Content uploaded by Per-Einar Binder
Author content
All content in this area was uploaded by Per-Einar Binder
Content may be subject to copyright.
1
Staying close and reflexive – An explorative and reflexive approach
to qualitative research on psychotherapy
Per-Einar Binder, Helge Holgersen, Christian Moltu
Per-Einar Binder, Dr.psychol., is professor and head of Department of Clinical
Psychology, University of Bergen.
Helge Holgersen, Ph.D., is associate professor and head of Outpatient clinics for
children and adolescents, University of Bergen.
Christian Moltu, Ph.D., is researcher and psychologist at Division of Psychiatry,
General Hospital of Førde.
This is an Author's Accepted Manuscript of an article published in in Nordic
Psychology, 64:2, 103-117 [copyright Taylor & Francis], available online at:
http://www.tandfonline.com/doi/full/10.1080/19012276.2012.726815
To cite this article: Per-Einar Binder, Helge Holgersen & Christian Moltu (2012):
Staying close and reflexive: An explorative and reflexive approach to qualitative
research on psychotherapy, Nordic Psychology, 64:2, 103-117
Address for correspondence:
Professor Per-Einar Binder
Department of Clinical Psychology
University of Bergen
Christiesgt. 12
5015 Bergen – Norway
Tel: +47 5558 3198
Fax: + 47 5558 9877
E-mail: per.binder@psykp.uib.no
2
Abstract
Qualitative research has the potential to explore patient and therapist experiences of
psychotherapeutic processes, as well as the challenges and opportunities inherent in
relational and technical aspects of therapy. This paper examines explorative and
reflexive ways of doing qualitative research on psychotherapy, based on the
ontological and epistemological premises of hermeneutic phenomenology. An
explorative–reflective thematic analysis is presented as a team-based approach, with
a firm and transparent structure to the process of finding and interpreting experiential
commonalities and differences in empirical material from semi- structured interviews.
We use two examples of the interplay between phenomenological exploration and
reflexivity from the interviews of two adolescent psychotherapy patients in a research
project examining experiences of useful ways to establish a productive therapeutic
relationship. A systematic way of conducting explorative–reflexive thematic analysis
in a research team and with the assistance of computer software is described and
discussed. It is emphasized that the procedures in themselves do not guarantee the
result – they will only contribute if they also stimulate self-reflexivity and awareness of
the researchers as interpreters of basically ambiguous human experience.
3
Introduction*
To an increasing degree, qualitative research methods are recognized as highly
useful for the investigation of the experiential world of clients and therapists, the
relational context of interventions and personal growth processes – the “how” and
“what” questions of process and change. This is a valuable addition to studies based
on “how much” – questions concerning the overall efficacy of psychological
interventions best investigated by quantitative approaches. Exploration of the
experiential world of clients, service-users and professionals within the mental health
field will inform us about the perceived relevance of interventions: how relational
processes constitute specific contexts of change for clients, and how personal and
interactional struggles are experienced as important and necessary conditions in
change and growth processes in psychotherapy (e.g. Binder, Holgersen, & Nielsen,
2010; Moltu & Binder, 2010).
Within clinical psychology, and especially the psychotherapy field, a tradition for
qualitative research has gradually developed through the last three decades (Finlay
& Evans, 2009; Frommer & Rennie, 2001; McLeod, 2011; Rennie, Watson, &
Monteiro, 2002). Investigating the lived experiences of a sample of participants
(clients and/or professionals) always brings with it a tension: we address the world of
particular persons and relationships, and, at the same time, we aim to compare,
abstract and make general statements about patterns of homogeneity and
heterogeneity in a group of individuals. In other words, we both aim to study each
participant’s personal and idiosyncratic experiences within psychotherapy in great
detail, and simul- taneously, to express common themes across multiple participants’
experiences. The question we will explore in this article is: how can one stay close to
the experiences of clients and professionals and, at the same time, explore, interpret
and find ways that adequately communicate these findings as knowledge contributing
to a professional and theoretical context?
Phenomenological exploration and hermeneutic reflexivity
We have found the ontological and epistemological framework of hermeneutic-
phenomen- ology useful to achieve a creative dialectic between phenomenological
4
exploration on the one hand, and interpretation and reflexivity on the other. Our
explorative reflexive approach is situated within the broader contemporary tradition
for qualitative research in psychotherapy (Frommer & Rennie, 2001; McLeod, 2011)
and adds a more extensive epistemological emphasis on the dialectic between
phenomenological immersion and context-sensitive theoretical and reflexive
interpretation (Finlay, 2003; Laverty, 2003; van Manen, 1990; Smith, 2007).
