Conducting non-participant observation in psychoanalytic research

In overt observation participants know they are being observed and by whom (Howitt & Cramer, 2005). Overt observations were conducted and justified by

Foucaults argument that mental health services are places of observation, often observation by strangers, staff, patients, inspectors and managers who observe and are observed Foucault (1961/2006). Non-participant observation involved the researcher making his presence known to participants and then taking an unobtrusive position, usually sitting in the background in a day room or nursing station where he could see, hear and absorb activity. The experience was that patients generally ignored the presence of the researcher on initial visits. Subsequent visits resulted in patients enquiring about the study’s progress and engaging the researcher in conversation.

Staff initially appeared conscious of the researcher, offering to explain their activities. This changed on subsequent visits to acknowledging the researcher’s presence and engaging less in meaning making. For observations to be meaningful it was necessary to be immersed in the setting, essentially developing a pattern of regular attendance to keep pace with day-to-day life (Bernard, 1988; Estroff, 1985; Lyth, 1988). Psychoanalytic research involves seeking sufficient data for saturation and providing a balanced picture mindful of repetitions. New data is repeatedly searched for until a level of certainty can be achieved, confirming what has been discovered while acknowledging that single events are not necessarily the norm of daily activity (Hollway & Jefferson, 2000). After repeated visits, opportunistic conversations, interviews and initial analysis, repetition in service occupants’ speech and actions was noted, indicating saturation (Beins, 2004).

In observation the researcher is part of the situation under scrutiny and the way in which the method is constructed (Taylor, 1994). The researcher’s identity, their relationship with the researched and the process itself contains elements of interpretation and power that need to be accounted for. The management of transference in psychoanalysis captures the inter-subjective experience of researcher and researched. Observations in the examples given here were conducted in a particular manner that acknowledges the researcher’s presence, position and bias. Non-participant observation requires the researcher to demonstrate respect for participants by being mindful not to obstruct or hinder the work of the organisation and to respect participants’ dignity and privacy. For example, during one observation period I was aware of loud, distressed, inarticulate shouting coming from the bathroom area. Nurses rushed to what appeared to be a critical incident. Observation of the incident may have provided valuable data however it was in an area where observation would not normally occur. Therefore researcher judgement was applied that direct observation would have been obtrusive and I relied instead on the subsequent discussion staff had regarding the critical incident (Moore, 2017).

An understanding of the function of the social organisation is essential so discretion in recognising when it might be inappropriate to remain in a setting where privacy is required or where their presence may add to tension becomes a researcher responsibility. The non-participant observer should simply observe and not engage in activity, including note-taking, fulfilling the psychoanalytic approach of quiet presence and free floating attention.

Observing, but not engaging in activities, causes elements of reactivity in researchers, both consciously and unconsciously. For example, when conducting observation in a unit area, where different activities and conversations may occur simultaneously, why would the researcher choose to listen more attentively and report on one over another? I made pragmatic decisions about recording when conversations were audible and therefore easier to report accurately or when incidents evoked staff responses. I found my attention drawn to patient and staff discussions of mental health care as these related to the research question and the literature on social bonds and discourse. This allowed me to focus on data relating to the study’s aim. The motivation for these choices was recorded in the field notes, analysed and discussed in supervision to guard against missing potential relevant material.

Knowledge of the field and recording in non-participant observation

Fieldwork skills include learning the language, developing awareness and memory, maintaining naïveté and development of writing skills (Bernard, 1988). To become part of any social group, speaking the language of its inhabitants gives access to cultural expressions, symbols, signifiers and their significance. I had an advantage of having worked in mental health services for 30 years prior to the study. Psychoanalysis’s concern with the otherness of language and the distance between articulation and desire raised concern that two sets of language needed to be considered, formal clinical language used for observation and categorisation and colloquial language spoken by service occupants. Additionally the individual subjective use of language would normally be accounted for in psychoanalysis, suggesting that an analysis of the total situations is difficult. However group psychoanalytic theory allows for the emergence of shared unconscious associations. Building explicit awareness refers to an ability to note small details of life revealing significant things about the organisation of culture and society.

