Nikki Kiyimba

The risk of secondary traumatic stress in the qualitative transcription process: a research note:

It is recognised that transcribing is not merely a neutral and mechanical process, but is active and requires careful engagement with the qualitative data. Whether the researcher transcribes their own data or employs professional transcriptionists the process requires repeated listening to participants’ personal narratives. This repetition has a cumulative effect on the transcriptionist and hearing the participants’ personal narratives of a sensitive or distressing nature, can have an emotional impact. However, this potential emotional impact is often not something which is accounted for in the planning stages of research. In this article we critically discuss the importance of considering the effects on transcriptionists who engage with qualitative data.

“This is a question we have to ask everyone”: asking young people about self-harm and suicide

WHAT IS KNOWN ON THE SUBJECT?: An essential part of the mental health assessment is to evaluate the risk of harm to self. Fundamentally this involves asking directly about self-harming behaviour and suicidal thoughts or urges, but practitioners often find it difficult to open up these conversations. This evaluation of risk is particularly important as self-harm and suicidal thoughts are frequently found in young people who attend mental health services. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Young people are not always routinely asked directly about self-harm or suicidal thoughts when they are assessed. There are two ways that mental health practitioners introduce this topic: first, by building up to it by initially asking about general feelings, and second by stating that it is a requirement to ask everyone. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: These questions should not be avoided by mental health practitioners just because they are difficult. We offer suggestions as to how to ask questions about self-harm and suicide based on real-world practice. ABSTRACT Introduction Questions about self-harm and suicide are essential in risk assessments with children and young people, yet little is known about how mental health practitioners do this. Aim The core aim was to examine how questions about self-harm and suicidal ideation are asked in real-world practice. Method A qualitative design was employed to analyse 28 video-recorded naturally occurring mental health assessments in a child and adolescent mental health service. Data were analysed using conversation analysis (CA). Results In 13 cases young people were asked about self-harm and suicide, but 15 were not. Analysis revealed how practitioners asked these questions. Two main styles were revealed. First was an incremental approach, beginning with inquiries about emotions and behaviours, building to asking about self-harm and suicidal intent. Second was to externalize the question as being required by outside agencies. Discussion The study concluded that the design of risk questions to young people had implications for how open they were to engaging with the practitioner. Implications for practice The study has implications for training and practice for psychiatric nurses and other mental health practitioners in feeling more confident in communicating with young people about self-harm and suicidal ideation.

Discursive Psychology as a method of analysis for the study of couple and family therapy

The field of couple and family therapy has benefitted from evidence generated from qualitative approaches. Evidence developed from approaches relying on language and social interaction using naturally occurring recordings of real-world practice has the benefit of facilitating practice-based recommendations and informing practice. The aim of this article is to provide an overview of one approach to discourse analysis, Discursive Psychology (DP), demonstrating how a social constructionist framework and focus on discourse can provide an important contribution to the field of therapy. To illustrate the methodological decision-making process for researchers and/or practitioners who utilize DP, we draw upon a video-recorded therapeutic session involving Tom Andersen. To conclude, we make recommendations for practitioners using DP to explore and examine therapeutic practice.

An exploration of the possibility for secondary traumatic stress among transcriptionists: a grounded theory approach

ABSTRACT While there is a small, growing literature considering the psychological safety of researchers, little attention has been paid in the qualitative literature to the wellbeing of transcriptionists. Transcriptionists play an integral and essential role in qualitative research but are often overlooked in terms of the emotional impact of the work. Using grounded theory methodology, transcriptionists were interviewed to ascertain their experiences of their role. Findings indicated that transcriptionists experienced emotional distress and feelings of helplessness. Analysis of the data demonstrated that transcriptionists did have some coping strategies, but also expressed an additional need to discuss their feelings. Furthermore analysis revealed that the lack of safeguarding protocols for the profession made the role even more challenging. The emergent core category identified was that there was a risk of secondary traumatic stress for transcriptionists. Recommendations were made for additional safeguarding of transcriptionists through the introduction of a research team approach.