The phenomenological tradition starts with Husserl (1936/1970). Amedeo Giorgi
(Giorgi & Giorgi, 2003) is the one who has most clearly elaborated and applied his
approach within empirical psychology. Husserl and Giorgi represent an essentialist
approach to phenomenology. In this tradition “bracketing” of the researchers
preunderstanding is thought to be both possible and necessary to reach the essential
experiential structure of the subject examined. In the hermeneutic tradition after
Martin Heidegger and Hans-Georg Gadamer, the concepts of “essential” structures
and “bracketing” are regarded as problematic. The meaning of the other person’s
experiences is thought to be discovered and constructed in the meeting between the
researchers’ experiential horizon and preunderstanding and the horizon of the person
whose experiential world is to be examined. Heidegger (1962) will also examine lived
experience, but this is phenomenology from a contextualized perspective where
meaning patterns arise intersubjectively, through interaction and the use of
communicative signs and language. Gadamer (1989) builds upon Heidegger’s
perspective when he develops his dialogical hermeneutic, a hermeneutic where
meaning is thought to arise in the fusion of horizons between the interpreter and the
text that he or she interprets. The interpreter’s reflexivity upon his or her
preunderstanding can increase in meeting with the otherness of the text. A
consequence of this is that phenomenology, in Heidegger’s sense of the concept,
and hermeneutics, in Gadamer’s sense of the concept, build upon the same
epistemological premises. However, phenomenology addresses lived experience and
hermeneutics addresses texts and to a stronger degree addresses the reflexivity that
becomes possible through dialogical encounters with the otherness of the other
persons horizon.
Qualitative investigation of the experiential world of research participants always
involves a tension between:
5
1) Staying close and giving accurate descriptions of the participants’ experiences
– the “finding” and “discovery” basis of qualitative investigation;
2) Giving meaningful descriptions and analyses of commonalities and differences
in these experiences and the contexts they arise within – the interpretative
aspect of qualitative investigation;
3) Being self-reflective of how one’s own position within a social and cultural
context, one’s own theoretical, professional and personal background and the
relationship to the participants shapes the direction of inquiry, the space of
possible questions asked and possible interpretations of the findings.
Allowing for phenomena to be formulated as they were experienced calls for both an
open exploratory and safety-enhancing interview situation. The researcher can
contribute by taking a position where he follows and supports the participant’s search
for meaning. However, in order to gain access to specific experiences that the
researcher finds more important or relevant in his/her context of interest and
foreknowledge, a higher degree of structure is needed. Here, the researcher takes a
more leading role in the conversation. Such decisions will have an effect on the
distance or proximity vis-a`-vis the lived experiences of the participant. The reflexive
pole in this practical example will be continuous attention and awareness directed
toward how such choices are made, and how they might influence how the
participant’s utterances and narratives are being developed in the dynamics of the
interview situation.
Trustworthiness of the results in qualitative studies depends on transparency about how the
tension between the three poles above is dealt with in the research process leading up to the
findings. Some qualitative researchers recommend a consensual approach, where a research
team uses a firm structure to generate reliable descriptions of findings (Hill, Knox, Thompson
et al. 2005). Others argue that trustworthiness always depends on the self-reflectivity and
transparency of the researcher, and that following a line of reasoning in the analysis is
sometimes best done by a researcher alone (Rennie, 2000). We will examine how an
explorative and reflexive phenomenological approach may adequately address the tensions
between close descriptions of experience and theoretical analysis, and thus balance firm
structure in the analysis, as well as a creative and self-reflective in-depth investigation of the
phenomena at hand.
6
In an explorative reflexive approach, our aim is to stay close to the participant’s
experience. The actively empathic mode of listening, while at the same time relating
to the otherness of the participant’s world, is an important investigative entrance both
in the interviews and in the reading of transcripts. This is the explorative
phenomenological pole of a study. At the same time, listening always requires a
listener, and therefore involves the bodily, emotional, intentional and cognitive
experiential horizon of the person conducting the investigation. Becoming self-
reflective upon preconceptions and pre-understanding is a process that gradually
unfolds through careful listening to the other. As the “otherness” of the other
becomes clearer, the “me-ness” of the researcher’s own contributions to the act of
giving meaning and understanding also come to the fore. This evolving awareness of
oneself as an interpreting subject is the reflexive and hermeneutic pole in this way of
conducting research.
Based on this tension between phenomenological discovery and hermeneutic
understanding, we define the following epistemic principles to guide the development
of our methodology:
1. Access to the explorative phenomenological dimension is a prioritized ideal
that guides the accomplishment of research within a self-reflexive recognition
that this can only be partially achieved.
2. Meaning is not given to be objectively found, but is co-created between two
persons in the research interviews, and also between the researcher and data
in the analyses.
3. The objective of developing theoretical knowledge and professional
understanding from research participants’ experiences necessarily involves
acts of interpretation from the researcher’s perspective.
In the following, we will elaborate on these principles, through discussing access to
the explorative phenomenological level, the research interview, as well as self-
reflexively aware hermeneutic interpretation and application of findings from
qualitative research. We will then relate these principles to the broader knowledge
base in the field of psychotherapy.
