Michael Larkin

Giving voice and making sense in Interpretative Phenomenological Analysis

In this paper, we discuss two complementary commitments of interpretative phenomenological analysis (IPA): the phenomenological requirement to understand and ‘give voice’ to the concerns of participants; and the interpretative requirement to contextualize and ‘make sense’ of these claims and concerns from a psychological perspective. The methodological and conceptual bases for the relationship between these phenomenological and interpretative aspects of IPA appear to be underdeveloped in the literature. We, therefore, offer some thoughts on the basis of this relationship, and on its context within qualitative psychology. We discuss the epistemological range of IPAs interpretative focus, and its relationship to the more descriptive features of phenomenological analysis. In order to situate our conclusions within a contextualist position, we draw upon concepts from Heideggerian phenomenology. The argument is illustrated by excerpts from our own research on relationship break-up. We conclude by encouraging IPA researchers to embrace the interpretative opportunities that are offered by this approach.

Developing an Interpretative Phenomenological Approach to Focus Group Data

Interpretative phenomenological analysis (IPA) is an approach to qualitative research that is now well-established in British psychology. This approach is concerned with understanding peoples experiences of the world and of themselves. The aims of IPA studies have been met most frequently through the use of one-on-one interviews. Relatively few studies have used focus group discussions as the basis for IPA studies, but focus groups may provide rich experiential data. In this article, we describe a process for integrating focus group data into an IPA study. We developed this during a study of the experiences of carers of people with mental health problems. Here we outline the various steps of our analytic process and discuss how these might be employed and adapted by other researchers wishing to apply IPAs concern with personal experience to the analysis of focus group data.

Towards addiction as relationship

In this article, we wish to offer some thoughts on the taken-for-granted connotations of the term ‘addiction’, and on the limits of the disease model which these assumptions support, and by way of comparison with parallel developments in the field of ‘schizophrenia’ research, to suggest some avenues for conceptual development.

A shared experience of fragmentation: making sense of foster placement breakdown.

Multiple placement transitions have been associated with poorer psychosocial outcomes for children growing up in local authority care. However, although there is an expanding literature examining the risk and protective factors connected with placement breakdown, very few studies have explored the quality of the move experience for those most closely involved with it. Our study considered how young people, foster carers and social workers made sense of unplanned placements’ endings. Bringing together the lived experiences of these key stakeholders in the placement system added a novel dimension to existing research knowledge. What emerged from our analysis was evidence of a pervasive and shared emotional experience; all of the participants were affected by the breakdown irrespective of age, experience, or professional role. However, despite many commonalities, there was also a strong sense of fragmentation between the groups, which was characterised by discourses of mistrust and miscommunication. This meant that emotional reactions to the breakdown were often suppressed or dismissed, resentments built-up and attempts to find a solution were thwarted by silence or angry recrimination. These findings raise real challenges for practice and policy development. In particular, they stress the importance of shared and meaningful dialogue between all key stakeholders within the social care system, the need for more effective and timely support when placements are in crisis and opportunities for those most closely involved with the placement breakdown to process the emotional experience.

Learning to change a way of being: an interpretative phenomenological perspective on cognitive therapy for social phobia.

Social phobia (SP) is a common and disabling condition for which cognitive-behavioral treatments (CBT) have demonstrated efficacy. However, there remains room for improvement. Hence, further exploration of the means by which CBT helps patients with SP is warranted. Studies examining patients’ perspectives on which aspects of treatment were most or least helpful may augment other established methodologies for identifying the more or less effective components and thus help to increase the efficacy and cost-effectiveness of CBT for SP. The current study used interpretive phenomenological analysis to analyze the transcripts of interviews with eight patients who had completed cognitive therapy (CT) for SP. Four related themes were identified: (i) social phobia as a way of being; (ii) learning to challenge social phobia as a way of being: transformative mechanisms of therapy; (iii) challenges faced in the pursuit of change; (iv) a whole new world: new ways of being. This analysis of patients’ experiences of CT for SP confirmed that the factors hypothesized to be important in maintaining SP in cognitive-behavioral models of the disorder are evident in patients’ descriptions of the processes of change in CT for SP (e.g., reducing internal focus of attention and reducing safety behaviors and avoidance). Helpful components of CT for SP were identified as areas where the protocol could be enhanced. Recommendations for the way in which CT for SP is implemented are made.

