by Qualitative data analysis method

Authors: Hadi Sağın ( MD Psychodramatist) and Ayşe Altan ( PhD, clinical Psychologist)

Abstract

Aim: In this study, the benefits of psychodrama, a group psychotherapy method, to the group members and psychodrama components associated with these benefits were evaluated by qualitative research methodology.
Method: In this sixteen-week’s study, the group members consisted of seven women and four men over 18 years of age, all volunteers with psychodrama experience in open group studies. HAT (Helpful Aspects of Therapy) forms which comprised the benefit feedbacks of the members were used as the data acquisition method. Qualitative data analysis and word analysis were performed on these data.
Findings: The mean age of group members was 41.6 years (range: 30-55). Except one member, all members were university graduates. Discourse analysis of HAT forms showed that the most frequent benefit codes were ‘awareness’, ‘warmup to new process’, ‘understanding’ and ‘getting a lesson’. During the group process, there was a decrease in expressions related to cognitive processes while no evident change was observed on expressions related to emotional processes. Evaluation of the source of the beneficial effects revealed that group support and universality principles were at the forefront.
Conclusion: Analysis of the members’expressions regarding the evaluation of their own processes revealed the contributions of psychodrama to the subjects. Qualitative data analysis seems to be a suitable method for the evaluation of psychodramatic group therapy processes.

Key words: Psychodrama, qualitative data analysis, therapeutic effect

Introduction

Positivism is the major approach in natural sciences. The only legitimate knowledge in natural sciences is ‘scientific knowledge’. Value judgements, opinions are not legitimate knowledge. Basically, quantitative research techniques are used in natural science research. Values, personal points of view have no place in the evaluation of observations, objectivity is indispensable and subjectivity is unacceptable (Fırat 2006; Kuş 2007). On the other hand, in social sciences, human behaviour needs to be signified and interpreted in a social environment. In research performed in the area of social sciences, it is not possible to control the variables (create laboratory conditions) as in the positivist approach since this area deals with the human being which is a biopsychosocial and at the same time a historical living creature (Topkaya 2006; Kuş 2007; Güleç 2016).
With the emerging of new scientific paradigma, a transition from quantitative to qualitative data research is taking place in social sciences and in the field of psychology because of the insufficiency of positivist science. It is believed that it is important to customize the conduction of research in the area of psychodrama with qualitative data evaluation. The aim of the present study was to evaluate the benefits acquired stated by the group members and psychodrama components related to these benefits with qualitative research methodology in a 16-weeks psychodrama group process.

Method

A specific theme or participant group was not anticipated in this study. The plan was to include individuals with even a slight experience of psychodrama with the expectation of motivation and high attendance rate. For this reason, a group of eleven members was formed by preliminary interview with volunteers who applied as participants after an announcement in the open group studies that were being conducted.
HAT (Helpful Aspects of Therapy) form which was developed by Robert Elliot (http://www.experiential-researchers.org/instruments/elliott/hat.html) for the determination of the beneficial aspects of therapy was used as the qualitative data acquisition method in our study. This form is recommended by the Research Committee of FEPTO (Federation of European Psychodrama Training Organisations) and widely used in studies performed by the same organisation.

The following points are being asked in this form: the most important or helpful event personally for the member in that day’s session (anything that might have happened, said or done by the member, another member or group leader), what made this event important or helpful and what did the member derive from this event. Similarly, anything that was found as frustrating is also asked. In the end of the study, HAT forms filled by the participants were transferred to the electronic media and used as source documents for qualitative data analysis.

Qualitative data analyses were performed by the MAXQDA program version 11 which is a data analysis software that enables the systematic organisation, evaluation and interpretation of data in the forms of text or multimedia. This software was used for coding the expressions according to the underlying concepts and creating categories from these codes after transferring the HAT forms to the electronic media. Results were visualized as ‘Code Theory Model’ and ‘Code Co-Occurrence Model’ as much as the capacity of the software permitted.
Word analysis was performed with the expressions in the HAT forms and ‘Word Clouds’ were formed. In these clouds, the most frequently used words were written with boldest and largest fonts and typographically the fonts were reduced with the frequency of the word’s usage

Results

The study group consisted of 4 men and 7 women. The mean age of group members was 41.6 years (range: 30-55). Except one member, all members were university graduates. The duration of each play session was two hours and the study consisted of 16 sessions excluding the warm-up games. The plays were protagonist play (12 times, two of them were dream studies), sociodrama studies (twice), vignettes (five times) and group plays (three times).