7
Phenomenological immersion – from empathy via co-creation to recognizing
the otherness of the other
The aim of our approach is to generate descriptive knowledge and analytic concepts
from everyday experience through dialogic engagement with the participants in the
interview situation and the transcribed texts in the analyses. The commitment to, and
preparation for, exploring experience on a concrete level is the basis of the
phenomenological element in this approach (van Manen, 1990). The specific
phenomenological element lies mainly in the attitude toward, preparation for and
presence in the interviews, and the empathic uses of imagination in the reading of
the interviews.
How should one understand the phenomenological immersion into the world of the
other? These excerpts from Carl Rogers’ description of empathy both highlight some
of the possibilities, and at the same time, at a more implicit level, the limitations
inherent in a purely empathic mode:
“An empathic way of being with another person […] means entering the private
perceptual world of the other and becoming thoroughly at home in it. It involves being
sensitive, moment by moment, to the changing felt meanings which flow in this other
person, to the fear or rage or tenderness or confusion or whatever that he or she is
experiencing. To be with another in this way means that for the time being, you lay
aside your own views and values in order to enter another’s world without prejudice”
(Rogers, 1980, pp. 142-143).
Rogers highlights how empathy is a way of being and relating to another, and how
this way of being depends upon confidence and relational and emotional presence,
moment by moment. At the same time, we find that some aspects of this way of
relating are not sufficiently addressed in the context of exploring experiences for
research purposes: is it possible to not make judgments? Is it possible to lay aside
views, values and prejudices? Rogers describes the respect for the reality of the
other person’s experiential world and the radical receptivity and openness required to
stay truthful to the otherness of the participant. However, when we attempt to grasp
the world of the other, the specific emotional tone, prejudices and preconceptions of
our own experiential world will meet with theirs, and thus influence our understanding
8
of the other person’s experience. In this meeting of minds, both our own world and
the world of the other are brought to light. This must be equally true for the
psychotherapeutic encounter and for the research interview.
This points towards the need for a more relational or dialogical epistemology than the
one Rogers built on when he formulated his conception of empathy. Rogers clearly,
and often beautifully, describes the process of putting oneself into the world of the
other, and of tuning one’s imagination into creating an understanding of how it is to
be there. But, this is only a first step in the process where we are relating to and
exploring the experience of the other. Resonance with another serves as a beginning
of a relationship where a more encompassing exploration is going on, an exploration
that unavoidably also involves one’s own horizon of experience. Martin Buber, in his
life-long work on dialogic phenomenology, discusses how I-Thou relatedness is
crucial to the stance that makes deep exploration possible: The meaning of
conversations “is to be found neither in one of the two partners nor in both together,
but only in their dialogue itself, in this 'between' which they live together." (Buber,
1970, p. 75). The “findings” or “results” of phenomenological exploration will therefore
always be co-created in line with what is also described as an intersubjective “third”
in relational theory (Benjamin, 2004), or the concept of “the encounter” in existential
thinking (see e.g., May, 1983). In such a relationship, neither part is fully “known.”
The experiential world of the other that we try to understand is always just partly
known, and this partly knowing always depends on the specific relationship that the
researcher establishes with him or her. Recognizing this irreducible “otherness” of the
other implies that our listening mode will be one of, “I try with all of myself to
understand, but I will never fully understand you. I am engaged in understanding as
much as possible when we, together, find words that embrace the meaning of the
parts of your experience that become accessible for both of us in our present
relationship.” As such, access to the phenomenological dimension resides at the
level of the researcher’s attitude and reflection when carrying out research interviews.
This can never be reduced to strict methodology rules, but can best be grasped as
epistemic principles (see e.g., Levitt, Neimayer & Williams (2005) for similar
discussions in psychotherapy theory).
9
Exploration and reflexivity in research interviews
Interview 1
In an exploratory and reflexive phenomenological approach, the interview is much
more than a “gathering” of data. It is a relationship with a specific goal – the
phenomenological investigation of the participant’s experience; the interview is a
way to give meaning to a certain subject. At the same time, the interview as a human
relationship is multi-faceted and multi-layered, where the participant and the
interviewer perceive and interpret each others’ intentions, attitudes and emotional
states – both in general, but mostly toward one another. Reflexivity on the interview
relationship is therefore an essential part of this approach.
To illustrate this, we give an example from two interviews conducted by the first
author. The first, which is presented at more length, is with a 16 year old female
participant in a research project about adolescents’ experiences in psychotherapy.
I, Binder, conducted the interview in what was for me a new environment: at a public
mental health clinic where the participant usually meets her therapist. I felt excited
about the interview, and also curious about whether the participant would attend; my
previous experiences as a psychotherapist with adolescents taught me not to
assume the participant’s arrival. The participant appears, looks down, seems a little
bit shy, and then she smiles. We shake hands and introduce ourselves to each other.
I show her the way to the office.
At first, she looks puzzled about the microphone in the room. Therefore, I begin by
giving her information about the confidentiality of our meeting. Basically, a research
article will present, in a form, her and other adolescents’ experiences from
psychotherapy; only she will be able to recognize any of the specific information
included about her. She says that her therapist already informed her about this; at
the same time, she seems relieved.
