Sampling 106 

Firstly, the study sample size of 14 participants can be viewed as a strength of the research. This number went above and beyond the originally anticipated cap of 12 participants, which suggests that data saturation may have been more likely to occur and the sample size was large enough to allow key themes to be present (Guest et al., 2006). The sample itself only included clinicians and not clients from IAPT services. Whilst this was appropriate in addressing the relative paucity of research investigating clinicians’ perspectives, it also limits any conclusions that can be drawn regarding the clients in this process. Any mention of the client in this study is

effectively “second-hand” opinion and reflects only the perception of clinicians, which may not be a true reflection of client experiences. Nonetheless, it would have been impossible to artificially remove the role of the client from a study regarding client-therapist relationships.

The sample can be viewed as adding external validity to the research, as participants were drawn from currently functioning services and described

experiences from current everyday practice. As a result, the study did not exclude clinicians who met clients face-to-face as part of their telephone treatment, as this represents the reality of present service delivery. Similarly, the sample included both PWPs and High Intensity Therapists as both types of clinician are reportedly

delivering telephone interventions in current IAPT services. However, it could be argued that this compromises the homogeneity of the sample. If some participants had met with clients, this is likely to have impacted upon the therapeutic alliance in terms of being more akin to face-to-face alliance. Therefore a “purer” sense of distance alliance could have been gained from using stricter inclusion and exclusion criteria, although this would have limited the ecological validity of the research. Similarly, the exclusion of High Intensity Therapists would have provided a more homogenous sample but at the expense of the ecological validity and range of views captured by the study.

The inclusion of High Intensity Therapists also helped to overcome another limitation of the sample. It could be argued that the PWPs included in this sample were not delivering CBT therapy as such, and therefore the present study does not fit with the existing evidence-base regarding telephone CBT using a more traditional format. Similarly, as alluded to in the current findings, some PWPs may not view themselves as “therapists”, making them seem an odd choice to investigate telephone therapy. However, the High Intensity Therapists included in the sample did report offering more “traditional” CBT via the telephone. It was also apparent that many PWPs did consider themselves to be therapists and were using traditional CBT techniques, albeit in a low-intensity format.

One limitation of the sample is the self-selected nature of participants. Clinicians with strong views or those who felt particularly positive about telephone work may have been more likely to volunteer for this project, and therefore this study may under-represent clinicians with more moderate views or those who feel

generally more discontentment towards telephone working. This may be due to feelings of apathy towards the topic, or clinicians possibly fearing reprimand if they were to discuss more negative aspects of their work. Similarly, it may have been assumed that the researcher held positive views of telephone work in order to wish to investigate it further, leading to demand characteristics. The researcher took steps to assure clinicians of the confidentiality of their interviews and the impartiality of the researcher, but nonetheless these factors may have influenced the research. This was noted by the researcher in the reflective log:

Excerpt from reflective log:

(Re: Transcript 3): “I am starting to think that perhaps the nature of my study attracts a certain type of clinician – someone who has good things to say about telephone work and wants to share these views, perhaps as an advocate against the “bad press” that telephone work receives. Alternatively it could be a form of response bias whereby people think I am looking for positivity, although I have been careful to appear as neutral as possible regarding telephone work.”

The pragmatic convenience sampling is another limitation of the study. Time and budget constraints limited the extent to which the researcher could employ true maximum variation sampling (Coyne, 1997). As a result, the sample is not ethnically diverse and consists of only two men in a sample of 14 participants. In addition, the sample appeared to consist predominantly of clinicians with around four to six years’

experience and only included two High Intensity Therapists. As a result, the

perceptions and experiences of much less or much more experienced clinicians may be under-represented, which may be important as therapist experience has been linked with the quality of alliance in recent literature (Horvath, 2001). However, the study did include a good range of ages and recruited clinicians from a number of different IAPT services which is likely to have broadened the range of perceptions and experiences included in the research.