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.