• Advanced Qualitative Research: A Guide to Using Theory

      O’Reilly, Michelle; Kiyimba, Nikki; University of Chester; Leicester University (Sage, 2015-05-29)
      This distinctive, nuanced book addresses the more complex theoretical issues embedded in the qualitative research paradigm. Adopting a reflective stance that emphasises the role of the researcher it carefully avoids a standardised ‘tick box’ approach to methods. Throughout each chapter, theory is powerfully and persuasively interwoven as its impact on practical topics such as data management and safety in the field is discussed. O'Reilly and Kiyimba bring an authority and clarity to the debate, taking us beyond the mechanical notions of qualitative methods and standardised approaches to research. Instead, they focus on subjects like methodological integrity, perspective driven data collection and theoretically-led analysis. This will be an important resource for anyone looking to practically engage with advanced qualitative research methods.
    • 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.
    • The clinical use of Subjective Units of Distress scales (SUDs) in child mental health assessments: A thematic evaluation.

      Kiyimba, Nikki; O’Reilly, Michelle; Karim, Khalid; University of Chester; University of Leicester (Taylor & Francis, 2017-07-04)
      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.
    • Developmental Trauma and the Role of Epigenetics

      Kiyimba, Nikki; University of Chester (British Association for Counselling and Psychotherapy, 2016-10-31)
      This is an article investigating the role of epigenetics in developmental trauma, providing fascinating insights into the debate about the relationship between nature and nurture, and the possibilities for healing
    • Discursive Psychology as a method of analysis for the study of couple and family therapy

      O’Reilly, Michelle; Kiyimba, Nikki; Lester, Jessica N.; University of Leicester; University of Chester; Indiana University (Wiley, 2018-03-08)
      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.
    • Discursive Psychology: Implications for counselling psychology

      Lester, Jessica N.; O’Reilly, Michelle; Kiyimba, Nikki; Wong, J.; University of Chester (Sage, 2018-07-13)
      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 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 doing DP, including the development of research questions, carrying out data collection, and conducting DP-informed analysis. 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.
    • 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.
    • Moving Forward: New frontiers in treatments for psychological trauma

      Kiyimba, Nikki (Wiley, 2019-04-11)
      Both the Diagnostic and Statistics Manual (DSM 5), and the International Classification of Diseases (ICD-11) embed PTSD (and complex PTSD in the ICD-11) as categories of mental health disorders. Although these classification tools offer criteria by which patients can be assessed as to whether they meet the criteria for diagnosis of PTSD, or complex PTSD, they are not able to provide guidance on treatment options. This special section of Counselling and Psychotherapy Research showcases three very new approaches to working with psychological trauma. The first paper by Kip and Finnegan introduces Accelerated Resolution Therapy (ART), which is a brief intervention protocol that is already demonstrating very promising early results, particularly within the military veterans community of those also experiencing traumatic brain injury (TBI). The second paper by psychiatrists Frank Corrigan and Alistair Hull, demonstrates the ways in which the Comprehensive Resource Model (CRM) is an excellent choice of treatment for those suffering from complex post-traumatic stress disorder (CPTSD). The third paper by Brochmann et al., explores the ways in which therapists can work effectively with groups of people who have experienced psychological trauma. Regarding the impetus of moving forward in tailoring treatments for those experiencing PTSD, the papers presented in this special issue provide a valuable starting point to discussions about treatments best suited for particular sub-populations of PTSD sufferers.
    • 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.
    • Question use in child mental health assessments and the challenges of listening to families.

      O’Reilly, Michelle; Karim, Khalid; Kiyimba, Nikki; University of Chester; University of Leicester (The Royal College of Psychiatrists, 2015-10-07)
      Background: The mental health assessment is a fundamental aspect of clinical practice and central to this is the use of questions. Aims: To investigate the frequency and type of questions utilised within a child mental health assessment. Method: The data consisted of 28 naturally occurring assessments from a UK child and adolescent mental health service. Data were analysed using quantitative and qualitative content analysis to determine frequencies and question type. Results: Results indicated a total of 9086 questions in 41 h across the 28 clinical encounters. This equated to a mean of 3.7 questions per minute. Four types of questions were identified; yes–no interrogatives, wh-prefaced questions, declarative questions and tag questions. Conclusions: The current format of questioning may impede the opportunity for families to fully express their particular concerns and this has implications for service delivery and training.
    • Reflecting on what ‘you said’ as a way of reintroducing difficult topics in child mental health assessments

      Kiyimba, Nikki; O’Reilly, Michelle; University of Chester; University of Leicester (Wiley, 2017-03-25)
      Background In child and adolescent mental health assessments, questions are integral to the process. There has been limited research focused on the assessment process, or on how questions are constructed within this clinical environment. Methods We examined 28 naturally occurring initial assessments, with particular attention to how practitioners used questions in their communication with children and young people. We utilised conversation analysis to examine the data. Results Analysis revealed a particular type of question preface used to reintroduce a prior topic. This was achieved through the use of ‘you said x’ as a foundation for asking a follow-up question and demonstrated active listening. Conclusions Arguably, this approach is a useful way of gathering assessment-relevant information in a child-centred way.
    • The risk of secondary traumatic stress in the qualitative transcription process: A research note.

      Kiyimba, Nikki; O’Reilly, Michelle; University of Chester; University of Leicester (SAGE, 2015-04-20)
      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

      O’Reilly, Michelle; Kiyimba, Nikki; Karim, Khalid; University of Chester; Leicester University (Wiley, 2016-08-08)
      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.
    • Trauma and Spiritual Growth

      Kiyimba, Nikki; University of Chester (Jessica Kingsley Publishers, 2017-04-21)
      This chapter explores how trauma impacts one’s sense of the spiritual, and examines the concept of post-traumatic spiritual growth
    • 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 Discourse and Conversation Analysis to Study Clinical Practice in Adult Mental Health.

      Kiyimba, Nikki; University of Chester (Palgrave Macmillan, 2016-04-22)
      This is a commissioned chapter in the edited collection: The Palgrave Handbook of Adult Mental Health. It focusses on the methodological use of discourse analysis and conversation analysis as helpful ways of analysing qualitative data in the advancement of understanding of clinical practice in adult mental health settings.
    • 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 Discourse Analysis: A Clinical Psychologist’s View.

      Kiyimba, Nikki; University of Chester (Palgrave Macmillan, 2015-09-02)
      As a discipline, Clinical Psychology has historically favoured a positivist approach to understanding human behaviour, and clinical psychological practice has been largely informed by research based on quantitative methods. Psychologists have tended to exploit the methodologies of the natural sciences by measuring phenomena (Peters, 2010). This bias towards quantitative research may at least in part be a function of how the discipline of psychology has from its genesis, been careful to define itself as a science. It seems that the development of a broader engagement with alternative methods has largely grown from challenges to psychology’s conception of what constitutes science, and debates regarding its merits developed in relation to our thinking about science (Biggerstaff, 2012). The growth of qualitative methods in psychology is therefore relatively new despite the rich history of the approach (Howitt, 2010). However, now that psychology is more securely established, this has begun to lead to a refreshing openness to embrace qualitative process methodology as well as outcome research.
    • 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.