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Determining the selection criteria and rationale for including participants in a qualitative study is an important initial step in conducting research’ (Suzuki et al., 2007 p. 299).

My inclusion criteria, which were informed by the literature, a pilot-interview that I conducted and my research questions, were originally rather broad and included any mother-therapist who had worked with a mother whose child had died, regardless of children’s ages, types of qualification, or types of death. Following my presentation of the research at the research panel, it was suggested to me that these inclusion criteria left room for a lot of in-sample variation. I was advised to be much narrower in the inclusion criteria in order to reach greater homogeneity, as it was felt that this would allow for a deeper exploration of a shared experience. This recommendation was given to me with the view that if the criteria became too narrow they could be widened.

73 My initial inclusion criteria thus were as follows:

Participants need to be qualified psychotherapists/counselling psychologists/clinical psychologists (of any orientation) and registered either with the BACP/UKCP/BPS.

They need to be active mothers of children under the age of 5 and not have suffered a miscarriage, loss of a child themselves or are pregnant at the time of the interview.

They need to have worked with mothers who were grieving a child no older than aged 7. This child should have died of reasons unforeseen during pregnancy and after being born.

I aimed to recruit 3-4 participants and interview them twice.

I used ‘snowballing’ (McLeod, 1994) as a recruitment method, which meant that I sent the recruitment poster to colleagues and peers, who in turn sent it to other colleagues. I contacted hospices within the West Midlands and London area, both children’s hospices and adult hospices. I contacted bereavement services, some of which specialised in working with bereaved parents/families in the West Midlands and got in touch with several children’s hospitals locally and the London area as well as NHS psychology departments. I furthermore advertised through the Counselling Psychology Newsletter, the website of ‘Child Bereavement UK’ and ‘Cruse’ (following gaining ethical approval from their own research committee) and emailed

counsellors, therapists and psychologists of the ‘Counselling Directory’.

Despite positive feedback and general interest in the study, recruitment was

unsuccessful for several months. This felt like an incongruence, which left me feeling confused but also curious. How could it be an exciting, interesting research yet no one came forward to take part? Reflecting on the general positive feedback from

74 practitioners who themselves did not fit the inclusion criteria, I concluded that rather than the research question or topic being the issue, it might have been due to the narrow inclusion criteria and potentially other factors. I therefore decided to widen my criteria on a couple of occasions. The university agreed with me that in order to make this research come off the ground I needed to allow for more variation within my sample.

Yet, the inclusion criteria did not seem to be the only obstacle that prevented mother-therapists from coming forward. During my attempts to recruit participants, I had a lot of feedback from agencies and professionals. I think it is of value to the reader to gain some understanding of the reasons why some mother-therapists chose not to participate and my reflections on them. I think this will help create insight into this research and the topic under study. Firstly, working with child-death is an issue that some mother-therapists choose not to engage with due to its potential impact on their personhoods. Secondly, some mother-therapists, though having worked with child-death, were concerned that the interviews might bring up issues for them that were too close to home. Thirdly, a lot of grief work is done less formally in group settings through other bereaved parents (Schiff, 1977), or systemically when the therapist works with the whole family not just the mother (Kissane & Bloch, 2002), as is common in hospice settings. Fourthly, lack of time and lack of identification with the research topic might have been an additional reason. Lastly, reflecting on my recruitment posters and emails, I, as a fellow mother-therapist remained largely absent. Thus, rather than creating a transference that portrayed me as being interested in their experience as a fellow mother-therapist, it might have created a transference of me as a more distant researcher. Sharing a sensitive experience

75 within this pre-transference might have felt unsafe or as opening themselves up to judgement and pain. Hence, unconsciously perceived power-dynamics might have been at play when potential participants decided that this research was ‘too close to home’. This final consideration comes as a result of reflecting on the participants who I did interview. All but one came through word of mouth and either had heard of me and the research through a third party known by both of us, or they knew me through previous professional involvement. Thus, a positive and safe transference might have been established before meeting me.

