Expanding the notion of researcher distress: the cumulative effects of coding

Lessons from insiders: Embracing subjectivity as objectivity in victimology

Due to the prevalence of victimization in society, it is likely that many victimologists have been victimized or will be in their lifetimes. This poses a challenge for the field of victimology as traditional, positivist conceptions of 'good science' require researchers to be outsiders relative to populations they study. This paper asks: What are the epistemological and practical implications of victimological research conducted by researchers who have firsthand experiences of victimization? What lessons can be retained by other victimologists and researchers in general? How can these epistemological considerations be applied in practice? To answer these questions, I examine the meanings of insider and outsider status and the implications for objectivity and subjectivity as per positivist and standpoint epistemologies. I present the case of victimologists who have been victimized as well as the advantages and disadvantages of this form of insider research. I deconstruct insider-outsider, subjectivity-objectivity dualisms as they pertain to victimologists, concluding that all victimologists can be subjective whether they are technically insiders or not. In closing, I discuss how all victimologists can embrace their own and their participants' subjectivity as a resource for objectivity by examining location, emotions and bodies, and ethics throughout the research process.

Strengths and Weaknesses of Inviting Men to a Voluntary-Based Domestic Violence Intervention

This study examines the factors motivating domestic violence perpetrators to participate in a voluntary-based intervention program. The experiences and determining factors around men's positive and negative responses to this invitation were examined through semi-structured interviews with professionals, observations, and reflexive notes during the first meeting with 29 men. Two major themes emerged from the thematic analysis: the factors making men more likely to attend the first meeting or resisting the group intervention. These findings can help professionals recognize the challenges of inviting perpetrators to interventions, especially in countries with insufficient laws for mandated domestic violence perpetrator programs. The paper discusses the importance during the first meeting of building rapport and trust and recognizing complex family histories to encourage voluntary attendance and intervention engagement.

Overcoming the challenges of recruiting and interviewing patients following critical illness

BACKGROUND

The strict restrictions implemented in England during the COVID-19 pandemic meant it was no longer possible to recruit or interview participants in person. However, virtual recruitment and interviews are not without their challenges, particularly when exploring sensitive topics.

AIM

To discuss how to overcome some of the challenges involved in recruiting and interviewing participants who have been critically ill with COVID-19.

DISCUSSION

An exploratory, descriptive study was conducted involving interviews with 20 people who had been critically ill with COVID-19 and had been discharged from two community-based healthcare settings in London, England. Participants were interviewed at home after being discharged from hospital after at least one month. The sensitivity of the research topic meant strategies for recruiting and interviewing needed to be adapted, including involving patient experience facilitators, using virtual interviews, managing the distress of participants and self-care for the researchers.

CONCLUSION

The adaptations used in this study can be used in research involving people who have been critically ill.

IMPLICATIONS FOR PRACTICE

Researchers can explore innovative ways to recruit participants using hospital or community staff who are not usually involved in research. Virtual interviews require additional skills, such as building rapport with participants, so may require additional training. A distress protocol for participants should always be considered when discussing sensitive topics. Self-care and debrief strategies for interviewers are also critical.

The Emotional and Psychological Labor of Insider Qualitative Research Among Systemically Marginalized Groups: Revisiting the Uses of Reflexivity

In response to decades-long exclusionary practices, academic institutions are now recruiting early career researchers (ECRs) from systemically marginalized populations who specialize in equity-related research. As a result, these ECRs are likely to conduct research within their communities on topics that have personal relevance-insider research. Methodological training for insider research places an emphasis on methods, such as reflexivity, to ensure rigor; however, the emotional and psychological impacts of these research methods on the researcher are seldom discussed. Therefore, I use analytic autoethnography to illustrate the embodied impacts of conducting insider research using an example of personal relevance and argue that methodological practices require an embodied reflexivity that centers the researcher and the impacts the research has on them. This paradoxically rewarding and taxing work necessitates changes in methodological training and practice, institutional support, and an openness to innovation when calling for equity, diversity, and inclusion in the academy.