Understanding the impact of HIV diagnosis amongst gay men in Scotland: An interpretative phenomenological analysis

Objectives: Although a wide literature details the psychological impact of human immunodeficiency virus (HIV) diagnosis, it predates the introduction of effective treatment for HIV (i.e. anti-retroviral therapies, ARTs). This article explores the psychological impact of HIV diagnosis in post-ART accounts. This is important, given the recent policy developments which focus upon increasing HIV testing and thus diagnoses. Design: This study presents a qualitative exploration of the experiential accounts of HIV-positive gay men living in Scotland. A total of 14 HIV-positive gay men took part in open-ended interviews. Methods: Interpretative phenomenological analysis was employed to identify recurrent themes across the interviews. Results: Our analysis focuses upon the participants’ struggles in adjusting to their HIV status. Diagnosis was a deeply shocking and unexpected experience. Stigma and fear of prejudice dominated their accounts. HIV was understood, variously, as a shameful, fatal and life-changing condition. Overall, within these accounts there was little sense of HIV normalisation. Conclusions: In Scotland, where HIV prevalence is low, and where no accessible HIV-positive sub-culture exists, there is on-going psychological distress and morbidity amongst gay men testing HIV positive. As HIV-related policy increasingly focuses on increasing rates of antibody testing, there is a need to reduce the psychosocial costs associated with HIV-positive diagnoses.

The personal meaning of romantic relationships for young people with psychosis

Romantic relationships are of particular importance to young people, and play a key role in the transition from adolescence to adulthood. Psychosis typically develops during late adolescence or early adulthood, a crucial period for gaining romantic experience. The significance of these relationships for young people with psychosis has never been explored. Eight participants were interviewed about their experiences and perceptions of romantic relationships using a semi-structured interview. The research was conducted using Interpretative Phenomenological Analysis (IPA). Five overarching themes emerged, suggesting that participants experienced conflict regarding romantic relationships, as they considered such relationships incompatible with psychosis, whilst they also associated them with normality and recovery. Relationships were perceived to be “risky”, and participants were concerned with strategies for reducing these risks. Respondents typically perceived themselves to have a relative lack of experience and resources, making it more difficult for them to engage in romantic relationships. As romantic relationships are associated with a range of personal and social benefits, young people who have experienced psychosis may benefit from services supporting them in negotiating stigma and facilitating their involvement in romantic relationships.

Expanding the evidence within evidence-based healthcare: thinking about the context, acceptability and feasibility of interventions

Evidence-based medicine is crucial to contemporary healthcare. It is dependent on systematic review methodology modelled on an arguably inadequate hierarchy of evidence. There has been a significant increase in medical and health research using qualitative and mixed method designs. The perspective taken in this article is that we need to broaden our evidence base if we are to fully take account of issues of context, acceptability and feasibility in the development and implementation of healthcare interventions. One way of doing this is to use a range of methods that better fit the different aspects of intervention development and implementation. Methods for the systematic review of evidence, other than randomised-controlled trials, are available and there is a readiness to incorporate these other types of evidence into good-practice guidance, but we need a clear methodology to translate these advances in research into the world of policy.

On the Brink of Genuinely Collaborative Care Experience-Based Co-Design in Mental Health

Inpatient mental health services in the United Kingdom are currently dissatisfactory for service-users and staff. For young people with psychosis, being hospitalized is often distressing, and can lead to disengagement with mental health services. This article describes how we took three qualitative research studies about hospitalization in early psychosis (exploring the perspectives of service-users, parents, and staff) and translated them into service improvements developed in collaboration with a range of stakeholders, including service-users, carers, community and inpatient staff, and management. We used an adapted form of experience-based co-design (EBCD), a participatory action-research method for collaboratively improving health care services. The use of EBCD is still relatively novel in mental health settings, and we discuss how we adapted the methodology, and some of the implications of using EBCD with vulnerable populations in complex services. We reflect on both the disappointments and successes and give some recommendations for future research and methodological development.

Against the odds: Foster carers’ perceptions of family, commitment and belonging in successful placements

This study examines carer attributes associated with placement stability for teenagers growing up in long term foster care, focusing on unexpected placement success. We explored experiences and perceptions relating to family, belonging and commitment in a group of foster carers providing a stable placement for a young person who had not been expected to settle. These placements showed positive outcome, despite factors in the child’s history that might have predicted otherwise. Seven foster carers were interviewed following a semi-structured guide, which covered their ideas about their relationship with the child in question, about the foster family, and the child’s sense of belonging in foster and birth family. Analysis of carers’ accounts of placements which had succeeded ‘against the odds’ revealed four major themes, described under the headings My Child—emotional bonding, the carers’ enlarged view of family and their parental regard for the young person; Jam in the Sandwich—working within a ‘compromised space’ between Local Authority and birth family; Repair and Rebuild—the craft of fostering including managing the foster/birth family boundary; Sticking with It—resilience, tenacity and maintaining hopefulness. The carers’ accounts offer pointers towards the ingredients of successful placements and prompt reflection on how these may be supported and promoted. They also highlight tensions inherent in the foster carer task relating to carers’ parental functioning for young people in long-term foster care.