She asks whether she can contact me to get the finished article. I confirm she can,
and give her my business card. She looks at it, saying, “Professor and psychologist.”
Smiling, she adds that she would like to study psychology: “Isn’t it interesting?”
10
Immediately, I smile in return, replying that I think that it is a very interesting subject,
and that I can recommend it. She sits a little bit deeper into the chair, and says that
she is ready. I turn on the microphone.
Already, before the interview has started, the relationship began to take shape. Her
arrival in itself functions as a relief for the interviewer; he wants to conduct as many
interviews as possible this day. Additionally, the participant responds positively to the
signs of pleasant surprise in his face when she sees him; she lets go of some of her
possible shyness and smiles back. In the office, the interviewer immediately
responds to her uneasiness about the microphone, something that seems to assure
her. At the same time, this makes her curious about the research article. When this
curiosity, as well as her wish to study psychology, is welcomed, the interviewer
senses that a feeling of mutuality is established in the room. Perhaps she feels
confirmed as something more and other than a “patient” – her wish to study
psychology is part of being a healthy person with possible plans for her life. A sense
of identification is also established in the interviewer; he sees some of the adolescent
he himself once was – the intellectual interest and the curiosity about what the future
might bring.
Interviewer (I): “When you start treatment, you meet a person; how did you
experience your therapist the first time you met?”
Participant (P): “I experienced him as very calm, and very forthcoming. And very
formal and informal at the same time. It was clearly formal, but he was very calm and
he met me and he said “hi.” And then he told a little bit about himself. And that was
very nice. I felt it was a little bit assuring, at least.”
The interviewer immediately felt that it was a possible parallel between the way she
describes the first meeting with her therapist, and the way he himself and the
participant just first met: the calmness, the mixture of formality and friendliness in the
air and the fact that he told her “a little bit about himself” by giving her his business
card and talking a little bit about psychology.
I: “It was important for you that he could tell a little bit about himself.”
11
The interviewer states what he felt was most significant in what she just told. It is also
the most ambiguous part of her description – there are many possible things that the
therapist may have told about himself.
P: “Yes.”
I: “And what kind of things was it that he told about himself, that you felt assuring to
hear?”
P: “In a way, it is that he let me know that he is not just a doctor. He is a human
being with experiences and other jobs and family and things like that. Of course he
has. But he told me, and I appreciated that. He was also going to South America.”
I: “Yes, what he had worked with, that he had family and things like that, that he was
going to South America.”
P: “I felt that it was nice, at least.”
The interviewer had suddenly felt a little bit sceptical toward the participant’s therapist
– is it really necessary to tell about family, other work relationships and South
America? It seems that the participant senses this on a non-verbal level, and gives
emphasis on “I” – and asserts her own point of view.
I: “It was something that felt assuring about it. That you recognised that there was a
person behind this...”
(The participant nods, seems more relaxed again)
The interviewer has become aware of how his own prejudices about self-disclosure
of “outside- therapy- life- details” have coloured what he just said, and enters back to
an empathic listing mode.
I: “Because it was OK that it was formal, and informal, at the same time.”
P: “Yes.”
I: “In which ways was it OK that it was formal too?”
12
He just recognises that a teenager has just stated that “formal is OK.” “Formal” might
be something quite different from the point of view of a professor in his early forties
than in the world of an adolescent, and his curiosity has arisen.
P: “It shall not be like a best buddy, then, I think. It is OK to have a professional…you
know from the first time that it is professional. You know? That it ‘works like so and
so.’ But there should be some loose threads as well.”
I: “If it had started to look like a best buddy it would have been something a little bit
different.”
The interviewer sees that the contrast to “formal” is “best buddy,” and starts to play a
little bit with this.
P: “That would have been a little bit weird.” (Laughs)
The participant responds to the playful attitude, and loosens up a little bit more.
As we see in the material above, an interview is more than just exploration of the
world of the other. It is an organic relationship, and the qualities of this relationship
determine what parts of the participant’s experience become accessible and what
parts will remain unarticulated. Possible understandings and ways to give meaning
emerge and are tested moment to moment. This includes developing understandings
of the participant’s utterances, but also the interview relationship; the interviewer
hopefully understands more through self-reflexive awareness. In this kind of
research, some data analysis will unavoidably begin immediately when the
interviewer and participant see each other.
Interview 2
The second illustration is from the same study. Here, Binder interviews a 17 year old
boy who has an immigrant background. When the interview started, I, Binder, first felt
a little surprised. Beforehand, I had been told that this participant had a history of
delinquent behaviour. Thus, I expected to meet a boy dressed in a sweater, t-shirt
and jeans, perhaps with an oppositional attitude to me and the interview. Instead, a
smiling young man dressed in a white shirt and black dress pants knocked on the
13
door. He looked much more like a real estate agent than a gang member. We shook
hands, he sat down, and I felt an air of formality in the room, as though we were
going to have a business meeting.