Discourse and related analyses

In the discourse and related analyses, codes determined from the expressions in the HAT forms and their frequencies are shown in Table I. Accordingly, benefit codes in order of frequency were ‘awareness’, ‘warmup to a new process’, ‘understanding’ and ‘getting a lesson’. Statements expressing being prepared to take a new step or determination either in the psychodrama study or in real life were assembled under the code ‘warmup to a new process’.
In the code models shown in ‘Figures’, outline weights of the connecting lines between two codes demonstrates the frequency of the expressions encoded with those codes. In order to define their inner source, expressions containing the words ‘I understood’ , ‘I thought’ or ‘should’ were classified as cognitive. Similarly, expressions containing the words ‘sadness’ or ‘anger’ were classified as emotional. Analyses of the HAT forms of all subjects in the group during the whole process (16 sessions) revealed 184 (65.2%) emotional and 98 (34.8%) cognitive expressions. Taking these expressions into account Figure 1 shows the benefits acquired by the subjects.
Analyses of the HAT forms of all group members during 16 sessions were used to prepare Figure 2 which demonstrates the code model of the benefits acquired drawn according to the type of play employed.

Word Analyses

Some very frequently used conjunctions, prepositions and adverbs in the Turkish language diminished the understandability of the clouds. For this reason, some words (more, very, for, but, as, me, about, mine, like, myself, just, happened, etc.) were omitted while forming the word clouds.
Word analyses of the HAT forms of all subjects during the whole16 sessions revealed (Figure 3) a frequency of 147 for cognitive expressions like ‘thinking’, ‘understanding’ and a frequency of 164 for emotional expressions like ‘feeling’. The frequency of the expression ‘to notice’was 80.
In order to assess any difference in the group members’ expressions within 16 weeks, the word analyses from the HAT forms of the first and last 8 weeks were both repeated.
In the first 8 weeks’s period, the frequency of cognitive expressions was 80 and for emotional expressions it was 81. In the last 8 weeks, the frequency of cognitive and emotional expressions was 67 a and 84, respectively. During the group process, there was decrease in cognitive expressions while emotional expressions’s frequency did not change markedly.

Discussion

In order to examine the reflections of anxiety in their expressions, the words ‘anxiety, worry and fear’ were counted in the HAT forms filled by the members in the first and last eight sessions. The frequency of these expressions was 25 in the first eight sessions or weeks and 14 in the last eight sessions. This decrease may be attributed to the understanding of the underlying reasons of these concerns and fears by expression and enaction with psychodramatic plays.
Contribution of psychodrama to the recognition and expression of the individual’s feelings can account for the decrease in the expressions related to cognitive processes in the HAT forms during the group sessions.
Besides ‘awareness’, ‘gaining a lesson’ and ‘understanding’ were among the more frequently determined benefits expressed by cognitive expressions. Among the benefits expressed by emotional expressions ‘awareness’ and ‘happiness’ were in the forefront. Benefits that were not among the cognitive expressions, including leaving to flow, relaxation, positive feeling towards self, reminiscence, tolerance, self-recognition, recovery, to be able to express, were also observed (Figure 1). This may reflect an association between awareness of emotions and benefits that can be applicable to actual life.
Among the 255 benefit codes expressed in the discourse analysis, the most frequently expressed code was ‘awareness’, followed by ‘warm-up to new process’, ‘understanding’, ‘getting a lesson’, ‘happiness’, ‘gain empathy skills’ (Table I). Increasing awareness and developing empathy skill are known as the most important aims of therapy. These aims are reached to a significant extent in our study group. On the other hand, the code benefit of ‘warm-up to new process’ demonstrates that psychodrama provides an opportunity to try new behaviours to the participants.

In the study conducted by Doğaner and Karabilgin (2011), analysis of the responses to the question related to ‘therapeutic change indicators’ (what changes occurred in you?) showed that recovery’, ‘love oneself’, ‘awareness’, ‘insight’ and ‘tolerance’were the most common answers. While evaluating the similarities and differences between the two studies, effects of subjective preferances related to the researcher which are inevitable in qualitative research, like different designations of code systems should be taken into account.
Among the benefits, ‘awareness’ was mainly acquired from protagonist plays which are therapeutic play studies and from vignettes in which the individual plays the main role to portray his own problem (Figure 2).

Evaluation of the source of benefit revealed the importance of group support and universality principle. These are the main superiorities of group therapies which have become apparent also in our study.
When the codes and frequencies of frustrations were examined, ‘negative feeling to self’, ‘nervousness/tension’ and ‘sorrow/sadness’ were noted as the most common situations. Themes coded as ‘negative feeling to self’ were usually noticed in protagonist plays in the context of feelings of neglecting the loved ones, feelings of guil, wasting out time and regret. Negative feelings of this type arising with awareness in nearly all psychotherapies can be evaluated as important opportunities for self recognition, self acceptance and change processes. Themes like uneasiness and sadness were especially expressed in the weeks in which bomb attacks took place in Turkey. Group members expressed their sorrow in the group sessions concerning the events occurring in the country.
Process evaluations from HAT form expressions of the last group session revealed that group members gathered several benefits from psychodrama group process and came up with many decisions regarding actions to be taken for their personal developments. It seemed that the effect of participating to the group would continue even after the end of the group.

