• Agenda setting with children using the ‘three wishes’ technique

      Kiyimba, Nikki; O'Reilly, Michelle; Lester, Jessica N.; University of Chester (Sage, 2018-03-15)
      The National Health Service (NHS; UK) offers initial screening appointments for children referred to Child and Adolescent Mental Health Services (CAMHS) to determine clinical need and assess risk. Conversation analysis was utilised on 28 video-recordings of these assessments, lasting approximately 90 minutes each with a multidisciplinary team. This paper 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.
    • Building a case for accessing service provision in child and adolescent mental health assessments

      O'Reilly, Michelle; Kiyimba, Nikki; Lester, Jessica N. (Sage, 2019-04-29)
      In everyday conversations, people put forward versions of events and provide supporting evidence to build a credible case. In environments where there are potentially competing versions, case-building may take a more systematic format. Specifically, we conducted a rhetorical analysis to consider how in child mental health settings, families work to present a credible ‘doctorable’ reason for attendance. Data consisted of video-recordings of 28 families undergoing mental health assessments. Our findings point to eight rhetorical devices utilised in this environment to build a case. The devices functioned rhetorically to add credibility and authenticate the case being built, which was relevant as the only resource available to families claiming the presence of a mental health difficulty in the child were their spoken words. In other words, the ‘problem’ was something constructed through talk and therefore the kinds of resources used were seminal in decision-making.
    • Doing mental health research with children and adolescents: A guide to qualitative methods.

      O'Reilly, Michelle; Parker, Nicola; University of Chester; Leicester University (Sage, 2014-07-07)
      Researching child and adolescent mental health can be a daunting task, but with the right practical skills and knowledge your students can transform the way they work with children and young people, giving them a ‘voice’ through their research in the wider community. Michelle O'Reilly and Nikki Parker combine their clinical, academic and research expertise to take your students step-by-step through each stage of the research process. From first inception to data collection and dissemination, they’ll guide them through the key issues faced when undertaking their research, highlighting the dilemmas, challenges and debates, and exploring the important questions asked when doing research with this population. Providing practical advice and strategies for dealing with the reality of conducting research in practice, this book will; - Provide your students with an overview of the theories that underpin methodological choice and the value of using qualitative research. - Guide them through the planning stage of your project, clearly outlining important ethical and legal issues. - Take them through the most popular qualitative data collection techniques and support them with their analysis. - Help them write up their findings and demonstrate how research evidence translates into effective clinical practice. Supported by helpful hints and tips, case examples and definitions of key terms, this highly practical and accessible guide throws a lifebelt to any students or mental health practitioner learning about the research process for the first time.
    • Ethics in Praxis: Negotiating the Role and Functions of a Video Camera in family therapy

      Hutchby, Ian; O'Reilly, Michelle; Parker, Nicola; University of Leicester (Sage, 2012-12-01)
      The use of video for research purposes is something that has attracted ethical attention and debate. While the usefulness of video as a mechanism to collect data is widely agreed, the ethical sensitivity and impact of recording equipment is more contentious. In some clinical settings the presence of a camera has a dual role, as a portal to a reflecting team and as a recording device to obtain research data. Using data from one such setting, family therapy sessions, this article shows how the role played by recording equipment is negotiated in the course of talk and other activities that constitute sessions. Analysis reveals that members of the therapy interaction orient in different ways and for different purposes to the value of recordings. The article concludes that there are layers of benefit to be derived from recording of clinical interactions, including for members themselves, and this has wider implications for the ways in which qualitative research designs in health sciences are evaluated.
    • An exploration of the possibility for secondary traumatic stress among transcriptionists: a grounded theory approach.

      Kiyimba, Nikki; O'Reilly, Michelle; University of Chester; University of Leicester (Taylor & Francis, 2015-11-23)
      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.
    • ‘Gossiping' as a social action in family therapy: The pseudo-absence and pseudo-presence of children

      Parker, Nicola; O'Reilly, Michelle; Birmingham and Solihull Mental Health Foundation Trust; University of Leicester (Sage, 2012-08-01)
      Family therapists face a number of challenges in their work. When children are present in family therapy they can and do make fleeting contributions. We draw upon naturally occurring family therapy sessions to explore the ‘pseudo-presence’ and ‘pseudo-absence’ of children and the institutional ‘gossiping’ quality these interactions have. Our findings illustrate that a core characteristic of gossiping is its functional role in building alignments’ which in this institutional context is utilized as a way of managing accountability. Our findings have a number of implications for clinical professionals and highlight the value of discourse and conversation analysis techniques for exploring therapeutic interactions.
    • Ongoing processes of managing consent: the empirical ethics of using video-recording in clinical practice and research