In the first part of the interview, I had difficulty understanding what the participant
said, as Norwegian was his second language. After a while, I became accustomed to
his pronunciation of Norwegian. Afterwards, when listening to the recording, I heard
that my own language was very much more formal than my usual way of speaking; I
felt it sounded like the Norwegian prime-minister from the conservative party in the
80’s. Perhaps this was due to a mixture of the formality I felt and my attempts to be
clear and understandable to him. This is a passage from some minutes into the
interview when the participant described his therapist; he has already described that
she has a sense of humour, gives him some freedom in the sessions and that “she
looks like she is 24 or 25, but maybe she is 30.”
I: “So she is relatively young; how is that for you?”
P: “Well, that is OK. At school they said they could find a psychologist from my
country. But I said no. If I speak my mother tongue I forget my Norwegian. I only
speak Norwegian at school; elsewhere I speak my mother’s language.”
The interviewer’s inner picture of the participant has started to transform – he senses
that the participant is a young man who really struggles to find a place for himself in
society, and perhaps want to use his therapy to get out of the “outsider” position. The
interviewer also reflects upon the fact that the participant chose a way to dress for the
interview that portrayed a significant contrast to the pre-given picture of a delinquent
boy. He senses that the participant really values his therapist and wants to explore
more of this positive side of the relationship.
I: “So her being Norwegian is good for you, and that she has a sense of humour and
that she lets you decide for yourself a bit?”
P: “Yes.”
14
I: “And she can be quite assertive, and say that this and this are wise things to do?”
P: “She decides. If she says something, and I say no, she might say ‘well it’s your life,
and if you don’t want to hear what I think, that is your decision – goodbye.’ You won’t
make it by coming here and be polite. Your goal is to be good, not to be polite. That’s
why, when she voices her opinions, I say OK, and if it works I might try it, and if it
doesn’t work I might try something else.”
The interviewer gets the impression that the participant experiences his therapist as
quite firm and self-confident, and wants to explore more of this.
I: “So she encourages you to voice your opinions? And not just be polite?”
P: “Like I said, it’s like a mirror. But not actually like a mirror, because this mirror
shows what’s inside of you. It takes out what’s inside and shows it to you.”
Another important side of the relationship between the participant and his therapist is
revealed: the therapist’s empathic resonance. Also, the interviewer is a little bit
surprised and impressed by the level of complexity in the participant’s reasoning,
which becomes clear through his use of the mirror metaphor.
I: “She sounds like one who can understand a lot?”
P: “Yes, she understands me – way too much. When I say I can’t do such and such,
she says well you can do that, and I know it. I think it is really good, the way she does
the method. And I think she works really well.”
The interviewer is quite impressed with the participant’s capacity to reflect upon the
emotional complexity of the therapeutic relationship, which is in large contrast to the
initial image of a boy with “macho” ideals. He also senses that the self- confidence
and firmness that the therapist shows has great importance to the participant.
As we can see clearly from the two illustrations, interviews with two different
participants involve different relational processes that give different contexts to
15
understanding the content as it is expressed in transcripts. The mode of being
together in the interview situation, which is influenced by the presence of both the
researcher and the participant, gives structure and meaning to aspects of the
participant’s previously unformulated therapy experience. One challenge in
qualitative research is to abstract the meaning of phenomena explored across
different interviews. In the interviewing process, part of the analysis of the
participant’s experience begins through the interplay between the exploration of the
meaning of the experiences the participant expresses, and the interviewer’s reflexive
challenging, as well as the transformation of his prejudices and pre-understanding,
through moments of surprise and an attitude of curiosity
The reflexive and hermeneutic pole - becoming aware of one’s own world and
the relationship to the other
The phenomenological exploration is carried out within the context of an interview
situation where experiences are recalled and relived in the intersubjective
relationship with the interviewer. Dialogue with, and listening to, participants and the
reading of transcripts necessarily involve the experiential horizon of the researchers.
The hermeneutical element in our approach implies that interpretation and
reconstruction of meaning are necessary and unavoidable acts when we try to
understand and point out the meaning of an utterance (Heidegger, 1962). Gadamer
(1989) offers an insight of importance to psychotherapy research when he states
that:
“Once again we discover that the person who is understanding does not know and
judge as one who stands apart and unaffected, but rather he thinks along with the
other from the perspective of a specific bond of belonging, as if he too were affected”
(p. 323).
Here, Gadamer holds the position that understanding an event, which comes to us
interwoven with our history, has to be dialogically constructed by speech partners
who come to an understanding with one another.
In line with reflexive methodology, we use the dialogue with the participants’ views to
explore and reflect upon our pre-understanding as professional therapists and
16
persons (and, in the instances where we interview younger persons; specifically as
adults) to examine how it might have affected the way interviews were conducted,
and also our analysis of the transcribed material (Alvesson & Sköldberg, 2000; Finlay
2003; Finlay & Evans, 2009; Morrow, 2005). A dialogical model of understanding
rooted in philosophical hermeneutics differs from both purely phenomenological
(Giorgi & Giorgi, 2003) and consensual models (Hill et al., 2005) for qualitative
research in its ontological premise that there are no “essential” structures to be found
or final statements to be made when it comes to understanding even minor parts of
the human condition. We see new understanding as achievable only through a
“fusion” of the experiential “horizons” of our own and of our participants (Gadamer,
1989; Laverty, 2003; Smith, 2007), which is dependent on whether one’s own
experiential horizon as a researcher comes in to reflexive awareness rather than
being tacitly present in the process of understanding.
