Interpretative phenomenological analysis

I will now justify my selection of IPA as an appropriate method to enable an in-depth exploration of clinicians’ subjective experiences of delivering the two recommended trauma treatments, EMDR Therapy and TF-CBT, and how they understand its impact on them, both during treatment sessions and cumulatively, over the long-term.

IPA is a qualitative approach developed to explore the unique lived experiences of individuals and to interpret how people make sense of these experiences, or phenomena

(Eatough & Smith, 2008; Finlay, 2011; Smith, 2004). It has been influenced by the philosophical concepts of phenomenology, hermeneutics and idiography (Smith, Flowers, & Larkin, 2009) which together explore the idea that reality is contextual. This viewpoint complements the critical realist position adopted for this research study, and is concordant too with the underlying philosophical assumptions inherent in the humanistic foundations of counselling psychology.

Phenomenology is the philosophical approach to the study of experience, specifically the careful examination of human experience, in the main focusing on aspects which have particular significance or meaning to us (Smith et al., 2009). Husserl argued that “focusing our

74

quoted in Smith et al., 2009; p.12), and this reflecting allows us to more accurately know our own particular experience of the essential qualities of any given phenomenon. This endeavour parallels not only the fundamental aim of counselling psychology training to be a reflective practitioner, but also resonates with what trauma clinicians (and their clients) are attempting to do during treatment, and what I, as a researcher-practitioner, am attempting to achieve in relation to each participant and the data emerging from their interviews with me.

In essence, I believe this stance also appears to fit well with the mindful, conscious, ‘noticing without judgement’ therapists teach clients in Phase 1 of trauma treatment, which allows clients to stay grounded and observe themselves and their processes, without triggering trauma responses such as shame and dissociation (Ogden & Fisher, 2015). This ‘without judgement’ stance mirrors the ‘bracketing’ that Husserl (1982) proposed we need to do in order to consciously set aside our ‘taken-for-granted’ automatic ways of perceiving the familiar context of our everyday world, or ‘lifeworld’. As Buddhists well know, setting aside our preconceptions, associations, evaluations and judgements, in order to experience afresh the purest

quintessence of the world ‘as it is’, represents a lifelong learning task at which it is unlikely we will ever fully succeed. As with perfume production, Husserl (1982) recommended a series of ‘eidetic’ reductions in order to distil out this essence (‘eidos’) of an experience or phenomenon, so that we may know it as truly as we are able. Husserl (1982) suggests these reductions therefore will take us, through a process of divergence and convergence, from participants’ unique and personal experiences of a particular phenomenon to elicit an irreducible common set of properties which characterise the essence of that phenomenon; in this way he proposed a way forward for qualitative science to authentically move from the particular to the general. Whilst Husserl’s ultimate aim was to go beyond, or transcend, the content of conscious experience, to explore consciousness itself (another Buddhist enterprise), “IPA has the more modest ambition of attempting to capture particular experiences as experienced for particular

75

people” (Smith et al, 2009; p.16) and it is this aim I wish to harness to explore my research question.

Heidegger (1962/1927) developed Husserl’s work in the direction of hermeneutics, the theory of interpretation; he initially grounded his position in Husserl’s ‘lifeworld’, a world concerned primarily with consciousness, awareness and perception, and containing people, relationships and language. However, Heidegger focused more on the ontological nature of existence and our uniquely human capacity for self-awareness and self-reflection, which he saw as irrevocably and always situated in the context in which we find ourselves, a concept he described as ‘Dasein’ (meaning, ‘there-being’). In this concept he recognised that an individual is always a ‘person-in-context’, inevitably subjective and interpretative. Heidegger uses the term ‘inter-subjectivity’ to refer to

“the shared, overlapping and relational nature of our engagement in the world. … Inter-subjectivity is the concept which aims to describe this relatedness and to account for our ability to communicate with, and make sense of, each other.” (Smith et al., 2009, p.17).

Inter-subjectivity thus also relates profoundly to the history and fundamentals of psychology and how we as humans exist, relate and develop. From being a baby, born into Stern’s (1985) world of interpersonal relating so fundamental to human emotional development, we learn to swim in a current of linguistically-mediated inter-related connections with others. Counselling psychology, founded in Rogerian humanistic principles, holds the therapeutic alliance at the core of our professional practice, recognising that inter-subjective awareness and reflexivity is crucial to effective work at relational depth (Douglas et al., 2016; Mearns & Cooper, 2005). And in complex trauma work, inter-subjectivity underscores the understanding that using our authentic self to connect with the client is essential to repair attachment bonds which have

76

been broken or damaged (De Zulueta, 2006; Parnell, 2013). Finally, inter-subjectivity

recognises that, in the process of answering the research question, interpretation of clinicians’ meaning-making activities is necessary in order to engage in a full phenomenological

understanding of the nature and experience of trauma work for them.

