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The use of why questions in child mental health assessmentsQuestions form the basis of mental health assessments and yet there is limited empirical evidence about the linguistic structure of question formats in these clinical environments. While many types of questions are used, the focus of this research was on why-prefaced questions with children. Interaction analysis was employed to interrogate the data, paying specific attention to the interactional organisation of how 'why-prefaced' questions were asked and responded to. Analysis demonstrated that when three core components were present in the question, then it was usual for a reason/explanation to be provided in response, and when one or more component was missing, it rarely elicited a reason or explanation in response. The three components were the sequential position of the question, how the question was indexically tied to the child’s prior statement, and the epistemic domain of the question. Implications for therapeutic communication and training were discussed.