Methodology

Design

A qualitative, thematic analysis design was chosen for this study for several reasons. Thematic analyses are best suited for psychotherapy and counselling research, according to Clarke and Braun (2018), who were the first to introduce the analytical approach in their 2006 paper. A key advantage of this approach in this research is its reflexivity, which entails that the researcher’s subjectivity is not regarded as bias, but as being part of the process (Braun & Clarke, 2020). Furthermore, the richness of the counts and data that is necessary for the research question and objectives to be satisfied cannot be captured through quantitative measures, the objectives of this research need to be analyzed through conducting a discussion with each participant, and cross-analyzing these different discussions to come up with a consensus on the matter; which is where the researcher’s reflexivity comes in. Secondly, a thematic analysis allows for a better understanding of the techniques and psychotherapeutic modalities that participants use with their patients, and which is also one of this research’s objectives (Clarke & Braun, 2018).

Procedure

Mental healthcare professionals specifically trained in treating trauma and dissociation were recruited for this study. An advertisement for the research, outlining research paper title, question, and objectives, and inclusion criteria, was posted on the International Society of Trauma and Dissociation’s (ISSTD) members’ newsletter. Furthermore, the researcher approached random participants through the ISSTD’s open members’ database through email and participants who responded to the email were then sent a Participant Information Sheet containing all the details covering the topic and methodology of the research and a consent form to sign. Once those were returned to the researcher via email, a time and date were set for the interviews and they were conducted over Zoom and recorded. Once all interviews were transcribed, common themes were highlighted, and recorded in all interviews. Subsequently, thematic analysis was conducted to group all relevant information under common themes to be discussed in the Results and Discussion sections.

Materials

The researcher devised ten main open-ended questions with sub-questions surrounding the topic of loneliness and how it affects dissociative states or episodes of DD patients for the interviews, guided by the literature reviewed (Alaryian, 2019; Kalsched, 2017; Parry et al., 2018; van der Hart et al., 2017; for full question list see Appendix C).

Participants

Fourteen participants were recruited for this study. In qualitative analysis for dissertations, collecting data from less than 6 in-depth interviews would not be sufficient for data saturation (in terms of having enough insight from a homogenous population on the topic to warrant conclusions accurate to the best extent possible) (Boddy, 2016; Malterud, Siersma, & Guassora, 2016). Data saturation has been observed to happen with 6 in-depth interviews in most cases, and usually occurs through 12 in-depth interviews (Boddy, 2016; Malterud et al., 2016). Recruiting more than 15 would be unethical as it means collecting unnecessary data.
All participants had been practicing as mental healthcare providers for at least two years with dissociative disorders patients; this was one of the main inclusion criteria outlined in the Participant Information Sheet and the advertisement sent to ISSTD members. Participants were of varying ages spanning late thirties to late seventies, and years of experience spanning at least five with some amounting to more than 20 years of experience with dissociation. Despite recruiting randomly, participants are evenly split in terms of gender; seven females and seven males.

Ethical Considerations

Minimal ethical challenges arose in this research; since this research relies on the sharing of patients’ sensitive information, the research and the University’s ethics committee ensured every measure was taken to mitigate risk of breaches in confidentiality. Participants were informed of these measures before consenting to taking part in the study. Participants’ own identities and personal information has been coded and eliminated, and their patients’ sensitive information has not been shared with the researcher in any of the interviews.

Analytical Approach

Coded thematic analysis was conducted through the following six steps as guided by Braun and Clarke (2006):
1. All interviews were transcribed, and read at least twice. A decision was made regarding how data will be analyzed: through an inductive (top-bottom) or deductive (bottom-up) manner. Inductive allows data to be analyzed with minimal theoretical constraints from the researcher, even if the data may seem irrelevant to the specific questions asked, whereas deductive is more analyst-driven, where rich details are not the focus but instead the detailed analysis of the data itself. Deductive was chosen because the interviews were varied in length, details, and cases discussed; participants offered different viewpoints on the link between loneliness and dissociation, and thus an analyst-driven approach was necessary to combine and find common ground between these factors.
2. Notable codes were identified, specific, noteworthy segments from all interviews were highlighted and color-coded according to sub-themes pre-identified by the set of questions devised. Each question targeted a specific factor, and those loosely determined the sub-themes expected to emerge. This was a preliminary step to prepare for the labeling of major themes. The purpose here was to identify the data relevant to research question and objectives.
3. All coded excerpts and data were now sorted into the preliminary sub-themes. At this point, the main themes playing a role in the perceived link between loneliness and dissociation were easy to identify and label.
4. Themes were reviewed critically and any that seemed superfluous or irrelevant to the data were eliminated. Similarly, themes that are too large were broken down into smaller ones, as can be seen in Table 1 in the Results section. All themes and data inserted in Table 1 were ensured to be coherent and logical; if a theme was irrelevant in terms of the research objectives, its significance to the findings was reevaluated before moving further.
5. Labels given to the themes in this phase were further refined for clarification. This, in other words, means that each theme must have a clear and homogenous essence capable of encompassing all sub-themes and codes, no matter how different they may be in nature; each code and sub-theme under a larger theme have something in common, and that was usually defined in terms of their impact on the theme. For instance, the codes that made up the sub-theme of “Lack of communication skills/self-expression,” under the theme of Social Support Networks is intertwined with the other two sub-themes: “Lack of social support networks,” and “Fear of people.” The common ground between the codes and sub-themes in that theme is their overarching effect on DD patients. All three show how these factors/variables hinder DD patients in terms of sociability and how they are a cause in being triggered by loneliness. In this sense, it is apparent why a deductive analytical approach was adopted for this research as well; connecting the themes to the trigger (loneliness) and coping mechanism (dissociation) was necessary for the research question to be answered.
6. Once the connections between themes were made, the significant codes, sub-themes, and themes were organized in a table (see Table 1), and the Results section was written to show how these themes emerged and how they connect to each other to cause the perceived impact of loneliness on dissociation.
In terms of replicability, the deductive approach adopted in this study entails that even if the study is replicated, the findings may be interpreted differently and thus the conclusions drawn may present different results (Braun & Clarke, 2020; Roberts, Dowell, & Nie, 2019). However, in this study, researcher reflexivity is not regarded as bias, but as part of the design as mentioned above.