Research Methods in Clinical Psychology. Arlene Vetere, PhD

Transcription

1 Research Methods in Clinical Psychology Arlene Vetere, PhD

2 Your Relationship to Research What is your experience of research? What are your beliefs about research? What is the role of research in systemic clinical psychology practice? Think of some research that has had an impact on you, and why? Discuss what criteria you used to judge the usefulness of the research

3 Qualitative Research Focus on understanding meanings underlying behaviour Emphasis on description versus general, causal explanations Focus on participants representations of reality Emphasis on subjectivity recognition of uniqueness of individuals and experience Focus on small number of participants; data as text, transcript, diaries, observation

4 Qualitative Research (cont d) Experience and behaviour should be viewed in context and in its full complexity Scientific process as generating working hypotheses (compare with clinical practice) Theorising as based upon emergence of concepts versus imposition of prior theory Variability of meanings over time and context Close relationship between researcher and participant

5 Criteria for Qualitative Research Accessible language, diagrams, presentation Interesting and inspiring Report draws reader in, fosters a sense of involvement Reflective shows evidence of self-appraisal: 1. On methods employed, findings, consideration of alternative methods, alternative interpretations possible 2. Reflections on researcher s own stance, assumptions and possible biases 3. Context indications of reflections on a variety of factors influencing the study and interpretation prestige, constraints, demands, and so on

6 Criteria for Qualitative Research (cont d) Participant s voice not just researcher s account but able to hear what participants have to say Collaborative evidence that participants were actively involved in the research process, including initial consultation to the research question

7 Reflexivity Expectation that the researcher will make explicit their speaking position their interpretative framework Expectation that they will reflect on this in supervision, with peers, in a research diary, in a self-reflexive interview What aspects of the researcher s interpretative framework have influenced the research process and outcomes?

8 Self-reflexive Activity Please reflect on the thoughts and feelings you have had over the last few minutes in relation to the material presented so far, and the way in which it was presented. Turn to your neighbour and reflect together on how these responses can get into research activity ie shaping the questions we ask, how we ask them, how we meet people.

9 Reflexivity: relevance to dissertation assessment Position statement and personal reflections the outcome of the research analysis represents a dynamic interaction between the researcher, participants and the data, including the researcher s interpretative framework. What did you bring to the analysis? What personal investment do you have in the topic? How might they have shaped the way you interpreted the data? Reflection on your emotional responses to the data and to accounts from individual participants. Reflect on the group analytic process. How have you been affected by doing the research?

10 Quantitative cf Qualitative Research Structured data vs unstructured data Random sampling vs purposive/theoretical sampling Statistical analyses vs conceptual syntheses Objective conclusions vs subjective conclusions Surveys, experiments vs focus groups, interviews, observations Generalisation to population vs generalisation to theory

11 Critical Appraisal of Qualitative Methods Difficult to generalise Lack of prescribed methods Premature closure of text to further analysis Focus on text loses performative aspects of language Representativeness of research: sampling Create new truths or no truths Weaker positioning for subjective methodologies Repeatability and reliability issues

12 Qualitative Research Methodologies Grounded Theory Discourse Analysis Rhetorical Analysis Narrative Analysis Interpretative Phenomenological Analysis Conversational Analysis Ethnography Focus Groups & Delphi Study Action Research & Participative Research Mixed Methods

13 Genres of Psychotherapy Process Research Types of Question and Appropriate Methods: 1. Quantification How frequent is a type of event? To what degree or intensity is a property generally present in therapy? What is typical? Descriptive quantitative methods: surveys, rating scales, category systems, descriptive statistics

14 Types of Question (cont d) Comparison: Does a type of therapy, event, or phase of therapy have more of something than another type, event or phase? Which therapy is better for this disorder? Quantitative experimental and quasi-experimental designs: inferential statistics, RCTs, meta-analysis of comparisons

