式。

And in these sort of situations, guidelines recommend that clinicians should associate the positive value of weight loss with the patient's existing or potential health concern. So something like, You've been here for your arthritis today. And did you know your arthritis in your knees? I know it's really bad, but it will be a lot better if you lost some weight. And that's sort of guideline recommended communication.

我听过许多临床医生反复这样做，非常严格地遵循指南，尽力而为。但结果是，几乎每次临床医生这样做时，患者在现实生活中的反应都不好。在对话分析中，我们进行所谓的序列分析，即观察一个人说了什么，下一个人紧接着说了什么。我发现，几乎每次临床医生将体重与健康联系起来时，患者在接下来的回应中要么感到不安或愤怒，要么开始为自己的积极健康行为辩护。

So I listened to lots of clinicians doing this over and over again, following the guidelines incredibly well, doing their best. And what happened was almost every time a clinician did this, it was not responded to well in practice in real life by the patient. So we do something in conversation analysis called sequence analysis. So we look at sequences and what one person says and what the next person says right after. And what I could see was that every single time or almost every single time a clinician associated weight with health, a patient in their next turn at talk, when it was their turn to respond, would either be upset or angry or begin to justify their positive health behaviours.

比如说，患者可能会回应‘我确实每天都游泳，而且饮食非常健康’。这种将体重与健康挂钩的谈话方式，暗示患者的关节炎或其病情加重是由他们自身的不良健康行为导致的——尽管我们知道事实并非如此。这几乎肯定不是临床医生的本意，但几乎每次当体重被明确关联到健康问题时，患者的反应都显示出他们感到沮丧或愤怒。因此，在这种情况下，指南推荐的沟通方式实际上并非讨论体重与健康的最佳方法。

So say stuff like, well, I do go swimming every day and I eat really healthily. Because this sort of way of topicalising weight implied that the patient's own health behaviours had caused their arthritis, for example, or caused a flare up in arthritis, even though we know that's not the case. And that's probably almost definitely not what clinicians intended with what they were saying. But that's what was happening every time, almost every time weight withheld was explicitly linked, patients would respond in a way that showed that they were upset or angry. So these guideline recommended practices in this case was actually not the best way to talk about weight and health.

我很幸运有机会参与制定英国公共卫生局关于体重管理转诊的指南。我向工作组提出的第一个观点就是：虽然现行指南认为将体重与健康关联是个好主意，但我掌握的大量证据表明这种实践效果不佳。我提出了一种更以患者为中心、在实践中能获得更好反馈的体重话题引入方式。当你看到这些实际互动数据时，很难反驳——因为你能清晰看到一种沟通方式能产生积极效果，而另一种方式则反复引发患者的负面情绪反应，确实应该避免。

And I was really fortunate that I had the opportunity to contribute to Public Health England guidelines on how to offer weight management referrals. And one of the first things that I said to the group was, Okay, I know that currently guidelines say that associating weight with health is a good idea, but I have got a lot of evidence that shows that really this practice doesn't work quite so well. But here's another way of topicalising weight in a more patient centred way that is responded to better by patients in practice. And when you see those data and you see those responses, it's incredibly difficult to argue with because you can see real evidence from real interactions that one practice can really have a strong positive effect, whilst the other can repeatedly in the patient's next turn cause upset or anger. So should be best avoided really.

这再次证明了会话分析的实用价值——通过分析真实互动而非主观臆测，我们能发现最佳沟通方式可能是反直觉的，或是那些需要分析数百次互动才能发现的、本应更频繁使用的罕见实践。

And I think that again shows how useful conversation analysis is by analysing real interaction rather than what people reckon about what maybe works in practice. We can find that the best approaches or the best way of communicating might actually be counterintuitive or might be so underused that it takes listening to hundreds of interactions to find this sort of one quite rare practice that actually really should be used more often in practice. And do you

我现在有无数问题想问，但尽量控制在三个以内。第一个问题是：你认为参与你研究的临床医生们，是否意识到他们在常规诊疗中使用的措辞或谈话方式可能给患者带来的焦虑或困扰？

think so I've got a gazillion questions now, and I'll try and keep to, like, three. I suppose the first one is, do you think the clinicians that you that took part in your work, do you think they picked up on within general clinical knows the anxiety or upset, which their wording or their conversation may have had on the patient?

这是个非常好的观察。结合其他研究方法（这正是会话分析的优势所在），我们从对全科医生等临床工作者的访谈和焦点小组中了解到，他们都觉得这类谈话令人不适，承认可能出现问题并引发患者情绪。但他们无法准确指出具体哪些互动环节在什么情况下导致了这种结果。而通过会话分析的系统性研究，我们既能展示非常成功的沟通案例，也能明确指出那些导致问题的具体互动环节——这正是对访谈研究结果的有力补充。

I think that's such a good point. So in general, and this is where conversational artists work so well with other methods, we know from interviews and focus groups with GPs or other clinicians that they find these conversations quite uncomfortable. They say that things can go wrong and people can become upset. But what they can't say is what specific bits of the interaction might be causing that in what circumstance. And what we can do with conversation analysis, because we do this very systematic, orderly analysis of interaction, is to say, Okay, these conversations can go incredibly well.

因为会话分析能实时捕捉互动细节，更重要的是（这也是该方法的核心优势），我们能同时观察医患双方的对话。我们不仅记录临床医生的观点，还能看到患者即时的语言反馈——这种双重视角让我们能完整评估整个互动过程。

Here's examples of that happening. But those examples of where things don't go quite so well, here are the different areas of the interaction that might be contributing to what you're reporting in your interviews and focus group studies. Because we have that ability to see what's happening in the moment there and then. But also, and again, a real strength of conversation analysis, is that we have access to both what the clinician and the patient is saying. So we're not just interviewing the clinician in the interaction and finding out what they think is best.

通过同步分析医患双方的对话动态，我们获得的是比单纯访谈医生更平衡的视角——这对优化沟通方案具有重要意义。

We can see both the patient and the clinician's interaction, how those things work. So it's more of a balanced perspective rather than just interviewing clinicians, for example, about optimising communication plans.

关于这一点，我还想深入探讨方法问题。你通过数据和文字记录感知或解读患者的情绪反应，但你本人并不在场——或者说你确实在场，因此带有民族志研究的成分。我认为这一切都是你对互动的诠释，或许你可以谈谈你是如何解读的。但你断言他们确实感受到某些情绪，这终究是你的诠释，我很好奇这与对话分析中的解释主义立场如何协调运作。

And this and the second we need to I want to dive into the methods as well, but you sense or you interpreted these emotional reactions within patients based on the data, the the transcription, but also you were you weren't there. These are just so so you you were there. So there's an ethnographic part to it. So I suppose all of this is you interpreting an interaction, and then perhaps you could say something about how you're interpreting that. But you're making a claim that they were felt however is your interpretation, and I just wonder how that works or how that fits with conversation analysis, that interpretivist position.

是的，这是个非常有趣的观点。我强烈认为对话分析本质上是一种非解释主义的研究方法。我们通过互动内部的证据进行分析，比如当患者对临床医生说'这让我很生气'时，这就是我判断某人愤怒的证据。

Yeah. So that's a really interesting point. And conversation analysis is, I would argue quite strongly, is a non interpretivist approach. So what we do with conversation analysis is use evidence from inside the interaction. So my evidence for somebody being upset or angry would be, for example, the instances where somebody says to their clinician, look, this makes me quite angry.

或是当患者说'我现在很难过'时。或者当他们展现出特定的互动特征，比如声音变得哽咽——就像我们快要哭出来时的声调。对话分析的优势在于它建立在大量前人研究基础上，这些在非应用场景中持续进行的细致研究，广泛揭示了人类沟通的运作机制。最奇妙的是，无论你注意到什么互动特征，比如某人声音变得嘶哑，都有相关论文研究这种'哽咽声'在互动中的功能与作用——其中就包括传递'我此刻很难过'的信号。

Or where they say, I'm becoming quite upset here. Or they display interactional features which show that they're upset, like their voice becoming quite croaky, like it does when we're about to cry. And one aspect of conversation analysis is that it builds on all this work that's come before us, really detailed work that's still going on in a less applied setting that tells us more broadly about how communication works. And that's what the really cool thing about it is, is that whatever interactional feature you notice, if somebody's voice is becoming a bit croaky, there's papers on croaky voice and the role of croaky voice and what it does in interaction. And one of the things that can do is kind of signal, I'm a bit upset here.

因此通过反复观察，我能够建立一个证据链：当讨论体重与健康关联时，参与者会展现出具有情绪困扰特征的互动模式。关键在于我们无法确知对方是否真的感到难过或愤怒。你可能注意到对话分析学者会说'这位参与者正在表现难过'或'正在表现抗拒'——这并非指他们在刻意表演，而是强调我们只能通过其言语行为来观察，无法确知内心状态。

So what I saw repeatedly, so it could build an evidence base of showing, following this association between weight with health, participants showed interactional features which displayed that they became upset. And that is a really key thing because what we don't know is if somebody actually was upset or if somebody actually was angry. And you might notice conversation analysts say stuff like this participant is doing being upset, or they're doing being angry, or they're doing being resistant. And it doesn't mean that they're doing this like big performance in the interaction. But what it does mean is that we can't know, but we can see what they're doing with their talk or their interaction.

这正是我们采用特定描述方式的原因。比如我们会说'这个人在提问'或'这个人在回答'——用行为标签来呈现可观测的证据，而非推测当事人即时的所思所感。

And that's why we describe things and label things that way. So this person's doing a question, or this person's doing an answer, for example. We'll label things in a way that shows it's being done, and we can see evidence that it's being done, but we can't surmise how someone's thinking or feeling in that moment.

如果要向完全不了解的人解释对话分析，你会如何用相对简单的方式说明它的本质和功能？

So if you're going to describe or explain conversation analysis to someone that hasn't heard of it at all, what would be a somewhat simple explanation of what it is and what it does?

对话分析是研究社会互动与沟通的一种方法，起源于社会学对日常生活的考察，但现已广泛应用于人文社科多个领域。其突出特点是研究者使用自然情境下的影音记录——即真实人物在特定社会情境中未经编排的原始互动资料。我们通过微观层面的精细分析，揭示人际互动背后的运作机制。

So conversation analysis is an approach to the study of social interaction and communication. It has its origins really in sociology and the sociological study of everyday life, but is used across a huge range of disciplines across the humanities and social sciences by people from all sorts of different disciplinary or methodological backgrounds. And I would say the sort of standout feature of conversation analysis is that analysts use recordings, so video and audio recordings of naturalistic interaction. So that's unscripted, unelicited, real interactions of real people interacting under the time and other constraints of their particular organisation or their social setting. And what we do as analysts is listen to these recordings and then a fine grained sort of micro level analysis to find out how interaction works and to sort of uncover the machinery behind interaction.

