Clinical research can be defined as research that is related to experiences and descriptions of individual and interpersonal problems, transition, and change.
This includes social science and medical science studies of human behavior and interactions, cognition, and somatic experiences from a variety of perspec- tives. Transition and change can occur as part of one’s life course experiences or as a result of clinical inter- vention. The purpose of this entry is to provide an overview of choice points for clinical researchers to consider. The entry is not meant to explain how to do qualitative clinical research; rather, it is meant to raise topics and possible issues for researchers to consider as they conceptualize, design, implement, and write up studies. The entry does not differentiate between clients and patients; rather, the wordclientsis used to refer to both patients and clients.
It is important for researchers to position them- selves as well as their theoretical and methodological framework, and in doing clinical research this trans- parency of integrating theory with practice becomes even more relevant. This is due to the multiple
relationships that can occur between researchers and the people participating in their studies as well as the potential for the research itself having an effect on the participants. To help researchers conducting clinical research, this entry contains the following sections:
(a) description of the links among epistemology, the- ory, methodology, and methods; (b) types of research questions; (c) underlying agendas driving questions;
(d) consideration of whose perspectives one is considering; (e) researcher/researched relationships;
(f) points in time being investigated; (g) presentation of findings; (h) ethical issues in clinical research; and (i) political context of clinical research. As this entry explains, clinical researchers are challenged with a multitude of decision points to consider during the research process. It is important for researchers to consider some of these points at the genesis of con- ception of a project. Other points of consideration come into play as the projects are designed, imple- mented, and written up (or performed). In addition, it is recommended that researchers continuously reflect on ethical and political ramifications of their work.
Linking Epistemology, Theory, Methodology, and Methods
This section is based on Michael Crotty’s The Foundations of Social Science Research.Crotty made a strong argument for the importance of logical consistency among one’s epistemology, theory, methodology, and methods. Although there is a wide range of methodolo- gies that researchers may draw on to organize their research efforts, how a particular methodology is employed and made sense of will vary according to one’s epistemology. This topic is discussed in the sec- tion on theoretical frameworks, and the point here is to advocate that researchers articulate their epistemologi- cal orientation and theories they are employing as well as how this framework will influence their methodol- ogy, methods, conclusions, and results.
As an example of this point, consider a researcher using videotape playback of sessions with open-ended interviews with clients to find out what they saw as meaningful in marital therapy. From the perspective of a postpositivist (objectivist) epistemology and symbolic interactional theory, the researcher might claim to be dis- covering the key points that the couple found meaning- ful in therapy. From the perspective of a postmodern and social constructionist theory, the researcher might sug- gest that the interviews themselves were shaping the couple’s memories and might have had a therapeutic Clinical Research———79
impact as well. Although both approaches have research legitimacy, the two studies might come to very different conclusions and implications.
Other aspects of these chains of logical consistency are whether and how researchers bring a critical per- spective into their studies. If researchers view human behavior as more than an intrapsychic phenomenon, such that human behavior and personal meaning are shaped by cultural sociopolitical contexts, then researchers will consider more than clients’ experi- ences and descriptions. The research will likely also consider how clients themselves are shaped by cul- tural discourses as well as how clinical practices are shaped by cultural practices. From this critical per- spective, researchers can even consider how their own research practices (and implicit biases) are shaped by cultural values and dominant themes.
Types of Research Questions
Clinical research questions are often viewed as being about either process or outcome; however, it is also useful to conceptualize clinical research as being for the purposes of predicting, understanding, emancipat- ing, or deconstructing. Although these four perspec- tives are often couched as each corresponding to different epistemological and theoretical frameworks, to some degree a researcher can conceptualize any of these goals in different epistemological grounding.
Clinical research seeking to find patterns for predic- tion is useful for the current evidence-based practice model. Research seeking to understand is helpful for studying the clinical process. Research seeking to emancipate is part of the action research movement and is sensitive to issues of power and social hierar- chies while also addressing social justice. Research seeking to deconstruct is examining how clinical prac- tices (and research practices) are not independent of one’s societal environment and how practices of power, identity, and meaning are culturally imposed.
Depending on the type of question(s) being asked and the purpose of the question(s), the researcher can decide which methodologies and methods may be best suited for the project.
Underlying Agendas That Drive Research Questions
In posing research questions, it is relevant to also con- sider who or what is organizing the research project
itself: For example, a clinical agency might be seeking a program evaluation. Clinicians might be interested in how their practices are experienced by their clients and in the effectiveness of their clinical work. Funding sources for a program may be behind the research proj- ect such that they are requesting data for determining future funding. Government funding sources might be shaping the research questions being posed. Also, the researcher himself or herself might be the one initiat- ing the research project based on his or her own per- sonal experiences or professional constraints or out of personal curiosity. Who or what frames the purpose of the entire research project can influence both the types of research questions being asked and how results are distributed.