      O'Reilly, Michelle; Parker, Nicola; Hutchby, Ian; University of Leicester (Sage, 2011-12-05)
      Using video to facilitate data collection has become increasingly common in health research. Using video in research, however, does raise additional ethical concerns. In this paper we utilise family therapy data to provide empirical evidence of how recording equipment is treated. We show that families made a distinction between what was observed through the video by the reflecting team and what was being recorded onto videotape. We show that all parties actively negotiated what should and should not go ‘on the record’ with particular attention to sensitive topics and the responsibility of the therapist. Our findings have important implications for both clinical professionals and researchers using video data. We maintain that informed consent should be an ongoing process and with this in mind we present some arguments pertaining to the current debates in this field of health care practice.
    • Parents’ resistance of anticipated blame through alignment strategies: a discursive argument for temporary exclusion of children from family therapy.

      Kiyimba, Nikki; O'Reilly, Michelle; University of Chester; University of Leicester (Palgrave Macmillan, 2015-09-02)
      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.
    • Reflections from behind the screen: avoiding therapeutic rupture when utilising reflecting teams

      Parker, Nicola; O'Reilly, Michelle; University of Chester; University of Leicester (Sage, 2013-03-06)
      Since Tom Andersen developed the use of reflecting teams to facilitate the progress and process of family therapy, little empirical evidence has emerged regarding their effectiveness or use in therapeutic practice. Reflecting teams are typically embraced by family therapists as a positive mechanism for enhancing practice and thus it is important that research explores how they are utilized. In this article, we draw upon videotaped data of naturally occurring family therapy from the United Kingdom. Using conversation analysis, we identified three performative actions related to interrupting the therapeutic conversation to consult with a reflecting team. We found that therapists had difficulty exiting therapy, that on some occasions exit was hindered, and that there were disturbances in feeding back the reflections of the team. By examining the use of teams in real practice, we were able to make a number of recommendations for practicing family therapists to facilitate the use of this valuable resource.
    • ‘She needs a smack in the gob’: negotiating what is appropriate talk in front of children in family therapy

      O'Reilly, Michelle; Parker, Nicola; University of Leicester; Birmingham and Solihull Mental Health Foundation Trust Spring Road Centre (Wiley, 2012-06-11)
      Tackling the day-to-day challenges of family therapy can prove difficult for professionals. A particular issue arising in family therapy is the notion of what is appropriate for children. Families report events from their social world, out-there to the therapy in-here. There are occasions where the content is ‘adult’ in nature and this has to be managed in front of the children. On some occasions family members use derogatory or negative descriptions of their children while their children are present. Drawing upon naturally occurring family therapy sessions, we present a discourse analysis of how this is managed through a range of discursive resources. We show that adult family members construct what is inappropriate for children to be exposed to by positioning blame with others. This has implications for how family therapists deal with inappropriateness when children are present while maintaining the equilibrium of therapeutic alliances.
    • 'Unsatisfactory Saturation': A critical exploration of the notion of saturated sample sizes in qualtative research

      O'Reilly, Michelle; Parker, Nicola; University of Leicester; Birmingham and Solihull Mental Health Foundation Trust, UK (Sage, 2012-05-17)
      Measuring quality in qualitative research is a contentious issue with diverse opinions and various frameworks available within the evidence base. One important and somewhat neglected argument within this field relates to the increasingly ubiquitous discourse of data saturation. While originally developed within grounded theory, theoretical saturation, and later termed data/thematic saturation for other qualitative methods, the meaning has evolved and become transformed. Problematically this temporal drift has been treated as unproblematic and saturation as a marker for sampling adequacy is becoming increasingly accepted and expected. In this article we challenge the unquestioned acceptance of the concept of saturation and consider its plausibility and transferability across all qualitative approaches. By considering issues of transparency and epistemology we argue that adopting saturation as a generic quality marker is inappropriate. The aim of this article is to highlight the pertinent issues and encourage the research community to engage with and contribute to this important area.
    • The use of why questions in child mental health assessments

      Kiyimba, Nikki; Karim, Khalid; O'Reilly, Michelle; University of Chester, University of Leicester (Equinox Publishing, 2017-12-18)
      Questions form the basis of mental health assessments and yet there is limited empirical evidence about the linguistic structure of question formats in these clinical environments. While many types of questions are used, the focus of this research was on why-prefaced questions with children. Interaction analysis was employed to interrogate the data, paying specific attention to the interactional organisation of how 'why-prefaced' questions were asked and responded to. Analysis demonstrated that when three core components were present in the question, then it was usual for a reason/explanation to be provided in response, and when one or more component was missing, it rarely elicited a reason or explanation in response. The three components were the sequential position of the question, how the question was indexically tied to the child’s prior statement, and the epistemic domain of the question. Implications for therapeutic communication and training were discussed.
    • Using naturally occurring data in qualitative health research: A practical guide.