它建立在这样一个原则之上：谈话或互动是系统且有序的。正因其系统性和有序性，才能成为实证科学研究的对象。我们作为会话分析者的工作，就是揭示交流如何运作——这套互动机制究竟是什么？而在应用场景中（我是一名应用会话分析师），我会思考：我正在研究这个特定的互动情境，

And it's founded on the principle that talk or interaction is systematic and orderly. And because it's systematic and orderly, it can then be the subject of empirical scientific inquiry. And that's what we do as conversation analysts, is to find out how communication works. What is this machinery of interaction? And in applied settings, so I'm an applied conversational analyst, I then think, okay, I'm learning about this particular interactional setting.

了解在这些特定约束下可能发生什么，学习事情可能在何时何地出错，又可能在何时何地顺利进行。基于这些认知，我就能为临床医生等提供关于交流或互动背后机制的改进建议。

I'm learning about what can happen under these particular constraints. I'm learning about how and where things can go wrong, how and where things can go smoothly. And based on that learning, I can then make some recommendations for clinicians, for example, on communication or that machinery behind interaction.

当你使用'机制'这类术语或强调坚实原则时，这些概念在我看来似乎与质性研究有些格格不入——毕竟质性研究通常被认为是柔软模糊的，没有确定性，不存在稳固结构，一切都是流动不稳定的。或许你可以谈谈会话分析在质性研究中的定位？甚至看你的一些论文时，会发现统计数据和比值比等量化元素，其他CA论文也是如此。这很有趣，因为它处理的无疑是质性数据（文本分析），研究者也在现场观察互动...

So when you've used things like machinery or kind of rests on kind of solid principles, these are kind of ideas which to me seem I suppose, out of place if you like within qualitative research, which is kind of generally soft and squidgy and nothing is certain. There are no kind of strong structures behind these these things are unstable and they're fluid. And I suppose, you know, perhaps you could say something about where or how conversation analysis sits within qualitative research. And even looking at some of your papers, there are some statistics and odds ratios and and other CA papers too. So it's it's curious because it's most definitely dealing with qualitative data, you know, textual analysis, and the researchers in a room with this interaction Mhmm.

观察、倾听、记录，听起来都非常质性，但同时又存在这些似乎披着量化实证主义外衣的基本前提和理论框架。

Observing, listening, recording. It all sounds very qualitative, but then there are these underlying premises and kind of theory which seem to kind of drape it in some quantitative positivist notions.

是的，会话分析某种程度上处于这种临界地带。但首先要说明的是，通常情况下，分析师不会参与数据收集过程。

Yeah. Conversation analysis sort of sits in this sort of liminal zone essentially. But I would say firstly that in general, the analyst won't be present during data collection.

哦，原来如此。

Oh, right. Okay.

我们可能会放置一台获得参与者许可的摄像机在房间里，或者请人们用数字设备录制对话。作为分析师，我们几乎从不会在对话发生时亲临现场。

So we might leave a video recorder in a room that's turned on and with permission that participants then know that that's recording. Or we'll ask people to tape record or not tape anymore, but we'll ask people to digitally record a conversation. So as analysts, it would be incredibly rare that we are there when the conversations themselves are occurring.

为什么会这样？为什么会这样？你为什么不在那里？

And why is that? Why is that? Why aren't you there?

因为我们观察的是自然发生的互动。如果房间里有一位分析师在场，虽然互动仍是自然发生，但已偏离我们原本要分析的情境——我们不再分析研究场景，而是在分析分析师，或所收集的数据会变成分析师采集数据的过程，而非自然发生的对话。因此我们会发现，更基础的会话分析研究多基于电话通话，主要是朋友或社区间的通话，他们手机里装有录音设备。当然，他们知情但没有分析师在场，之后分析师可以收集录音。这一传统我们至今仍在延续。

Because we're looking at this naturally occurring interaction. If you've got an analyst there in the room, suddenly it's naturally occurring, but it's not the setting that we set out to analyse because we're suddenly analysing instead of research setting, we're analysing an analyst or the data we would capture would be an analyst capturing data rather than this conversation happening naturally. So we'll see that more kind of foundational conversation analytic work is phone calls, mainly phone calls between friends, between communities, where they had a recording device in their phone. Again, of course, they knew about it without the analyst present, but the analyst could collect the recordings afterwards. And that's a tradition we strongly continue.

因为民族志研究中民族志学者就在现场。我们初期大量工作就是让人们习惯我们的存在，证明我们是合法可信的。而会话分析完全不需要这些，因为我们不在场。录音设备在那里，但我们在别处，日后才会听录音。

Because if we think about ethnography, the ethnographer is there. And so much of what we do at the beginning of ethnography is kind of people getting used to us demonstrating that we're a legitimate person, that we're trustworthy, that we're all of these things. And in conversation analysis, we quite simply don't need to do that because we're not there. And the recording device is there, but we are elsewhere and we'll listen to the recording at a later date.

你提到这种方法兴起于60年代社会学，与科学方法或文本科学解读相关？能否展开说说？

And so when you said about the emergence from sociology from the 60s tied to that kind of scientific method or making this interpretation of text science y? Maybe take us that way.

会话分析源于哈维·萨克斯和伊曼纽尔·谢格洛夫的研究，他们都是欧文·戈夫曼的学生，还有60年代的盖尔·杰斐逊。它本质上是对当时主流社会学方法的批判——那些依赖宏大假设理论的研究。这是一次彻底的反叛，打破了社会学的传统范式。它不从理论出发，而是从数据开始，是高度数据驱动的方法。

So conversation analysis came out of the work of Harvey Sachs and Emmanuel Shagloff, were both students of Irving Goffman, and Gail Jefferson in the 60s. And what it was really was this critical response to standard sociological approaches at the time that worked sort of with these grand hypothetical theories. And it was a strong reaction against this type of research, a paradigm shift essentially that broke the rules of what sociology was and what sociology could do. And it starts rather than with theory, it starts with data. It's such a data driven method.

早期研究者使用民族志等观察方法依赖田野笔记，而萨克斯用录音设备揭示互动背后的机制。他说要拆解单个对话序列，找出其中规则、技巧、程序、方法和准则，这些能生成我们所研究对话中的有序特征。其他方法都无法触及对话的微观机制，因为它们受记忆局限或社会期望偏差影响。要了解对话当下发生的事，最佳方式就是录制当下，才能知道真实情况。

And whilst earlier researchers were sort of using these observational methods like ethnography and relying on field notes, Saxe was using an audio recorder to capture and uncover the machinery behind interaction. And Sax said that the idea is to take these singular sequences of conversation and tear them apart in such a way as to find the rules and the techniques and the procedures, the methods and maxims, which can be used to generate the orderly features which we find in the conversations we examine. And if we used any other method, we couldn't get to those nuts and bolts of what's happening in conversation because anything else would be limited by recall or social desirability biases. So the best way to know what happens in the here and now of a conversation is to have a recording of the here and now so we know what actually happened at the time.

这听起来很像你描述的从宏大理论转向数据驱动的转变。非常像扎根理论——同样兴起于六十年代，格拉泽和施特劳斯后来回应了那种仅用宏大理论或验证理论的定性研究传统，转而基于数据生成新的微观理论。有趣的是，这两种方法论同期出现，都有改变现状的相似初衷——不再只是验证宏大理论，而是生成新的实质性微观理论。宏大理论的目标是生成理论，而你说会话分析不一定执着于发展某种互动理论。

So it sounds very much how you described the shift away from kind of testing these grand theories to start with data. Sounds very much like grounded theory, which starts you know, merged around the same time, the sixties, and with later and Strauss responded to that tradition of qualitative research or sociological research largely just using the grand theories or using research to test those theories rather than generating new micro theories based on data or grounded in data. So it's curious, I don't know, my sociological history isn't at all developed, but how those two methodologies or methods emerged around the same time with a similar ignition to change the status quo of just testing grand theories and generating new substantive micro theories. Grand theory has a particular outcome, which is to generate theory. Maybe you said CA isn't necessarily kind of hell bent on developing a theory about an interaction.

这可能没那么抽象。所以当谈到具体细节时，或许存在比生成更正式或更抽象内容更为细致的层面。

It may not be so abstract as that. So when you're talking about nuts and bolts, maybe there is something more granular about it than generating something more formal or kind of more abstract.

是，但也不完全是。核心区别在于我们观察的数据类型截然不同，研究终点也大相径庭。我们并非试图通过会话分析来构建关于世界运行的新理论，而是旨在揭示特定互动中发生的实际情况。关键在于，我们在某个互动中观察到的内容是由该特定互动中的对话者局部生成的。

Yes, but also no. The core differences between the two is that the types of data that we look at are very different and our endpoints are also very different. So we would not be seeking to sort of generate new theories about how the world works with conversation analysis. Rather, we're seeking to uncover what is happening within a particular interaction. And the core thing is that what we see in one interaction is locally produced by the interlocutors in that particular interaction.

我们从会话分析中学到的部分知识关乎对话的普遍运作机制——这些稳定的沟通模式如何展开。例如提问的运作方式、回答的呈现形式，或哪些回应与问题相关。这让我们更深入理解互动机制，那些精细的运作部件，那种法医级别的互动细节，以及我们如何通过问答、回应和请求构建对话。在应用场景中，我们运用会话分析产生的关于互动机制的知识，来探究特定机构环境（如医疗互动）中的交互模式。

And some of what we learned from conversation analysis is about how conversation in general works. So how these stable patterns of communication unfold. For example, how questions work or how answers are delivered, or what responses are relevant to questions. And that tells us more about how interaction works and those fine grained nuts and bolts, that forensic level of interaction, and how we build conversation through questions and answers and responses and requests. And in an applied setting, we use that knowledge generated from conversation analysis of how interaction works and apply that to find out more about interaction in specific institutional settings, like in medical interactions.

比如我们从临床医生沟通COVID风险的方式中获得的经验，可能适用于心血管风险沟通，但也可能不适用。我们无从预知，唯一的方法是同时听取两类风险沟通实例，验证某情境下的发现是否具有可迁移性。特别是在机构环境中进行会话分析时，我们必须对每个特定主题进行独立研究。常有人会说：你们已经研究过心血管疾病风险沟通了——

So what we learn from how clinicians communicate COVID risk, for example, might be transferable to how to communicate cardiovascular risk, but it also might not. And we don't know. And the way to find out is to listen to examples of both types of risk communication happening and see if what we're learning in one situation is transferable to another or not. And particularly when we do conversation analysis in institutional settings, we do need to research each particular thing separately. So often someone will say, oh, you've done this risk communication about CVD risk.

直接把现有结论套用到COVID风险或抗疟药依从性风险上就行。但会话分析强调：已知经验可能具有可迁移性，也可能没有。我们无法仅凭一类互动观察，就指导临床医生在不同情境下处理类似但存在差异的沟通场景。

So just map what you know onto COVID risk or risk of not adhering to antimalarials, for example. But with conversation analysis, we're very explicit that what we know might be transferable, but it might not be transferable. We can't, from listening to one type of interaction, then advise clinicians, for example, on how to communicate in a similar but different interaction in a different setting in different context.

确实，这个观点很好。我认为它们的共同点在于都对数据抱有特殊兴趣，但由此产生的成果却大不相同。那么会话分析研究是否存在元综合？比如像质性研究那样进行荟萃分析、系统评价或叙述性综述？

Yeah, that's a good point. I think that's what's common amongst them is they take a particular interest in data, but what arises from that is quite different. Yeah. And are there meta synthesis of conversation analyst studies? So where people pull and is there some meta analysis of that like there is with qualitative synthesis or even a systematic review or narrative review?

