Interviews began with a review of the consent form (Appendix C). If the interview occurred via Skype, email, or an online chat program, I asked the participants to sign and return the consent form to me in advance of the interview start time.
Interviews with Octavia and Sophia utilized the video-recorder provided by my department. It was not feasible to video-tape interviews with Alex, Jaime, and Nadine due to location of interview as well as my travel schedule. Interviews with Grace, Anna, Brenda, and Bella were video-recorded using my computer’s screen capture program, an application that can capture interviews as they are happening on Skype. Interviews with Melissa, Jake,
and Ellen occurred via email and were not videotaped. All interviews, minus the emailed interviews and the interview that occurred over Google Chat, were audiotaped for transcription purposes.
My interview questions were both open-ended and specific, targeting a variety of topics around disability and psychology, including support in graduate school, self-disclosure methods, training, and the participant’s understanding of how disability impacted the therapy process. I asked the following questions (also in Appendix D):
1. What are the major challenges you face in being a therapist?
2. What are the most important experiences that have shaped your development as a therapist?
3. How has being deaf [or blind] impacted your work as a therapist?3
4. How has being deaf [or blind] influenced your relationship with your clients (e.g., therapeutic alliance)? Please tell me about a specific time when you have felt this impact.
5. How have you self-disclosed your disability to clients and responded to client’s questions about your disability? Please tell me about a time when you’ve self-disclosed that feels particularly meaningful or challenging to you.
6. Please tell me about a time you had strong feelings about your disability in response to a client’s comment or experience.
7. How has your disability influenced the ways by which you listen to and understand your clients? Please tell me about a specific instance that feels particularly
3 I changed the wording depending on the client’s preference (e.g., preferred to go by hearing-impaired rather than deaf or visually-impaired rather than blind).
meaningful or challenging to you.
8. How has your disability influenced your choice to become a therapist? What about your theoretical orientation?
9. How have your experiences in supervision and graduate training been impacted by your disability? How do you talk about your disability to others when they ask about it?
I attempted to stick as closely to the script as possible, while also being aware that the lived experience of each participant required that I be flexible in changing the script and interview structure as needed.
Following discussion of the consent form, I took a moment to set up the video and/or audio recording. I encouraged the interviewee to make themselves comfortable and engaged in pleasantries to further rapport building. As participants spoke, I asked questions either for clarification or because I did not hear something. In-person interviews tended to run longer due to the set up time as well as the fact that interviewing face-to-face often led to greater rapport and deeper conversations.
Interviews using Skype, Purple Communications, or Google Chat often began with a lot of missteps, largely due to Internet connectivity issues on one side or the other. If the video could not be established or if the screen was frozen, as was the case for some of my interview with Grace, we relied on text-based communication (e.g., typing in the chat box below the video screen). This was effective in that it allowed me to get everything the participant was saying, as lipreading over a video screen can be difficult. Even if the video picture was clear for the entire duration of the interview, some text-based communication was needed due to my difficulty in lipreading via screen. With respect to interviews that occurred over email, once I had received the consent form, I then sent my participants the
list of questions. Any follow up questions, which I tried to keep to a minimum, were specific and brief in order to elicit more free association from participants.
All audio/video-recorded interviews were transcribed by Christy Azzarello, a real-time captioner who has been working with me since my first year in graduate school at Duquesne University. For interviews that occurred online, I compiled and edited the transcripts for the purpose of analysis.
Method #1: IPA Step-by-Step. I initially read each transcript without making any notes, as I wanted to get a feel for each interview and my overall project. During this process I took care to pay attention to the themes implicitly stated in my questions as well as the themes my participants deemed important, such as challenges faced outside the therapy room.
I also noted differences in themes between deaf and blind participants.
Once I had completed an initial reading of the transcripts, I imported transcripts into a program called NVivo, a software platform for qualitative researchers with large amounts of data to code. This program allowed me to upload all my interview transcripts into a folder and code by highlighting an excerpt of text and creating a new theme (called
“node” in NVivo). I could also annotate the text by highlighting the selected passage and making a note in the right hand margins.
In determining what and how often to code, I turned to Smith, Flowers, and Larkin’s (2009) Interpretive Phenomenological Analysis as a guide. The writers recommend reading through for explicit and implicit themes that appear on a line-by-line basis and also to make note of linguistic themes, interviewer reactions, and tentative interpretations. Using NVivo, I created nodes under the heading “Emergent Themes” and another under “Exploratory Comments.”
