BLURRED LINES BETWEEN METHODS
One of the primary biomedical treatments for embodied trauma is a common form of talk therapy called cognitive behavioral therapy (CBT). During psychotherapeutic sessions, clients, in collaboration with a licensed, practicing clinician or therapist, often engage in reflective personal storytelling. The goal is for the client, with the support of the clinician or therapist, to carefully re-experience and reflexively process traumatic memories. To guide the process, the clinician asks open-ended prompting questions, validates the client’s experiences, and provides alternative or additional interpretations and ways to understand past experiences. Over time, the clinical treatments seek to help the client to attach different meanings and feelings to the recollection of past events, developing the skills necessary to develop hope for and resilience against future retraumatization and move toward healing.
Even if you have not personally experienced this model of therapy, its approach should feel familiar to anyone who has used ethnographically derived research methods like qualitative interviewing. Tad Hirsch documents in his 2020 paper “Practicing Without a License: Design Research as Psychotherapy” how research tools such as semi-structured interviewing and mirroring participant responses were directly drawn from psychotherapeutic techniques. Hirsch argues that qualitative interviews and other participatory research methods often strive to achieve three critical and interrelated aspects of the therapeutic encounter: rapport, congruence, and empathy (Hirsch 2020).
Rapport is the sense of connection and comfort between the parties. It is a topic that appears in numerous methodological texts, like Harry Wolcott’s book The Art of Fieldwork, (Wolcott 2005) and is discussed in at least 48 essays and papers in EPIC’s archive. Congruence, or “genuineness,” can be seen as what helps facilitate that sense of rapport. For a therapeutic encounter to be successful, the therapist must engage with clients in a transparent and authentic way. Hirsch notes that the same is true in research encounters. Good research practices involve being “open with participants about intentions, goals, and emotional responses to their stories. This may involve researchers “sharing personal experiences or simply expressing emotions during interviews” (Hirsch 2020). Finally, both forms of encounters depend on the clinician or therapist leading the encounter to develop and express a form of shared understanding of the participant’s experience, commonly referred to as empathy. While there has been a movement within the qualitative research community to critically reexamine the way empathy is deployed as a concept—for example, Maggie Gram’s N+1 paper “On Design Thinking” (Gram 2019) and Rachel Robertson and Penny Allen’s 2018 EPIC Conference paper “Empathy Is Not Evidence: 4 Traps of Commodified Empathy,” (Robertson and Allen 2018)—its cultivation remains an important component of many research and design processes.
Hirsch argues that there is nothing inherently wrong with cultivating rapport, congruence, and empathy. In fact, the shifting of focus towards these was in part tied to the work of feminist, indigenous, and other scholars and practitioners who have been advocating for more humane and equitable approaches to research for decades.6 That said, it’s critical to acknowledge how encouraging people to talk about past experiences and share unvarnished feelings while working to build a sense of authentic connection and shared understanding during a research interview creates the conditions for the resurfacing of trauma and, in some circumstances leads to the researcher essentially practicing therapy without a license.
We suspect many people reading this have experienced an interviewee jokingly—or perhaps not so jokingly—comparing a research encounter to a “therapy session.” At times, it’s easy to allow the two to collapse into each other, both in terms of asking open-ended questions about past experiences and trying to be supportive of their interviewee and validating the feelings that they are sharing.7 However, despite the trappings of similarity, Hirsch reminds us that the two forms of encounters—therapeutic and research—have vastly different goals. Psychotherapeutic sessions focus on easing the client’s suffering and facilitating steps toward healing. When the talk therapy process is successful, a client may partially or fully rebuild their ruptured world. While the precipitating events cannot be undone, the memories and the resulting trauma can be better integrated into the client’s ongoing life experience. This focus on reintegration is not part of the typical research encounter. Rather, research sessions focus on collecting data to advance some form of study, project, product, or service. The degree to which the participant receives any psychological benefit from participating (beyond compensation) is a byproduct of the process and not the expressed goal.
