Practitioner research

Practitioner research must be evaluated by its own criteria (Reed and Biott, 1995, Freshwater, 2008) as the findings are inextricably linked with the researcher’s experience. In common with other forms of qualitative research, findings have limited generalisability and the position of the

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inquiry include ‘sounding out’ with colleagues to identify commonalities and inconsistencies. The origins of homeopathic practice can be considered as a form of practitioner based research. Taking a self-critical approach with the aim of improving treatment, a research strategy was initiated from observations of illness and recovery. Self-experimentation evolved into detailed experimental protocols. Homeopathic practice developed out of critique of speculation and conjecture in contemporary medical practices. Theoretical texts were informed by years of systematic clinical observation (Hahnemann, 1987, 1st published 1921). Individualised treatment requires a fresh approach to every patient. Consultations are in depth with detailed questioning and avoiding closed questions and making assumptions. Clinical data is recorded in detail, verbatim where possible. This rich phenomenological data is analysed, followed by a systematic and rigorous investigation of materia medica data. Research is conducted into biomedical diagnosis and any prescribed medicines. Patient response is carefully monitored and treatment effects evaluated. I suggest that practitioner based research is ingrained in homeopathic practice, as homeopaths we are also researchers of our own practices. This thesis explores this proposition and proposes a way of conceptualising this.

Research conventions are challenged by acting both as researcher and practitioner. The stance of practitioner researcher determines the inquiry’s aims, perspectives and methods. How you frame a question is hugely influential on the potential answers generated by the research. CAM research conducted by biomedically trained researchers so often fails to ask the most appropriate questions (Lewith, 2004a). This is what Fox (1999, p.198) calls the “different world- views”; the researcher perceives data and the practitioner, people. The impact of research on practice and on the practitioner is an essential feature of practitioner research. This inquiry eliminates the infamous gap between research and practice by creating a symbiotic relationship: the inquiry transforms practice and the practitioner, and practice transforms the inquiry. Rolfe (1998) proposes:

“integrating practice and research in a single act whose aim is not primarily the generation of knowledge and theory but the implementation of clinical change, so that research becomes ‘built-in’ to practice and clinical change is built-in to research”. (p.176)

This is a passionate engagement from within the experience, but researching the culture in which you are embedded demands reappraisal from a range of theoretical perspectives and to address issues of surveillance of professional practice. Wenger’s model of communities of learning and practice is a useful way to consider the tensions arising from inhabiting both a community of professional practice and at the same time, interrogating my community’s interests through participation in an academic community:

“A learning community is therefore fundamentally involved in social re- configuration: its own internally as well as its position within broader configurations.” (Wenger, 1998, p.220)

This process of re-orientation between communities in flux is visible in the dynamic nature of doctoral supervision. I found group supervision with other practitioner researchers a particularly

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am constantly mediating between academic discourse and homeopathy discourse. Reflective practice (Schön, 1983) offered a starting point to engage critically with my tacit knowledge to create an inquiry based approach.

Lewith (2004b) asks whether the practitioner’s conviction that ‘what I do is effective for my patients’ and their financial dependence on professional practice, precludes the critical distance needed to conduct research. He argues that CAM practitioners ‘enter the belief system’ of their therapy in a distinctly different way to medical doctors. Whilst agreeing that the context of research is different, this raises the question as to whether biomedical researchers challenge the underlying tenets of biomedical ideology? Lewith suggests that if the inquiry undermines the practitioner’s beliefs, there is a risk of becoming less effective in practice. He advocates mentoring and supervision to assist the researcher to challenge themselves and their practice. I extend the trajectory of his argument. Through this inquiry I intend to demonstrate how a critically reflexive approach is essential for interrogating practice from competing perspectives within a social, ethical and political context. I intend to disrupt the apparent stability and order of habituated practice and to explicate taken for granted practices, with the aim of generating potential benefit of patients.