这类研究非常罕见，但极具价值。我曾主导过关于不同场景中行为改变沟通的会话分析质性系统评价与主题综合。研究发现存在一系列跨场景稳定使用的沟通实践，能反复观察到这些模式令人振奋。会话分析强调'处处皆秩序'，我们确实持续见证着这种高度有序的沟通方式不断重现。

Yes, they're very rare, but I think they are incredibly useful. So I led a qualitative systematic review and thematic synthesis of conversation analysis work around behaviour change communication in various different settings. And what we found was there was a series of stable practices used consistently across all these different settings. It was brilliant to uncover them and see repeatedly. Conversation analysis has this thing of order at all points, and we could just see it happening all the time, this very orderly way of communicating coming up again and again.

但通过躯体元合成方法，我们能够对所有不同实践进行概览，分解展示每种实践的应用场景、时机、方式，以及关键的是——在特定情境下患者对实践的本土化反应。我认为这对临床医生特别有价值，因为会话分析有其特定的研究方式和呈现形式，我们会展示这些体现谈话方式的转录文本。我能理解，当阅读会话分析论文时，面对这些非常规转录文本并从中提炼核心结论可能有些困难。但这些转录文本对于展示分析过程、体现研究数据是绝对必要且精彩的，它们是会话分析的基石。

But what we could do with the somatic metasynthesis was sort of overview of all the different practices, break it down to show where each practice was used, when it was used, how it was used, and importantly, how practices were responded to locally by patients in that particular setting. And I think these are so useful for clinicians in particular, because conversation analysis has a certain way of doing things and a certain way of presenting things where we present these transcripts that show how talk is delivered. I can understand that it might be a bit tricky if you're presented with a conversation analysis paper to see all these kind of unusual transcripts and sort of wade through those to get to the really kind of crux of what the conclusions are. And those transcripts are necessary to show the analysis, the analytic process, and to be a visual representation of the data. So they're wholeheartedly necessary and absolutely brilliant and a really foundational aspect of conversation analysis.

而在主题合成中，我们能够面向略有不同的受众，既引导临床医生关注原始论文，又能整合研究成果，突出核心实践建议——就像我们在主题系统评价或统计系统评价中所做的那样。

But in the or thematic synthesis, we're able to talk to a slightly different audience and orient clinicians to those original papers, but also aggregate them, highlighting kind of core recommendations for practice like we would do with a thematic systematic review or a statistical systematic review.

我们稍后会深入探讨杰斐逊转录法，这个方法很有趣。它看起来就像我把iPhone交给六岁孩子写购物清单时的效果——与逐字转录完全不同。但回到对CA类研究的系统评价或综合，您提到存在关于会话（而非语言）的底层原则、实践和稳定性。那么关于文化差异呢？比如在您的系统评价中，有研究巴西医患对话的，也有研究英国和美国的。

We're going to dive in or we're going to get to the Jefferson transcription approach or method because it's intriguing. It looks a bit like if I give my six year old my iPhone and ask them to write down a shopping list, it looks they look like that because it's it's completely different to a verbatim transcript. But just coming back to the the kind of the systematic review or synthesis of CA type studies or CA studies, what does CA say about so so you said that there are these underlying kind of principles and practices and stability around language or around conversation, not language. What does it say about the cultural differences? So let's say within your systematic review, there's a a study looking at conversation with clinicians and patients in Brazil, and there's one in The UK, one in The US.

难道这些对话不是由各自文化规范和价值观塑造的吗？它们的稳定性如何？是仅在国家层面稳定，还是在全球或全人类范围稳定？

Isn't the conversation shaped or underpinned by those cultural norms and values, and how how stable are they? The case they're just stable nationally or they're stable globally or mankind.

这个问题非常到位。我想这正是我们要检验结论可迁移性的原因。与其笼统断言'我在某个互动中注意到这个现象，所以它必然普适'，我们更注重考察不同情境下的适用性。不过确实存在一些出色的跨语言研究，探讨会话运作的基础规律。

That's such a good point. And I guess that's why we're talking about checking to see how transferable things are. So rather than making these sweeping statements, like I noticed this one thing in this interaction, so it must be relevant everywhere. Well, we always check to look at how transferable things are and research each setting differently. But there have been some really neat cross linguistic studies to look at certain kind of foundational things about how conversation works.

有项关于互动中停顿的研究特别有趣。停顿暗示着'非优选回应'——这不是个人好恶，而是会话结构上的非优选回应即将出现。比如你问'想去散步吗？'

And one study was just so interesting, which I'll share with you, about pauses in interaction. So pauses indicate dispreference. And this doesn't mean personal dispreference. It means conversationally, a dispreferred response might be coming next. So that means like if you say, Do you wanna go for a walk?

如果我立刻回答'好'，能看出是热情回应。但如果你问完后出现停顿，我们就能预感到拒绝要来了。

And I go, Yes. And immediately we can tell that that's quite an enthusiastic yes. But if you say, Do wanna go for a walk? No. We can sort of hear that a no's on the way because we have that pause.

停顿可能暗示着多种情况，但其中一种潜在含义是接下来会出现不受欢迎的回应。我们知道这种情况确实存在。Tania Stivers这项精彩的研究通过观察多种语言中的停顿现象，证明这种表达模式具有惊人的稳定性。即在众多语言中，停顿都预示着不受欢迎的回应，但关键不在于停顿是否存在。

So pauses indicate that potentially, they indicate many things. But one of the things they indicate is potentially a dispreferred response is coming next. And we know this happens. And this really neat study from Tania Stivers looked at pauses across lots of different languages and showed that this practice was incredibly stable. So pauses indicated dispreference in loads of languages, but it wasn't the presence or absence of a pause.

而在于停顿时长的差异。这项研究表明这种稳定的交流模式具有普遍性，但具体应用方式——在本研究中即停顿时长——会因语言不同而产生变化。我认为这是个绝佳案例，它展示了如何通过研究跨语言现象，来验证哪些交流原则能超越单一语言的界限。

It was the length of a pause that differed. So this stable communication pattern was shown to be consistent, but it was how it was used or the length of the pause in this particular study that differed according to different languages. And I think that's a really neat example of checking, looking at things that might be transferable and studying language and how it works across different languages to see which of these practices and principles are stable beyond our own language.

让我们思考下数据与分析。以停顿为例，作为会话分析师，你会特别关注停顿所隐含的特定意义。而像我这样非会话分析的理论研究者，在聆听对话时也会注意到停顿。

So let's think about the data and the analysis. And so we've got so thinking about the pause, for example. So as a as a conversation analyst, a pause is something which you're particularly interested in and infers some kind of meaning or significance. And as a nonconversation analyst, grander theorist, whatever, I and I'm listening to a conversation. I'll notice the pause.

我不会用特殊符号标注它，但作为研究者可能会记录：'这人似乎情绪低落'或'此处出现停顿'之类的备注。

I won't transcribe it. There won't be some funky little symbol. Mhmm. But I suppose as a as a researcher, I might think that person seemed upset or unhappy or there was a pause or whatever it might be. I might write a memo about that.

停顿对我来说具有指示性，它为文本赋予某种形态或色彩，可能影响我的解读分析与最终报告。但正如你所说，会话分析关注的是像停顿这类微观细节的精密结构。能否谈谈你在分析时关注的具体要素？是怎样的分析思路？

So that pause indicates something to me and it gives some kind of shape or colour to the transcript. And it might feature in my interpretation and analysis and write up. But in conversation analysis, like you said, it's the nuts and bolts that the pauses and all the other kind of micro granular detail. Perhaps just say, give us a sense of what you're interested in during the analysis. What kind of things, what kind of analytical thinking takes place?

没错，如你所说停顿至关重要。我们不仅关注时间节点，更注重序列关系。这正是会话分析与其他类似方法的本质区别——我们通过事件发生的顺序来证明序列的重要性。就像你说的，分析师能意识到停顿可能预示某些情况。

Yeah. So as you said, pause is essential. One of those things that we look at is a timing of things, but also sequence. And I think that's kind of one of the core things where conversation analysis differs from other methods that might claim to do similar things, is that we look at the order in which things happen and show that order is really important. And again, a bit like how you said, Well, I know as an analyst that pauses might indicate something's happening there.

我们每天都在进行各种形式的互动，都是互动专家。会话分析所做的，就是将我们已知的互动模式系统化，并在研究中发现新规律。以问候语为例，这正是序列分析重要性的绝佳例证。

We all interact every day, right? We interact in a range of different ways. We're expert interactors. So what we do with conversation analysis is formalize lots of those things that we already know and learn new things as well as we go. So a great example of sequence analysis being important or a useful thing to study is thinking just about greetings, for example.

当我们开始互动时，比如我们刚开始交流时你会先问候，如果问候出现在互动结束时就会显得有点奇怪，可能会造成对话不畅。或者如果问候突然出现在互动中间，也会显得怪异，导致对话不顺畅。所以我们知道顺序很重要。这是个——

So when we start interactions, like when we started our interactions that you do a greeting, if a greeting came at the end of an interaction, would be a bit weird, maybe cause a bit of conversational bumpiness. Or if a greeting suddenly came in the middle of an interaction, bit weird, cause a bit of conversational bumpiness. So we know sequence is important. It's- A

专业术语是吗？‘不畅’？

technical term, is it? Bumpiness?

是的。或者说问题，我们会说对话问题。所以我们知道表达事物的顺序和方式非常重要，因为我们倾向于在对话开始时问候，对吧？当我们认识到顺序的重要性并开始揭示其运作规律时，就能发现可以从中学习如何更好地组织临床互动等场景。所以顺序是个关键要素。

It is, yeah. Or troubles, we'd say conversational troubles. So we know that sequence and the order in which we deliver things in is really important because we tend to greet at the beginning of a conversation, right? And when we know sequence is important and begin to uncover how sequences work, we can see that we can learn a lot about how to better organize clinical interactions, for example. So sequence is a really key thing.

我们最近关于戒烟分析的研宄确实凸显了顺序组织的核心地位。我曾参与由Rakshna Begg博士主导的MASK试验。该试验旨在探究如果全科医生或其他初级保健专业人员向长期吸烟相关疾病患者提供电子烟，帮助他们通过减少吸烟总量来降低危害，会发生什么情况。这些研究对象都是不愿戒烟的人。

Our recent studies of smoking cessation analysis really highlighted sequence organization as a core thing. So I worked in a trial called the MASK trial that was led by Doctor. Rakshna Begg. And in the trial, the aim was to find out what would happen if GPs or other primary healthcare professionals offered people with long term smoking related illness an e cigarette to help reduce the harms of smoking with the name of cutting down the total amount of cigarettes that they were smoking. This is people who didn't want to quit.