Experiences of Conducting Research With Vulnerable and Disempowered Participants in a Developing Country: Perspectives From a Novice Researcher

Sensitive, emotionally laden research requires mental strength, emotional fortitude, and logistic supports for novice researchers. Little is known about the challenges that the novice researcher faces while conducting sensitive, emotionally laden research. This is exacerbated where participants of such studies have little/no idea about expressing the value of a particular research study (i.e., where the first question to arise from the participants is "what would be my benefit if I participate in your research?"). Based on the student researcher's self-reflections, this article focuses on the inherent challenges that a researcher faced while conducting in-depth interviews among a group of emotionally vulnerable people-survivors of the disastrous Rana Plaza collapse in Bangladesh. It suggests how the challenges can be reduced or mitigated, and the researcher's self-care can be ensured. It also raises important methodological questions, including whether in-depth narrative interviews are appropriate in relation to those living with significantly different cultural norms.

Getting "clean" from nonsuicidal self-injury: Experiences of addiction on the subreddit r/selfharm

BACKGROUND & AIMS

Previous studies have shown that nonsuicidal self-injury (NSSI) has addictive features, and an addiction model of NSSI has been considered. Addictive features have been associated with severity of NSSI and adverse psychological experiences. Yet, there is debate over the extent to which NSSI and substance use disorders (SUDs) are similar experientially.

METHODS

To evaluate the extent that people who self-injure experience NSSI like an addiction, we coded the posts of users of the subreddit r/selfharm (n = 500) for each of 11 DSM-5 SUD criteria adapted to NSSI.

RESULTS

A majority (76.8%) of users endorsed at least two adapted SUD criteria in their posts, indicative of mild, moderate, or severe addiction. The most frequently endorsed criteria were urges or cravings (67.6%), escalating severity or tolerance (46.7%), and NSSI that is particularly hazardous. User-level addictive features positively predicted number of methods used for NSSI, number of psychiatric disorders, and particularly hazardous NSSI, but not suicidality. We also observed frequent use of language and concepts common in SUD recovery circles like Alcoholics Anonymous.

DISCUSSION & CONCLUSION

Our findings support previous work describing the addiction potential of NSSI and associating addictive features with clinical severity. These results suggest that NSSI and SUD may share experiential similarities, which has implications for the treatment of NSSI. We also contribute to a growing body of work that uses social media as a window into the subjective experiences of stigmatized populations.

Response-An Extreme Ordeal: Writing Emotion in Qualitative Research

Responding to the stimulus afforded by Little et al.'s "Pragmatic pluralism: Mutual tolerance of contested understandings between orthodox and alternative practitioners in autologous stem cell transplantation," this paper explores how the norms of qualitative inquiry affect the representation of emotion in research reports. It describes a conflict between the construction of emotion in qualitative research accounts and its application to analysis and theorization, whose origins may lie in researchers' reticence when it comes to conveying or using the emotional features of data. The technical aspects of report writing that are associated with this conflict are explored via a deconstruction of Little et al.'s paper and a survey of the qualitative research methods literature. Writing to convey emotion and analysing to include author-constructed emotional context are neglected topics. Using data in Little et al.'s text, the paper demonstrates the importance of author-constructed emotional context to theory generation. The paper recommends the inclusion of emotional context as data in analysis and points to lessons Little et al.'s paper offers in the areas of narrative technique and reflexive practice.