      Kiyimba, Nikki; O'Reilly, Michelle; Lester, Jessica N. (2018-11-05)
      This highly practical resource brings new dimensions to the utility of qualitative data in health research by focusing on naturally occurring data. It examines how naturally occurring data complement interviews and other sources of researcher-generated health data, and takes readers through the steps of identifying, collecting, analyzing, and disseminating these findings in ethical research with real-world relevance. The authors acknowledge the critical importance of evidence-based practice in today’s healthcare landscape and argue for naturally occurring data as a form of practice-based evidence making valued contributions to the field. And chapters evaluate frequently overlooked avenues for naturally occurring data, including media and social media sources, health policy and forensic health contexts, and digital communications. Included in the coverage: · Exploring the benefits and limitations of using naturally occurring data in health research · Considering qualitative approaches that may benefit from using naturally occurring data · Utilizing computer-mediated communications and social media in health · Using naturally occurring data to research vulnerable groups · Reviewing empirical examples of health research using naturally occurring data Using Naturally Occurring Data in Qualitative Health Research makes concepts, methods, and rationales accessible and applicable for readers in the health and mental health fields, among them health administrators, professionals in research methodology, psychology researchers, and practicing and trainee clinicians.
    • The Value of Using Discourse and Conversation Analysis as Evidence to Inform Practice in Counselling and Therapeutic Interactions.

      Kiyimba, Nikki; O'Reilly, Michelle; University of Chester and University of Leicester (Palgrave Macmillan, 2016-04-08)
      This is a commissioned chapter for an edited collection in The Palgrave Handbook of Adult Mental Health. It focusses on the benefits of using the analytic methodologies of discourse analysis and conversation analysis in studying therapeutic and counselling interactions. In particular it examines the value of qualitative research of this kind as evidence within the evidence-based hierarchy for therapeutic practice.
    • 'We are alone in the house': A case study addressing researcher safety and risk

      Kiyimba, Nikki; O'Reilly, Michelle; University of Chester; University of Leicester (Taylor & Francis, 2013-01-08)
      Historically, the safety of research participants has taken precedence in health research. More recently, however, in response to anecdotal reports, there is growing concern for researcher safety, which has resulted in policy development. Also, there is a small body of empirical discussion emerging. In this article, we present a case study example of a particular incident that happened to one of the authors during the course of data collection. We present this as a case study using two sources of data to support the narrative. We utilise extracts from the original interview in which the threat to safety occurred, and this is supplemented by an interview with the transcriptionist who transcribed the threatening interview. Using thematic analysis, we found three key themes from the data: physical threat, emotional responses, and managing risk. Our findings suggest that despite reflectively considering and adhering to valuable protocols relating to risk assessment, unprecedented events may still occur. We recommend, therefore, that research teams develop strategies to manage the implications and impact of research involvement to maintain a healthy research team.
    • 'You can take a horse to water but you can't make it drink': Exploring children's engagement and resistance in family therapy

      O'Reilly, Michelle; Kiyimba, Nikki; University of Leicester; Birmingham and Solihull Mental Health Foundation Trust (Springer Verlag, 2012-11-13)
      Children’s engagement and disengagement, adherence and non-adherence, compliance and non-compliance in healthcare have important implications for services. In family therapy mere attendance to the appointments is no guarantee of engaging in the treatment process and as children are not the main initiators of attendance engaging them through the process can be a complex activity for professionals. Through a conversation analysis of naturally occurring family therapy sessions we explore the main discursive strategies that children employ in this context to passively and actively disengage from the therapeutic process and investigate how the therapists manage and attend to this. We note that children competently remove themselves from therapy through passive resistance, active disengagement, and by expressing their autonomy. Analysis reveals that siblings of the constructed ‘problem’ child are given greater liberty in involvement. We conclude by demonstrating how therapists manage the delicate endeavour of including all family members in the process and how engagement and re-engagement are essential for meeting goals and discuss broader implications for healthcare and other settings where children may disengage.