我在试验中的角色是对话分析师，负责观察这些免费电子烟的提议是如何进行的，以及我们能从中学习什么来指导未来的临床实践。我发现大多数临床医生在互动一开始就提出电子烟提议，比如问‘今天想要免费电子烟吗？’然后患者会回应说‘哦，我以前试过不喜欢’或‘里面化学物质太多’。

And my role in the trial was to be a conversation analyst and find out how these offers of a free e cigarette were being made and what we could learn maybe to advise clinicians in future if they were going to go ahead and do this. And what I found was that most clinicians started the interaction by offering the e cigarette at the start. So saying, Well, would you like a free e cigarette today? And then the patient would respond and say something like, Oh, I've tried it before. She didn't like it.

接着临床医生会再次回应，试图缓解他们的顾虑。但这些回应很少针对患者的具体担忧，通常只是说‘但这个真的很好，而且是免费的因为是试验’，然后继续推进。

Too many chemicals in it. Then the clinician would respond again, trying to alleviate some concerns that they had. But that response was rarely tailored to the patient's concerns. And it would normally be something like, Oh, but it's really good and it's free because it's a trial. And they would carry on.

当采用这种顺序时，每当出现拒绝免费电子烟的情况，总是发生在这种顺序下。但这种做法非常普遍。我注意到第二种很少被采用的顺序：临床医生不是以提议开始，而是先询问观点，比如‘你对电子烟怎么看？’然后患者会回应他们的真实想法。

And this sequence, when rejection of the free cigarette occurred, always occurred when that sequence was used. But it was used really commonly. I noticed a second sequence that was used far more rarely, where clinicians started not with an offer, but with a perspective elicitation. So finding out something like, how do you feel about e cigarettes? And then patients would respond about how they felt.

临床医生会消除所有顾虑。如果有人表示对化学物质有些担忧，他们会说：别担心，让我详细解释这些成分。这是Aleafa，我们一起来讨论。

Clinicians would alleviate any concerns. If somebody said, oh, a bit worried about all the chemicals, they'd say, Well, don't worry. Let me tell you more about the chemicals. Here's Aleafa. Let's talk about it together.

然后共同解决关于电子烟的各种疑虑，在了解并回应这些担忧后，再提供免费电子烟。每次采用这种顺序时，患者都会接受免费电子烟。尽管采取的是相同行为——行为是会话分析的另一核心部分——你们会注意到我并未聚焦措辞，而是强调诸如'提议'或'观点引导'这类行为。

And sort of address all these concerns about e cigarettes together, then offer the free e cigarettes after those concerns had been elicited and addressed. And every time that sequence was used, patients went ahead and accepted the free e cigarette. So even though the same actions were done, an action is another core part of conversation analysis. So you'll notice I didn't really focus on the word choice. I was telling you actions like an offer or a perspective elicitation.

这两种顺序中执行的行为相同，但方式略有差异。通过分析数百段录音，我发现：以'提议'开头的常见方式虽使用最频繁，但采用另一种较少使用的方式时，接受率反而更高，因为患者有机会表达顾虑并与医生探讨。我们能看到，在这个互动机制中，一旦顾虑得到解决并收到提议，人们就会接受。这是非常有用的工具，我认为其他研究序列组织的方法对此利用不足。

So those actions were being done in both sequences, but in a slightly different way. And what I was able to do by listening to hundreds of these was to say, Okay, this one where you start with an offer was used most commonly. But if you use this other one that was used a bit less often, actually it's much more likely to result in acceptance because patients have the opportunity to share their concerns, address them with the clinician. And we can see that in general, this machine of the interaction that's happening, once concerns are addressed and an offer is made, people accept. So it's a really useful tool and I think quite underused in other methods looking at how sequences are organised.

因为我们知道某些环节在特定序列位置效果更好。通过数据分析，我们能识别这些环节的最佳位置。

Because we know things work well in particular parts of a sequence. And by analysing data, we can see where those things work well or where they should be placed.

以此为例——作为当下实例——你录下了那次诊疗互动，带着录音设备进入诊室（现在早就不用磁带录音机了，用的是数字录音机），设备就放在医患之间，完全没有隐藏，非常显眼。

And so using that, I suppose, as an example, as a current example, so you audio recorded that interaction, that consultation, you went in the room, there was, I want to say tape recorder. We haven't used tape for fifty years. An audio recorder, digital recorder. And that was placed between the patient and the clinicians. It wasn't hidden away, it was very much on view.

是的。出于伦理考虑，必须让参与者知晓正在录音。那个录音设备就放在医生桌面上。

Yes. So particularly for ethical reasons, it's important that people remember they're being recorded. But yeah, that recorder was on the clinician's desk during the interaction.

所以是医生按下录制键？而不是你冲进房间按下录音键就逃跑？

So the clinician presses play or presses record rather. It's not that you go in the room, press record, run out?

不是的。实际上是临床医生按下录音键。在这个特定案例中，医生在当天开始时就按下录音键，他们只会接诊那些同意录音并参与试验的患者。所以那盘磁带录音或数字录音会持续记录一整天。显然有研究人员在患者就诊前提醒他们已同意录音，并在他们进去交谈前再次确认同意。

No. So the clinician actually presses record. In this particular instance, the clinician pressed record at the beginning of the day and they were only seeing patients who had consented to recording and were taking part in the trial. So that tape recording or digital recording just carried on recording throughout the day. And there was a researcher obviously reminding people before they went in to see their clinician that they previously consented to recording, checking consent before they went in and had a chat.

所以你们不在房间里，因为想尽可能保持自然状态。但房间里有个叫录音器的设备，双方都知道它的存在。那你们怎么处理这个问题？你们会说虽然不在场，但有个设备在记录——考虑到'霍桑效应'（我们在民族志那期节目讨论过），这可能会改变人们的互动行为。

And so you're not in the room because you wanted to be as naturalistic as possible, but there's something called a recorder in the room and both people know that there's a recorder. So how do you address that? So you would then say, well, you're not in the room, but there's a device which is you know, thinking about the horse on effect, which we spoke about in the ethnography episode, then that's another thing that might change people's interaction and behaviour.

你就是审稿人二号吧，奥利弗？这就是审稿人二号的风格。我觉得你暴露自己了。审稿人二号最爱问这个问题：'这不自然，因为房间里有录音设备'。

Are you reviewer two, Oliver? This is reviewer two. I think you've revealed yourself. It's like reviewer two is the most common question. It's always, but it's not natural because there's a recorder in the room.

我同事海伦娜·韦伯（牛津大学高级研究员）有个绝妙的实例。我们可以反复强调'其实你会习惯的'。有个小录音器在那里，和有人坐着记笔记完全不同。她有个验光咨询的精彩案例：房间里有摄像头，验光师转身在电脑前打字时，后面的患者站起来整理裤子。这说明人们会习惯被记录，虽然知道设备存在，但不会过度改变行为。

My colleague, Helena Webb, who is a senior researcher at the University of Oxford has a really neat example of this in practice. Because we can say as many times as you like, actually, you know what, you just get used to it. And you sort of, it's very different having a little recorder there than it is unless sat there scribbling notes. And she's got brilliant example from her optometry consultations where there was a camera in the room of actually the optometrist turning around, typing at their computer and the patient behind us sort of readjust standing up and sort of readjusting his trousers. And I think we can say as many times as we want, people get used to it and you sort of know it's there, but you're not adjusting your behavior too much.

这个例子很好展示了当事人知道被录音且已同意，但不会因此抑制那些我们正在分析的微观行为。

But that was such a nice example to show that person knew they were being recorded, they consented to recording, but wasn't feeling sort of inhibited to change these sort of microbehaviors, which are the type of things that we're we're analyzing.

假设你能隐形且伦理上可行，作为对话分析师，你认为能获取更多信息吗？比如某种无人知晓的录像，你觉得能捕捉到促进对话分析的视觉线索或观察数据吗？

And do you think you would get let's just say you could be invisible, and ethically, was acceptable. Do you think as a conversation analyst, you would pick up more? So do you think, you know, let's just say you could have a kind of some kind of, you know, video recording. No one knew. Do you think you would pick up stuff, some visual cues or some visual observational data which would facilitate your conversation analysis?

这个问题很棒。我认为不会，因为对话分析的核心是观察参与者的定向——互动双方如何捕捉彼此线索、回应并协作构建对话。如果我在场，可能会获得参与者不知道的信息，从而导致过度解读。

Such a good question. And I would say no, because the main point of conversation analysis is to look at the members' orientation. So how are the parties in their interaction picking up on each other's cues, responding to each other and collaborating to construct this conversation? So if I was there, I might have access to information or something that those parties didn't have access to. So be over interpreting, for example.

但通过能够记录、观看、反复观看并分析发生的情况，核心在于观察这些成员如何协作构建互动。我的想法并不重要。一个很好的例子是关于提问的。你可以问某人一个问题，比如'你怎么样？'听起来像个问题。

But by being able to record and watch and rewatch and analyze what's happening, the core thing is to look at how those members are working together to construct the interaction. It doesn't matter what I think. A really neat example, I guess, is of a question. So you can ask someone a question, How are you doing? Sounds like a question.

虽然我们认定这是个问题。但如果互动中的另一方不将其视为问题而做出完全不同的反应，那么我们就知道在那个语境下它并未成为真正的问题。它没有实现完整的'提问性'。所以我的想法并不重要，重要的是对方的理解。

Recognize it as being a question. But if the other party in the interaction doesn't respond to it as a question and does something completely different, then we know that's not been a question in that context. It's not had its full questionness realized. So it doesn't really matter what I think. It matters what that person thinks.

在互动中发生了某种情况，他们要么选择不回应这个问题，要么问题以他们无法识别为提问的方式被提出。这才是关键所在，而非我认为如何，或我是否隐形或是个超级英雄。而且我不认为隐形会是我选择的超能力。虽然不确定会选什么，但就我作为对话分析师的角色而言，它可能没有想象中那么有用。

And something had happened in the interaction where they've either chosen not to respond to the question or the question's been delivered in such a way that they can't recognize it as a question. And that's what matters, not what I think, or if I'm invisible or a superhero. And I don't think invisible would be the superhero power that I would choose. I don't know what it would be. But I think for my role as a conversation analyst, it wouldn't be quite as useful as maybe one would think.

好的。那么录音正在进行中。除了那些选择不参与的人，它会全天录制。然后录音资料会传到你那里。接下来你会怎么做？

Okay. So the recording's taking place. It's recording all day except for those that choose not to take part. Then the recording gets to you. And then what do you do?

当我拿到录音时，首先要做的是进行转录。我会使用对话分析中的一种转录规范。最基础也最常用的是杰斐逊转录系统，但也有其他能捕捉互动不同要素的系统。我会开始反复聆听，一遍又一遍，然后进行转录。

So the first thing I would do when I get recordings is go ahead and transcribe them. And I would use one of the transcription conventions in conversation analysis. So the foundational one and the most commonly used one is the Jeffersonian transcription system. But there are other ones that can capture different elements of interaction. So I would start, I would listen, I listen again, listen again and transcribe.

对于每一类句子或话轮——每当我们在语法、行为和韵律上完成一个完整表达时，那就是一个话轮。我会进行转录，可能花几分钟或几小时来转录非常简短的互动，因为我们不仅要记录说了什么，还要精确捕捉人们是如何表达的。我们会观察语速——这个词或这几个词比周围词语说得快还是慢？

And each kind of sentence or turn at talk. So every time we achieve something that's complete in grammar, action and prosody, that's a turn at talk. I would transcribe and might take minutes or hours to transcribe a very brief interaction because we're capturing not just what it said, what is said, but how in micro detail people are saying it. So we look at speed. So is this bit of talk, is this word, are these two words faster or slower than the surrounding words?

