Research does not take place in a vacuum but is affected by the social, cultural, political and intellectual context in which it takes place (Kingdon, 2005). As a researcher positioning yourself within any piece of work is essential in order for others to interpret what you have done and how you have influenced the knowledge produced at every stage of the research process, from design to dissemination, whether it is a clinical trial or ethnography (Davidoff, et al. 2001). From a social constructionist perspective there is no such thing as an ‘absolute truth’ (Lincoln & Guba, 2000). Instead we offer an understanding from our unique subjective perspective and are reflective in considering how our values and interests and are likely to have shaped our thinking (Atkinson & Hammersely, 1995).
My personal interest in working with people experiencing psychosis was inspired after attending a talk by Jacqui Dillon, an advocate and campaigner, who has personal and professional experience of hearing voices and mental health services (Dillon, 2009). Working in an 80 bedded inpatient unit at the time, which only had one clinical psychologist (my supervisor May Sarsam) who had been in post for about a year, meant that there was an opportunity to develop the psychology input to the wards and offer a group specifically for people with psychosis. Later I was able to attend hearing voices group facilitation training run by Jacqui which helped me to develop ideas about my role in
organising and managing the inpatient groups, with the intention of facilitating a collaborative group, rather than purely therapist led group, but with a focus on CBT and coping strategies.
Developing a research project in an area of clinical interest was important to me and extremely motivating. However it also presented a number of challenges in balancing the dual role of being a clinician and researcher, a common dilemma for clinical psychologists (Thompson & Russo, 2012). This was difficult at times, for example, when as a clinician I would have liked to follow up with participants individually after groups or when speaking to control group participants and could see much potential for intervention. However, whenever these issues arose I was able to utilise the staff co-facilitator, or a member of the ward staff, to follow up on these issues. At other times, it was frustrating to lose some people who wanted to take part in the groups but were put off by being asked to complete the study questionnaires. Although this was essential in order to be able to measure change, if I were to repeat the study I would change the way this information was collected (this is discussed further in the next section).
One particular challenge which highlights this dilemma was the inclusion of additional wards in the project over time. Once we started running the intervention groups on one ward, several managers from other wards wished to offer the same groups on their wards, without particularly wanting to take part in the research project. As a clinician this news was encouraging, demonstrating that the groups were valued by the care team. But from a researcher perspective it was problematic to have some wards only offering one arm of the trial. However, due to limited time and resources we allowed the additional wards to participate only in the intervention arm of the trial in order to maximize our data collection. As a result we have ended up with quite unequal numbers of participants in each group which affects our ability to draw firm conclusions from the data.
One of the greatest strengths, and biggest challenges, in running this group was that it offered participants a different message to the one that they were often (but not always) given by the medical or wider care team. Offering a group with a different perspective on mental health and ‘illness’ within a hospital setting required a careful balance in seeking to promote a new approach, without
undermining the modality of care being provided by medical and nursing staff. This was extremely important because the relationships service users built with the care team, and their confidence in the team’s approach and abilities, were essential for recovery. It was important that service users did not
lose confidence by interpreting the group’s introduction of a different message as direct conflict within the care team. Generally participants welcomed this different, more hopeful, message that they could do something to help themselves, and only occasionally did group discussion about the different messages appear to increase participants’ sense of frustration; usually (understandably) when people were detained involuntarily. In these situations, acknowledging the individual’s distress at their current circumstances in the group discussion was often something which brought empathy and altruism from other group members and I believe encouraged group cohesiveness. In addition, the majority of ward staff were overwhelmingly positive and encouraging about the group and accepted that it presented a different, additional perspective rather than a conflicting one.
While I have attempted to account for my own assumptions and expectations in this research it is inevitable that these will have influenced the data collection and analysis. I was responsible for collecting data, running groups and conducting the analysis so it is possible that I have unconsciously interpreted some participants’ responses as more favourable towards the group than those in the control group. This is an unfortunate consequence of inadequate resources to conduct blinded procedures. It is also possible that participants will have felt more inclined to give socially desirable responses in the intervention group. However, this was not always the case and some people were very clear in saying what aspects of the group they did not find helpful. Having built up relationships with people who attended the groups it is also likely that they might not want to give unfavourable responses on the satisfaction questionnaire, even when we directly asked what was least helpful. However, whilst we need to understand the context in which the findings have been produced, and bear this in mind when generalising and making interpretations, it does not mean that the findings are invalid or lack authenticity (Lincoln & Guba, 2000).