From Whose Perspective Do the Data Emerge?
Research data can emerge from many different per- spectives. If one conceptualizes clients from a sys- temic or ecological perspective, the starting place can be (a) the individual (client), and the context can be expanded to include (b) multiple clients (couple, family, or social network), (c) the clinician, (d) the researcher(s), (e) the community, and (f) cultural dis- courses. Research can focus on any one of these per- spectives or consider multiple perspectives.
In terms of framing the individual perspective, such as with a biopsychosocial–spiritual framework, data could include emotional descriptions, behavioral change, current cognitive processes, retrospective descriptions, biological processes (either self-reported or observed by others), and spiritual and religious accounts. Each of these aspects of an individual’s experience might involve different methods of data collection.
Multiple clients’ perspectives could include a couple, a family, or a broader social network. In con- sidering a multiple-clients perspective, it is important to consider how data are gathered. For example, if a couple is interviewed, are the members interviewed separately, together, or a combination of alone and together? If it is a combination, how are the different accounts woven together? The broader social network might include the client’s friends, neighbors, extended family, or fictive kin. The clinician’s perspective can include a single clinician or a clinical team working together. With a clinical team, it is important to con- sider whether the team data are gathered individually, 80———Clinical Research
in a group, or using a combination. The researcher himself or herself can also be a source of data. This is true in autoethnography and heuristic inquiry, but the researcher can include personal reflections and expe- riences in other methodologies as well. The commu- nity perspective could include sources such as officers of the court, social service workers, and school personnel. Finally, one can also consider the cultural perspective on clinical practices, for example, how society’s dominant discourses might influence the definitions of health, dysfunction, pathology, diag- noses, practitioner/healer, and responsible treatment.
Relationships Between the Researcher and the Researched There are various types of relationships that can occur between the researcher and those being researched. In classical experimental research, the people being stud- ied were referred to as subjects. This created a clear separation between the researcher and the “other” in terms of power, personal relationship, voice, and knowledge.
In clinical qualitative research, there are multiple signifiers a researcher can use to define the researcher and “other” relationship. Are the people being researched considered participants, collaborators, co-researchers, or some other concept? The choice of terms has real implications for the research endeavor, with both epis- temological and phenomenological impacts. In designing a study, the researcher should have a clear rationale for what descriptors are used in the study and an appreciation for how the language reflects the researcher’s relationship with the people being stud- ied. When the people being researched are considered co-researchers, this implies that they have a voice in the research process itself. This voice can include shaping the design before the study is conducted, shaping the analysis, and even having a say in whether or how reports are to be written. When the researcher considers the relationship as collaborative, it is impor- tant to consider how power is shared, how decisions are made, and how consensus and nonconsensus are negotiated.
Points in Time Being Investigated Another consideration for the clinical researcher is what points in time are being studied. Is the researcher interested in the experiences and phenomenon prior to
intervention or prior to the occurrence of the prob- lem(s)? Is the researcher interested in the experiences and phenomenon that occur during the course of treat- ment? Does the researcher need to have inquiries about the experiences and phenomenon after clinical treatment? Research can look at any of these points in time or at multiple time points. Often when conduct- ing clinical research, one considers multiple time peri- ods. Therefore, it is important for the researcher to be clear as to which anchor points are being studied. For example, if one researcher is looking at the actual talk of therapy through conversation analysis and another researcher is interviewing clients posttreatment through videotape playback, these are two discrete time periods with unique data and interpretation. To consider these two data sets as comparable is prob- lematic. The study of the “talk of therapy” (phenome- non that occurs in treatment moment to moment throughout the process) may be very different from the study of the “talk about the talk of therapy” (dis- cussion by client, researcher, or other about what has happened in therapy or as a result of treatment).
Presenting Findings
There are a number of ways in which findings and reports of a research project can be presented. These include written texts, papers/articles, posters and talks at conferences, web postings, and performances. The type of audience the researcher wants to present to (scholarly, professional, lay, or all three) can also influence how the data are analyzed and written.
Ethics and Clinical Research
Although attention to ethics is important for all researchers, clinical researchers need to be particu- larly attentive and prepared for issues that may arise.
