Per-Einar Binder

Toward Caring for Oneself in a Life of Intense Ups and Downs: A Reflexive-Collaborative Exploration of Recovery in Bipolar Disorder

In this article, we discuss processes of recovery in bipolar disorder. We utilized a hermeneutical-phenomenological approach developed within a reflexive-collaborative framework to examine what individuals do to promote improvement and positive change in their own lives. The study was designed and carried out in collaboration with an expert-by-experience group of 12 coresearchers with firsthand experiences of mental distress and recovery. In-depth interviews were conducted with 13 participants who acknowledged having lived and dealt with a bipolar disorder. Four core themes were drawn from our analysis: (a) handling ambivalence about letting go of manic states; (b) finding something to hang on to when the world is spinning around; (c) becoming aware of signals from self and others; and (d) finding ways of caring for oneself. Interrelationships between the four themes, along with limitations, strengths, and implications of the study are discussed.

Staying close and reflexive: An explorative and reflexive approach to qualitative research on psychotherapy

Qualitative research has the potential to explore patient and therapist experiences of psychotherapeutic processes, as well as the challenges and opportunities inherent in relational and technical aspects of therapy. This paper examines explorative and reflexive ways of doing qualitative research on psychotherapy, based on the ontological and epistemological premises of hermeneutic phenomenology. An explorative–reflective thematic analysis is presented as a team-based approach, with a firm and transparent structure to the process of finding and interpreting experiential commonalities and differences in empirical material from semi-structured interviews. We use two examples of the interplay between phenomenological exploration and reflexivity from the interviews of two adolescent psychotherapy patients in a research project examining experiences of useful ways to establish a productive therapeutic relationship. A systematic way of conducting explorative–reflexive thematic analysis in a research team and with the assistance of computer software is described and discussed. It is emphasized that the procedures in themselves do not guarantee the result – they will only contribute if they also stimulate self-reflexivity and awareness of the researchers as interpreters of basically ambiguous human experience.

Why did I change when I went to therapy? A qualitative analysis of former patients' conceptions of successful psychotherapy

Abstract Aim: Much research has been undertaken to identify significant events and change processes in psychotherapy. Most of these studies use categories and concepts consonant with the researchers particular theoretical affiliation. But how do patients themselves, retrospectively, give meaning to what they felt most important for their realization of change? The present study sought to identify specific experiences and reflections of former psychotherapy patients who described their previous therapy as successful. Methods: Semi-structured, qualitative, in-depth interviews with ten former psychotherapy patients, recruited through an advertisement in a local newspaper. A descriptive and hermeneutically modified phenomenological approach was used to analyse interview transcripts, technically carried out with the assistance of Nvivo 8 software. Findings: The different ways the participants gave meaning to change processes and events clustered around the following themes: (i) Being in a relationship with a ...

Trait Self-Compassion Reflects Emotional Flexibility Through an Association with High Vagally Mediated Heart Rate Variability

Converging evidence shows a positive effect of self-compassion on self-reported well-being and mental health. However, few studies have examined the relation between self-compassion and psychophysiological measures. In the present study, we therefore examined the relation between trait self-compassion and vagally mediated heart rate variability (vmHRV) in 53 students (39 female, mean age = 23.63). Trait self-compassion was assessed using the Self-Compassion Scale, and resting vmHRV was measured during a 5-min ECG baseline period. We hypothesized that higher levels of trait self-compassion would predict higher levels of resting vmHRV. Controlling for potential covariates (including age, gender, and BMI), the results confirmed our hypotheses, showing that higher levels of trait self-compassion predicted higher vmHRV. These results were validated with a 24-h measure of vmHRV, acquired from a subsample of the participants (n = 26, 16 female, mean age = 23.85), confirming the positive correlation between high trait self-compassion and higher vmHRV. The relation between trait self-compassion, vmHRV, self-reported trait anxiety (the trait scale of the State-Trait Anxiety Inventory; STAI) and self-reported rumination (the Rumination subscale of the Rumination-Reflection Questionnaire; RRQ-Rum) was also investigated. Higher levels of trait anxiety and rumination were highly correlated with low levels of trait self-compassion. Trait anxiety, but not rumination, correlated marginally significantly with the level of vmHRV. The findings of the present study indicate that trait self-compassion predicts a better ability to physiologically and psychologically adapt emotional responses. Possible implications and limitations of the study are discussed.

The role of work in recovery from bipolar disorders

Being in recovery from bipolar disorder involves work-related concerns. The specific aims of this study are to: 1) understand the role of work in recovery from bipolar disorders, and 2) understand how people with such disorders deal with work-related challenges. These topics are examined from the stance of the recovery process, in which work-related activities were explored. Semi-structured, qualitative interviews were conducted with persons who had experienced recovery from bipolar disorder. Analysis was performed through thematic and phenomenological analysis, with hermeneutic phenomenology and reflexive methodology as a framework. The findings are presented through the following themes: 1) many types of work – finding meaning and a focus; 2) helpful roles and contexts – to be much more than a person with an illness; 3) making work possible – the role of supportive relationships and supportive medications, and 4) the costs of working too much – finding a meaningful and healthy balance.

