Comment

Giving voice to adults with intellectual disabilities and experience of mental ill-health

Reflecting on the role of a narrative psychosocial approach
Giving voice illustration

Reflecting on the role of a narrative psychosocial approach

As a researcher preoccupied with Hollway and Jeffersons free association narrative interview method (Hollway and Jefferson 2000 , 2012 ), I was interested to read Sutton and Gates (2018) recent contribution. In their paper, they describe the adaption of this method and some of the methodological challenges involved in using it as part of a study exploring the experiences of care and support of adults with intellectual disabilities who have also experienced mental ill-health. A well-thought out strategy was implemented of engaging participants over time, involving initial introductory meetings, the presence of participants main carers in interviews and in the case of some of the older participants the use

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Reflecting on the role of a narrative psychosocial approach

Giving voice illustration
Picture: iStock

As a researcher preoccupied with Hollway and Jefferson’s free association narrative interview method (Hollway and Jefferson 2000, 2012), I was interested to read Sutton and Gates’ (2018) recent contribution. In their paper, they describe the adaption of this method and some of the methodological challenges involved in using it as part of a study exploring the experiences of care and support of adults with intellectual disabilities who have also experienced mental ill-health. A well-thought out strategy was implemented of engaging participants over time, involving initial introductory meetings, the presence of participants’ main carers in interviews and – in the case of some of the older participants – the use of photographs from life history books as visual prompts.

Sutton and Gates’ (2018) paper reflects the growing interest among nurse and mental health researchers in the free association narrative interview method. It also provides further evidence of the value the method can have in the purely practical sense of inspiring researchers to follow participants’ leads – at least, in initial interviews. As Frosh and Saville Young (2008) put it, citing Hollway and Jefferson (2000), ‘holding attentively to what emerges without irritably seeking to order and understand it and simply encouraging participants to speak on or around the topic under study… can pay dividends in terms of the narrative data that is produced’. Sutton and Gates (2018) highlight some of the specific skills required when using this type of interview approach with participants with intellectual disabilities, including the need to use simpler language and tangible reference points if a participant appears to be struggling with their response. 

An emancipatory research stance

What I was struck by in reading Sutton and Gates’ (2018) account was the extent to which they position the method as consistent with an emancipatory research stance and a desire to ‘give voice’ to socially marginalised populations, and providing a way ‘to achieve a more equal relationship between researcher and participants in the production of knowledge’. Contrastingly, in other work and commentary concerning the method, for example Parker (2003), a large part of what is viewed as controversial and problematic about it is the level of interpretive authority afforded to the researcher over the participants. This work has questioned whether Hollway and Jefferson’s deployment of certain psychoanalytic principles situates the researcher in an expert position in explaining what participants say and communicate in terms of underlying psychodynamics.

In considering this disjuncture, it can be acknowledged that Sutton and Gates (2018) say generally very little about the method’s ‘psychoanalytically informed’ quality. Moreover, criticisms of the free association method can feel more or less compelling, depending on researchers’ professional backgrounds and the particular disciplinary contexts in which they are working (Archard 2020a, 2020b).

At the same time, I also think that it is important for nurse researchers interested in the method to recognise that the label ‘psychoanalytically informed’ can cover a range of practices. On the one hand, one might say that a research method only qualifies for this label if the conclusions drawn from its application cohere with psychoanalytic practice and theory. In this view, clinical psychoanalytic practice is taken as ‘the ultimate touchstone for checking the value of new insights, and for seeing whether new insights are valuable from a psychoanalytic point of view’ (Lievrouw 2003). On the other, one may say that the theory and practice of qualitative research interviewing is already – in some ways heavily – permeated by psychoanalysis in terms of the different, more general ways in which clinical prescriptions and practices from psychoanalysis and psychodynamic psychiatry have affected social sciences in a historical sense (Levine and Scotch 1968).

Free association

Reading Sutton and Gates (2018), I thought in particular about free association as ‘a principal technique in psychoanalytic practice’ borrowed by Hollway and Jefferson. Hollway and Jefferson’s (2000, 2012) articulation of free association is misconstrued if it is not understood in terms of its place and understanding within the Kleinian/post-Kleinian tradition of psychoanalysis. Their conceptualisation of the research participant as ‘defended psychosocial subject’ is rooted in this tradition, which differs from other schools of thought and practice in psychoanalysis in how the activity of free association is formulated (Spacal 1990).

Hollway and Jefferson’s framing of free association is also consistent with the way it has been moved away from the traditional context of the silent psychoanalyst and analytic couch and is used in writing about psychiatric social work and short-term psychodynamic psychotherapy and counselling. In these contexts, the terminology does not just denote the patient attempting to give voice to whatever comes to mind as ‘the fundamental rule’ of psychoanalytic treatment. Rather, it is invoked in respect to the ‘associative’ ordering of conversations between client or patient and professional or therapist and ways in which free-flowing conversations involving an interested and sensitive listener can have a therapeutic effect.

Researchers attempting to draw on aspects of Hollway and Jefferson’s approach should reflect carefully on whether their work involves a sufficient concern for unconscious processes to be considered psychoanalytic or whether they are using this terminology as a gloss to enliven descriptions of a more ‘basic’ research approach. Reflective accounts that detail the use and adaption of the method enable comparative judgements to be made about the similarities and dissimilarities between the framing of different psychoanalytic concepts and techniques associated with the method and their articulation in other clinical and extra-clinical contexts.


Philip John Archard, mental health practitioner, Child and Adolescent Mental Health Services, Leicestershire Partnership NHS Trust, EnglandPhilip John Archard is a mental health practitioner, Child and Adolescent Mental Health Services, Leicestershire Partnership NHS Trust, England

 

 


References

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