This attention begins with the conceptualization of the project: What risks might participants face from being a part of the project? What information might researchers learn that becomes a legal or moral issue for them (e.g., child abuse, illegal activity, elder abuse, affairs)? Sometimes information gathered is not even relevant to the study but respondents disclose anyway, and then researchers must do something with this knowledge. When is it appropriate to refer a respon- dent for clinical help? How do researchers know when the boundaries between themselves and respondents have gotten blurred and when the relationship is not Clinical Research———81
professional? How do researchers take care of them- selves as they learn about painful and emotional events that may trigger their own emotions? How do researchers manage multiple roles such as when they are both clinicians and researchers? Which profes- sional lens do they use in conducting interviews and analyzing data? For example, clinical interviews are different from research interviews, and how researchers/clinicians respond can achieve different outcomes.
Addressing these issues is relevant in preparing for human subject approval, but also the researcher needs to be prepared for the unexpected. It is useful to have colleagues to talk with about issues as they arise. Finally, in preparing a report of findings, the researcher needs to consider possible long-range impacts of the study. How might respondents feel when they read the document later? How does the researcher honor the participants’ voices but main- tain confidentiality? How does the researcher deal with ending research relationships, particularly when the research process has been very collaborative and intimate in the sharing of information? Addressing these questions prior to data gathering may prevent potential ethical dilemmas later for the researcher and participants.
Politics of Research
The last section considers the broader context of the research. Different professional and interpersonal dynamics are at play for research conducted in a uni- versity setting, in a hospital setting, at an agency, or for one’s private practice. It is important to consider the potential differences among these settings. These might include elements such as who gets (or “owns”) the information learned, timelines, relationship dy- namics, authorship, data storage, confidentiality, and funding.
In terms of clinical research, it is also important to consider the relationship between one’s research and the current culture of privileging evidence-based research. Not all contexts are supportive of qualitative research, especially during the era of evidenced-based health care. Evidence-based medicine is the notion that clinical expertise should be integrated with best research evidence and patient values. Although for many scholars randomized clinical trials and meta-analyses are considered the best external evidence
when researching clinical interventions, there are many questions about “best evidence” that can be answered qualitatively.
Regardless of whether one is doing evidence-based research using a mixed-methods study or a stand-alone qualitative study, the following are questions to con- sider: How can qualitative research contribute to evidence-based studies? How might qualitative research challenge the findings of evidence-based studies? How might researchers deal with other schol- ars who may minimize qualitative clinical research and the research findings? These biases could include those of dissertation committee members, fellow fac- ulty or professional colleagues, funding agencies, and other influential people and institutions. What are the implications of funding sources for clinical research?
Might a funding source control which results are to be published?
It is important for researchers to be aware of the politics and professional ramifications of conducting qualitative research within their institutions (e.g., medicine, education, government, industry). Finally, it is important for researchers to consider how their find- ings might be used (or misused) by others, such as for policy change.
Jerry E. Gale and J. Maria Bermudez
See alsoCollaborative Research; Critical Discourse Analysis; Critical Research; Emotions in Qualitative Research; Epistemology; Evidence-Based Practice;
Multicultural Research; Participatory Action Research (PAR); Researcher–Participant Relationships;
Transparency
Further Readings
Berg, D. N., & Smith, K. K. (Eds.). (1985).Exploring clinical methods for social research.Beverly Hills, CA: Sage.
Crotty, M. (1998).The foundations of social research:
Meaning and perspective in the research process.
Thousand Oaks, CA: Sage.
Denzin, N. K., & Lincoln, Y. S. (Eds.). (2005).The SAGE handbook of qualitative research(3rd ed.). Thousand Oaks, CA: Sage.
Engel, G. L. (1992). George L. Engel and the development of the biopsychosocial model.Families, Systems, & Health, 14,409–452.
Fischer, C. T. (Ed.). (2006).Qualitative research methods for psychologists: Introduction through empirical studies.
Boston: Academic Press.
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Gale, J., Odell, M., & Nagireddy, C. (1995). Marital therapy and self-reflexive research: Research and/as intervention.
In G. H. Morris & R. Chenail (Eds.),The talk of the clinic (pp. 105–129). Hillsdale, NJ: Lawrence Erlbaum.
Holstein, J. A., & Gubrium, J. F. (1997). Active interviewing.
In D. Silverman (Ed.),Qualitative research: Theory, method, and practice(pp. 113–129). London: Sage.
Lincoln, Y. S. (2005). Institutional review boards and methodological conservatism: The challenge to and from phenomenological paradigms. In N. K. Denzin & Y. S.
Lincoln (Eds.),The SAGE handbook of qualitative research (3rd ed., pp. 165–182). Thousand Oaks, CA: Sage.
Schein, E. H. (1987).The clinical perspective in fieldwork (Qualitative Research Methods series, No. 5). Newbury Park, CA: Sage.
Sprenkle, D. H., & Piercy, F. P. (Eds.). (2005).Research methods in family therapy(2nd ed.). New York: Guilford.