Re-establishing contact: A qualitative exploration of how therapists work with alliance ruptures in adolescent psychotherapy

Abstract What challenges do therapists face when they experience ruptures in the working alliance in psychotherapy with adolescent clients; and what are their most typical strategies when they try to re-establish contact? These issues were explored through qualitative interviews with nine psychotherapists from outpatient child and adolescent psychiatric clinics in Bergen, Norway. A descriptive and hermeneutically informed phenomenological approach was used to analyse the interview transcripts. Most therapists/participants described that they would explore the reason for the rupture from the adolescents point of view, and all participants often understood ruptures in light of the adolescents’ need for autonomy. However, the participants differed strongly in how much they would focus on the relationship per se, on intrapsychic factors, or on the adolescents life outside therapy. For the therapists who regarded the relationship as something to be explored, client ambivalence to treatment was seen as someth...

Facing the fear of failure: An explorative qualitative study of client experiences in a mindfulness-based stress reduction program for university students with academic evaluation anxiety

The aim of this qualitative study was to investigate the subjective experiences of 29 university students who participated in an 8-week mindfulness-based stress reduction (MBSR) program for academic evaluation anxiety. Participants who self-referred to the Student Counseling Service underwent individual semi-structured interviews about how they experienced the personal relevance and practical usefulness of taking the MBSR program. Interviews were transcribed and analyzed through a team-based explorative–reflective thematic approach based on a hermeneutic-phenomenological epistemology. Five salient patterns of meaning (themes) were found: (1) finding an inner source of calm, (2) sharing a human struggle, (3) staying focused in learning situations, (4) moving from fear to curiosity in academic learning, and (5) feeling more self-acceptance when facing difficult situations. We contextualize these findings in relation to existing research, discuss our own process of reflexivity, highlight important limitations of this study, and suggest possible implications for future research.

We have travelled a long distance and sorted out the mess in the drawers: Metaphors for moving towards the end in psychotherapy

Abstract Aim: To explore the process of ending in psychotherapy, in particular how clients and therapists draw on their notions of client improvements and prepare for the upcoming end. Data: The data comes from an intensive process-outcome study at the University of Oslo, Norway. The study includes audio-recording from all sessions and separate post-therapy interviews with clients and therapists. Twelve psychotherapy dyads were selected because they had reached a ‘good enough’ ending. Therapy duration ranged from 7–43 months. The number of sessions ranged from 10–67. Method and analysis: A hermeneutical-phenomenological approach analysed and combined the observational and reflexive data. The analysis was carried out using a method for systematic text condensation and through reflexive dialogues with the material and between the researchers. Findings and discussion: The language of improvement towards the end of treatment seemed packed with metaphors conveying growth in both affective and relational manage...

Two Ways of Living through Postpartum Depression

Abstract Our aim with this descriptive phenomenological study was to identify and describe the essential meaning structure in the experience of postpartum depression (PPD). We interviewed four women diagnosed with major depression and analyzed the data with Giorgi’s descriptive phenomenological method. Our analysis revealed two essential meaning structures of PPD. The first structure describes the mother as thrown into a looming, dangerous world, coupled with a restricted, heavy body that hindered her attunement to her baby. Tormented by anxiety, guilt and shame, she tried to deal with her pain by analytical reflection and social isolation. The second structure describes sudden lapses into intense feelings of alienation from the self, the baby, and from the social and material world. With a distorted primordial self-awareness, the mother no longer felt that she existed as herself in the world. We reflect on these findings using the insights of Fuchs, Van den Berg, Heidegger and Merleau-Ponty.

This is what I need a clinical feedback system to do for me: A qualitative inquiry into therapists’ and patients’ perspectives

Abstract Routine outcome monitoring and clinical feedback systems (ROM/CFSs) are promising methods of providing naturalistic research data and enhancing mental health care. However, implementation in routine care is challenging, and we need more knowledge about clinicians’ and patients’ needs from such systems. Objective: We aimed to study perspectives of clinicians and patients to explore how ROM/CFS can be helpful and acceptable to them. Method: We interviewed 55 participants in focus groups and individual interviews and analyzed the data through rigorous team-based qualitative analyses. Results: We report 3 overarching domains: (a) Shared needs, (b) Specific patient needs, and (c) Specific therapist needs. Shared needs, in which perspectives of different stakeholders converge, was the dominant domain in the material. Under each domain, we report 3 specific themes: (a1) Degree of trust in therapy, (a2) Allowing for openness, (a3) Monitoring joint objectives; (b1) Life functioning, (b2) Canary in the coal mine, (b3) Holistic report; and (c1) Emotional presence and style, (c2) Monitoring risk and symptoms, and (c3) Agency and ownership of process. Conclusions: In what should increase our confidence toward core aspects of ROM, we suggest that an integration of relational feedback concepts and stringent clinical dimension tracking into the ROM/CFS can be beneficial.