Considering these aspects and the voices that are therefore not represented in this research project means that the voices that are represented in this research consist of mother-therapists who firstly, felt they could take on this work, secondly, felt they had something to say about this work and thirdly, felt that they could talk about this work in a research environment. As Polkinghorne (2005) states:

‘Thus, gathering participants involves not only choosing those who fit a selection strategy but also finding people who are willing to be interviewed.’ (p. 141)

The obstacles I encountered in this recruitment process thus highlight the concept of

‘inclusion bias’ (Polkinghorne, 2005) in qualitative research and purposive sampling in that usually only those who feel they have something to say on the topic will be included or come forward to the study, resulting in other opinions not being taken into account (Suzuki et al., 2007).

76 Influenced by Polkinghorne’s above statement, I applied a more open approach to sampling, which meant that I went to see who was prepared to be interviewed about their work with a bereaved mother. Doing so meant that I could include my pilot interview in this research project, who did not fit the initial inclusion criteria. I furthermore managed to recruit another five mother-therapists. I interviewed all mother-therapists twice (the participant from the pilot only once as I could include her first interview), with full consent, which included consent to the material being

published.

Following these interviews, I had a further review of my sample with my supervisor and with the head of research at Metanoia. It was felt that within this sample of six mother-therapists there was a range of in-sample variation, which could be split into two separate samples. Sample 1: consisting of four mother-therapists who were either in training or fully qualified counsellors/psychotherapists/psychologists with children under the age of 16 at the time of their first interview, and who had worked with mothers whose younger child had died (0-16). Sample 2: two mother-therapists who were volunteer-counsellors and mothers of older children (+16), and who had worked with mothers whose older child had died (+18). Due to their differences in training routes, professional status and ages of the children it was felt that they should not get mixed in an IPA study. Keeping them separate meant that

homogeneity of either sample would be greater and thus more desirable for an IPA study.

Since this doctorate is in the area of Counselling Psychology, we decided that the analysis would be on the interviews of sample 1 only. However, since all participants

77 gave consent to publication, it was suggested to me that the data of sample 2 could be used in a separate piece or be used in combination with sample 1 following the completion of this doctoral research project. Moreover, despite the mother-therapists from sample 2 not featuring in the analysis of this thesis they are present silently in the structure of the research. They were the first two interviews (after the pilot interview) that I conducted. They therefore greatly challenged some of my biases, such as my belief that this work would constitute only challenges and make mother-therapists scared that their own children would die. I learnt through these two interviews that within this work there was potential for connection, mutuality and deeper appreciation of life. Learnings, which widened my researcher lens.

Due to participants’ consent suggesting that their data could be used for publication, I concluded not to inform the two mother-therapists of the decision not to include them in the data analysis for this project. For if I do publish a text that involves the data of the mother-therapists in sample 2 in the future, after telling them that their data would not be included, this might feel confusing to them. I arrived at this decision after careful reflection and consultations with a supervisor and a trusted colleague, who both questioned the ethics of informing participants about not being included. For participants gave their consent to use the data in a way that felt appropriate to the research, which in this case was not the analysis but the overall research, so they are still in the research. Furthermore, hearing that they would not feature in the analysis might make them feel that their contributions were less valuable or not good enough. It could be perceived as hurtful, which was the

personal experience of my colleague who had been told that her interview would be

78 excluded from the analysis of a research in which she had taken part. The decision not to inform them is therefore a combination of all these reflections.

The recruitment process felt messy and created moments when I felt stuck. I felt anxiety around how to move forward and fears that this study would not happen. I had not foreseen these issues. I engaged in a lot of self-reflection and supervision in order to come to terms with these obstacles and arrive at a creative stance that enabled me to embrace and overcome them rather than to fight them. Nevertheless, this process taught me a lot about the intricacies of conducting qualitative research and the different hurdles that can emerge at various parts of the process.