Heidegger, dissecting the meaning of the word phenomenology, recognised that a

phenomenon is something that is perceived to appear, whereas logos is a complementary

activity concerned with analysing and seeking the deeper meaning of the phenomenon, which may be hidden beneath its surface. Heidegger also suggests, perceptively and crucially, that

“Whenever something is interpreted as something, the interpretation will be founded essentially upon the … fore-conception.” (Heidegger, 1962/1927; p.191-192).

This gives us clear insight into the process of IPA research activity, where we must try to prioritise our perception of a new phenomenon as it appears, whilst holding in mind the

possibility of latent meanings hidden below the surface. At the same time we must both bracket off our pre-conceptions about the new phenomenon, whilst also recognising that our new

understanding can also work in the other direction to affect our prior conceptions. Gadamer (1975) explains this well, as

“A person who is trying to understand a text is always projecting … The

important thing is to be aware of one’s own bias, so that the text can present itself in all its otherness and thus assert its own truth against one’s own fore-meanings” (p. 267- 269).

This dynamic process of iteratively moving back and forth between phenomenon and interpretation, known as the hermeneutic circle, is central to the IPA approach. As Smith et al.

77

comment succinctly, “[w]ithout the phenomenology, there would be nothing to interpret; without the hermeneutics, the phenomenon would not be seen” (2009; p.37).

However, because the phenomenon under investigation in this research study is not a thing or an object but an individual, a person just like the researcher, the interpretative elements of IPA become a two stage hermeneutic process where “the researcher is trying to make sense of the participants trying to make sense of their world” (Smith & Osborn, 2003, p.51). IPA is particularly interested in experiences which are of special meaning or significance to the participant and Smith et al. (2009) observe that the person often “engages in considerable ‘hot cognition’ in trying to make sense of it” (p.33). This is of relevance too, because trauma treatment also works by finding the ‘hot cognition’ and up-dating the meaning of it whilst the client is in a state of emotional flux. This leads me also to consider the importance of accessing both thoughts and emotions during a successful research interview.

Two other phenomenologists, Merleau-Ponty and Sartre, also posit useful concepts whose contributions are of particular relevance for my choice of IPA for this research study. Merleau-Ponty (1962) argues that, because of our capacity for reflection and self-awareness, we understand ourselves as individuals, separate from the world, which we experience through our bodies. This notion of embodiment is a key concept in trauma treatment where memories of trauma are held somatically and revealed in the body’s responses to reminders of the original event. The consequence is a continual, raw sense of re-experiencing in the present-moment of traumatic experiences that, logically, are known to have occurred in the past (van der Kolk, 2014). Mirror neurons may connect therapists unconsciously to clients’ physiological and physical responses, and lead them to feel empathic somatising (Porges, 2011), a type of experience I sense it may be important to recognise and acknowledge in the research data, even if it can never be entirely captured via verbal means.

78

Sartre also made an interesting point which is relevant to work in trauma research: he realised, on an occasion where he became self-consciously aware that he was being watched, that the direction of perception can aim both ways (Sartre, 1956/1943). This is a critical concept in trauma work for the client, who often experiences shame at being observed as somehow damaged or defective – either by their own internal self, or externally, by others – and this can impact negatively on the therapy (Ogden & Fisher, 2015; van der Kolk, 2014). This is also important for the clinician, who may also feel observed, critiqued, exposed or shamed by the process of disclosure during an interview. Both experiences interfere with the relationship (therapeutic or research) and, as Smith et al. comment, the shame only makes sense when seen in an interpersonal context which also contains the possibility of reparation (2009; p.20).

Unlike nomothetic quantitative paradigms which are concerned with what can be successfully generalised, a third major influence on IPA is idiography. This focus on the particular is expressed in two ways. Firstly there is a commitment to a thorough and rigorous examination of every particular detail in analysing the data. Secondly, there is a commitment to “understanding how particular experiential phenomena (an event, process or relationship) have been understood from the perspective of particular people, in a particular context” (Smith et al., 2009; p.29). In fact, there is an argument that the particular and the general are inextricably linked, mirroring the hermeneutic circle. Thus, the idiographic approach allows the responses of individual participants to be preserved and heard, whilst at the same time, through a process of interpretation and the convergence and divergence of themes arising from their data, it also offers the possibility of elucidating, or distilling, common experiences. The knowledge acquired from the idiographic approach advocated by IPA will therefore provide a deeper understanding of the lived experiences of the clinicians who deliver both recommended approaches to trauma treatment, and these experiences held in common may then serve to inform clinical practice for other therapists, as well as furthering the evidence base for counselling psychology knowledge.

79