The emergent themes column consisted of themes noted in a few words that applied to an entire passage, as seen in this example from Alex’s transcript:
I: So can you tell me a little bit about why you went into psychotherapy?
A: Sure. Complex. Probably many factors, my life didn't necessarily initially go in this direction at first. But at the same time it kind of did. I think a lot of the factors had to do with the reality of my disability and I was diagnosed with a rare form of cancer when I was two years old and lost most of the sight in my right eye and all the sight in my left eye.
The italicized section was then coded as “disability impacted career choice,” which later became a recurring theme across many interviews.
The exploratory comments column consisted of my initial impressions and thoughts about each line of text on linguistic, descriptive, and conceptual levels, as seen in this
example, also taken from Alex’s interview: “I’ve heard people yell out the window also at me that he's not really blind, he's faking it. You know, I’ve had people laugh at you, people honk the horn at you. Yell at you” (Laugh). This passage was first coded under emergent themes as “discrimination” and “misconceptions about blindness.” But reading it again, more introspectively, I wondered about the role of humor as a defense against possibly anxiety or painful feelings arising from the memory of this event. Under the exploratory comments node, I coded “humor as defense.”
NVivo was also helpful in that it allowed me to make multiple sub-themes within a primary theme, so that I could cluster together similar threads. This process is not unlike the traditional method by which researchers color code across different themes or move sheets of paper around under major thematic headings. An example of NVivo in action is provided below:
After I coded each interview with emergent themes and exploratory comments, I then clustered together similar themes. For example, the superordinate theme “Challenges”
included subordinate themes, “General Challenges” and “Challenges as a Disabled
Therapist.” The NVivo program made it possible to see which interviews were coded under a particular theme, thus saving me the work of having to move stuff around. Throughout this process, I frequently asked myself: “What is the person trying to achieve here? Is something leaking out here that wasn’t intended? Do I have a sense of something going on here that maybe the participants themselves are less aware of?” (Smith & Osborne, 2008, p.
55).
Following my first round of coding with all interviews, I took a break of about two weeks before returning for a second round of coding. This break felt necessary in order to get some space from the data and to ensure I was not imposing my own beliefs on the material. Upon returning to the data, I attempted to capture themes that were not explicitly
obvious. Drawing from the recommendations put forth by Smith, Flowers, and Larkin (2009), I also organized emergent themes in terms of the temporal moment where they occurred, noted the frequency with which a theme occurred, and noted the function of the theme within in each transcript. When material was coded in more than two places (as was often the case), I made a decision about which code was primary and which was secondary. I also attempted to move responses “to a slightly higher level of abstraction and [invoked]
more psychological terminology” (Smith & Osborne, 2008, p. 68). For example, comments that were initially coded under “therapist’s view of self ” were later coded to reflect
underlying mixed feelings about embodying or rejecting the supercrip narrative.
Throughout the process of coding, I frequently asked myself: what does this theme mean to my overall dissertation? Why might participants find this action or belief useful?
Deaf researcher and English professor Brenda Brueggemann reminds us that the search for concrete answers or themes is not the goal of humanistic research; rather one is better served by guiding questions, such as “Which of our representations give us voice, make us silent?” (Brueggemann, 1996, p. 34). This perspective that seems especially important when doing research with disabled populations. My final coding list is below (also seen in
Appendix F). The number listed after the major and minor themes indicate how many unique times it was mentioned throughout interviews.