Ideally, both our research partners and our object of study can “talk back” and
surprise us, which in turn may challenge and change our understanding. Gadamer’s
“philosophical hermeneutics” deny that the ability of understanding needs an
awareness of rules. An awareness of rules of understanding does not necessarily
lead us to understanding. From this perspective, doing qualitative research means to
constantly reflect on our ability to understand, for instance the scientific rules, on
which our understanding is based. This can be formulated as the need for a dialogue
between the theoretically informed interpreter and life-worldly situated objects
(Kögler, 1999). The principle of approaching the research process with hermeneutic
reflexivity is something different than a set of definitive rules or guidelines. At the
level of principles, this might be stated as a way of questioning ourselves and our
work throughout the whole research process (Stige, Malterud & Midtgarden, 2009).
It is important to notice that Gadamer (1989) holds the position that hermeneutic
understanding does not imply one method over another. Therefore, hermeneutics in
qualitative research is often explicated and expressed as the researchers are being
“inspired” by the work of Gadamer, or when the analysis of the material has been
carried out “according” to philosophical hermeneutics. This may have been done in a
perfect manner, but it opens up the need for explication of “how” the research has
been done. The link between the philosophy of Gadamer and the practical daily work
17
of doing qualitative research must be explicitly described to achieve sufficient
transparency in considering how the process of understanding has been carried out.
Even if understanding on an epistemological and ontological level does not need an
awareness of rules, conducting research as a practical task is dependent upon a
principle of transparent structure (Malterud, 2001). Here we want to address one way
that empirical investigations can be conducted in a transparent and structured way,
and at the same time be rooted in the epistemological premises of hermeneutic
phenomenology. A qualitative inquiry into the experiential worlds of a sample of
participants in exploratory reflexive phenomenology needs a practical structure for
data analysis that helps us to work towards the goals of:
1) Securing and describing transparent links and connections between the
specific acts of meaning (Bruner, 1990) that occurred in the interview material
and the themes interpreted as “commonalities” among, and “differences”
between, the experiences of the participants. Such an open exploration and
“transparent grounding” in the material is a premise for trustworthiness and
rigor in the study.
2) Facilitating clear communication of both which meaning patterns and themes
are found in the study, and how these were found.
3) Facilitating reflexive awareness on the researchers’ part. This is best done by
not mechanically following a structure, but abiding by the structure as it is
adapted and further designed to fit the particular study at hand to reach the
goals of 1) and 2).
4) Facilitating an open and exploratory curiosity toward the research question
and a playful attitude within the space of possible understandings that are
inherent in both the specific acts of meaning in the interview situation and the
transcribed material.
Using our goals and principles to carry out analyses on a practical level
It follows from this that there should be no definitive way of conducting a reflexive
and explorative empirical phenomenological study. However, one also needs to use
a clear structure when handling the large amount of data from a study that
investigates the experiential world of several participants. Here, we will describe
steps in a structure for thematic analysis that has proven useful in our own research
18
(e.g. Binder et al., 2011), where the above described goals and principles have led
our work. The structure of this thematic analysis is highly compatible with the
pragmatic stepwise approaches described by Braun and Clarke (2006) and Boyatzis
(1998).
By comparing the individual accounts, we want to identify patterns of commonalities
and differences in how participants experience themselves and the situation under
investigation. Here, differences between the experiences of participants may be just
as important as commonalities and patterns. Particularly, heterogeneity in a
homogenous group of participants may be interesting, while heterogeneity in a
heterogeneous group certainly will be of less interest.
In our group, the projects usually involve a team of researchers, and we will describe
the stage-wise process as it is conducted in a team.
Analysis proceeds through the following stages:
1) The interviewers note their immediate impressions and responses after their
dialogues with the participants, as done in the example above. They discuss
these observations to establish a basic sense of both the heterogeneity and
the homogeneity of the participants’ experiences, and to increase reflexive
awareness of interpersonal processes in the interview situation.
2) All researchers read all of the transcribed material to obtain a basic sense of
the participants’ experiences. A gradual recognition through dialogue of some
personal and professional preconceptions is also part of this phase.
3) Examining those parts of the text relevant to the research question, the
researcher leading the project identifies separable content units that represent
different aspects of the participants’ experiences. The following utterance,
from the beginning of the interview with the 16 year old, is an example of a
content unit consisting of statements about “how participants experience the
way their therapist acts”: “I experienced him as very calm, and very
forthcoming. And very formal and informal at the same time. It was clearly
formal, but he was very calm and he met me and he said “hi”. And then he told
a little bit about himself. And that was very nice. I felt it was a little bit assuring,
at least.” This sorting into content units can of course also be done by two
19
members of the team in collaboration, or the whole team, if this is practically
possible. This sorting into content units can also be done with the assistance
of computer software designed for qualitative analysis (e.g., Nvivo or
Hyperresearch). It is important to notice that all parts of the text do not need
to be relevant to the research question. Reflecting upon the text can also
reveal that the participant’s statement may be understood as an answer to
another question, which in turn opens up for other approaches to the material
later on.