它们是更轻还是更响？这个词的重音在哪里？音调是上扬还是下降？我们还会特别关注话轮末尾的语调，这非常关键——在话轮结束时，说话者听起来像是要继续发言并接下一个话轮吗？

Are they quieter or louder? Where's the inflection in this word? Are people punching up or going down? We'd also look at turn final intonation, which is really key. So at the end of a turn, is somebody sounding like they're going to carry on talking and take another turn?

或者有人停下来表示他们已经说完了？所有这些细节都非常重要，因为这样我们才能开始理解一个话轮何时结束，为什么下一个人会接着说话，或者什么时候轮到他们说话才合适。我们还会记录重叠对话的情况。当人们同时说话时，往往在后续互动中可能会出现的沟通不畅，可能就是因为他们之前有部分对话重叠，没有完全听清对方在说什么。所以这些微观层面的细节真的非常重要。

Or somebody stopped and indicated they finished? All of those things are so important to capture because we can then begin to understand when one turn is over, why somebody else is talking next or when it's relevant for them to talk. We also capture overlap. So where people are overlapping, because often a miscommunication that we may notice later in an interaction might be because people were talking in overlap a bit earlier and didn't quite hear what their conversational partner was saying. So these sort of very micro level things are really important.

我这里有个小例子需要你配合我一起完成。

And I've got a bit of an example that I need you to collaborate with me to do.

我们开始吧，好的。

Let's do it. Yeah.

我希望你能为在家的各位读一下这个。你能告诉大家这上面写的是什么吗？

So I'd like you to read this out for everyone at home. Could you read out what this says?

上面写着：我没有给他打电话。

So it says, I didn't call him.

好的。那么如果你改变一下重音，这句话的意思会不会有所不同呢？

Okay. So could it say something else if you sort of changed your emphasis?

我没有。给他打电话。

I didn't. Call him.

好的。再来一个？

Okay. Another one?

我没给他打电话。是的。

I didn't call him. Yeah.

或者你也可以说，我没给他打电话，就像我给其他人打了电话那样。或者我没给他打电话，是你给他打了。又或者我没给他打电话，而是在房间另一头喊他，因为他当时在别处。所以这简单的四个字'我没给他打电话'，可以有多种不同的解释。而你在说的时候还加了停顿。

Or you could have, I didn't call him, like I called somebody else. Or I didn't call him, you called him. Or I didn't call him, I shouted to him across the room because he was somewhere else. So that these four words, which were I didn't call him, can have like multiple different interpretations. And you added a pause to yours.

我们通过各种方式来改变这句话的含义。如果只是逐字转录，作为分析者，我们某种程度上会丢失原本的含义或表达方式。而用杰斐逊式转录法，我们就能捕捉所有这些细节。我们将转录文本与录音配合使用（我们会反复听录音），作为对话声音的可视化呈现。这样就避免了像'我没给他打电话'变成'我没给他打电话'或'我没给他打电话'这样的情况，因为我们能在转录文本上看到那些重音和语调变化。

We did all sorts of things to change the meaning of that. And with a verbatim transcription, we as analysts sort of lose that original meaning or the way things are originally delivered. So with Jeffersonian transcription, we can capture all of those things. And we use the transcription alongside the recordings, which we continue to listen to, as a visual representation of what that talk sounds like. And it avoids things like I didn't call him becoming I didn't call him or I didn't call him because we can see on the transcript where those emphases and inflections are.

这太有意思了。所有质性研究的共同点就在于那种沉浸感——你不断地听、思考、转录，而作为研究者，你本身就是分析工具，对吧？没有什么其他机器

It's fascinating. What I is similar across all the qualitative work is just that immersion that you're just listening and thinking and transcribing and you're still you as the researcher, you're the analytical instrument, aren't you? There's no other kind of machine

所以或者

So or

SPSS能替你完成这项工作——你必须完全沉浸或努力沉浸在数据中。

SPSS that does it for you're very much immersed or endeavored to become immersed in data.

我完全同意。在会话分析中我们不太常用'沉浸'这个词。比如如果我在做主题分析，我会对给我递茶或咖啡的同事说：走开，我正沉浸在数据中。但在会话分析中，与其说是我个人沉浸于数据，不如说这与共同构建的概念相关——我更多是戴着分析者的帽子，全神贯注于那些机械般的细节运作。发生了什么？

I would completely agree. And we don't tend to use the word immersed so much in conversation analysis. If I was doing thematic analysis, for example, I would say to colleagues offering me tea or coffee, Go away, I'm immersed in my data. But with conversation analysis, rather than thinking of it as me personally, and I guess it's to do with this sort of co construction thing, Rather than think it was me personally being immersed in my data, I think of it as having sort of my analysis hat on and just being completely focused on that nuts and bolts of machinery. What's happening?

为什么现在出现这个？为什么接下来会发生这件事？是什么导致了另一件事的发生？所以这是种截然不同的数据研究方式。做主题分析时，我会感同身受地回忆我做过的访谈。

Why this now? Why is this thing happening next? What caused this other thing to happen? So it's a very different type of being into your data. With thematic analysis, I'll kind of feel it and I'll be there with them and remembering the interviews that I did.

但会话分析是更系统化的过程，需要逐步梳理，观察这些稳定有序的交流模式如何展开。

But with conversation analysis, it's this much more systematic process of working through things step by step to see these stable and orderly patterns of communication unfold.

我想说，你在尝试保持超然甚至客观的态度吗？你是在以观察而非共建的方式处理这些数据吗？因为你描述它时非常视觉化——特定的转写符号系统、独特的文本表达方式——你既关注听也注重看，这种抽离感让你排斥'沉浸'的概念。那么你的立场究竟是什么？是从外部观察数据而非与数据互动共建吗？

I want to say, you try and be detached, even objective? Do you try and look upon this or listen upon or look upon this data? It seems like because you describe it as a very visual thing, like these the particular way of transcription with particular symbol signs and various kind of textual a very particular way of expressing this data, and you'll focus on looking at it as well as listening to it, it seems somewhat detached and you kind of rejected or resisted the idea of being immersed or it didn't really fit so well. But again, what is your position? Is it one of viewing the data from outside rather than co constructing and building this data with that interaction with the data?

是的，我认为这正是会话分析区别于其他质性研究方法的特点。我们不进行数据共建，而是采用'无动机观察'作为分析起点。这不是说我们缺乏研究热情，而是意味着我们不会带着先入为主的假设或主观情感进入数据，只是纯粹地拆解这个交流机制。

Yeah, so I think that again is a really kind of thing that marks CA out against other qualitative methods where we might co construct data in the analysis process or in the data collection process is that I would argue that we're not co constructing data in conversation analysis. We use a process called unmotivated looking when we start analysis. And that doesn't mean that we're not like motivated researchers that enjoy our jobs. But what it does mean that we don't go into the data with a priori assumptions about what we'll find or carrying our thoughts and feelings about a particular topic with us. We just look at the data and begin to unpick this machinery.

所以我们关注：对话的第一个话轮发生了什么？下一个话轮如何衔接？话轮由哪些成分构成？如何构建？后续出现什么相关回应？而主题导向的研究方法可能更关注人们对特定情境的看法感受。

So what happens in the first turn at talk, and then the next turn at talk, and then the next one. And what are the components of that turn? And how is it built? And what's a relevant response as we go through? And with more topic focused research methods, so we might be looking at how people think or feel about a certain situation.

比如在主题分析中，我们会带着对特定情境的认知和情感去提问、去分析——这正是其核心特征。反思性主题分析的优点就在于研究者能承认这些主观带入并反思数据共建过程。但会话分析不涉及思想情感，我们研究的是互动背后的机械原理，毕竟我们无法真正触及他人的所思所感。

Maybe in a thematic analysis, for example, we have thoughts and feelings about that particular situation that we bring with us and we brought with when we ask the questions and we brought with us when we're doing the analysis. And that's a core feature of thematic analysis. One of the real strengths of reflexive thematic analysis is that we, as a researcher, acknowledge all those things that we brought with us and how we co constructed the data. But in conversation analysis, because we're not engaging with thoughts or feelings, we're looking at this mechanics behind the interaction. And we can't access thoughts or feelings.

我们可以观察人们所展现的内容。人们可能展现积极态度、消极态度、提出疑问或给出回答。我们不像在躯体分析或扎根理论中那样进行诠释性解读。正因如此，我们较少使用或强调反身性。比如如果我在做主题分析，我会带着反身性日记做笔记，在每个阶段思考自己提问的动机、当时的想法和当天的感受。

We can access what people are displaying. People might be displaying being positive or displaying being negative or doing a question or doing an answer. We're not working to interpret things in the way that we are with somatic analysis, for example, or in grounded theory. And because of that, we don't use or we're less explicit about our use of reflexivity, for example. So if I was doing a thematic analysis, I'd be taking my reflexivity journal, making my notes, considering at each stage why I asked a question, what I was thinking, what I was feeling that day.

但在会话分析中，我们不以同样方式处理反身性。更准确地说——如果我们考虑定量数据分析方式——虽然我们仍是分析师，仍在进行诠释和主导，但该方法本身并非诠释主义。会话分析同样不属于诠释主义方法。我们不会比做定量分析时更多地将自我带入分析，尽管我们确实存在于世且带着个人背景进行着分析工作。

But in conversation analysis, we don't do reflexivity in the same way. And it's much more If we think about how we do data quantitatively, I guess we're still an analyst, we're still interpreting things, we're still an analyst driving things, But the method itself is not interpretivist. And the same with conversation analysis is not an interpretivist approach. We're not bringing ourselves to analysis any more than we would if we were doing a quantitative analysis with the caveat that we still exist in the world and we're still an active agent doing the analysis with our own sort of stuff around that.

那么你会记日记或做笔记吗？我理解你们不会以正式备忘录形式进行反身性思考。但当你听录音时总会有想法和感受。现象学家可能会说他们会将其'悬置'或搁置。你会如何处理这些想法？

So do you keep even a diary or just do you note down? Do you feel that I mean, I suppose that I get that you you don't engage in reflexivity in a more kind of formal way, memos. But when you're listening to the audio recording, you're gonna have a thought and a feeling. Are you able to I suppose phenomenologists would say they bracket it or they just park it. What do you do with it?

那些念头会突然冒出来，你无法消除它们，反而越想越强烈。我想知道你是如何管理这些对数据的情感反应的？

It pops into your head. You can't like get rid of it, but it's still there. And the more you think about it, the more it's there. So I suppose how do you manage that, manage those emotional reactions to data?

是的，个人而言——我相信每位会话分析师做法不同——这可能取决于他们的学术背景。会话分析融合了社会学、心理学、语言学、人类学等多种传统，我们接受过不同训练。我本人是人类学背景。

Yeah, so personally, I'm sure all conversation analysts do it different ways. And it probably depends on the tradition that they came from. So conversation analysis draws on all these different traditions from sociology to psychology to linguistics to anthropology. And all of us train in these different ways. So I trained in anthropology.