The Value of Using Discourse and Conversation Analysis as Evidence to Inform Practice in Counselling and Therapeutic Interactions

The evolution of both discourse analysis and conversation analysis (henceforth DA and CA, respectively) has been a progressive movement from their inception as an inductive focus and unmotivated interest in how language works and what it accomplishes. From their early beginnings, quite sophisticated structures and frameworks have been developed to understand how people use language in interactions to accomplish social actions. With this framework in place, more latterly attention has turned towards the possibility of how these principles might be usefully applied to different settings (we refer you to Chapter 1 of this volume — Lester & O’Reilly — for a good overview). With this second wave characterised by a greater focus on the real-world usefulness of CA and DA findings, there is an exciting opportunity for researchers using these methodologies to interrogate the nuances of institutional interactions in order to make recommendations for changes in practice. This chapter is situated within this cutting-edge movement, which is transposing the scientific rigour and credibility of CA and DA findings into real-world applied settings and evidence-based practice (see, e.g. Kiyimba, Chapter 2, this volume). In our contemporary culture, a primary concern for practitioners across a range of institutional contexts, and particularly within therapy and counselling, is to work within evidence-based models of care and demonstrate efficacy and cost-effectiveness of interventions. We therefore seek to demonstrate that both DA and CA have a great deal to offer the evidence base in this field. It is thus extremely timely and salient for this discussion to take place in a handbook such as this one.

Discursive Psychology: Implications for counselling psychology

In this article, we present discursive psychology (DP), a qualitative approach that focuses on the study of conversational and textual materials, including everyday interactions. Although DP is well-established methodologically and theoretically, and is used widely in Europe and in the Commonwealth countries, it is relatively unknown in counseling psychology in the United States. As such, the purpose of this article is to provide a general overview of DP and offer guidance for researchers who may be interested in studying and using DP. We thus discuss practical considerations for utilizing DP, including the development of research questions, carrying out data collection, and conducting DP-informed analyses. We also provide a general overview of the history of DP and key resources for those interested in studying it further, while noting the usefulness of DP for counseling psychology.

The clinical use of Subjective Units of Distress scales (SUDs) in child mental health assessments: a thematic evaluation

Abstract Background: Despite the ubiquitous use of Subjective Units of Distress scales (SUDs) in mental health settings to establish levels of distressing emotion, there has been little empirical research in this area. SUDs are commonly used in therapy and assessments, and are a particularly useful tool for establishing current and previous levels of distress in children and young people. Aims: To explore the use of the SUD analogue rating scale in initial child mental health assessments to better understand its application in this context. Method: The data corpus consisted of 28 naturally-occurring video recordings of children and young people attending their first assessment appointment at Child and Adolescent Mental Health Services (CAMHS). A thematic analysis was utilised to explore the specific interactional use of SUDs. Results: Four themes were identified; recency, longevity, context and miscommunication. The first three themes were found to supplement the child’s emotional score on the scale and were important in establishing the necessity for further therapeutic support. Miscommunication as a theme highlighted the need for clarity when using SUDs with children and young people. Conclusions: Recommendations were suggested for practitioners working with children and young people relating to the extended use of rating scales in clinical assessments.

Parents’ Resistance of Anticipated Blame through Alignment Strategies: A Discursive Argument for Temporary Exclusion of Children from Family Therapy

In this chapter, we utilise a discourse perspective to explore ways in which parents manage therapeutic alignment in family therapy. As therapy is an activity which relies heavily on the use of language (McLeod, 2001), we use a language-based analytic approach to explore child mental health, particularly as discourse analysis is most appropriate for looking at family therapy processes (Roy-Chowdhury, 2003). In this chapter, we present a case for the deliberate temporary exclusion of children in the initial stages of a series of therapeutic sessions. The purpose of this temporary exclusion is to provide opportunities for therapists to engage in active solution-focused alignment with parents in order to provide a foundation and set boundaries for later work with the whole family. We also argue that while this initial session with parents is taking place, the child could be otherwise engaged in a session of their own so that the child’s perspective and expectations are also managed effectively.

Agenda setting with children using the ‘three wishes’ technique

The National Health Service (UK) offers initial screening appointments for children referred to child and adolescent mental health services to determine clinical need and assess risk. Conversation analysis was utilized on 28 video recordings of these assessments, lasting approximately 90 minutes each with a multidisciplinary team. This article focuses on the agenda setting strategies used to establish relevant goals with children and adolescents; specifically, the technique of offering ‘three wishes’. For example, ‘if you had three wishes, what would you like to make happen?’ In cases where children initially volunteered an assessment-relevant wish, they tended not to articulate further wishes. Non-assessment-relevant wishes (i.e. fantasy wishes, such as being ‘rich’) were treated as insufficient, with many approaches used to realign establishing assessment relevant goals. Where responses were not institutionally relevant, practitioners undertook considerable discursive work to realign the focus of the three wishes task to assessment relevance. In these cases, the wish responses were treated as irrelevant and tended to be dismissed, rather than explored for further detail. Such work with the children’s contributions has implications for engaging children and child-centred practices.