Researchers, similar to psychoanalysts, aim to collect data relating to a question while remaining open to possibilities that the material uncovered may or may not provide an answer. The requirement to recognise and analyse content and dynamic is a parallel process to maintaining naïveté. Adopting the position that the world is shaped by the self and shapes the self, there is a risk that naïveté would be sidelined in favour of seeking confirming data in the analysis process. By conducting an exhaustive description the possibility of arriving at an understanding of what is observed and analysed is somewhat protected. Assumptions in psychoanalysis are held at bay by free-floating attention, which is not attempting to make conclusions or connections until an exhaustive exploration is completed. The avoidance of deliberately concentrating on any particular aspect guards against following expectations and inclinations and the risk of only finding out what was already known. Maintaining naïveté allows the researcher to be surprised. Psychoanalytic research is directed at what is seen but also what is hidden such as the latent (hidden and disguised) content and gaps in the data. The investigation is less in description of phenomena and more in the analysis of speech and actions. In the following example we see a student unconsciously mimicking patient behaviour. Both patient and student are distressed and both are unaddressed by the staff present:

Outside the window in the observation area there is a male patient pacing back and forth. Occasionally he talks to himself as if he is responding to a voice he hears. He also makes unusual gestures with his hands; he appears distressed. This behaviour is consistent for the hour I spend in the office. There is a student nurse on the unit. He is on their first placement in a mental health service and does not appear to be engaged in any specific activity. The student is also wandering back and forth outside the office. At one point the student came and stood outside the door looking into the office in the same manner I had noted patients doing. He then paced around the observation area mimicking the gestures and movements of the patient I had noticed pacing in this area.

(Moore, 2012)

This critical incident picks up on the small details of life in the social situation that would not have been captured if interviews alone were used. Similarly it would have eluded analysis without the psychoanalytic approach to analysing latent content in a social setting.

On-site field notes were taken by hand. For consistency all data was transferred onto a standard template including indices of time, place and social activity as well as the researcher’s reflections and analysis of the recorded observation. While consistency in data recording is important and used as an expression of validity, there are inherent risks that valuable information can be misrepresented or lost in the process of translation from one medium to another, therefore original notes and recordings were retained and reviewed to ensure accuracy. Being mindful of reflexivity and the desire to maintain quiet presence the researcher observed interactions, incidents or activities and then left the immediate area to make notes privately, to avoid being intrusive (Taylor, 1994). All participants were assigned a code to disguise their identities, to reflect the translation from individual to group psychology and to gather data on the total setting as opposed to analysis of subgroups or individuals. Quotations, including participant speech, occasionally included biographical work role information to establish context. An exception was made when attending multidisciplinary team (MDT) meetings, where notes were recorded in the presence of participants. MDT meetings varied in duration between 45 minutes and two hours generating more data than could be retained accurately without notes. If I had opted to remove myself at intervals for note making it would have disturbed participants, data may have been missed and/or quiet presence not maintained.

This flexibility in recording data, while essential, led to an incident where the note-taking was commented on,‘he is writing frantically now’ (Moore, 2012), by a team member during a fractious exchange about patient care.

Interviewing techniques in psychoanalytic research

The technique of quiet presence guided observations in both opportunistic conversations and formal recorded interviews. Non-participant observation generated opportunistic conversations with participants who addressed the researcher, indicating an element of self-selection. Frequently these started when a participant inquired about the study and proceeded to speak about their understanding of the mental health service. These participants had something to say and used the opportunity opened to them by the researchers presence and interest. I presented no agenda, beyond a brief explanation of the study, and then allowed the participant to speak freely. This approach is similar to the instructions given to a patient in psychoanalysis who is asked to say anything and everything that comes to mind, to free associate, while the analyst listens.

Quiet presence is established over time and enables observation of and acceptance by participants and implies being open to making your presence explicit when required. Copies of the permission to conduct the study and the ethical approval were carried on all data collections visits. Introductions were repeated on return visits even after I became recognisable to participants who acknowledged my presence allowing the observation of activities without repeating explanations. Psychoanalysis is usually conducted with the analyst outside the patients line of vision.Taking a position at the periphery, listening in a focussed manner is a specific purposeful ritual (Nixon, 2005). Following repeated visits my peripheral presence did not appear to disturb the organisation unduly.