Further, while talk therapy is helpful for some people, it is not necessarily a path to healing for others. Some studies have shown that clinicians and therapists estimate that between five and ten percent of clients are actively harmed by the talk therapy process (Boisvert and Faust 2003). One of the reasons might be the limiting nature of talk therapy and the overemphasis on brief, interventional programs that are primarily intended to be more prescriptive and can often recklessly overpromise a faster track to healing. Although effective for some, as noted above, this limiting approach does not always focus on the serious and complex underlying challenges of trauma. This calls us to note that there is a parallel issue at play with prescriptive talk therapy and some research approaches: they both can overvalue the quickness of productivity rather than the necessary time and space for compassionate inquiry, nuance and complexity, and interpersonal reflection.
Beyond the question of the healing aspects of the two different encounters, we also want to point out that the training (both methodological and ethical) that researchers and clinicians each receive is quite different. These differences in training are especially notable when planning for and triaging unexpected events like retraumatization. Clinicians and therapists typically receive years of formal and informal training, supervision, ongoing case and practice consultation, and continuing education related to their profession’s practice standards. Unlike most qualitative researchers, they are prepared for and have the tools to respond to these emergent situations.
This leads us to two particularly challenging questions: (1) how much training should research practitioners get to prepare them for triaging a crisis, and (2) what steps should they take to mitigate matters of concern if they do not have such training? It’s important to note that we are not advocating for researchers to become clinicians, although some do pursue this route and have more in-depth training and competencies in these areas. However, we should be taking steps to both anticipate and minimize the potential for harm to both participants and practitioners. If we are unable to involve clinicians in our processes (something we will strongly advocate for below), then it is incumbent upon us to take the steps necessary to be able to identify situations that can evoke trauma in ourselves and those we are interacting with and develop the responsible and necessary skills8 to triage situations where that trauma begins to surface. This, in turn, leads us to the topic of becoming trauma informed and responsive.
SIX PRINCIPLES FOR A TRAUMA INFORMED & RESPONSIVE APPROACH
Trauma informed and responsive approaches begin from the understanding that people may have some history of trauma and take that into account in all engagements. These methodologies began to be developed by physicians, psychotherapists, and social workers (among others) to assist with treating returning veterans of the Korean and Vietnamese Wars. The addition of Post Traumatic Stress Disorder to the Diagnostic and Statistical Manual III (DSM-III) in 1980 greatly increased the amount of research conducted on trauma and the application of the concept beyond the space of military conflict. By the end of the first decade of the twenty-first century, medical and mental healthcare institutions were beginning to adopt integrated trauma informed approaches to assist in the delivery of healthcare (Center for Substance Abuse Treatment (US) 2014).
In 2014 the United States Substance Abuse and Mental Health Service Administration (SAMHSA) published its landmark treatise SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. Among other things, the document laid out six principles to guide trauma informed engagements: (1) Safety, (2) Trustworthiness & Transparency, (3) Peer Support, (4) Collaboration & Mutuality, (5) Empowerment & Choice, and (6) Attention to Cultural, Historical & Gender Issues (SAMHSA’s Trauma and Justice Strategic Initiative 2014). SAMHSA’s framework9 is intended to shift and share power while addressing the trauma that everyone involved in the process may be carrying. While originally intended to guide therapeutic encounters in emergency and first responder contexts, all of these can and should be applied to the ethnographic and qualitative research process.
As we consider each of the principles, we ask you to keep three things in mind. First, while we are addressing them one by one, the principles are all inherently interrelated and build upon each other. Secondly, they are not intended to be applied in a unidirectional way. The principles are not things you do at a participant. Instead, we integrate and apply them to everyone involved in the planning, conducting, analyzing, and sharing of research or design. In other words, at a minimum, we need to consider how each principal impacts both the people and the environment the research focuses on and the people who are conducting the research and the processes they are creating. Ultimately, we should extend this framework to everyone we interact with—our colleagues and clients (internal and external), and perhaps most importantly, to our friends and family.10
Finally, we want to acknowledge that every one of the principles could be the subjects of their own individual papers (or books). In fact, many have been. Our treatment of each one will necessarily have to be cursory. Our goal is to sow seeds about how each principle can influence the research process and to highlight additional resources to explore as you consider how to apply these principles to your personal, team, and organizational practices.