15 Types of Question (cont d) Relationship Which aspects of therapy vary together? What types of event typically precede or follow another? What predicts therapy process and outcome? Bivariate and multivariate correlational methods; sequential analysis; prediction research, path analysis, meta-analyses of relational research

16 Types of Question (cont d) Method Quality How well (reliably, validly) can an aspect or event be measured by means of a particular process or outcome measure? Psychometric or measure development research

17 Types of Question (cont d) Definition What is the nature of a particular therapeutic phenomenon? What defines or constitutes it? Phenomenological research (IPA, theme analysis), grounded theory, ethnographic research

18 Types of Question (cont d) Description What kinds of events or aspects exist in therapy? What features, types or patterns do these events or aspects have? Naturalistic qualitative research (participant observation), grounded theory, ethnography, quantitative content, cluster, interaction analysis

19 Types of Question (cont d) Interpretation What is the meaning of a therapeutic event or process? Why did it happen? How did it develop? Interpretative research (IPA), narrative case study research, comprehensive process analysis, task analysis, discourse analysis

20 Types of Question (cont d) Critique/Action What is wrong with how things are now? How could it be made better? Feminist research, participant action research

21 Types of Question (cont d) Deconstruction What implicit assumptions are made in this research? Whose interests are served or ignored? Conceptual analysis, self-reflection, systematic analysis and critique of typical practice, discourse analysis, rhetorical analysis

22 Honing the Research Question Think of a process moment in your practice Develop a research question to explore it further What do you want to understand? What would you learn? How would it change your practice? How would it benefit your client/s?

23 IPA: Theoretical Underpinnings Phenomenology: explores in detail individual personal and lived experience Hermeneutics: a two-way interpretative process the double hermeneutic similarities and patterns Idiography: analysis begins with a detailed reading of a single case

24 IPA: Epistemological Position Constructionist position Focus on individual s beliefs and experiences of topic under study The approach is phenomenological (ie how individuals make sense of events or experiences associated with topic under study) (

25 IPA: Epistemological Position The meaning that individuals give to events or personal experiences becomes the focus of the study The generation of meaning is an interpretative process for both the individual and the researcher what might it mean for participants to have these concerns in this context? Language and context shape an individual s response to his or her understanding of events, or personal experiences

26 IPA Analysis: Looking for Themes Number the lines of the interview transcript, leave wide margins and use double/triple spacing Read the interview transcript many times, using right side margin to note anything of interest (meaning and context, and your responses to the text interpretative activity) Use left side margin to annotate key words and quotations for emergent themes (claims, concerns and understandings linguistic, descriptive and conceptual: trying to represent your participants perspectives/experiences)

27 IPA Analysis: Looking for Themes List all these emergent themes on a separate sheet and look for connections, using your right side margin notes to help - numeration, abstraction, function, contextualisation, polarisation Make clusters of the emergent themes and give these subthemes a new name, etc. Do this first for each interview, subsequently across all interviews Then cluster the sub-themes into super-ordinate themes give them a name Produce a table of themes ordered coherently: indicate where sub-themes lie under super-ordinate/master-themes; indicate where examples (quotations) can be found in the transcript

28 Theme Analysis: Practical considerations Development of semi-structured interview Relationship between research interview and therapeutic interview Transcription and editing para-lingusitic information An embarrassment of data Take it slowly risks of abstracting too quickly strip the data of meaning Self-reflexivity use right side margin notes to aid the clustering process and development of themes Interviewing more than one person focus groups

29 Uses of IPA Research Understand the experiences of particular groups of people Develop and evaluate services, therapeutic interventions, and so on Interpret the associative findings from conventional quantitative research Situate and understand people in their socio-cultural contexts Evaluate and reflect upon the role played by therapeutic, institutional and legislative cultures Re-evaluate existing theory

30 What is Thematic Analysis? What counts as a theme? A rich description of the data set, or a detailed account of one particular aspect? Inductive (bottom-up) versus theoretical (deductive/top-down) thematic analysis? Semantic or latent themes? Epistemology: essentialist/realist versus constructionist thematic analysis? The many questions of qualitative research and their inter-relationships?