4) The leading researcher (or the team) develops “meaning codes” for those
units, which are concepts or keywords attached to a text segment in order to
permit its later retrieval (Kvale & Brinkmann, 2009). Then the text can be
edited in accordance with those codes into coded groups of text, with the
assistance of computer software. For example, the utterance above was
sorted together with similar utterances from both this and other participants
and given the code “the therapist is experienced as calm and comfortable with
the situation.”
5) The leading researcher (or the team) interprets and summarizes the meaning
within each of the coded groups of text fragments into conceptions and overall
descriptions of meaning patterns and themes. These should reflect, according
to consensual understanding in the team, what emerges as the most important
aspects of the participants’ experiences. Through this process, the overall
pattern in the utterances coded as “the therapist is experienced as calm and
comfortable with the situation” and utterances given another code “the
therapist is experienced as comfortable with his or her way of working” is
summarized in the theme “Show Me that You are Comfortable with Being a
Therapist.” What becomes clear from the two different interview examples
above is that meaning is expressed through quite different communicative and
experiencing styles. The girl is quite expressive when it comes to her feelings
about the relationship, while the boy expresses more concrete narratives or
instances where his experiences of the relational qualities are more implicit.
The reflexive exploratory phenomenological approach allows flexibility in
coding larger segments of data based on its implicitly expressed meaning,
rather than being locked to the specific utterance sentence by sentence. This
flexibility resides in the prioritized position of the research interview, process
20
notes and reflexivity of relational processes in meaning creation, and in the
researchers’ ability to make the analytic steps transparent to the reader.
6) The research team turns back to the overall text to check whether voices and
points of view shall be added, and can develop the conceptions and
descriptions of themes further, or represent correctives to the preliminary line
of interpretation. Preferably, a researcher that is not part of the team of
interviewers may have a leading role in critically auditing the identification of
thematic units and meaning patterns. This may lead to a reorganization of
some themes that he or she can bring back to the others for consensual
discussions.
7) The themes are finally formulated and agreed upon by the whole research
team.
“A “meaning pattern” appears when we condense and sum up the meaning units of
relevance for a particular research topic and compare the experiences inherent in the
narratives of several participants. That is, a pattern emerges when there is
convergence between the experiences of different participants, and when there is a
moderate degree of divergence between them that makes the pattern thematically
rich. In this way, the identification of a “meaning pattern” combines the hermeneutic
element of interpretation and the empathic use of imagination on the researcher’s
part with the phenomenological element of commitment to the participants’ lived
experience. We express the meaning pattern through the formulation of themes.
The above steps are not meant to define another “brand name” within the field of
qualitative research. Rather, they are meant to inspire ways of transparently
conducting thematic analyses that are committed to staying close to the experiential
world of the other, and thereby the “data” combined with reflexivity on one’s own
horizon and one’s relationship to the other. To ensure rigor and trustworthiness, this
process should have a clear structure with steps that can be explicitly articulated. In
this way, the relationship between the actual utterances in the interview situation and
the formulation of results in the form of themes become visible and understandable –
to the audience, and last, but not least, to oneself.
Conclusion
21
The analysis of commonalities and differences between participants’ experiences in
qualitative psychotherapy research demands a firm structure to achieve transparency
and trustworthiness. We have shown a team-based approach to analysis with steps
involving phenomenological immersion into the experience of the participants,
reflexivity and dialogical interchange in the researcher team, structured coding of text
and discovery of meaning patterns. These steps are part of a process creating a
creative tension between phenomenological closeness to participant’s experience
and hermeneutic reflection upon ones own position as a researcher. However,
structure will not in itself guarantee the result – analytical steps will only contribute if
they also stimulate self-reflexivity and awareness of the researchers as interpreters of
basically ambiguous human experience.
References:
Alvesson, M., & Sköldberg, K. (2000). Reflexive methodology. New vistas for
qualitative research. Thousand Oaks, CA: Sage.
Benjamin, J. (2004). Beyond doer and done to: An intersubjective view of thirdness.
Psychoanalytic Quarterly, 73, 5-46.
Binder, P. E., Holgersen, H., & Nielsen. G. H. (2010). What is a "good outcome" in
psychotherapy? A qualitative exploration of the former patient's point of view.
Psychotherapy Research, 20, 285-294.
Binder, P.E., Moltu, C., Hummelsund, D., Sagen, S., & Holgersen, H. (2011). Meeting
an adult ally on the way out into the world: Adolescent patients' experiences of useful
psychotherapeutic ways of working at an age when independence really matters.
Psychotherapy Research, 21, 554-566.