To illuminate tensions for the practitioner researcher, let us create a fictional dialogue between Homeopath, Homeopath Researcher VOICE OF THE RESEARCH TEXTBOOK and Conceptual artist Susan Hiller (represented in the text as Susan).

Homeopath: Reflective practice helps me to explore practice. To question what I do, with the aim of improving practice.

Homeopath Researcher: Every practitioner is also a researcher, as questioning what is happening, is crucial to all forms of practice. Reflective writing can reinforce your assumptions, focus on your strengths and brush over difficulties. I take a more critical approach exploring tensions, inconsistencies and contradictions.

Homeopath: There’s a problem here. As a practitioner I need to believe in what I do. If you come along and question everything I do, that may disrupt my relationship with patients.

Homeopath Researcher: Why can’t we challenge belief?

Homeopath: Like many homeopaths, I wanted to study homeopathy because of personal experience of the positive effects of remedies. At college, the potential for homeopathy to improve health was regarded as commonsense. This was reinforced by what I witnessed in the teaching clinics. This became naturalised as intuitive in professional practice. Now I am more confident to allow for uncertainty in assessing response to treatment. However underlying this, is the belief that homeopathic treatment can be a catalyst for improving health.

Homeopath Researcher: This is a crucial aspect to explore together, and could contribute to understanding paradoxes of homeopathy, as part of the medical profession yet accused of being

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that…………(interruption)

A RESEARCH TEXTBOOK ON THE TABLE BECOMES ANIMATED, FLIPS OPEN....

VOICE OF THE RESEARCH TEXTBOOK: THIS IS NOT ACADEMIC RESEARCH! YOU CANNOT FULFIL BOTH ROLES, YOU ARE THE RESEARCHER AND YOU MUST USE OTHER PEOPLE AS THE SUBJECTS OF YOUR RESEARCH. THIS IS NOT LEGITIMATE DATA GENERATION AND YOU WILL NOT BE ABLE TO CRITICALLY ANALYSE YOUR FINDINGS. HOW DO YOU INTEND TO PROVE ANYTHING?

Homeopath Researcher: I appreciate your viewpoint. I have no intention of proving anything. The findings are inextricably linked with my experiences, and cannot be replicated or generalised. VOICE OF THE RESEARCH TEXTBOOK: I DOUBT THAT YOU WILL COMPLETE YOUR PHD, LET ALONE HAVE PAPERS ACCEPTED FOR PUBLICATION!

Homeopath Researcher: I agree the inquiry will be incomplete. Representation is always provisional and partial. At best it is always in the process of becoming. What is important is taking critical perspectives....

(LOUD SIGH AND THE TEXTBOOK SLAMS SHUT)

Homeopath: Critical perspectives…. This makes me feel uncomfortable. I have lost the sense of solid ground. This destabilises what I thought I knew....

Homeopath Researcher: That’s a good sign! We need to question what is going on in practice and in the research process. We are part of the research process, and through reflexivity, we are able to situate ourselves as knowers in wider social, ethical and political contexts and challenge habituated practice.

Homeopath: Knowers? I go to continuing professional development events to keep up to date and to increase my knowledge. Often I learn more during the tea breaks from talking with other homeopaths about their difficult cases or experiences of using specific remedies, than I do about the topic of the event. This sharing of experiences is very valuable to me but cannot be measured in research terms. Homeopath Researcher: Yes this is practitioner knowledge that is intuitive and subjective. In this inquiry we explore how we account for and record this as evidence in ways that honour the artistry of practice. We draw on the idea that subjective ways of knowing are as valid as empirical evidence. Homeopath: (in a troubled voice) But how can I challenge daily practice when I am integral to what I am researching?

Homeopath Researcher: We are both involved and at distance from clinical experience. I seek to examine homeopathy as a cultural phenomenon, its values, assumptions, customs and rituals, and to gain insight into factors that shape and influence our practice.