我使用其他研究方法时，确实认为反身性是那些方法的优势。所以我习惯做笔记，进行会话分析时也会记录。但我的个人想法和感受相对不那么重要，因为我不能像在其他方法中那样用主观感受主导分析。这算是会话分析的一个关键特征。

I use other research methods and I really see reflexivity as a strength of other methods. So I'm used to taking notes. So when I do conversation analysis, I do take notes. But my personal thoughts and feelings are just less important because I can't lead the analysis with my thoughts and feelings the same way that I might in another method. And that's kind of a key marker, I guess, of conversation analysis is this way that we do things.

比如我可能是社会建构主义者，而你可能是实证主义者；我可能非常熟悉医患互动分析，而你从未看过医生。但如果我们看同一段数据，关键在于我们会观察到相同现象——因为我们关注的是对话机制，而非依赖个人想法、感受或经历。我们会看到这个问题引出了答案，或这类提问引发了另一个问题。

So I could be, I know, a social constructivist and you could be a positivist. And I could be really experienced analyzing GP interactions and you could have never been to a GP in your whole life. But if we looked at the same bit of data, the important thing is that we would see the same things there because we're looking at the mechanics, not drawing on what we think or feel or our own experiences of an interaction. We would see that this question produced an answer. Or this type of question produced another question in response.

这些正是我们会注意到的现象。不论我看过全科医生5000万次而你从未看过，我们都能识别出对话中这种稳定的模式。虽然思考这些问题很有趣也很重要，作为方法论来考量这些更广泛的实践，但会话分析的妙处在于，无论你的本体论立场、认识论立场或接受过何种方法训练，一旦掌握会话分析技巧，我们在数据中看到的都是相同的东西。我们还有称为数据研讨会的活动，这在我看来是会话分析独有的，大家聚在一起——全国各地都在举办——分享数据并展开讨论。

So those are the type of things that we would notice. And it doesn't matter that I've seen my GP 50,000,000 times and you've never seen a GP, we can recognise that stable pattern happening in talk. So whilst it's really fun, I think, to think about these and important as methodologies to think about these kind of broader practices, the wonderful thing about conversation analysis is that it doesn't matter what your ontological position is or your epistemological position or what kind of methodological training that you've had, once you know how to do conversation analysis, we all see the same things in the data. And we have this thing called data sessions, which again, I think are quite unique to conversation analysis, where we all get together and they happen all over the country. People all get together, share data and discuss it.

我们会播放录音，一起查看文字稿，讨论观察到的现象及其证据依据。比如我认为某人提出了问题，因为下一话轮中参与者用回答锁定了前一话轮的信息。我们就这样分析数据，描述所见。极少有人说‘我完全不同意’，因为我们研究的是这些机械性规律，揭示正在发生的、极其稳定的现象。

So we'll play the recording, look at the transcript together and discuss what we see happening and discuss the evidence for why we think that. So I think this person has done a question because in the next term, the participant responds with an answer targeting information that they received in the previous term. So we'll look at these data, describe what we're seeing. And it's very rare that someone will say, Oh no, I completely disagree with you. Because we're looking at these mechanics and we're uncovering what's happening and seeing these very stable things.

这与你的科学哲学观无关，这些现象确实稳定存在。

And it doesn't really matter your philosophy for science. You can see these things stably occurring.

这是在单项研究中你会与同事核对分析结果，还是存在某种评估者间信度检验？亦或是独立完成？质量把控如何融入分析过程？

And is that the case in a single study that will you check your analysis with a colleague or is there some inter rater kind of reliability thing that's done or is it just you? How the quality checks come into the analysis?

确实没有评估者间信度检验，也没有所谓的复核程序。但如前所述，会话分析始终建立在前人大量研究基础上，是个不断累积的过程。每项研究都在前人基础上贡献新知，为后续研究铺路。这是累积性的，而我们各自掌握着这个庞大研究体系的不同领域。

Yeah, so no inter rater reliability and no checking per se. But I think what I said earlier is conversation analysis builds consistently on this large body of work that has already happened to the cumulative process of learning more and more with each study. Each of us contribute to what's happened before and then lay something out for someone else to build on next time. So it's cumulative. And we all know different areas of this large body of research.

数据研讨会的作用之一就是互通有无。比如我擅长回应性感叹词研究，能详述相关文献、使用场景、出现位置、不同情境下的回应方式等整套理论。但正因专精于此，我对问题设计（如提问格式）就知之甚少，而这恰是其他人的专长。

One role of data sessions is that we can find out knowledge for other people that know things we don't know. So I'm quite good at response cries. Things like, Oh, and Ah, I can tell you all the literature about them, tell you where they used, how they used, what position they occur in, how people respond in different situations, different settings, and all the literature around it. But because I know a lot about response cries, I don't know everything about question design, for example, question formatting. But someone else would have read all of that literature, which is great.

数据研讨会让大家能共享不同专业领域的知识，既避免疏漏又丰富分析维度。有次研讨会上，一位临床医师反复说‘对，对，对’，我当时就想：患者说完后这种回应肯定很重要——它在发挥什么作用？需要结合前后语境来考察。

So when you get together at a data session, people can share this different knowledge that they've developed with the different areas of speciality to make sure that you're not missing stuff, but to add richness to your analysis. And I was at a data session once when a clinician had gone, Yeah, yeah, yeah. And I was thinking, Gosh, I'm sure that is really important that a patient said something and they've gone, Yeah, yeah, yeah. And I think, What work could this be doing? Looking what happened next, what happened before?

在数据研讨会上，我的一位同事说：‘哦，这篇关于Yeah Yeah Yeah的论文太棒了。给你，我这就发邮件传给你。’我看到这篇论文分析了数百次关于Yeah Yeah Yeah的互动案例，包括其使用场景、方式及对交流产生的影响。因此，协作参与数据研讨会并相互学习是提升质量的关键环节。

And one of my colleagues at the data session was like, Oh, it's brilliant paper on Yeah Yeah Yeah. Here it is. I'll just email it over to you. And I could see this paper where someone had analyzed just hundreds of interactions before about Yeah Yeah Yeah and where it's used and how it's used and the effect that they can have in an interaction. So that is kind of a key area of quality is working together, going to data sessions and learning from each other.

另一个展示我们成果的领域是会话分析中的结果呈现方式。我之前提到我们会展示极其详细且至关重要的文字记录。即便面对不熟悉转录本的临床医生，我仍会呈现这些细节——只是会用更详尽或清晰的方式解释，让外行也能理解。我们展示转录本是为了让人看到我所说的数据依据。

And another area, I guess, to show or demonstrate what we've done is the way that we present results in conversation analysis. So I said before that we present these transcripts, which are incredibly detailed, but incredibly important. And just because I'm communicating to clinicians who don't know how to read the transcript, doesn't mean that I'm not going to show these detailed transcripts. I might explain them in a more detailed way or a clearer way so that people unfamiliar can understand what I did. But we show the transcripts so that people can see the data that I'm talking about.

如果我提出他们不认可的分析结论，他们可以说：‘你认为患者在此处表达了消极倾向，但我从当前或上一轮对话中看不出任何消极回应的证据。’这正是会话分析的关键——展示完整过程。我们不会用省略片段来呈现，而是向读者展示完整的对话内容。

And if I'm making an analytic claim they don't agree with, they can say, well, you've said that the patient indicated dyspreference here, but I don't see any evidence in their turn or the prior turn that a dyspreferred response was produced. And that's kind of a key part of conversation. Analysis is showing what we've done. We don't show quotes with like dot dots with bits missing. We show the bitter talk that we want to show people in our readership.

我们会展示前后大段上下文，就像我现在向观众比划引用长度一样（虽然你们看不到手势）。这些我们称之为‘摘录’而非片段，因为它们真实展现了互动发生的语境、序列位置及表达方式。

And we'll show the context before and after quite chunky, often like I'm gesturing to people at home to show how long our quotes are, but you can't see my gestures. We'll About

三英寸左右。

three inches.

没错。我们会展示大段摘录，以呈现互动发生的完整语境、序列位置及表达方式。这正是萨克斯倡导的研究方法——通过这种呈现，他人既能审视我们的工作，也能提出异议。

Yeah. We'll show quite chunky quotes, which we call excerpts, because they're excerpts really, rather than a snippet of what's happening, to show the context around an interaction, where it occurs in a sequence and how it's delivered. And that was a key part of what Sacks kind of encouraged people to do. He said you could, by presenting things in this way, others can look at what we've done. And if they want to, they can disagree with us.

这使得我们的决策依据、分析对象变得极其透明。我们会在详细转录本下方逐行解析：比如‘转录一摘录一的第七行，参与者开始谈论X’，然后逐一描述每轮对话及其分析解读，确保每个结论都清晰可溯。

It makes it very explicit, the decisions that we made, why we made them and the particular bit of data that we're talking about. So again, showing this kind of very detailed transcript and talking through our analysis below the transcript. So we refer to line numbers. So we'll say, for example, in transcript one, in excerpt one, on line seven, the participant starts talking about X. And then we'll go through all and describe each line, each turn at talk, what's happening or our analytic interpretation of what's happening to make it very clear and explicit the decisions we make.

所以如果人们愿意，他们可以不同意我们的观点，或者不同意他们对数据的解读。

So if people want to, they can disagree with us or disagree with what they're saying about the data.

关于这一点，我有个问题没问：假设是与患者和临床医生进行的半小时咨询，你们是转录全部内容，还是只转录与研究问题或研究目标相关的关键部分？

One thing I didn't ask related to that is that let's say the half an hour consultation with the patient and the clinician. Do you transcribe all of that or just the salient parts which are pertinent to your research question or the study aims?

这是个非常好的问题。答案是，黄金标准是尽可能多地获取数据。因此理想情况下应该记录整个互动过程，比如完整的咨询过程。但在我最近的项目中，由于伦理审批机制的限制，我只被允许分析与特定研究问题相关的内容。比如在关于新冠风险沟通的项目中，我只能保留与新冠风险沟通相关的互动部分。

That's such a good question. And the answer is that the gold standard is to have as much access to as much of the data as possible. So the gold standard would be to have the whole interaction, the whole consultation, for example. Sometimes in my recent project, because of how ethics approval system works, I only was allowed ethics to analyze the particular research question I was answering. So in my project about COVID risk communication, I'm only allowed to keep the parts of the interaction that are about communicating about COVID risk.

其余部分我必须删除。这可能导致我遗漏某些内容。有时参与者会说'我之前提到过这个'或'我早前告诉过你那个对吧'，但由于剪辑，我错过了这些前文提到的内容。

And I have to delete the rest of the interaction. And it might mean that I miss things because I've done that. So in some instances, participants will say, Oh, know, was saying earlier about this thing. Or I told you earlier about that, didn't I? So I missed those bits where they said things earlier.