Boyatzis, R. E. (1998). Transforming qualitative information: thematic analysis and
code development. Thousand Oaks, CA: Sage Publications.
22
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative
Research in Psychology, 3(2), 77-101.
Bruner, J. (1990). Acts of meaning. Cambridge, Mass.: Harvard University Press.
Buber, M. (1970). I and Thou. (trans. Walter Kaufmann). New York: Charles
Scribner's Sons.
Elliott, R., Fischer, C. T., & Rennie, D. L. (1999). Evolving guidelines for publication of
qualitative research studies in psychology and related fields. British Journal of
Clinical Psychology, 38, 215 - 229.
Finlay, L. (2003). Through the looking glass: intersubjectivity and hermeneutic
reflection. In L. Finlay & B. Gough (Eds.), Reflexivity: a practical guide for
researchers in health and social sciences, (pp. 105-119). Oxford: Blackwell.
Finlay, L., & Evans, K. (Eds.). (2009). Relational-centered research for
psychotherapists. Exploring Meaning and Experience. Chichester, West Sussex:
Wiley-Blackwell.
Frommer, J., Rennie, D. L. (Eds.) (2001). Qualitative psychotherapy research.
Methods and methodology. Lengerich, Pabst Science Publishers.
Gadamer, H. G. (1989). Truth and method. London: Sheed & Ward.
Giorgi, A. P., & Giorgi, B. M. (2003). The descriptive phenomenological psychological
method. In P. M. Camic, J. E. Rhodes & L. Yardley (Eds.), Qualitative research in
psychology. Expanding perspectives in methodology and design. Washington, D.C.:
American Psychological Association.
Heidegger, M. (1962). Being and time. Oxford: Basil Blackwell.
Hill, C. E., Knox, S., Thompson, B. J.; Williams, E. N., Hess, S. A., & Ladany, N.
(2005). Consensual Qualitative Research: An Update. Journal of Counselling
Psychology, 52, 196-205.
23
Husserl, E. (1970). The crisis of european sciences and transcendental
phenomenology: An introduction to phenomenological philosophy. Northwestern
University Press.
Kögler, H. H. (1999). The power of dialogue: critical hermeneutics after Gadamer and
Foucault. Boston: MIT Press.
Kvale, S., & Brinkmann, S. (2009). Interviews. Learning the craft of research
interviewing. Thousand Oaks, Cal.: Sage Publications.
Levitt, H. M., Neimeyer, R. A., & Williams, D. C. (2005). Rules versus principles in
psychotherapy: Implications of the quest for universal guidelines in the movement for
empirically supported treatments. Journal of Contemporary Psychotherapy, 35, 117 -
129.
Laverty, S. M. (2003). Hermeneutic phenomenology and phenomenology: A
comparison of historical and methodological considerations. International Journal of
Qualitative Methods, 2. Retrieved from:
http://www.ualberta.ca/~iiqm/backissues/2_3final/pdf/laverty.pdf
May, R. (1983). The discovery of being. New York: W. W. Norton & Company, Inc.
Malterud, K. (2001). Qualitative research: Standards, challenges, and guidelines.
Lancet, 358, 483-488.
McLeod, J. (2011). Qualitative research in counselling and psychotherapy. London:
Sage Publications.
Moltu, C., Binder, P.E., & Nielsen, G. H. (2010). Commitment under pressure.
Experienced therapist's inner work during difficult therapeutic impasse.
Psychotherapy Research, 20, 309 - 320.
24
Morrow, S.L. (2005). Quality and trustworthiness in qualitative research in counselling
psychology. Journal of Counselling Psychology, 52, 250–260.
Moltu, C., & Binder, P.E. (2010). The voices of fellow travellers: Experienced
therapists' strategies when facing difficult therapeutic impasses. British Journal of
Clinical Psychology, 50, 250-267.
Rennie, D. L. (2000). Grounded theory methodology as methodical hermeneutics:
Reconciling realism and relativism. Theory & Psychology, 10, 481–502.
Rennie, D. L., Watson, K., D., & Monteiro, A. M. (2002). The rise of qualitative
research in psychology. Canadian Psychology/Psychologie canadienne, 43,179-189.
Rogers, C. (1980). A way of being. Boston: Houghton Mifflin
Smith, J. A. (2007). Hermeneutics, human sciences and health: linking theory and
practice. International Journal of Qualitative Studies on Health and Well-Being, 2, 3-
11.
Smith, J. A., Flowers, P. & Larkin, M. (2009). Interpretive phenomenological analysis:
Theory, method and research. London: Sage Publications.
Strauss, A. & Corbin, J. (1998). Basics of qualitative research techniques and
procedures for developing grounded theory. London: Sage Publications.
Stige, B., Malterud, K. & Midtgarden, T. (2009). Toward an agenda for evaluation of
qualitative research. Qualitative Health Research, 19, 1504-1516.
van Manen, M. (1990). Researching lived experience: Human science for action
sensitive pedagogy. Albany: The State University of New York Press.