Troubling/trouble in the academy: posttraumatic stress disorder and sexual abuse research

The potential and actual impact of traumatic research work on researchers has been of focus in academic literature for at least the past 30 years (Alexander et al., Violence and Victims, 4(1), 57-62, 1989; Bahn and Weatherill, Qualitative Research, 13(1), 19-35, 2012; Coles et al., Violence Against Women, 20(1), 95-117, 2014; Coles and Mudaly, Child Abuse Review, 19, 56-69, 2010; Connolly and Reilly, Qualitative Inquiry, 13(4): 522-540, 2007; McCosker et al., Forum: Qualitative Social Research, 2(1): 1-13, 2001). This period of time-over 30 years ago-is approximately same age I was when I commenced writing this paper as a result of my direct experience with posttraumatic stress disorder (PTSD) as a consequence of academic research. For the entirety of my life, researchers have been writing their accounts of trauma, and yet it is an experience that I, and many others, still endure. In this piece, an autoethnographic account is used to explore my diagnosis of PTSD as a consequence of involvement on an academic project examining particular aspects of sexual abuse. In doing so, I examine how PTSD is approached and addressed within the academy, the serious impact that working with traumatic material can have, and suggest a number of approaches that can be considered to address this. These include outlining how we can plan for trauma in research, how considerations of trauma should be built into institutional review boards and ethics applications, and how we can best understand and address the unfair impact that trauma has on fixed-term and casual staff members.

Vulnerability and Resilience in Sensitive Research: The Case of the Quantitative Researcher

The emotional experiences of quantitative researchers, particularly while conducting sensitive research, are largely neglected. This article aims to advance the awareness of possible emotional strains for quantitative researchers engaged in sensitive research. It qualitatively assesses the ethical and emotional experiences of quantitative researchers conducting a study on aging of bereaved parents and people with a physical disability. Based on the detailed minutes of 66 weekly research meetings held during 2015-2017, a thematic analysis of the researchers' experiences was performed. Our analysis identified two main themes: vulnerability and resilience. We delineate these themes, along with their subthemes and affinity to vicarious traumatization, moral stress, and vicarious posttraumatic growth. The current study is among the first to introduce the emotional and ethical experiences of the quantitative researcher. Tentative recommendations for the advancement of the researcher's safety and well-being by training, institutional support, self-care skills, and policy development are provided.

Risk of Secondary Distress for Graduate Students Conducting Qualitative Research on Sensitive Subjects: A Scoping Review of Canadian Dissertations and Theses

Qualitative research, in the methods employed and topics explored, is emotionally demanding. While it is common for ethics protocols to protect research participants from emotional distress, the personal impact of emotional work on the researcher can often go unaddressed. Qualitative researchers, in particular graduate student researchers studying sensitive topics, are at risk of psychological effects. It is unclear, however, how this impact on the researcher is discussed in graduate student work and/or the steps taken to address this risk. To provide an overview of how impact on the researcher is considered in Canadian graduate student research, a comprehensive scoping review of dissertations was conducted. Less than 5% (n = 11) of dissertations reviewed included a plan to mitigate psychological risk to the researcher-suggesting a need for further guidance on minimizing risk of emotional distress. The application of trauma and violence-informed principles to graduate supervision policy and practice is discussed as a promising harm mitigation strategy.

The risks and rewards of researching victims of crime

The concept of emotional labour is described as any effort, conscious or not, to change one’s feelings or emotions, thereby offering a useful framework for understanding the experiences of qualitative researchers working within so-called ‘sensitive topics’. Despite this, it has received little research attention in criminology and criminal justice compared to related concepts such as vicarious trauma. Vicarious trauma refers to pervasive, cumulative and permanent changes that occur in a professional’s views of themselves, others and the world around them as a result of exposure to graphic and/or traumatic material. Conducting ‘sensitive topic’ research, such as with victims or offenders of crime, may expose researchers in this field to significant emotion work through engagement with potentially shocking and graphic experiences that are characteristic of serious trauma survivors. Victimisation is thought to be so disruptive because it challenges at a fundamental level our beliefs in a safe and benevolent world, and of ourselves as good (and hence undeserving) people. This article will draw on existing literature and the author’s extensive experiences of conducting in-depth interviews with victims of crime to explore the psychological impact of working closely with survivors of violent crimes. It will then show how the process of vicarious trauma mirrors that of trauma in victim/survivors. It will place this discussion against the backdrop of a rapidly changing and commercialising higher education sector and explore how the increasing pressures and reduced freedoms, in addition to the subject matter we study, require significant emotional labour and place us at a heightened risk for vicarious trauma. Finally, suggestions will be made regarding the best practice to avoid vicarious trauma and why, despite the risk, research in this area is still necessary and rewarding.