1. Safety
The first priority must be that everyone involved in the research encounter (participants, observers, and researchers alike) feel emotionally, psychologically, and physiologically safer11 when participating in the process. This focus on safety begins before the planning stages of research and continues through every stage of the process. One way to start this is to engage in a “safety audit” by asking, “how might participating in this research cause or fuel more harm to a participant?” and “What steps can be taken to mitigate or minimize that harm?” Hirsh points out that this is especially important as more and more research focuses on exploring sensitive subjects, often engaging with vulnerable communities. Whenever possible, this type of audit should be done collaboratively. It’s a place where clinicians or social workers can and are starting to be brought into the process. Or, even more optimally, it’s an opportunity to have members of the community you are working with actively engage and participate in the planning as experts and advocates for their communities.
For those familiar with Ethics Committees or Institutional Review Boards (IRBs) these questions may feel very familiar. However, a trauma-informed concept of safety is far more inclusive than the foundational minimum requirement that is often expected with IRBs. Embracing the multidimensional perspective of being trauma informed and responsive means also asking, “How might performing this research harm a researcher?” For example, consider the additional emotional burden that is often placed on BIPOC researchers who are asked to conduct research within BIPOC communities, especially around sensitive subjects, because of assumptions around intersubjectivity (Sunderland and Denny 2016, 224). Continually asking a BIPOC team member to research and/or speak and stand in for BIPOC communities risks activating vicarious, community, and intergenerational trauma (Menakem 2017).
In cases where there are safety concerns and the possibility of retraumatization, we must learn to ask the difficult question “Is this research necessary?” and “Has this research already been done?” As believers in ethnographic methods, we put a premium on getting into the field and learning from those with lived and living experiences. However, we should also recognize the immediate and long-term stress that this can place on the individuals and communities we work in. As the organization Chicago Beyond states in their excellent publication Why Am I Always Being Researched?:
In the hometown of urban research, Jonte asks aloud “why am I always being researched?” His peers are in three studies at once. A grandmother on his block, neighbors, and staff at nonprofits serving him, remember being in studies, too. Jonte is one of thousands in Chicago who, over decades, have participated in research studies with price tags in the millions, all in the name of societal change. And yet, the fruits of those studies have infrequently nourished the neighborhoods where their seeds were planted (Chicago Beyond 2019, 10).
There are often less invasive methods to gather information12, especially in cases where significant research has already been done on a subject. Empowering individuals and teams to choose not to do research or to change how the research is conducted to address safety issues is also deeply tied to the fifth principle: empowerment, voice, & choice.
If a decision is made to continue the research while acknowledging safety concerns, then mitigation plans that were thought through and considered ahead of time need to be activated. For example, at the non-profit Code for America, we train our researchers to identify the signs of traumatization and give them and their participants the ability to stop the interview at any time for any reason (Rappin et al. 2020). We also create lists of helpful aid resources and organizations that can be shared with participants to assist them with the challenges they are facing. Code for America also requires two researchers to be present in most engagements to support each other and participants through the research process; see the postscript in this paper for a demonstration of why this is so important.
Researchers should also consider how the other person’s environment should shape the research format.13 For example, for some people, a call is safer than a Zoom because it doesn’t require showing someone’s home or the use of a data plan. Additionally, there should also be procedures in place to help people who are experiencing acute stress or retraumatization during an interview (including stopping the interview to check in and co-determine next steps [e.g., continue the research process or not], and if necessary, calling social care resources or a mental health hotline for the individual in distress).
The work of creating psychological, emotional, and physiological safety continues throughout the research process. While a significant amount of focus is placed on interactions with our participants, it is not the only place where traumatization and retraumatization can occur. As noted earlier, retraumatization is often activated by revisiting past events without adequate support. Since analysis and synthesis of data necessarily require us to return to and relive interview sessions, it is another stage primed for the reactivation of trauma and support structures should be put in place for researchers, especially in cases where they know that they will be returning to sensitive and potentially activating or triggering conversations.
