Social sciences research is guided by underlying philosophical assumptions based on the nature of social phenomena (ontology) and how this word can be known (epistemology; Blaikie, 2007). At one end of the ontology spectrum is the position that the social world exists independently of social actors, and at the other is the view that social phenomena are the product of social interaction (Bryman, 2016). Epistemology asks how social reality can be known, or what constitutes acceptable knowledge (Bryman, 2016).
Ontological and epistemological assumptions are intimately connected, as statements about the nature of social phenomena have implications for how knowledge can be gained of these social phenomena, and the appropriate research methods used (Blaikie, 2007; Bryman, 2016). The assumptions also provide a particular framework through which reality is viewed (Silverman, 2015), and influences the conclusions which can be drawn from research (Moisander & Valtonen, 2006). It is therefore crucial that a researcher states the positions taken, given these implications for the type of knowledge which is produced.
One ontological stance is “realism”, which posits that external reality exists separately to our descriptions of it (Blaikie, 2007; Bryman, 2016). Within realism, phenomena in both the natural and social world have an existence which is
independent from social actors, and social science aims to discover regularities and laws in the social world (Blaikie, 2007). When it is believed that the terms used to describe reality correspond very closely to reality’s true nature, this position is often referred to as “naïve”, “empirical”, or “shallow” realism (Blaikie, 2007; Bryman, 2016). According to this version of realism, it is possible to accurately know reality, given the right methods are employed (Bryman, 2016).
However, “realism” refers to a wide range of views (Pernecky, 2016), and many realist researchers do not subscribe to the more extreme claims made by “naïve” realism. Critical realism is member of the realist family, which has grown from the work of Roy Bhaskar (for example, Bhaskar 1979; 1989). Ontologically, critical realism asserts that a real world does exist independently of our beliefs, but also takes a constructionist epistemological position by stating that this real world cannot objectively be known (Maxwell, 2012; Pernecky, 2016; Guba, 1990). A
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constructionist epistemology involves recognising that meanings are constructed and influenced by context, and that researchers and participants construct meaning
together (Blaikie, 2007; Silverman, 2015). This contrasts with the positivist approach sometimes associated with naïve realism, due to positivism’s focus on collecting data in a value-free, objective manner to arrive at an accurate picture of the truth (Silverman, 2015). However, critical realism also rejects the assertions of some constructionist approaches that there are multiple socially constructed realities, and instead posits the existence of “different valid perspectiveson reality” (Maxwell, 2012, p.9)
Additionally, limitations in the human senses and the nature of observing as interpretive (Blaikie, 2007) means that knowledge of social reality cannot be certain and will always be flawed (Scott, 2007). Critical realism accepts that there are differences between the social world as it actually exists, and the terms used to label this reality (Bryman, 2016). The nature of knowledge as theory-laden is accepted (Maxwell, 2012); the theories and interpretations produced by different researchers will vary, but they all attach in some way to reality.
Relatedly, there is space within critical realism to include theoretical terms in explanations of social reality, which further contrasts with positivist and empiricist approaches in which only observations via the senses constitute legitimate scientific knowledge (Bryman, 2016; Pernecky, 2016). Bhaskar (1989) refers to “generative mechanisms”, which are theoretical explanations for observed regularities in the natural or social world. These mechanisms are of key importance, as critical realists attempt to develop explanations for observed associations between phenomena (Maxwell, 2012). The appreciation of context is also relevant to the centrality of generative mechanisms, as contextual factors influence generative mechanisms (Bryman, 2016). Additionally, critical realism regards mental phenomena as equally real to physical phenomena, as mental states influence social actors’ actions and worlds (Maxwell, 2012). To obtain the richest explanation of social reality, critical realism considers social actors’ inner states, context, and the possible generative mechanisms producing an observed regularity (Bryman, 2016; Scott, 2007).
The critical realist approach is also sometimes associated with a
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“hypothetico-deductive method” which advocates the collection of data in an attempt to refute a particular theory (Popper in Blaikie, 2007). Theories “passing” this test can be tentatively accepted; as with critical realism, theories are proposed as a way of explaining observations, but this knowledge can never be truly certain. The role of theory in the present thesis is outlined in further detail below (see Section 2.1.2).
Having outlined the core principles of critical realism, I would like to now explain why I deemed this to be an appropriate epistemological and ontological choice for the present thesis. With team discussion, I felt that there was an interaction of some kind occurring between TBIs users and the TBIs themselves, existing as part of social reality. Consequently, I take the realist ontological
component of critical realism, and aim to explore the nature of this interaction with this thesis.
As described above, critical realism accepts the use of theoretical
terminology in referring to social reality (Maxwell, 2012). In the present thesis, I am examining the interaction between users and TBIs through the theoretical lens of therapeutic alliance. Therapeutic alliance theory was chosen due to the decades of previous research conducted on the concept in the context of face-to-face therapy (see Sections 1.10 and 1.11). In brief (full details provided in subsequent sections if this chapter), the systematic review synthesised data on the user-TBI interaction using a framework built from concepts central to therapeutic alliance theories. Many of the questions in the qualitative interviews also concerned these concepts, and participants’ accounts were interpreted in light of them.