Homeopath: This is difficult as you are a product of the culture you are researching. I feel exposed and open to criticism. Other homeopaths may not appreciate our findings. Anyway research should be about important issues. Isn’t it conceited to think that my practice knowledge merits this attention?

Homeopath Researcher: The value in this inquiry is that rather than an outsider looking in, I am seeking to re-examine our daily experience of clinical practice from an insider’s perspective.

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consultation process should be explored together.

Homeopath Researcher: Homeopathy is a complex intervention, a process, evolving over time in response to the patient’s and practitioner’s perception of change. Analysis of your reflective journals reveals how you internalise the incantation of ‘prove it works’ and how we can develop language to articulate our own research-minded approach to practice.

(pause in the conversation)

[Thoughts not vocalised ....I am struggling to conceptualise this inquiry. How do I present this inquiry in a way that is authentic and congruent with homeopathic philosophy? To critique from an insider’s perspective, I need to move between the intimacy of practice and critical distance. Do other research domains offer any inspiration? I know, I’ll call my friend Susan Hiller, who works as a conceptual artist. She tackles postmodern issues of representation, describing practice and art as epistemology]

Homeopath Researcher picks up the phone and dials, sets up a conference call………..)

Homeopath Researcher: Hello, Susan, can you help as we’re struggling here to conceptualise subjective and intuitive knowing in clinical practice?

[This account is entirely fictitious and is informed by my reading of Susan’s interviews and lectures (Hiller, 1996b)]

Susan: First let me congratulate you both on your curiosity and openness to inquire. “I made the decision when I left anthropology that I never wanted to be again an observer, that I didn’t believe there was anything called ‘objective truth’, and I didn’t want to be anything but a participant in my own experience” (Hiller, 1996, p.46).

Homeopath Researcher: Yes, this resonates with our position as practitioner researchers. Participants and observers are inseparable.

Susan: Let’s create an analogy. Are there connections between the role of an artist and the practitioner researcher. They both “modify their culture while learning from it… perpetuate their culture by using certain aspects of it…change their culture by emphasising certain aspects of it, perhaps previously ignored ... show hidden or suppressed cultural potentials... operate skilfully within the very socio- cultural contexts which formed them... are experts in their own cultures”(Hiller, 1996, p. 24).

Homeopath Researcher: I find being an expert in my own culture constraining.

Susan: My work offers a critical analysis of my role and function as an artist, in particular how I act as a carrier of societal values. I encourage you to visualise how your culture inscribes what you know.

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Susan: I am searching for a way to be inside all my activities and for the viewers/participants to get inside their own activities. I examine “how our embeddedness in culture and how the outline of culture incribes what we know” (Einzig, 1996, p.1).

Homeopath: I’m beginning to feel more comfortable. Is it about how to be fully present in the consulting room and also to attempt to articulate the changing values and assumptions that shape my practice through the research process?

Homeopath Researcher: We explore homeopaths’ ways of knowing. As my supervisor Peter suggests, homeopathy itself becomes the patient. We take the case of homeopathy using its own methods of analysis. I realise that as researcher I am also participant in the research. Critical perspectives are essential to challenge my biases and blind spots.

Homeopath: I use myself therapeutically in the consulting room in supporting patients’ recovery, so does the researcher use themselves through the inquiry?

Homeopath Researcher: You are shifting from practice based to practitioner based research. This makes more sense. Susan, you explore our own culture through artefacts. I have an idea, we could explore homeopathic principles as artefacts of homeopathy discourse. Wow, what about using items from the paraphernalia of practice, to include texts, bottles and pills as reflexive devices?

Susan: Yes I encourage you to inquire creatively. I have enjoyed our conversation. Goodbye.

Homeopath and Homeopath Researcher: (in unison) : Susan, thank you for your insights. It has been thought provoking. Goodbye.

End of fictional dialogue.

Well reader, I hope this dialogue has illuminated the framing of this inquiry and created a sense of anticipation for the journey ahead. You may be wondering why I am using fictional dialogue, so let us turn to issues of representation and the relations between form and content.