Tendencias de cambio

My clinical training and the need to hold the possibility that “participants” might evolve into “patients” created a more structured intake interview than might possibly be the norm within the research process. However, I felt it was imperative to obtain the necessary clinical background in order to facilitate the transition should this become necessary or desirable. In both settings there was no option of referring patients on for therapy. If the potential participant decided subsequently to withdraw from the research process, but still required therapeutic intervention, I needed to ensure that the necessary processes had been initiated.

While this might be viewed as an intrusion and entrenchment of a professional-patient power differential, I try to maintain a stance of respect and mutual exploration when working in the community, rather than of attempting to impose knowledge and or

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direction. In my clinical training there was an emphasis that, no matter what the context, presenting complaint or treatment approach, the underlying principles of person-centred therapy, (empathy, unconditional positive regard and congruence) should prevail. I try at all time to foreground these values in my interaction with patients and/or research participants (Mearns & Thorne, 2007).

From my experience, in the community, of working with patients presenting with medically unexplained symptoms (MUS), I compiled a basic framework of questions (See Appendix B). In formulating this list I attempted to frame the questions to provide both leeway for participant contribution while simultaneously ensuring that they were specific enough to allow collection of the kind of data that would be relevant to my research question.

I conducted a total number of 43 interviews with 20 research participants. I have not included in this number the sessions for those participants who subsequently became patients on an ongoing basis. All interviews were recorded and I personally transcribed each one, despite being offered the possible assistance of a professional transcriber. I felt this to be necessary both as a way to stay close and involved with the data, as well as to maintain the confidentiality of the stories. I felt uncomfortable with the idea of anyone else listening to the participants‟ intensely private, often heart-breaking stories that were presented to me privately within the context of a conversation between two people in a room. While these are made public within the context of this research, some distance is created by the anonymity that is inevitable with the use of pseudonyms, the extraction of pieces of dialogue from the whole and the written word offered in place of the spoken.

While I am aware that in many qualitative studies a pilot study is performed initially in order to fine-tune the process and content of inquiry (Morse, Barrett, Mayan, Olson, & Spiers, 2008; Silverman, 2013), I did not feel this was necessary in my particular research situation. As previously mentioned, my prior work in the two hospitals concerned rendered this superfluous. I was familiar with both hospital environments and infrastructure, had significant clinical exposure in both settings to patients with the condition under enquiry, a pre-existing referral relationship with the medical officers and allied health workers, and had the full cooperation of the management at both Hope and Waterstroom Hospitals.

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Listening to the interviews during the process of transcribing allowed me to refresh my memory of the content. While I had made supplementary clinical notes, I was surprised at how much of the subtlety I had missed while focusing on the exchanges in the room. Once all the interviews (forty three) had been transcribed, I did a close first reading of all these interviews and identified the sections which were related to physical symptoms, the patients understanding and experience of them, their interaction with the referral agent (apart from two exceptions they were all medical officers) and their feelings about being referred to psychology. Incorporated in the latter was an exploration of their understanding of psychology as a discipline. I grouped the initial headings into the following broad categories:

 Experience of symptoms;

 Experience of medical management;

 Understanding and feelings about referral to psychology;

 Their assessment of the outcome, i.e., how effective they felt the time with psychology had been.

During subsequent readings I further expanded these broad categories to include subheadings, providing more details and nuance in terms of their lived experience of the entire process.

I utilized a high quality digital recorder with excellent sound quality. I did not record the first session with Angela, as I hadn‟t anticipated the possibility of flat batteries. I was unable to record Mavis’s first session due to her aphonia. However, in both instances I kept notes in the session and once it had been completed and the patient had left the room, added to them to supplement anything I had been unable to capture. I did not want the taking of copious notes to disturb or undermine the relationship. As I mentioned in 3.4.3.3., throughout the year of data collection (and beyond) I kept a research diary in which I recorded my feelings – both positive and negative – about the process. My frustrations, observations, feelings of inadequacy, joy at pivotal moments, comments regarding transference and countertransference. Where appropriate these have been incorporated. I think that this journal, writing in it and

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reading it periodically, was an extraordinarily helpful mechanism to allow me to reflect on what I was doing and where I was going. It gave me the opportunity to assess my own processes with regard to both roles – researcher and clinician. Through writing in this journal, sometimes on a daily basis, I learned to adjust and refine both my clinical skills and my research activity.