31 Phases of Thematic Analysis Familiarise yourself with your data: transcribing, reading and re-reading, noting initial ideas Generating initial codes: coding interesting features of the data in a systemic way across all the data, collating data relevant to each code Searching for themes: Collating codes into potential themes, gathering all data relevant for each potential theme Reviewing themes: checking if themes work in relation to the coded extracts and the entire data set, generating a thematic map of the analysis

32 Phases of Thematic Analysis Defining and naming themes: ongoing analysis to refine the specifics of each theme, and the overall story the analysis tells, generating clear definitions and names for each theme Producing the report: the final opportunity for analysis. Selection of vivid, compelling extract examples, final analysis of selected extracts, relating back from the analysis to the research question/s and the relevant theoretical and research literature, producing a scholarly report of the analysis Braun and Clarke, 2005

33 Grounded Theory Simultaneous involvement in data collection and analysis phase of the work Creation of analytic codes and categories developed from the data, not preconceived hypotheses (creating categories early in the research shapes subsequent data collection; categories reflect interaction between observer and observed) The development of middle range theories to explain behaviour and processes

34 Grounded Theory (cont d) Memo-making ie writing analytic notes to explicate and fill out categories Theoretical sampling ie sampling for theory construction, to check and refine emerging categories, disconfirmation Delay of the literature review

35 Grounded Theory: line-by-line coding What is going on? What are people doing? What is the person saying? What do these actions and statements take for granted? How do structure and context serve to support, maintain, impede or change these actions and statements?

36 Activity: What is Discourse? Think of a time in your childhood, and Think of now What discourses about health and well being were current then and now? How have they changed? What has changed?

37 DISCOURSE: A Definition DISCOURSE - constellation of shared ideas/beliefs (explicit or implicit) which map out how areas of experience are to be seen and what is to be done DOMINANT DISCOURSES - any given culture and parts of it contain dominant shared assumptions or discourses e.g. discourse of mental illness

38 Discourse Analysis: basic tenets Language is seen as constitutive People struggle in language over the nature of events People use language to construct versions of the social world Discourses are the constructs, often derived from wider social and cultural repertoires, used to present accounts Some discourses more dominant in society than others

39 Discourse Analysis Discourse analysts ask particular kinds of questions about language: What action does this piece of talk perform? What accounts are individuals trying to construct in interaction with each other? How do these accounts change as contexts change? What are the limitations and consequences of the discourses that individuals use?

40 Activity: Text Extract With a colleague, free associate to the text Reflexivity: ask yourself why am I reading this text this way? What do you think is the function orientation of the text? How is the text organised rhetorically?

41 Steps in Discourse Analysis Selection of text: selection of themes; selection of dialogue both content and form Analysis: a) construction how is the information put together/constructed? Look for assumptions; b) variability look for inconsistencies; c) function articulate the implications of a particular account Maintaining self-reflexivity ask other analysts to view the text and your analysis

42 Doing Discourse Analysis Immersion in the text Clarify some questions of interest Alternative readings Presentation of self Search for pattern Look for consistencies/inconsistencies in the text How are the ways things being said a solution to the problem? Use of language eg metaphors Focus on depth and submerged meanings External contexts eg influence of dominant cultural discourses

43 Rhetorical Analysis Focus on action rather than cognition Conversation as argument justification and criticism Issues of accountability and agency

44 Rhetorical Analysis (cont d) unhappy incidents Recipient design Use of facts Extreme case formulation Use of vagueness Category entitlement Use of common sense maxims

45 Rhetorical Analysis: Questions to ask of the extract How do the identified discourses position Jim/May in the interaction, and how does he/she position themselves in relation to them? How are worry discourses (interpretive repertoires) promoted/undermined? How are blame and responsibility dealt with? What alternative versions are being constructed in the text? How could a therapist respond to the challenge to the therapeutic context from Jim?

