Researching the Psychotherapy Process: A Practical Guide to Transcript-Based Methods
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Although IPR questions can be wordy at times, participants seem to internalize the focus of the study quickly, facilitating a smooth conversational flow to the interview.
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The following is an excerpt drawn from one of our transcripts to illustrate a reasonably succinct IPR question that includes reference to a specific video-recorded segment, a focus on process, a reference to the past, and a focus on hope. Interviewer: Being able to bounce those positive words around in the session, what did that do for your hope in that moment? IPR interviewers must draw on their intuitive and instructed knowledge of human interaction and behavior. As is common in other qualitative interviewing, attending to interviewees' nonverbal behavior, both on the video-recording and in the IPR interview, can reveal times of heightened emotion or inner processing as interviewees communicate their experiences, not only through words but also using tone of voice, expressions, pauses, and gestures Kvale, The interviewer is the research instrument Kvale, ; McLeod, Process interviewers must have the ability to facilitate in-depth, process interviews in a manner that gathers rich information and promotes the psychological safety and well-being of interviewees.
In our counseling process and hope research study, we have found that interviewers need to be comfortable with displays of strong emotion from interviewees. Although these displays are rare, possessing skills to work with interviewees who might experience emotional distress during process interviewing is essential. In addition, in our research we ensure that readily available, free-of-charge, qualified counseling is available to any participant who might need this service. Hence, our participants may return to their counseling therapist or another counselor to debrief any issues of concern following IPR.
Of course, the nature and potential for participant distress will be related to the nature of the process being examined. For example, our research reviewing recent counseling sessions might elicit quite different emotional content than an IPR interview focused on a patient education session at hospital discharge. In addition to preparing themselves for participants' emotional reactions during IPR, interviewers need to prepare themselves to work through any of their personal reactions following IPR interviews.
The impact of in-depth qualitative interviewing on graduate research assistants working with emotionally intense interview content can include the need to make sense of the inexplicable as well as experiencing difficult comparisons to one's own life Beale et al. Support systems such as debriefing sessions i.
Established debriefing procedures also allow the interviewer to consult if there are ethical or safety concerns that stem from the interview. During our research project our interviewers KF and RS met regularly with each other and the principal investigator DL to discuss their reactions, concerns, and questions regarding both IPR interviewing and any emotional impacts they were experiencing resulting from interviews. Following client interviews, KF, the client-interviewer in the current study, found journaling to be a very helpful way to process her experience of each interview.
Journaling allowed time to reflect on potentially emerging ideas or themes, new questions, and the personal impact of the interview. Regularly scheduling time to journal offered a moment to focus and reflect on her practice as an interviewer and her underlying intentions in the interview. For KF, journaling became an integral activity to think reflexively about potential ethical issues, refine issues for further discussion in research meetings, and process her emotional responses to facilitating the interviews.
KF also found it important to know that she was free to contact the study's primary investigator or the other research assistant for debriefing or with questions following client-interviews. At the end of IPR interviews it is important for interviewers to debrief with interviewees to ensure that they feel comfortable with the experience. IPR can put interviewees in a sensitive and vulnerable position where they have shared not only the content of their counseling session but also their private inner experiences.
Participating in IPR can also bring up emotional responses elicited by reviewing the counseling session. Nevertheless, client-interviewees as well as therapist-interviewees in our study report that participating in IPR proved overall to be either neutral or additive to their counseling experience. In our research the IPR investigators are also professional counselors.
Being trained counselors is both helpful and challenging to the IPR interview process. We suspect that practitioners from other disciplines who become IPR interviewers are likely to recognize benefits and challenges similar to those we have encountered. With respect to the benefits of selecting interviewers from within the profession under investigation, we found that being sensitized to the work of counseling allowed the interviewers to approach the IPR interviews with a broad foundational knowledge of the counseling context, therapeutic approaches, and common client issues.
These background skills and experience were invaluable in approaching the task of IPR interviewing. The interviewers' counseling training also raised challenges that needed to be addressed, as this training introduces the possibility of engaging in dual-role relationships with client-participants. The boundary between being an empathic, respectful interviewer and offering counseling was sometimes less than clear. In our research it was essential for the interviewer to remember that IPR is a research interview, not an opportunity to continue counseling from the session under review.