Understanding the vicarious trauma and emotional labour of criminological research

The psychological cost of exposure to traumatic events is receiving greater recognition in recent years, especially in terms of its impact in helping professions and emergency services. However, the costs to researchers remain relatively unexplored. In this article, we will discuss the nature and impact of vicarious trauma using two criminological research projects as case studies: one a qualitative project engaging with survivors of childhood sexual abuse, and the other, a quantitative analysis of police hate crime reports. In addition to considering the trauma elicited in fieldwork such as interviews, we interrogate the costs imposed on researchers during the coding and analysing processes. We suggest that the cost is potentially greater when the researcher has a personal connection with the issues being researched, but that this personal experience also provides the researcher with important skills for responding to new or compounded trauma. The costs of engagement with trauma may be compensated by the productive outputs and impact on policy and practice that this type of research may elicit. Understanding the impact and costs of engaging with close analyses of trauma is critical in developing more robust and ethical research processes to ensure that this trauma is appropriately managed so as to avert the long-term damage this work can inflict on researchers and participants.

Who else Needs Protection? Reflecting on Researcher Vulnerability in Sensitive Research

Ethnographic research characterised by immersion, reflexivity, and rapport can be unpredictable and uncontrollable, producing a wide range of emotional responses. Much of the literature on sensitive research focuses on ethical requirements and strategies for protecting participants while less attention has been given to the need for researcher protection. In this paper, we share some of the concealed and/or overlooked aspects of researcher vulnerability that are commonly disregarded or under-explored. Based on our fieldwork experiences with a vulnerable population, it considers some of the different ways doing sensitive research with people experiencing homelessness has had an impact on our research team and wider. Specifically, we analyze the emotional impact of distressing and painful research experiences on those directly and not directly involved with the collection of research data (i.e., transcribers and coders). The themes that are discussed include: i) blurring of roles in the field; ii) dealing with heart-rending life stories; and iii) handling emotionally charged experiences. By reflecting on our fieldwork experiences and emotions, we also explore the ways in which emotional impacts can be managed in practice. Strategies for emotion management that have helped us deal with the unique challenges of this research are outlined.

Researcher Self-Care in Emotionally Demanding Research: A Proposed Conceptual Framework

Researchers are emotionally and psychologically affected by emotionally demanding research that demands a tremendous amount of mental, emotional, or physical energy and potentially affects or depletes the researcher's well-being. Little attention has been given to preparing doctoral students and novice researchers engaged in such studies. Four possible types of emotionally demanding research experiences are presented: sensitive issues, personal trauma previously experienced, experience of traumatic life events during research, and unexpected events that arise during research in what was previously not identified as a sensitive issue. The need for self-care is highly relevant to each type, despite their different impacts on researcher well-being. This conceptual article furthers conversation in the field about how researchers and educators can address the need for self-care to prepare novice researchers and proposes a conceptual framework for researcher self-care in emotionally demanding research, with an aim for future empirical study.

"They Said on the Death Certificate…But Really What I Think Happened": Characterizing Cause of Death in VA Medical Centers

Cause of death information is a vital resource for family and public health, yet significant issues persist regarding its determination, documentation and communication. In this study, we aim to characterize cause of death attribution process from the perspective of next-of-kin of Veterans who died in Veterans Affairs (VA) Medical Centers. Using a semi-structured guide, we explored next-of-kin's experiences of the Veteran's terminal hospitalization and conducted a content analysis of interview texts. In over two-third of cases next-of-kin's understanding was not consistent with their recollection of physicians' determination of cause of death. Discrepancies between official cause of death and lay understanding engendered confusion and distress. Findings have relevance for shaping the context of post-death patient/family-centered clinical practice and serve as a means for improving efficacy of cause of death communication and reducing potential for misunderstandings.

