The PhD: my next stage as an occupational therapy researcher

In the previous two blog posts, I described how research slowly infiltrated my working life to the extent that, for a short while, I was doing little else. This next stage is about how research took over, which was not as bad as it sounds. There were concerned enquiries about my “work-life” balance, enquiries I dismissed conceptually as much as anything else, for until then I had never felt more alive at work than when I did my PhD. I had resolved to delay it until my daughter started secondary school, but the new local mental health day services manager approached the university following the previous research (Bryant et al 2004, 2005). She was setting up a forum for service users and staff and could we, the researchers, be involved? I joined the first forum meeting as a guest. I was aware of the limited conclusions we had drawn from the previous research, as the data were gathered from focus groups, focused on evaluation of existing services. How could collaboration with service users and staff delivering services (not strategic leaders) shape a research design and take findings forward in cycles, exploring and reflecting? This meant doing participatory action research.

There is a tension between participatory action research and formal approval processes: it is easier to get approval for designs that are well defined and constructed, but in participatory research, design is part of the research process (Banks et al 2013). There are many ethical issues to consider when doing participatory research within mental health services. At the time, it worked best to refine the design before obtaining approval, but since then I have supervised similar projects where researchers have gained provisional approval to get started and I think this is advisable. To give an idea of timescales, I attended the first forum meeting in summer 2003, registered for my PhD and got my honorary contract by spring 2004, and had the design agreed and all my formal approvals in place by Autumn 2005. The main data gathering took place from late in 2005 to spring 2007, and then I spent a year writing up. My viva was in July 2008. And yes, it was a part time PhD. As a lecturer, I was nominally allowed one day a week for research and scholarship, which included gathering information for teaching. There were benefits in working with colleagues who had also been through PhDs, and in having time to discuss my ideas with them and with students.

Being a PhD student is a bit special in some people’s eyes, but not everyone’s, and I enjoyed exploring the insider/outsider dynamic as I progressed. I was an occupational therapist who had worked in day services but was now an academic; a mum who had a book on critical ethnography to read while my children had swimming lessons; as a person who had never experienced severe mental health problems but had a PhD turning point after a serious car accident. Initially I struggled to know what was important or relevant. I did not know how to pace myself or manage the routine of supervision, even though I had been supervised as a clinician for years. I really enjoyed gathering the data but getting to grips with the findings was more challenging. In the final months of writing up, it felt like my PhD took over every part of my life which did not involve essential self care for me and the children, or my day job. Right at the end, I went to stay with my parents and spent the weekend eating and sleeping on their sofa, just like a stereotypical student. I would have brought the laundry too, if I could have got organised.

But it was the best thing, doing a PhD. I am envious of occupational therapists now who have the opportunity much earlier in their careers. I relish supervising people through PhDs: it is such a privilege to be able to focus on research, even when balanced with the rest of life. You can read about what I researched in the publications listed below, and in the next blog I’ll explain how the themes of my PhD led to my postdoctoral research.

Banks S, Armstrong A, Carter K, Graham H, Hayward P, Henry A, Holland T, Holmes C, Lee A, McNulty A, Moore N, Nayling N, Stokoe A & Strachan A (2013) Everyday ethics in
community-based participatory research, Contemporary Social Science, 8:3, 263-277

Bryant W (2011) Mental health day services in the UK from 1946 to 1995: an “untidy set of services”. British Journal of Occupational Therapy, 74 (12) 554-561

Bryant W, Tibbs A, Clark J (2011) Visualising a safe space:  the perspective of people using mental health day services. Disability and Society 26  (5) 611-628.

Bryant W, Vacher G, Beresford P, McKay E (2010) The modernisation of mental health day services: participatory action research exploring social networking. Mental Health Review Journal 15 (3), 11-21

Bryant W, Craik C, McKay EA (2005) Perspectives of day and accommodation services for people with enduring mental illness Journal of Mental Health 14(2): 109-120

Bryant W, Craik C, McKay E (2004) Living in a glass house: exploring occupational alienation. Canadian Journal of Occupational Therapy. 71(5):  282-289.