I accept that I can only know reality via my own interpretations and terms I use to describe it, which is limited in its correspondence with actual social reality. Thus, I accept that I am attaching theoretical concepts to the data synthesised in the systematic review and the accounts given by qualitative interview participants regarding their reality. This is in keeping with critical realism, but would have been unacceptable had I taken an empiricist approach, as theoretical entities such as the “therapeutic alliance” are not directly observable.
The presence of generative mechanisms in critical realism is also relevant to my thesis’ aims, because therapeutic alliance has been suggested as a causal
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concerned with creating explanations for observed phenomena (Bryman, 2016; Maxwell, 2012), exploring therapeutic alliance as a possible mechanism that influences user engagement with TBIs is philosophically consistent with critical realism.
Lastly, I also feel it is necessary to outline why critical realism was felt to be appropriate for the qualitative interview study. Indeed, Maxwell (2012) has
specifically written a book to advocate the value of realist approaches for qualitative research, as this is an uncommonly stated position within qualitative research
(Maxwell, 2012). As critical realism provides a position from which is it possible to examine the relationships between social actors’ perspectives, situations and
contexts, it can be a useful approach to qualitative research (Maxwell, 2012). With examples from the the present project, this means I could examine how the context in which someone accesses a TBI influenced their interpretations, or consider how my interview questions influenced their account. As realist positions can be useful within qualitative research for exploring causal explanations (Pernecky, 2016), it is an appropriate position for exploring some of the interview study’s research
questions (for example – “which factors influence the alliance in TBIs?”). As ontological and epistemological assumptions influence the kind of research questions asked and knowledge obtained, I should note that alternative positions could have been chosen, which would have altered the kind of knowledge produced by this thesis. One such alternative approach is “interpretivism”, which rejects the notion that natural science principles can be used in social science, as the social world is completely different to the natural world (Bryman, 2016). The focus of an interpretivist piece of research involves understanding the subjective meaning and interpretations that people attach to their world, rather than examining external “forces” acting upon it (Bryman, 2008). Interpretivism is typically associated with the use of qualitative methods (Maxwell, 2012).
An example of an interpretivist approach is phenomenology, which seeks to understand, in detail, how an individual makes sense of their surrounding world and experiences (Bryman, 2016). A phenomenological method known as interpretative phenomenological analysis (IPA) emphasises the detailed exploration of an
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to make general claims; rather, it focuses on the perceptions of a particular group in great detail, and therefore often aims for a relatively homogenous sample (Smith & Osborn, 2015). Using IPA in this study, I would have been able to draw conclusions about the detailed experiences of a small group of TBI users. As my research aims are concerned with common engagement and therapeutic alliance features present across the experiences of people representing a range of clinical groups and TBI formats, it does not appear that IPA would have been an appropriate approach for this study.
Indeed, taking an interpretivist approach to this thesis would produce would alter the claims I can make regarding therapeutic alliance and TBIs. This is because an interpretivist approach focuses on the subjective meanings social actors hold with regard to their experiences, and does not seek to make claims regarding an external reality. With an interpretivist approach, I would be able to make claims regarding TBI users’ interpretations of their experiences using a TBI, but unable to make claims about an external reality pertaining to those beyond my participant group. As such, I did not opt for an interpretivist approach, as I wanted the ability to make wider suggestions about people’s interactions with TBIs beyond the perspectives of those I interviewed, or data from the papers included in the systematic review, and ultimately influence TBI development.
With an interpretivist position such as phenomenology, it would also be inappropriate to examine a previously outlined theory (in this case, therapeutic alliance theory), as this would unduly constrain participants’ responses in this approach. Whilst an interpretivist approach aims to understand participants’
perspectives, a realist approach aims for explanation and causality (Pernecky, 2016). Given the aims of the project included answering causal questions, a cautious reality approach was deemed to be more appropriate.
To summarise, the philosophical position I have taken with regard to this thesis is critical realist. Ontologically, I am asserting that an external social reality does exist, and epistemologically, I am asserting that the way this reality can be known is mediated by our interpretations. I acknowledge a degree of constructionism in my position, as I will inevitably influence the way in which the account of reality is constructed in both the systematic review and qualitative interview study.
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It is also worth nothing here that research methods are much more “‘free- floating’” in terms of epistemology and ontology than is often supposed” (Bryman, 2008 – p.593). To illustrate, although qualitative research is typically associated with constructionism and interpretivism, and quantitative research with objectivism and positivism, this is not always the case (Bryman, 2016). Although certain
philosophical approaches are often associated with particular methods, these should be viewed as tendencies rather than absolute commitments (Bryman, 2016). This is relevant, due to my project’s apparent deviations from this usual divide (i.e. use of a realist approach within qualitative research).