或者我可能错过了他们之前开怀大笑的部分，而现在我们正处于非常积极、流畅的对话中，因为咨询中有个特别融洽的环节。但由于这项特殊研究的性质，获取完整咨询记录既不实际也不可行。不过真正的黄金标准是，在我所有工作中都尽可能获取参与者愿意提供的完整咨询内容。

Or maybe I missed if they had a really good laugh earlier and now we're in a really positive, we're having really kind of smooth running conversation because we've this brilliant affiliative section area in the consultation. But because of the nature of this particular study, it wasn't practical or feasible to get access to the full consultations. But the gold standard really, and what I try to do in all my work is to access as much as people are comfortable with as much of the consultation as possible.

那么会话分析（CA）试图解决哪些类型的问题？它旨在回答什么样的研究问题？

So what kind of questions does CA seek to address? What sort of research questions does CA look to answer?

会话分析旨在回答关于事物在实践中如何运作的问题。我认为这是该方法常见的误解——人们以为它有点像主题分析，研究人们在互动中的想法或感受。但实际上我们无法获取这些，我们不知道人们怎么想或感受，这也不是获取这类信息的合适方法。

So conversation analysis looks to answer questions about how things actually work in practice. And I think this is a common misconception with the approach actually, is that people think it's a bit like thematic analysis, where we're looking at how people think or feel in an interaction. But we can't access that. We don't know how people are thinking or feeling. And it's not an appropriate method to access those types of things.

因此我们关注互动中达成的目标、参与者如何实现这些目标，以及特定情境中存在的互动挑战或困境，各方如何协作应对或解决这些挑战。在应用场景中，我通常以制定临床指南或培训方案为总体目标，同时研究如何优化该场景下的沟通方式——不是通过假设或询问理想状态下的沟通改进方案，而是观察人们在组织实时约束下的互动，看能实现什么、如何共同克服困难。或者当我们看到医患对答流畅时，这种效果是如何达成的？我们能从中汲取什么经验？

So we look at what's being accomplished in an interaction, how things are achieved by participants, and maybe what the interactional challenges or dilemmas are in a given situation and how parties work together to address or solve those challenges or dilemmas. In an applied setting, so I tend to work with the overall aim of developing guidelines or training for clinicians. I tend to also answer research questions about how things might be done or how can we optimize communication in this setting. And that's not through hypothesizing or asking people how could communication be better in a world that is ideal, it's by looking at people interacting under the real time constraints of their organisation and seeing what can be done and what can be achieved and how troubles can be overcome together. Or how when we see a conversation that runs very smoothly, the patients respond well and clinicians are responding well, how is that achieved and what can we learn and draw from that?

或者我们可以为其他处于类似情境的临床医生重点推荐哪些实践方法？

Or what practises can we highlight for other clinicians in similar situations?

我想回到特征这个话题，这也是会话分析如此有趣的原因——正如我所说，它具有定性研究的特征：包含文本成分，聚焦社会互动与关系（虽然您不研究关系层面，但互动中确实存在关系）。同时它又带有我们讨论过的那些看似量化、实证主义的元素，那种保持距离的客观性特质，这在其部分分析中有所体现。

I suppose coming back to the features, and this is why CA is so interesting because it has features of, as I said, characteristics of qualitative research. There's a textual component. There's a focus on social interaction and relationships. I know you're not looking at relationships, but there's a relationship there and it's but then there's this element to it, which as we've kind of talked about, which seems quantitative and positivist and this notion of being a bit detached and objective. That comes through in some of the analysis.

我提到过您的研究包含统计元素。那么在分析层面，对术语频率、停顿时长等量化数据的分析，与会话分析是如何结合的？

I mentioned your work that there's some statistics within And the so in terms of the analysis, what is the quantification of the frequency of terms and length of pauses or the more numerical side of analysis? How does that fit into conversation analysis?

这是个非常好的问题。关于量化与会话分析的关系存在大量学术讨论，甚至有人认为会话分析不属于定性方法，因为它非诠释主义取向，而更接近实证主义。有人认为即便不进行量化，它也不算定性研究。在我看来，若将实证主义与诠释主义视为连续谱的两端，会话分析或许处于中间地带，属于两者之间的阈限空间。

Yeah, that's such a good question. And there's lots of sort of work and scholarship around quantification and conversation analysis. And some people even argue that conversation analysis isn't a qualitative method because it's not interpretivist, because it could be argued that it has a more positivist approach. People will say that even if we're not quantifying, it's still not qualitative. So from my perspective, if we think about a kind of a continuum, when we have positivism on one side and interpretivism on the other, maybe conversation analysis is in the middle, kind of halfway, neither one nor the other in a sort of liminal space.

但就像多数定性方法一样，它能与其他研究方法良好配合——无论是其他定性方法还是量化方法。会话分析学者非常明确该方法能做什么、不能做什么：我们能揭示话语背后的运作机制，观察实际达成的效果；但我们无法探知人们的思想或感受。

But it works well, like most qualitative methods, it works well with other research methods as well. Either other qualitative methods or other quantitative methods. And what conversation analysis or conversation analysts are very explicit about is what we can and can't do with conversation analysis. So what we can do is uncover this machinery behind the talk or see what's being accomplished. What we can't do is find out what people are thinking or feeling.

我认为会话分析的优势之一正是这种明确性——承认单一方法不能包办一切。这种方法特别擅长解析社会互动机制，可与关注体验感受的定性方法（如访谈研究、主题分析）形成互补。因为它捕捉的是即时互动，配合访谈能进一步了解当事人的想法感受。当然它也能与量化方法结合使用。

And I think one of the strengths of conversation analysis is that being that explicit about what we can do, that one method can't do everything. And this particular method really shines at looking at social interaction and how those things work. And it works well with qualitative methods, maybe interview studies or thematic analysis studies that might be looking more about experiences and how people feel about experiences. Because it's a snapshot of a moment in time we can see interaction happening and maybe could be complemented with interviews to find out more about thoughts and feelings or reported thoughts and feelings. And it can also be used with quantitative methods.

我倾向于在两者中都使用它。我认为，关于会话分析的另一个误解可能是人们不太愿意使用它的另一个原因，即人们认为量化只关乎词汇选择——特定情境下出现了多少词汇。但事实并非如此。我之前说过，序列是会话分析的核心特征。

And I tend to use it with both. And I think, again, another kind of misconception about conversation analysis, and this might be another reason why people might be a bit reticent to use it, is people think that quantification is all about word choice. How many words occurred in this particular situation. But that's not the case at all. And I said before that sequence was this core feature of conversation analysis.

因此，事情发生的顺序及其在互动中的位置非常重要。如果我们进行量化，通常是对特定序列位置发生的事情进行量化。正如我所说，量化方式多种多样。例如，我们可能关注对某类行为做出反应时的停顿——即那些序列位置中的停顿。

So the order things happening, their placement in an interaction is really important. And if we're quantifying something, we tend to work at a quantification of something happening in a particular sequential placement. And as I said, there's loads of different ways to quantify things. We might be looking at pauses in response to a certain type of action, for example. So pauses in that sequential placement.

我认为一个很好的例证是我对临床医生向肥胖患者推荐免费转诊至Weight Watchers或Slimming World的研究。我对患者对提议的反应很感兴趣。因此我整理所有数据并绘制互动图以观察情况。其中一个行为是提议——正如我们所说，行为也是会话分析的亮点之一。

And I think a nice illustration is a study that I did of clinicians recommending free referrals to Weight Watchers or Slimming World to people living with obesity. And I was interested in patient responses to the offer. So I all my data and I mapped the interaction to see what was happening. One of the actions, because we said actions was a cool thing about conversation analysis as well. One of the actions was an offer.

在提议之后，患者会做出回应。在会话分析中，我们通常不太关注词语本身，而更关注这些词语所执行的行为。在这个特定序列位置（即对提议的回应），我想量化发生的情况，看看是否存在与患者行为的长期关联。当医生提出'您想参加Weight Watchers或Slimming World吗？'时，有时人们会说'好的'。

And following the offer, there was a response from patients. And we tend to be, in conversation analysis, a bit less interested in words and more interested in the action those words are doing. So in this particular sequential placement, my response to an offer, I wanted to quantify what was happening to see if there were any longer term associations with patient behaviors. So we had our offer, would you like to get to Weight Watchers for Slimming World? Sometimes people said yes.

有时他们说'嗯'，有时是'哦好的'，有时则是'太棒了，我很想去'，有时则是'不'或'绝对不去'。根据现有会话分析文献中关于序列语境中行为的研究，我对这些回应进行了分类。

Sometimes they said yeah. Sometimes they're like, oh yes. Or sometimes they're like, fabulous, I'd love to go. Sometimes it was no or definitely not. So what I did drawing on the existing conversation analysis literature of actions in their sequential context, I grouped those responses.

我将'不'和'绝对不去'归类为实际拒绝，因为它们都在拒绝提议并执行相同行为。然后将'太棒了''太好了'这类回应归类为显著积极回应，因为它们超出了基本肯定，明显表现出积极态度。此外还有简单的'嗯'。

So no and definitely not are called actual rejections because they're rejecting the offer and doing the same action together. So group those. Then I had lots of absolutely fabulous, wonderful group those together as a marked positive response because they were going over and above. Yes, markedly showing or displaying a positive response. Then I had a yeah.

我们知道，互动中的'嗯'可能并不像想象中那样表示完全同意。通过阅读关于'嗯'在特定序列位置作用的前人研究，我将其单独归类。还有'是的'，以及包含'哦'的回应。

And a yeah, we know interactionally might not do agreement quite as much as we maybe think that it would do. And I know that from reading all this previous work around year and what the year does in particular sequential placements. So had year on its own. I had yes. And then I had a response where I had, oh.

于是我就量化了这些内容。我统计了有多少个'哦'，多少次实际拒绝——关注的是行动而非言语，有多少次表现出积极态度。所有这些都发生在特定的序列位置，即对这次提议的回应环节。在定性分析方面，我必须说明为何选择这个量化点。

So had, And then I quantified those things. So I counted up how many o's, how many actual rejections. So the action rather than the words, how many marked positive stance. And then all in this sequential placement, so in response to this offer, so this particular part of the interaction. And qualitatively, I had to justify why that was my quantification point.

我选择这个量化点是因为我对互动过程进行了细致的会话分析。发现患者对医生提议的这次回应，是他们首次表明对提议接受态度的关键节点。而且他们在这个位置展现的态度具有一致性——没有人先拒绝后又同意。

So why did I choose this point to quantify? And I chose it because I'd done a really detailed conversation analysis of what was happening in the interaction. And I found that this response to the author was sort of the key point where patients first asserted a stance towards the acceptability of the offer. And the stance that they showed in that placement was consistent. So nobody said no and then said yes later.

也没有人先同意后又反悔。他们都保持了最初表明的立场。因此我有充分的会话分析证据表明，这个回应点是合适的量化位置。随后我将其与长期患者数据对比（这些数据此前我是盲测的），发现与会话分析文献一致：'嗯'根本不代表同意。

And nobody said yes and then said no later. So they maintained this initial stance that was asserted. So I had good conversation analytic evidence that this response point was an appropriate place to quantify. So I compared it with my long term patient data, which I'd previously been blinded to. And what I found was that in line with the conversation analytic literature, wasn't doing agreement at all.