The emotional challenges of conducting in-depth research into significant health issues in health geography: reflections on emotional labour, fieldwork and life course

Emotions are increasingly being recognised and integrated into human geography and it has been highlighted that focusing on the 'interrelatedness' of the research process is crucial. By contextualising fieldwork within the life course of the researcher, greater acknowledgement of the 'emotional labour' involved in fieldwork can be highlighted. The author reflects on the 'emotional geographies' of conducting PhD research into significant health issues with participants who had recently suffered a heart attack in Fife, Scotland. This paper reveals emotions involved in this kind of research, drawing on perspectives from participants as well as the researcher. The author also draws attention to, and reflects on, the lack of engagement with researcher's emotional labour within formal academic structures, such as research training and ethics application processes. Reflecting on fieldwork experiences from a distance, the author discusses the influence and impact of her emotional experiences of fieldwork. This paper contributes to work concerned with emotions and fieldwork in geography and asserts that greater importance and value needs to be given to this type of emotion work as embedded and situated within researchers' life courses.

The psychosocial needs of students conducting research with patients and their families in advanced cancer and palliative care: A scoping review

OBJECTIVE

The objective of this article was to explore the extent of the scientific literature and evidence base about the psychosocial needs of students conducting research in the fields of advanced cancer and palliative care.

METHOD

A scoping review was conducted in major scientific databases. English-language articles on the topic of interest were retained if they were published in peer-reviewed journals between 1995 and 2013.

RESULTS

A total of 3,161 references were screened, and 7 were retained for analysis. Only two articles were empirical studies involving the collection of primary empirical data. The remaining ones were commentaries and personal reflections. While there is a near absence of empirical research about the psychosocial needs of students, several commentaries suggest that students in this field have a high need for support. Three themes were identified in the limited literature retrieved: (1) the importance of proper training and supervision; (2) the availability of emotional support structures; and (3) the use of effective and deliberate self-care strategies.

SIGNIFICANCE OF RESULTS

This scoping review demonstrates that little is known about the psychosocial needs of students conducting research in advanced cancer and palliative care. However, what is clear is that there is a large emotional impact on student researchers engaged in this type of work. Adequate training and support is needed to promote students' health and well-being, encourage retention of students, and foster high-quality studies. More empirical data are needed to better understand the experiences of students conducting this type of research and to ensure the sustainability of training and research in this field.

An Auto-Ethnographic Study of the Disembodied Experience of a Novice Researcher Doing Qualitative Cancer Research

Qualitative health researchers who explore individuals' experiences of illness are exposed to an emotionally demanding work environment. After doing 49 interviews with cancer patients living alone, I was confronted with serious emotional distress that kept me from my work for almost 6 months. Because there is a need for discussion within academia about the emotional risks encountered by researchers, I used auto-ethnography to explore what I call the "three disembodied experiences" I encountered during the research: disembodiment linked with suppression of emotions, disembodiment linked with distal traumatization, and disembodiment linked with overidentification with the participant. I illustrate these concepts with personal stories of doing research with cancer patients living alone. I conclude that writing down experiences of doing qualitative research in an embodied and reflexive way holds two advantages: It can protect the researcher and enhance the quality of research.

Lived Observations: Linking the Researcher's Personal Experiences to Knowledge Development

As researchers in palliative care, we recognize how involvement with seriously ill and dying persons has an impact on us. Using one's own senses, emotional and bodily responses in observations might open intersubjective dimensions of the research topic. The aim of the article is to highlight how phenomenological theories on intersubjectivity can be useful to develop rich and transparent data generation and analysis. We present three field note examples from observation in a hospice ward, which illuminate how researcher awareness of aspects of intersubjectivity can add valuable insights to data and analysis. Out of the examples, we elaborate on three arguments: (a) how the researcher's lived experience of time and space during fieldwork triggers new research questions, (b) how observations as an embodied activity can bring new insights and open new layers of meaning, and (c) the value of observations in gaining insight into relational aspects in a hospice.