46 NARRATIVES: Some definitions LANGUAGE AS ACTIVE - language is used actively, strategically to persuade, influence, justify - present oneself in preferred ways DOMINANT DISCOURSES - any given culture and parts of it contain dominant shared assumptions or discourses e.g. discourse of mental illness DISCOURSE - constellation of shared ideas/beliefs (explicit or implicit) which map out how areas of experience are to be seen and what is to be done NARRATIVES/STORIES they help organise, make sense of, give coherence to experiences over time; they connect the past, present and future

47 NARRATIVES: Some Definitions (cont d) SELF - distributed, fragmented across different contexts - questions idea of a unitary self or personality POWER - dominant groups in any given culture have the power to produce and maintain/reproduce dominant culturally shared ideas discourses PROBLEM-SATURATED TALK - ways of talking about difficulties can shape problematic systems

48 NARRATIVE ANALYSIS Assumptions: Self narrations are both constructions and claims of identity Types: Life story method; sequence of core narratives; emplotment and genres; poetic and metaphor approach Identifying the narrative: look for markers eg I ll give you an example, or, through its structure eg act (what), scene (where/when), agent (who), agency (how), purpose (why) The story: agent uses instrument to take action to achieve goals There is no other way for us to describe lived time other than through narrative (Ricoeur, 1984)

49 NARRATIVE as PERFORMANCE Relationship between the teller and the listener Power who asks the questions and for what purpose? Intentions of the story teller to convince, justify, explain, persuade, amuse and so on Co- construction prompting, editing, encouraging, validating, disagreeing and so on Connecting with shared stories cultural, literary, religious and so on

50 Narratives can be seen to vary on a number of important dimensions. ELABORATIVE vs. CONSTRICTIVE/pre-emptive e.g. you are always selfish and everything you do is... FRAGMENTED vs. COHERENT e.g. well I suppose my mother was... sort of kind... but she did let me down a lot and... at the end of the day she was OK but I don t really care anyway, I ve kind of forgotten about it... REFLEXIVE vs. CONCRETE e.g. I have no idea why she used to hit me, she s just a cruel personality I suppose CONSTELLATORY vs. DIFFERENTIATED e.g. he stole some money and he just couldn t be trusted with anything, I think he would let his friends down, even his family, he had no respect for anything...

51 NARRATIVE ANALYSIS: Interpretative decisions Its co-construction Its cultural context What problems it solves for the narrator Psychological processes change processes Narrative as performance: look at positioning of self and others (links with discourse analysis) Its intended purpose: why is it being told in this way? Here? Now? Turning points

52 NARRATIVE ANALYSIS: Life Story Method Accounts are constructed/translated by the analyst from the text Plot-lines are contrasted across the interviews Particular attention is paid to points where expected story-lines are disrupted Stories of restitution or reparation; chaotic or frozen stories

53 NARRATIVE ANALYSIS Life Story Method and Sequence of Core Narratives: Examination in relation to structure, style, content and form Plot lines are contrasted across the interviews Thematic connections between narratives within interviews Emplotment and Genres: Influenced by Ricoeur s narrative theory canonical narrative forms What cultural genres are drawn on by the person to present their self account eg The Quest, as a form of agency

54 Narrative Analysis: a systemic approach Summarise the narrative in terms of structure and function the main plot Summarise the narrative themes within the interview, and compare and contrast the themes across the interviews Process analysis: how is the story being told? What is the narrator trying to achieve? What are the discourse markers? A connection is assumed between the way we speak about our close relationships and the nature of those relationships themselves