Challenges [14]
Time Management & Self Care [2]
Challenges as a Disabled Therapist [14]
Accommodations [4]
ADA [3]
Anxieties in Relational Dynamic with Others [6]
Impact of Colleague and Client Assumptions [11]
Client Populations & Therapy Modalities [9]
Discrimination [5]
Exhaustion Related to Lip-Reading & Impact on Self [5]
Isolation & Lack of Community [8]
Loss of Self-World [3]
Implications of Passing/Not Passing[9]
Self-Esteem Building Responses to Challenges [13]
Does Not Personalize [2 participants]
Impact of Disability on Therapy Processes [14]
Clients Use of/Response to Disability [11]
Clients Response as Diagnostic for Therapist [4]
Clients as More Understanding than Colleagues [3]
Clients Belief in Therapist Ability to Empathize [4]
Clients Belief in Therapist Ability to Overcome [4]
Helping Behaviors Displayed by Clients [7]
Unique to Blind Participants: Clients Desire to “Hide” from Therapists [4]
Effects of Disability on Therapy Alliance/Relational Spaces [11]
Therapist Experiences Disability as Fluid [3]
Power Dynamic Struggles Between Client & Therapist [5]
Psychodynamic Processes [11]
Client Projections about Disability & Impact on Therapy [8]
Transference-Countertransference around Disability [11]
Does not have an impact [3]
Therapist Process of Self-Disclosure [13]
Client Response to Self-Disclosure [10]
Styles of Self Disclosure on Patient Reactions [12]
Therapist Use of Disability [13]
Body as Therapeutic Tool [6]
Dog as Healing or Special [2]
Facilitate Client’s Understanding of Self [4]
Unique to Deaf: Positive Impacts of Mishearing Clients [2]
Modeling/Psychoeducation [10]
Unique Listening Skills/Non-Verbals [12]
Importance of Time on Self-Confidence [5]
Negative Impact of Disability on Therapy Career [1]
Positive Impact of Disability on Therapy Career [8]
Therapist View of Self [12 Participants]
Impact on Beliefs [10]
Accomplished [6]
Anxieties about Success [3]
Recognizes Limitations [5]
Sees Self as Super Crip/Wounded Warrior [4]
Disability as Having Personal Value [2]
Must Fight Systemic Oppression [1]
Minimization of Disability [4]
Impact on Self-Esteem [10]
Effects of Positive/Negative Training Experiences [14]
Growth of Colleagues/Classmates [7]
Effects of Negative/Mixed Support [10]
Effects of Positive Support [12]
Therapist’s Growth [2]
Non-Verbals on Interview Dynamic/Interviewee Underlying Feelings [10]
Following completion of the detailed steps above, I then wrote up the Major and Minor Table of Themes with corresponding excerpts (Appendix G) as well as the individual themes for each participant (Appendix H). Smith, Flowers, and Larkin (2009) point out that when a study is large it can be hard to effectively manage data; thus, paying close attention to how many times a theme recurs is important in creating the results chapter.
Process of Writing up IPA Results. Rather than providing an excerpt from every interview transcript illustrating the theme under review, I arranged the results chapter to focus on just two or three poignant examples to avoid redundancy and a plethora of quotes.
My criteria for choosing extracts to represent in the results chapter are as follows: they were rich with emotional complexity, excited my imagination, or illustrated links between different themes. Occasionally, I included atypical extracts to illustrate contradiction or complexity. I also included a few themes that were endorsed by only a small number of participants rather than the majority (e.g., 2/3).4 I am aware that this choice goes against traditional IPA methods, but my project’s content demanded a slightly different orientation – one that cripped normative approaches to qualitative analysis. In addition, given the lack of
4 Appendix H provides a more holistic look at each participant’s major themes, as well as their thoughts and feelings about disability. I also include some of my own notes throughout this appendix.
representation by disabled participants in the psychology field, I wanted to include as many voices as possible.
Method #2: Autoethnographic Analysis. My autoethnography was written throughout the process of conducing interviews and coding the results. Given that my use of autoethnography and IPA are informed by each other, in that I am a researcher who shares the same disability as many of my participants, critically reflecting on my own experiences throughout the writing of this dissertation felt imperative in making key connections between participant themes and my own, as well as calling attention to differences.
I began my autoethnography by free writing about those experiences in my life that felt important to my overall dissertation project: my upbringing, my personal journey toward becoming a therapist, and moments with patients that seemed particularly meaningful with respect to my own understanding as a deaf clinician. I then reviewed themes derived from my analysis, reflecting on similarities and differences between my experiences and that of my participants. After free writing about many different examples, I chose to include those that seemed most relevant to the material at hand. In deciding what to keep and cut from my autoethnography, I frequently asked myself: “How can I invite readers […] to use my stories and experiences [and that of my participants] for their own sense making?” (Adam, Jones &
Ellis, 2015, p. 39).
As described in the literature review, there is no one set way to write an
autoethnography. Doing so is an intense personal journey that requires a critical look at one’s motivations for including their own experiences and how such experiences compliment, challenge, and do justice to participant experiences. Autoethnography is a personal journey;
thus, readers interested in autoethnography should not attempt to replicate my process but
to find their own process.5