As client-participants respond to questions about their remembered experiences from their counseling session, they sometimes begin reprocessing issues in the interview. In these cases, interviewers can seek to validate participants' feelings and gently redirect them to focus on their remembered processes from the session. In addition, we have found that at the end of IPR interviews interviewers must debrief with participants to ensure that they have not become distressed from participating in the interview. Participants are also reminded that they can bring anything they learn or experience during the IPR interview back to their therapist if they so choose.
That's not my role right now [being a counselor]. I'm finding that safety planning techniques are helpful sometimes. In our research therapist-participants also contribute to our data collection.
Issues between interviewer and therapist-participants differ somewhat from those encountered between interviewer and client-participants. To provide their contribution to the research, therapist-participants make themselves vulnerable by opening up the intimacy of the counseling process and the therapeutic relationship to exploration by an outside observer. To assist therapist-participants in feeling comfortable with the IPR interview, it can be helpful to acknowledge their contribution gratefully and to clarify the role of the interviewer.
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Therapist-participants might feel more comfortable knowing that the interviewer will approach the IPR interview as a researcher, from a place of curiosity, not from one of judgment. The IPR interviewer is interested in the therapist-participants' experiences and how these experiences guide their clinical choices.
The focus is not on clinical skills or judgment of those skills. In addition, it is helpful to discuss that boundaries regarding professional roles are important and will be maintained.
We seek to assure therapist-participants that we will not be providing clinical interventions with their clients. Any requests that their client-participants might make for professional care will be redirected to the clinician for discussion.
Researching the Psychotherapy Process: A Practical Guide to Transcript-Based Methods
Furthermore, our research focuses on a single session. Hence, as researchers we take no responsibility for follow-up and do not track any follow-up with the client. This is entirely the responsibility of the counselor working with the client. Participating in qualitative research focused on personally meaningful topics often leads to positive feelings or a sense of personal growth from the experience Kvale, They offer interviewees the opportunity to reflect on their experience, explore personal values, and create new meanings.
Researching the Psychotherapy Process
IPR interviews are no different. Interviewees tend to delve deeply into the memories and inner experiences of the issues they examined in the session. They are invited to reflect back on themselves and their actions both inside and outside of the session. In the current study interviewees reported that their IPR interview was helpful and enhanced their perception and understanding of their counseling session.
Because I'm hearing myself think.
Similar effects are reported in other IPR studies. For example, in Rennie's seminal counseling process study exploring the client's covert experiences of therapy, all 12 interviewees indicated that the IPR inquiry had affected them. Several suggested that they had gained a different or enriched view of the therapy session as a result of participating in the IPR interview.
Therapist-participants in our research also report positive experiences with the IPR process. All five therapist-participants in our research have indicated that they acquired knowledge from the research experience that they find valuable in their clinical practice. Reviewing the video-recorded session in a systematic and disciplined way assists many therapist-participants in attaining a clearer view of the client and of the counseling process in a particular session. Therapist-participants have reported that these new understandings can then be carried into subsequent sessions with the client.
Participants further stated that taking part in the IPR interview was an affirming experience and confirmed the value of their work. Finally, many therapist-participants indicated that they had learned about their own hope and their own process as a therapist. IPR interviewing methods provide a unique way of accessing aspects of human interaction that are difficult to approach via other research means i.
Because of the uniqueness of video-assisted interviewing and a focus on process, some final implications for the use of IPR, for participant selection, and for use in various disciplines must also be noted. First, as with many professional practices employing conversation e. With its intense focus on process and reflection, the role of reflexivity in IPR interviewing is clearly important and worthy of further exploration and research.
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In a related issue, with respect to participant selection, the nature of IPR interviews requires interviewees to delve into, reexperience, and describe their inner cognitive, affective, and somatic experiences and processes. Nevertheless, even our seemingly less self-reflective client-participants have provided rich insight and description of various aspects of the counseling process from their perspective. Also with respect to participant selection, taking part in an IPR interview can be an emotional experience for the interviewee.
At times the focus on underlying process might even elicit a more visibly emotional response than the therapeutic session under investigation does. Individuals who are currently experiencing acute crisis, suicidal ideation, or other potentially overwhelming situations are not considered suitable candidates for IPR.
In addition, because participants observe their own behavior on screen during the IPR interview, this interview method is not advisable for use with individuals struggling with psychoses.