55 ATTACHMENT REPRESENTATIONS: The layers of attachment PROCEDURAL MEMORY: memory for how we do things: embodied, rate of talk, expressed affect, relationship with interviewer cf. systemic patterns / process (R) SENSORY MEMORY: visual images, smell, touch, auditory (R) SEMANTIC MEMORY: cognition, beliefs, attitudes (L) EPISODIC MEMORY: narratives, stories, inter-connected experiences (L and R ) INTEGRATIVE MEMORY: reflection, meta-cognition, on-going monitoring of our speech and thought.. (L and R) Right Brain Implicit Left Brain - Explicit

56 ACTIVITY: Transcript process analysis Structure how well ordered is the interview, relationship with interviewer? Imagery what visual, sensory material is there? Semantic what are the concepts, generalisations about relationships made? Episodes what are the stories told, how coherent are these? Integration how is material from the above brought together, what evidence is there of insight, reflection on self and others Engagement and therapy: How would you position yourself, approach, think about, feel about, fantasise about starting to work with this person?

57 Focus Group Analysis (IPA) Concerns and experiential claims: summarise and sort into emergent patterns Positionality: perspectives and stance Roles and relationships: references to other people Organisations and systems: how are they described? Stories: structure, genre, temporal reference, imagery and tone

58 Focus Group Analysis (IPA) Language use: metaphor, idiom, euphemism, pattern, context and function Return to emergent themes: what experiences are being shared? How are they making things meaningful? What are they doing as a group? Consensus issues? Conflict? How managed/resolved? Integration of multiple focus groups: commonalities and differences, connection to theories and explanations

59 Evidence Based Practice: Hierarchies of evidence Level 1: Single RCT or meta-analysis of RCTS Level 2a: At least one well designed controlled study without randomisation Level 2b: At least one other well designed quasi-experimental study Level 3: Evidence obtained from well designed nonexperimental descriptive studies, eg case studies, correlation studies Level 4: Expert committee reports or opinions and/or clinical experiences of respected authorities

60 Participant Observation Methodologies Participant observation as a continuum of roles: The complete participant The participant as observer The observer as participant The complete observer Ethics and involvement Reactivity and demand characteristics Social facilitation

61 Approaches to Structured Observation Elliott s (1991) Five Stage Process of Decision-Making Stage One: Perspective of the observation study 1. Is researcher a trained observer eg in use of reliable coding scheme? 2. Or an expert participant eg a psychotherapist or supervisor? 3. Or an index participant with expertise eg psychotherapy client or supervisee?

62 Approaches to Structured Observation Stage Two: Focus of the observation Which element of the behavioural process is studied: Is it the client or client system? The psychotherapist or their agency? Or the rated quality of their relationship? (interaction of participants)

63 Approaches to Structured Observation Stage Three: What kind of behaviour or process variables are to be studied? Content, or what is said, meant or expressed (as ideas or themes) Action/intention (behaviours, tasks, response modes) Style, or how it is done, said or expressed (duration, frequency, intensity, mood, para-linguistic, non-verbal behaviour) Quality, or how well it is done, said or expressed (accuracy, skilfulness, appropriateness)

64 Approaches to Structured Observation Stage Four: Selected useful units of study Idea unit (sentence, single expressed idea) Interaction unit (a speaking turn, a response to the other) Topic or task unit (episode, series of actions or speaking turns) Scene unit or occasion (eg time limited interaction) Interpersonal unit (relationship between two people) Institution unit, or organisation, system of relationships Person (self history, sets of beliefs, organisational involvement)

65 Approaches to Structured Observation Stage Five: Sequential phase, what happened before, during, after the unit of process Context or antecedents, what led up to the process eg previous behaviours, speaking turns Process or behaviours eg particular process observed at given level or unit Effects or consequences, eg psychotherapy outcomes

66 Comprehensive Process Analysis CPA (Elliott, 1989) was developed to analyse both individual events and themes across events, focusing on four areas of understanding: Expanding key or peak responses in an event eg exploring implied meanings within a response The context out of which the event arises, and that gives it meaning, eg what had been happening before or after the event, nature of the therapeutic alliance, background features of client and therapist, client s preferred ways of coping, cultural attunement of the therapy,...