Across the research process, we can also consider utilizing tools and approaches from clinical practices where risk assessments and safety planning are not just everyday practices but an expectation for ensuring minimal risk to harm. We mention this as potential inspiration with the caveat that we also honor and more thoughtfully integrate the knowledge and expertise that has come from the very individuals who have learned, unlearned, and adapted these tools in and outside a clinical practice in innovative ways. In this respect, we discourage simply borrowing from other disciplines but rather, keeping with principle five, encourage their inclusion and deeper integration for enhanced co-learning and collaboration. For example, in academic or academic adjacent settings, consider reaching out to your school’s masters-level social work program to better understand how risk assessments and safety planning are currently being adapted in community-based work. Following the SAMHSA trauma informed framework (in particular, principle four, collaboration and mutuality), it is best to work directly with clinicians and other social work and social care professionals to plan and conduct research in ways that are safer for all.
2. Trustworthiness & Transparency
Drawing inspiration from activist Mervyn Marcano, we must learn to operate “at the speed of trust” (brown 2017, 42). This means working to be as open as possible about our research with our participants. At a minimum, we need to disclose why the research is being done, who it’s being done for, how the data will be collected and stored, and how the findings will ultimately be used. It also means that communications with participants should be delivered in culturally respectful and representative ways with a commitment to a focus on clarity and accessibility.
Additionally, we need to be transparent about what will be covered in a research session and what it may feel like to participate. This is especially important in research that will cover sensitive and complex topics. If there are concerns that questions might create stress or could potentially be especially activating and lead to retraumatization, then that needs to be clearly discussed with participants ahead of the research as part of the fluidity of an ongoing informed consent process. We also must be clear about the ways the participant can steer and control their participation in the research. This will be discussed in more depth with principle five, empowerment, voice, & choice. For the moment, it is enough to say that consent is not truly possible without transparency.
Being transparent and building trust takes time. In the best-case scenario, this means working at the pace your participants desire to work at rather than necessarily a rushed or urgency-ridden project timeline. Often, business, and other needs, make taking that time difficult. When it is not possible to negotiate more time, then it’s important to find ways to be transparent about your constraints with both your stakeholders (in clearly expressing the limits of what can be researched under those conditions) and with your participants (about why the research is happening on the schedule it is).
Finally, trustworthiness and transparency extend beyond the interview. Whenever possible, it includes sharing the results of a research project or a summary of findings with participants. Part of that process includes indicating what you will be and are not able to share as part of preparation with a participant while also being mindful of how to continuously protect all participants’ confidentiality with high-level findings.
3. Peer Support
Throughout the process, it’s critical to think about how participants and researchers can support each other. While this may be challenging, especially in research situations where participants don’t have the opportunity to meet one-on-one, there are still opportunities for support. For example, one can work with a network of community partners to help identify ways to support research participants with their challenges. In more participatory methods, such as participatory design or co-design projects, there are also opportunities to build participant support and review sessions in the various stages of the process. Additionally, one should not discount how sharing research results—through conversations, print publications, presentations, etc.—can help foster a sense of peer support for participants in so much as it provides them with a chance to see how their experiences are often shared by others. In many ways, this practice finds synergy with the principle of empowerment.
Peer support can also mean creating spaces within research organizations for researchers to support each other after difficult interviews. For example, at Code for America, the team has a framework for providing more immediate support if a team member has had a particularly challenging research experience. Another example of this in practice is a project where Civilla, a Detroit-based design non-profit, partnered with Social Workers Who Design so that team researchers could schedule debriefing and processing sessions with a clinically trained social worker-designer on an as-needed basis. The primary goal was to provide a dedicated, recurring, private space for the researchers to discuss specific design-based and structural challenges while working on a long-term project with varying levels of intensity in the child welfare system.