'嗯'只是表示听到了对方说话，属于我们所说的'反馈信号'或最低限度回应。它可能是在请求更多信息，因为有时医生会接着提供更多说明。但我发现：所有说'哦'的患者最终都同意了转诊建议，而且除一人外都实际履约了。

Yeah was acknowledging that someone had spoken, was doing what we call a back channel or a minimal acknowledgement. It was just acknowledging the clinician has spoken. It might have been acting to request more information, because sometimes following a year, clinicians delivered more information. But what I did find was that when patients said, Oh, every single patient that said, Oh, went on to agree to their free referral at the end of the consultation. But also, all of them apart from one, I think, went on to actually attend that referral later.

量化分析实际上为会话分析结论提供了数据支撑：'哦'表现出对提议的强烈积极态度。后续定量数据显示，互动中表现积极的人最终都会履约。这对医患互动极具参考价值——通过序列分析可见，患者说'哦'后医生仍会试图说服，但听到'嗯/是'后就会停止，因为他们认为对方已同意。

The quantification essentially actually to add another layer of data, shoving what I'd concluded from the conversation analysis, which was that Yeah displays strong positivity towards this offer. And we can see with this subsequent quantitative data that people who displayed positivity in the interaction also went on to attend. So that's super useful like interactionally to know that that happens, but also useful for clinicians. Because from doing my sequential analysis, I could see that after, oh, clinicians went on to try and sort of convince or persuade people that attending would be a really good idea. But after a yeah or a yes, they sort of posed the interaction because they indicated that they'd understood people had agreed.

但事实恰恰相反。说'嗯/是'的人可能只是在索取信息，会话证据显示他们并未真正同意——这些人后续会继续提问才做最终决定。而说'哦'的人则全程保持积极互动态度。

And actually the opposite was true. So people who said yeah or yes may have been requesting more information. There wasn't conversational evidence they were actually agreeing. Because afterwards they would go on to ask more questions before making final response at the end. Whereas people said, Oh, maintain this really positive response towards the interaction.

他们不再提问，当医生试图提供更多转诊信息时，他们会认为这些信息多余。因此我们既有扎实的会话分析证据，又有定量数据佐证——不是通过词频统计，而是基于序列语境中的具体行为，这些都植根于对交互过程的微观分析。

Didn't ask any further questions. And when the clinician tried to deliver more information about the referral, they oriented to that information as redundant or unnecessary. So we had this strong sort of conversation analytic evidence and this additional quantitative evidence as well, But not done through words or word frequency, but through these actions in their sequential context that was grounded in this very solid micro level analysis of what was happening throughout those sequences.

因此你不会说这是混合方法。它确实是混合方法，但不是作为一种方法论的混合方法。不过你确实使用了两种不同形式的数据，可以这么说，来汇聚出某种意义或发现。这非常混合方法

And so you wouldn't say that's mixed methods. Is mixed methods, but it's not mixed methods as a kind of methodology. But you're using two different forms of data, if you like, to converge on some sort of meaning or some finding. It's very mixed method It

这是混合方法y。我同意它并未采用混合方法方法论，但确实如此。就对话分析而言，我们对能做什么和不能做什么非常明确。我能看到的是互动中正在发生的事情，或者说我能分析的是互动中正在发生的事情以及人们如何回应。但我们不知道那个人在做出回应时的想法或感受。我们可以看到他们表现出积极性或构建论点时展现的积极态度，但我们不知道这如何转化为长期行为。

is mixed method y. And I would agree that it's not using sort of mixed methods methodology, but it is So with conversation analysis, we're very explicit what we can and can't do. And what I can see is what's happening or what I can analyze is what's happening in the interaction and how people are responding. But those, we don't know that person's thoughts or feelings when they're doing that response. We can see they're displaying positivity or build an argument they're displaying positivity, but we don't know how that might translate to longer term behaviours.

在这个特定的研究问题中，我们感兴趣的是在互动中哪些会得到积极回应，哪些会与咨询后满意度评分相关，以及哪些对话方式可能支持人们真正接受转诊。我认为因为我们的研究问题涉及咨询内外的内容，所以需要来自咨询内外的数据才能恰当回答这个问题。

And in this particular research question, we were interested in what would be positively received in an interaction, what would be associated with post consultation satisfaction scores, and also what may support people to actually the conversational approaches that may support people to actually attend a referral. So I think because our research question was asking questions about inside and outside the consultation, We needed data from inside and outside the consultation to appropriately answer that.

那么我想最后提两点建议。一是建议或询问那些想了解更多关于对话分析的人，他们应该从哪里开始？你会建议人们从哪里入门？因为你看，我在想你可以拿起一篇主题分析论文或语法理论论文，不一定需要了解太多质性研究。

So I suppose two final things. One is to suggest or to ask for those that want to learn more about conversation analysis. Where would they start? Where would you suggest that people begin to? Because it is so, you know, I guess I'm thinking you can pick up a thematic analysis paper or a grammar theory paper, not necessarily know too much about qualitative research.

这是个故事，不是吗？它是基于参与者访谈的元叙事。但对于对话分析来说，似乎更难入门，或者说更难理解这种方法。

It is a story, isn't it? It's a narrative kind of meta narrative based on participants' interviews. But with CA, it seems a bit more difficult to access maybe or to get one's head around the method.

那么

So what would be a

对于想了解更多的人来说，什么才是好的方式呢？

good way of people wanting to find out more?

首先，我想说，你可能认为会话分析非常有用，但自己却不想从事这项工作。这完全没问题。那些运用或进行会话分析的研究者们已经积累了丰富的成果，涵盖法庭、邻里互动、电话交流、日常对话以及各种临床环境中的互动等应用场景。我们可以从中学习到很多。所以我的第一个建议是：即使你对会话分析感兴趣，也不一定要亲自去做。

Firstly, I would say that it might be that you think conversation analysis will be incredibly useful, but you don't want to do it yourself. That's absolutely brilliant. What the group of analysts who use or do conversation analysis have produced is this amazing body of research on all sorts of applied settings, in courtrooms and neighbor interactions and phone calls and everyday conversations and all these different clinical interactions in different clinical settings. And we can learn so much from those. So I'd say firstly, it might be you're interested in CA, but you don't want to do it.

这很好。但请多接触相关文献。资料非常丰富。不妨试着浏览一下，甚至可以做现有会话分析研究的系统综述——如果你已经掌握系统综述方法的话。因为其中蕴含大量值得学习的内容。第二点建议是：如果你想进行会话分析，请找一位友善的导师。这不是那种读本书就能成为专家的领域。

That's brilliant. But engage with the literature. There is so much out there. Don't be afraid to have a look and maybe do a systematic review of existing conversation analytic studies, if you're already skilled in somatic synthesis, for example, because there is so much learning, so much of relevance The there for second thing I would say is if you do want to do conversation analysis, find a friendly mentor. So it's not something as you were saying, but you can sort of read a book and then be a pro conversation analyst and off you go.

其实今天受邀来谈会话分析时，我也在想：天啊，关于会话分析我能说些什么呢？我仍在学习中。感觉我们所有人都处于持续学习的状态。这个领域的研究成果如此浩瀚，没人能全部掌握。

And even when you invited me to come and talk about conversation analysis today, I sort of thought, Oh my goodness, but what am I gonna say about conversation analysis? I'm still learning. And I feel that we're all still learning all the time. There's such a large body of work that's being produced. We can't know it all.

我们都在持续学习的过程中。对我来说，拥有导师、参加数据研讨、融入会话分析社群，这些方式让我能持续精进。所以我建议其他人也这样做：找导师、加入社群、参与数据研讨、参加培训课程——虽然结课后你不会立刻成为专家，但能借此建立人脉，结识同行，打好基础。之后可以继续提升技能。

And we're all on this ongoing process of learning. So for me, having mentors, going to data sessions, engaging with the conversation analytic community means I can carry on this kind of ongoing learning and find out more. So I would advise other people to do just the same. Find a mentor, engage with the community, go to data sessions, go on a training course, even though you won't come out a pro conversation analyst, that's another way to build your community, meet other people in a similar situation, learn the basics. And then from there, can continue to develop the skills after the training, the formal training has finished.

参加学术会议、与人交流、阅读文献，让自己沉浸其中。

Go to conferences, talk to other people, read the literature, sort of immerse yourself in it.

确实。作为偏解释主义的质性研究者（主要做访谈），我认为会话分析对细节的专注——比如你提到的序列结构、声音嘶哑等特征——即使最终不从事这个领域，也能让我更敏锐地捕捉语调、表达方式等细微变化。这种对语言和声音的敏感度，对任何质性研究都有助益。

Yeah. I think even for me who's a more of an interpretivist qualitative researcher that does interviews, I think the granular detail or the attention that conversation analysts place on the granular kind of, as you said, ordering sequencing, yeah, yeah, yeah, croaky voices, you know, that if nothing else, if I didn't end up doing CA, it's just I'm really attuned or alive to that variation in tone and, you know, delivery and all the things that you would be much more formal in your analysis. But as any quality research, I think just having that attention to voice and to language is going to be helpful and is going to enrich whatever form of qualitative research that you end up doing.

绝对如此。虽然这曾是小众方法，但现在越来越受欢迎。针对临床工作者的培训课程（如Elizabeth Stokoe教授开创的会话分析角色扮演法QAM，或Ruth Parry教授的Real Talk项目）都基于真实互动案例——这很合理，不是吗？

Definitely. And I think people are really, even though it was traditionally quite an underused method, it's becoming more and more popular. Training courses for clinicians, training approaches approaches for for clinicians now grounded in conversation analysis. So QAM, which is the conversation analytic role play approach, which was pioneered by Professor Elizabeth Stokoe, Real Talk pioneered by Professor Ruth Parry. All of those train clinicians based on examples from real interaction, which makes sense, right?

用非真实交流的方式培训人员其实不太合理。因此我认为这些培训方法的发展非常出色，政策制定者、指南开发者以及英国国家医疗服务体系现在都高度关注会话分析能带来的价值。虽然了解人们对特定互动的想法和感受很重要，但理解互动如何运作、在特定情境下如何有效，并基于真实互动建立良好或最佳实践的实证基础，而非仅凭推测什么可能是好主意，同样至关重要——我认为这也是非常积极的进展。

It sort of doesn't make sense that we would train people with anything that isn't real communication. So I think it's brilliant that these training approaches are developing that policymakers, people developing guidelines, NHS England are all really attuned now to what conversation analysis can offer. And that whilst it's really important to ask people about how they think or feel about a particular interaction, It's also important to understand how interactions work and how interactions can work in particular circumstances and show that we can develop an evidence base of good or best practise based on real interaction rather than reckoning what might be a good idea, which I think is a really positive thing as well.

夏洛特，非常感谢你。

Charlotte, thanks so much.

哦，非常感谢。

Oh, thank you so much.

如果你喜欢本期播客，请访问www.wordsmatter-education.com查看节目注释、资源和博客，并了解关于背痛相关语言与沟通的在线课程。我们下次见。

If you enjoyed this podcast, visit www.wordsmatter-education.com for all the show notes, resources, and blogs, and check out the online course in language and communication in relation to back pain. And I'll see you next time.