How I’ve done occupational therapy research: becoming an academic

I’ve been following the #OTalk discussions about research with interest. This is the second in a short series of blogs reflecting on my own experience. It is about the transition to being an academic, from doing research alongside the day job of providing occupational therapy. Studying for my MSc Occupational Therapy made this transition possible and gave me another experience of doing research in mental health day services. The MSc refreshed and formally introduced me to occupational science and professional reasoning. As well as my part-time work in social care, I was soon working regularly as a sessional lecturer, discovering the complexities of pre-registration occupational therapy education. That is a separate career change which I will not focus on here.

I was very keen to focus my MSc research on social care. However in a session about funding for research, we were shown a real life example, a letter inviting a tender to evaluate local mental health day and accommodation services using focus groups. I did not hesitate: as soon as the session ended, I announced that I wanted to do this research as it involved mental health service users and built on my previous research. A swift and positive response from my lecturers got the project going. They won the tender in March 2002 and soon got university and NHS ethical approval, which was a quick process in those days. I was appointed as research assistant. Recruitment and data gathering via the twelve focus groups took place in May. We had funds for a transcriber and as she sent the transcripts through, I reviewed them. I had completed the data analysis by September and wrote up two reports on the findings (later published as Bryant et al 2005). In October, for my MSc dissertation, I returned to the data from the four service user focus groups on day services for further analysis. Some ideas about occupational alienation and living in a glasshouse emerged, which shaped my dissertation (Bryant et al 2004). I handed it in just before Christmas, exhilarated and exhausted.

That project had many aspects which were easier because of the hard work and commitment of everyone involved. The local occupational therapy manager had secured the support of her senior colleagues to fund an independent evaluation, seeing this as an essential step for developing and improving the services. The local partnerships were well-established, making practical arrangements easier. The formal approach to the university and the funding made it possible for a small university team to be formed, consisting of Christine Craik, Elizabeth McKay and me. We worked closely together, sorting out the details of the project and negotiating with the funders before gathering the data. Our team work lasted well beyond the project, as we co-authored two articles  (Bryant et al 2004, 2005) and collaborated on further research. We were also all very experienced in working in mental health settings, which informed our decisions for setting up and facilitating the focus groups. We carefully structured how to work together, but also had fun discussing which stars would be involved in our story in “Focus Groups: The Movie”.

I gave up my part-time job as an occupational therapist which felt a very significant decision, although by that time I was also doing sessional teaching at the university and other projects elsewhere. The timescale was so intense that I felt really stressed. Now, having supervised many MSc and PhD students, I’m not surprised when others experience this, but at the time I was disorientated. I probably didn’t recognise the impact of being a novice researcher. The sense of responsibility was overwhelming, not just to meet the deadlines but to try and do something worthwhile with the data. The voices in the data were potentially more powerful than those of the people I’d worked with for so many years.

Analysing the focus group transcripts as qualitative data was initially challenging as it was difficult to know where to start. I hadn’t really been convinced by the pseudoscientific approaches offered in some of the textbooks which emphasised structures for analysis. But I loved David Silverman’s work: his writing suggests how doubts can be used creatively to think and make decisions, which can be constantly revised and revisited (Silverman 2013). This helped me see that as an artist and as an occupational therapist, the process of analysis was familiar as the creative process itself: scrutinising, coding, decoding, making links, synthesising, testing, resynthesising. I taught myself to use N6, an early version of NVivo, a qualitative data analysis software tool, so I could streamline the process initially.

Looking back now, I wonder how I did it. My children were primary school age and my husband worked away from home a lot. We had one computer and a dial up modem connection. We had spent savings on a laptop for me, an expensive purchase in those days. It felt like I had to keep the MSc firmly in its place, to minimise the impact on family life, but still my daughter came to me saying her feet were really hurting when she had outgrown her shoes and I had not noticed. I thought about occupational alienation when sitting in different school halls, choosing a secondary school for my son. I wondered about day services and where things were heading, but had no idea that my next step in research would be focused on this.

Bryant W, Craik C, McKay E (2004) Living in a glass house: exploring occupational alienation. Canadian Journal of Occupational Therapy. 71(5):  282-289

Bryant W, Craik C, McKay EA (2005) Perspectives of day and accommodation services for people with enduring mental illness Journal of Mental Health 14(2): 109-120

Silverman D (2013) Doing qualitative research. A practical handbook. 4th edition. London: SAGE Publications (I used an earlier edition).

Some useful advice on choosing a software package like NVivo is available from here http://www.surrey.ac.uk/sociology/research/researchcentres/caqdas/support/choosing/