Speaking from the Inside: Challenges Faced by Communication Researchers Investigating Disease-Related Issues in a Hospital Setting

This commentary came from within the framework of integrating the humanities in medicine and from accompanying research on disease-related issues by teams involving clinicians and researchers in medical humanities. The purpose is to reflect on the challenges faced by researchers when conducting emotionally laden research and on how they impact observations and subsequent research findings. This commentary is furthermore a call to action since it promotes the institutionalization of a supportive context for medical humanities researchers who have not been trained to cope with sensitive medical topics in research. To that end, concrete recommendations regarding training and supervision were formulated.

Exploring researchers' experiences of working with people with acquired brain injury

PURPOSE

This study aimed to investigate the challenges and positive experiences of researchers who work with people who have experienced an acquired brain injury and their families.

METHODS

People who were currently or had previously worked as a researcher in the field of acquired brain injury (using either quantitative or qualitative methods) were invited to participate in a focus group or individual interview about their experiences. An expert reference group meeting was held to discuss strategies that could be implemented to enhance the researcher experience based on the interview data.

RESULTS

A total of 19 researchers who worked across four different research teams took part in the study. Six inter-connected themes were identified: researcher motivation, meaning and fulfillment; human connection; knowing and understanding the role; complexity of brain injury in the research context; the research process; and state of the researcher. A number of recommendations for supporting researchers more effectively were identified.

DISCUSSION

Researchers described a number of positive aspects as well as tensions they encountered in their role. The findings highlight the need to ensure researchers are supported effectively to ensure the quality of research studies in the field of brain injury.

"I was ready to take him home": next-of-kin's accounts of loved one's death during hospice and palliative care discussions in Veterans Affairs Medical Centers

This study explored next-of-kin's retrospective accounts of hospice and palliative care discussions for hospitalized veterans. In-depth, face-to-face interviews were used to generate narrative accounts of 78 next-of-kin's experience of their loved one's hospital care during the last days of the patient's life. One-third of participants reported taking part in a hospice or palliative care discussion during the patient's final hospitalization. In over one-half of those cases, the patients died before discharge or transfer to hospice or palliative care was accomplished. Hospice and palliative care discussions in the hospital setting shaped family perceptions of the patients' care, directed family efforts in the days prior to death, and engendered anticipation of remaining quality time with the patient. Discussions about hospice or palliative care have meaning, emotional impact, practical effects, and unintended consequences for next-of-kin. Social workers in hospital settings can play a critical role in supporting family members through the hospice and palliative care discussion process and facilitate timely care transitions. They also can attend to the psychosocial concerns of family members, particularly when death occurs prior to discharge to hospice or transfer to an inpatient palliative care service.

Exploiting Loss?: Ethical Considerations, Boundaries, and Opportunities for the Study of Death and Grief Online

More people are turning to the Internet to communicate about dying, death, and grief experiences. This theoretical article explores the ethical dilemmas, challenges, and opportunities presented to researchers interested in exploring how death and grief are communicated online. Weaving together the literatures of computer-mediated communication and thanatology (dying and death), we discuss the ways in which many common ethical dilemmas uniquely manifest related to death and grief. We also explore the emotional impact studying death and grief online has on researchers and the importance of thinking about researcher emotions on scholars who study these issues. We end with recommendations of how to move forward in the dialogue about ethics and studying death and grief online.

A Qualitative Exploration of Researcher Trauma and Researchers’ Responses to Investigating Sexual Violence

Vicarious trauma can be a problem for those who work and research in areas where clients or participants are survivors of sexual violence. The aim of this study was to explore the trauma experiences of sexual violence researchers from different countries, identifying the issues that traumatized them and the protective strategies they found effective. This article reports on a moderated electronic discussion board run for 4 weeks from September to October 2009 and four purposeful interviews. A total of 15 researchers participated, 4 males and 11 females. Institutions and organizations researching in this area should consider researcher safety in project design.

