Análisis comparativo: EEUU, Cuba y España

Act 2, Scene 1: What I tell you you are

Having worked in ED services I was very conscious of the “not good enough” themes that were being perpetuated by the different service thresholds and

commissioning structures nationally. I was reluctant to start advertising for a study that contributed to this narrative by only wanting to interview participants with severe and enduring experiences of eating disorders. In consultation with my supervisors it was felt this could be minimised by recruiting through services who could circulate the advertisement around service-users that were more likely to meet the inclusion criteria of a minimum of 10 years self-reported experience, and the exclusion criteria of having to be known to specialist service.

However, this did not result in enough interest initially. Previous qualitative research with individuals have reported a reluctance of participants with long-term experience with EDs to trust new professionals and researchers (Robinson, Kukucska, Guidetti, & Leavey, 2015), and one of the participants, Mark, sheds further light on why this might be the case, by sharing, with permission, a text from his friend who didn’t want to participate:

I also suspected that recruitment was slow because I was dependent on clinicians informing potential participants, which was going to be subject to their 1)

remembering to do so in a busy work environment and 2) ascertaining if they felt their clients were “well enough” to approach.

This challenge was happening during the period where I was undertaking my literature review and coming across structuralist and postmodern schools of thought for the first time. By exploring the role of language in the experience of anorexia nervosa I began to understand more about the oppressive nature of language and patriarchal service structure. I began to – again - emotionally rather than logically appreciate the truth behind statements like “the world is not a simple reflection of how it actually is, but is created and sustained by social processes, particularly language” (Forrester, 2010, p. 22).

This helped me make sense of why I had been so nervous about the way I spoke to people, and service-users in particular, about why I was constantly worried about how I answered questions about clinical theory and research and what I felt uncomfortable about getting “wrong” in these conversations with colleagues, peers and even friends. Having spent much of my formative academic years learning about a positivist interpretation of psychological theory and research, much of what I was feeling and assimilating was at odds with how I had come to understand how knowledge was constructed and deemed credible.

However instead of these realisations making me more nervous about how I approached things, I felt my knowledge and understanding about structural

approaches and feminist perspectives gave me the confidence to better understand and articulate my intentions. I put through an amendment to expand recruitment to a special interest group, and I redrafted some of the recruitment material in line with

how participants I had already interviewed spoke about their experience, making changes like “long-term experience” instead of “severe and enduring experience”. A further six interested parties came forward after this second phase of recruitment, three of which took part in the study. Of the other three, two stopped responding to emails and one had to cancel the interview and was unable to reschedule within the timeframe the interviews needed to be completed by.

Of the two that had stopped responding I initially excluded one due to them not having experience of specialist services. However, when they explained that this was because it had not been available in their geographical area when they required it, I went back to the NHS ethics committee and advocated for their inclusion. I was surprised and disappointed that in my own attempt to extend beyond an objectivist stance and enabling people to self-define their experience in terms of length and type of eating difficulties, I had overlooked the possibility that this research would end up being so excluding. Unfortunately by the time the Ethics committee responded to and accepted my request, this person was no longer responding to my emails.

This highlighted for me how easy it is to overlook those who have already been overlooked. In the interplay between undertaking my literature review, and simultaneously recruiting, interviewing and listening to participants’ experiences, I was beginning to realise the full value of postmodern and discourse analytic approaches, which “retreat from the investigation of core questions” (Abraham & Hampson, 1996, p 226 in Crossley, 2007) and end up highlighting alternative

Act 2, Scene 2: How I went about this

For the research paper, my research question remained broad. Although I was interested in experiences of specialist service provision, I employed an unstructured approach to the qualitative interviews to facilitate the generation of biographical narratives (Howitt, 2010). I did this so as not to put a boundary on the type of story I wanted to hear, and there were strengths and limitations to this approach. A strength was that participants might have found it prescriptive or deterring to limit the content of their interviews to their experience of services, particularly given how many were still availing of their support. I also wanted to maximise on the value of the narrative approach in situating an individual in their wider social and cultural contexts.

Nevertheless, while narrative approaches can be particularly powerful and emotive, the potential for this was made clear to interested participants, and I wanted to give them as much or as little time as they felt comfortable with to express their experiences. Summary stories were made available within two weeks of the initial interview date and participants were offered to review these in person, via email or over the phone. This created the opportunity to provide containing feedback about the interview experience, and an acknowledgement of the value and importance of

However, this also resulted in hours of rich data per participant, to which I later had to apply a more content specific narrative analysis in to order explore participants’ interactions with services, and elicit the consequent impact of these on the development of their self-constructs.

Thus, while I found this approach reassuring as it allowed me to verify my understanding and interpretation of the participants’ personal narratives and better facilitated the two-way “dance” of appropriation in narrative interpretation (Murray, 2008, p. 121) in allowing me to feel more confident that I understood participants’ perspectives, and motivations for sharing different aspects of their stories. This process heightened both the challenges, and the value of employing a narrative approach, which “can appreciate the linguistic and discursive structuring of ‘self’ and ‘experience’” (Crossley, 2007, p.226) while also maintaining a sense of the personal and “real” nature of individual subjectivity.