67 Comprehensive Process Analysis Important features of the event, eg therapist action, interpretation and style, and client expression of thoughts and feelings Impacts of the event eg understanding, changes in mood and beliefs, anticipated changes, etc

68 Helpful Aspects of Therapy/Supervision Questionnaire Immediately following a therapy or supervision session, identify one helpful event, and rate it 1-5 on a Likert scale (least to most helpful) Write a brief description of the helpful event, and say why it was helpful Identify one unhelpful event and rate it 1-5 Write a brief description of the unhelpful event and say why it was unhelpful Rate the overall helpfulness of the session, 1-5, least to most helpful

69 Helpful Aspects of Therapy/Supervision Questionnaire (cont d) Again, using 5 point scales, each event can be rated on the following nine areas: Personal insight Problem clarification Problem solution Understanding about others

70 Helpful Aspects of Therapy/Supervision Questionnaire (cont d) Increase in understanding Reassurance Sense of relief Involvement in the therapy/supervision Personal contact with the therapist/supervisor

71 Publishability Guidelines: Quantitative & Qualitative Research Explicit scientific context and purpose Appropriate methods Respect for participants Specification of methods Appropriate discussion Clarity of presentation Contribution to knowledge

72 Publishability Guidelines: Qualitative Research Owning one s perspective Situating the sample Grounding in examples Providing credibility checks Coherence Accomplishing general vs specific research tasks Resonating with readers

73 Trustworthiness Criteria for a Qualitative Research Dissertation Rationale for the research question Methodology Persuasiveness Reflexivity Coherence Relevance/pragmatic use

74 Validation/Credibility Checks Respondent validation Face/Ecological validity Concurrent/contextual validity Triangulation Independent audit Presentation of evidence/rhetorical power Internal coherence Transparency and reflexivity Generativity

75 Validation/Credibility Checks Sensitivity to context: Relevant theoretical and empirical literature Socio-cultural setting Participants perspectives Ethical issues Empirical data Yardley, 2000

76 Validation/Credibility Checks Commitment and rigour: Thorough data collection Depth/breadth of analysis Methodological competence/skill In-depth engagement with topic Yardley, 2000

77 Validation/Credibility Checks Transparency and coherence: Clarity and power of your argument Fit between theory and method Transparent methods and data presentation reflexivity Yardley, 2000

78 Validation/Credibility Checks Impact and importance: Practical/applied Theoretical Socio-cultural Further research Yardley, 2000

79 Criteria for Evaluating Qualitative Research Rigour competent management and systematic approach? Relevance value of the research in terms of applicability and contribution? Resonance taps into emotional/artistic dimension that touches the reader? Reflexivity researcher self-awareness and openness about the research process? (Finlay and Evans, 2009)

80 A few references. Braun V and Clarke V (2013) Successful Qualitative Research: A practical guide for beginners. London: Sage Bryman A (2006) Integrating quantitative and qualitative research: how is it done? Qualitative Research, 6, Bryman A (2007) Barriers to integrating qualitative and quantitative research. Journal of Mixed Methods Research, 1, 8-22 Burck C (2005) Comparing qualitative research methodologies for systemic research: the use of grounded theory, discourse analysis, and narrative analysis. Journal of Family Therapy, 27, Dallos R and Vetere A (2005) Researching Psychotherapy and Counselling. McGraw Hill/Open University Press

81 A few more references. Harper, D and Thompson A (2012) (Eds)Qualitative Research Methods in Mental Health and Psychotherapy. Chichester: Wiley Blackwell Lyons E and Coyle A (2007) Analyzing Qualitative Data in Psychology. London: Sage Robson C (2011) Real World Research. Third Edition. Oxford: Blackwell Smith J (2008) Qualitative Psychology: A practical guide to research methods. Second Edition. London: Sage Smith J, Flowers P and Larkin M (2009) Interpretative Phenomenological Analysis: Theory, method and research. London: Sage