"A room full of chairs around his bed": being present at the death of a loved one in Veterans Affairs Medical Centers

Historically, death took place at home where family held vigil around the dying patient. Today, family presence is an important feature of death and dying in hospital settings. We used hermeneutic phenomenology to explore experiences of being present at the hospital death of a loved one. We conducted in-depth, face-to-face interviews with 78 recently bereaved next-of-kin of veterans who died in 6 Veterans Affairs (VA) Medical Centers in the Southeast United States. Two major themes emerged: 1) "settling in," characteristic of the experiences of wives and daughters in the initial phase of the patient's hospitalization; and 2) "gathering around," characteristic of the experiences of a wider array of family members as the patient neared death. An in-depth understanding of experiences of next-of-kin present at the hospital death of a loved one can increase staff awareness of family's needs and empower staff to develop policies and procedures for supporting family members.

Reflective research: supporting researchers engaged in analyzing end-of-life communication

OBJECTIVES

The objectives of this commentary are to: (1) identify unique aspects of communication at end-of-life as compared to more commonly studied healthcare encounters; (2) outline challenges and opportunities research team members may encounter in coding and analyzing end-of-life communication; and (3) offer recommendations for quantitative communication research teams. This commentary is based on ours and others' experiences in studying the communication among patients with terminal illnesses, their families and their providers. Provider-patient/caregiver communication at end-of-life has some differences as compared to other forms of healthcare communication and, thus, has implications for researcher response. Challenges and opportunities for research team members include gaining new knowledge, developing feelings of attachment to study participants, burn-out, and emotional and existential impact on personal life. Practical and psychological considerations for conducting end-of-life communication research are discussed.

CONCLUSIONS

Researchers engaged in the study of end-of-life interactions may experience unique challenges, potentially compromising the validity of the research results and interpretation of communication processes. A balance between likely coder emotions and objectivity must be achieved.

IMPLICATIONS

Anticipating and facilitating the research teams' reactions to end-of-life interactions while still maintaining scientific standards may be achieved by using a reflective, mindful approach.

Reflexivity and the capacity to think

Reflexivity is fundamental to qualitative health research, yet notoriously difficult to unpack. Drawing on Wilfred Bion's work on the development of the capacity to think and to learn, I show how the capacity to think is an impermanent and fallible capacity, with the potential to materialize or evaporate at any number of different points. I use this conceptualization together with examples from published interview data to illustrate the difficulties for researchers attempting to sustain a reflexive approach, and to direct attention toward the possibilities for recovering and supporting the capacity to think. I counter some of the criticisms suggesting that reflexivity can be self-indulgent, and suggest instead that self-indulgence constitutes a failure of reflexivity. In the concluding discussions I acknowledge tensions accompanying the use of psychoanalytic theories for research purposes, and point to emerging psychosocial approaches as one way of negotiating these.

Performance, emotion work, and transition: challenging experiences of complementary therapy student practitioners commencing clinical practice

Few researchers have explored the clinical experiences of complementary and alternative medical practitioners and students, including the emotion work they perform. In this article, using a constant comparison approach and a heuristic framework (a dramaturgical perspective), we analyze semistructured interviews with 9 undergraduate practitioners in training to examine challenges experienced when students first attend to patients. A feature of students' learning about clinical work concerned performance in a public arena and associated demands placed on the inchoate practitioner. Preliminary patient consultations represented a dramatic rite of passage and initiation into a transitional phase in professional identity. Juggling the roles of student and practitioner within an observed consultation led to anticipatory anxiety, impression management strategies, and conflict with other individuals. Of the coping strategies, participants regarded sharing and feedback from peer groups as most effective in examining and resolving the challenges of becoming a practitioner.