In conversations and formal interviews I remained detached so as not to engage in a relationship where participants performed to produce satisfactory answers. Detachment was achieved by not expressing opinions or reacting to participants’ critiques. When participants responded to the open-ended question to say anything and everything they wanted to about the mental health service and their relationships with other occupants, by asking me to be more specific, I responded by encouraging them to start anywhere as I was interested in everything they could tell me. Narrative interviews with open-ended nondirective questions, as recommended by Kvale (1996), centring on the stories the participants want to tell, were encouraged. Free association in the clinic involves asking the patient to say whatever comes into their mind to elicit narrative that is not structured according to conscious logic, but according to unconscious logic, in other words, the associations follow pathways defined by emotional motivations, rather than rational intentions (Hollway & Jefferson, 2000) and this was my aim during conversations and interviews.

This technique required the researcher to allow a silence to occur if the participant cannot answer immediately or to provide additional cues by rephrasing the question to stimulate a response such as saying:‘How do you find it here?’ or ‘What kind of encounters have you had here?’ For example when given this opportunity a participant gave the following account, which provides data about the social bond between service occupants:

I was frightened to talk, I could not find a beginning, it was so tangled I was talking in reams. I relied mostly on the nurses; being feminine they could calm you. I would not trust anyone at all to understand to know me, I was afraid of myself and the power in my head.

(Moore, 2012)

In contrast, another participant gives an account of the power the social setting gives staff to behave in a manner that would be unacceptable in another social situation:

You reduce their personhood to a diagnostic problem and everything gets sucked into the explanatory power of that and it is enormously powerful and you end up finding people behaving in ways that they wouldn’t do in any other context. It is really quite astonishing. It swings almost completely to the opposite direction where you have people being talked at in very, very disrespectful kinds of ways. Ways that you would not speak to someone at a party, in a café. Really astonishing stuff and you know there is almost like an implicit permission when you dehumanise people, to behave towards them in certain kinds of ways, it’s part of kind of institutionalisation, kind of culture that sometimes dominates the mental health system.

(Moore, 2012)

Systemic chronological narrative was discouraged by not including a timeframe in questions as this is less likely to lead to the disclosure of unconscious material than a free-flowing account of anything that comes to mind. The instruction to tell your story as it occurs allows for repetitions and for new and additional material to emerge. In this way data collection and preliminary analysis merge. The cues provided, which cannot be set in advance, are generated by the narrative and are an initial interpretation of the data.

The researcher seeks, through analysis of the narrative, themes that connect aspects of the story. “The interview technique involves not intervening until the interchange is handed back and identifying the themes which are apparent, so as to return to them in the order of their appearance to elicit further detail” (Hollway & Jefferson, 2000, p. 40). The style in which Freud encouraged patients to speak and how he recorded case histories with little regard for the sequence of their histories (Mahony, 2005) implies circularity in interpretation, the relation of parts to the whole, indicating interdependence between the interpretation of individual interviews and the total data amassed (Audi, 1999). An analytic task for the researcher is to enable unconscious data to emerge from participants by enabling them to run around in the data allowing interpretation to take place. Cues need to be simple, encouraging and balanced in order to maintain quiet presence and enable free association, for example,‘Continue, I’m listening’ or‘Yes’. This maintains quiet presence and avoids leading the participant in a particular direction in their narrative.This requires the researcher as analyst and the participant as researched to remain active in the process even when it appears daunting or fruitless. By allowing each story to be finished rather than seeking clarity and risk cutting across the interviewee’s narrative s/he is invited to continue his/ her story wherever it goes with noncommittal but interested cues resulting in narratives that are a product of the relationship between the researcher and the participant (Hollway & Jefferson, 2000). This style demonstrates that the key elements of a psychoanalytically informed interview technique are intertwined with the application of psychoanalytic theory in data analysis.

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