This study will create an example for later studies on the application of qualitative data evaluation in the field of psychotherapy.
In a questionnaire study consisting of open-ended questions aiming to gather information on the use of qualitative research strategies in the field of psychology in Turkey, 12 out of 23 participants stated that they performed qualitative research. Detailed evaluation of the questionnaire revealed that most of these participants either analysed quantitative data by qualitative methods or used qualitative data in a setting of qualitative research (Kuş 2007).

Studies employing qualitative data analyses have been reported in the field of psychiatry in recent years in our country (Bilgin, Keser and Kutlu 2011; Meriç and Oflaz 2013; Özkan, Teskereci and Kulakaç 2013; Özkan et al. 2014).
However, in Turkish medical literature, there is only one study which assessed the effects of a therapeutic method using qualitative data analysis. In this tudy the author reported the aim as ‘ providing evidence on the facilitating effects of psychodrama on individual’s development; exploring the endogenous and subjectively defined changes in individuals after this long study; observing the subjective results of complaints and needs by subjective measures; creating a basis or step for developing a specific scale for measuring the effect of psychodrama’. In the same study, therapeutic alteration indicators and factors thought to make a therapeutic effect were evaluated by content analysis of expressions obtained from counselee and training groups by open-ended questions (Doğaner ve Karabilgin 2011).
Although positivist paradigms are still dominating, new developments are observed in this discipline under the influence of paradigmatic transformations in the area of psychology. The Center for Qualitative Psychology founded in 1999 in Germany, organizes an international meeting every year. On the other hand, “Forum: Qualitative Social Research”, an online qualitative research journal publishes articles on qualitative research from the discipline of psychology. Also, method books on qualitative research in the field of psychology are being published (Kuş 2007).
The results of our study demonstrated the contributions of psychodrama to the individuals as reflected by data analyses and the members’ self evaluations of their own processes.

We propose that qualitative data analysis is suitable as the primary method for the evaluation of psychodramatic group therapy processes and its use should be considered even if specific scales are being used.

References

Bilgin, H., Keser, N. ve Kutlu, Y. (2011). Adli Psikiyatri Kliniklerinde Çalışan Hemşirelerin Rollerini Algılamaları: Niteliksel Bir Çalışma. Türkiye Klinikleri J Psychiatry-Special Topics. 4(1), 73-80.

Doğaner, İ. ve Karabilgin, Ö. S. (2011). Bazı Danışan / Hasta ve Eğitim Gruplarında Psikodramanın İyileştirici, Geliştirici Etkileri: İçerik Çözümlemesi Verileri. Psikodrama, Dr. Abdülkadir Özbek Psikodrama Enstitüsü Dergisi. 3, 43-48.

Elliott R. Helpful Aspects of Therapy Form. http://www.experiential-researchers.org/instruments/elliott/hat.html Access date: 15.03.2016.

Fırat, N. Ş. (2006). Pozitivist Yaklaşımın Eğitim Yönetimi Alanına Yansıması, Alana Getirdiği Katkı ve Sınırlılıklar. Dokuz Eylül Üniversitesi Buca Eğitim Fakültesi Dergisi. 20, 40-51.

Güleç, C. Psikoterapilerin Meşruiyeti. http://www.cengizgulec.com/psikoterapilerin-mesruiyeti/ Erişim tarihi: 26.02.2016

Kuş, E. (2007). Sosyal Bilim Metodolojisinde Paradigma Dönüşümü ve Psikolojide Nitel Araştırma. Türk Psikoloji Yazıları. 10(20), 19-41.

Meriç, M. ve Oflaz, F. (2013). Hemodiyaliz Hastası Olan Bir Eşle Yaşamak: Eşlerin Yaşamlarındaki Gelgitler. Psikiyatri Hemşireliği Dergisi – Journal of Psychiatric Nursing. 4(1), 21-26.

Özkan, B., Arguvanlı, S. Ç., Saraç, B. ve Medik, K. (2014). Kronik Ruhsal Bozukluğu Olan Hasta Yakınlarının Stigmaya İlişkin Görüşleri. Yıldırım Beyazıt Üniversitesi Sağlık Bilimleri Fakültesi Hemşirelik E-Dergisi. 2(1), 1-6.

Özkan, İ. A., Teskereci, G. ve Kulakaç, Ö. (2013). Varoluşçu Felsefe Bakış Açısına Göre Jinekolojik Kanser Yaşantıları: Bir Niteliksel Meta-Sentez Çalışması. Psikiyatride Güncel Yaklaşımlar. 5(3), 313-329.

Topkaya, E. Z. (2006). Yıldırım Ali ve Şimşek Hasan Sosyal Bilimlerde Nitel Araştırma Yöntemleri. Eğitimde Kuram ve Uygulama. 2(2), 113-118.

Information about the authors

Hadi Sağın is a medical doctor/pathologis, and a psychodramatist. After working as a pathologist, he continued his proffessional life working in health education and medical projects after 1999. He is the founder of Prodo Consultancy where he currently works and continues on his medical projects.
He has participated in the Communication Volunteers Project with the leadership of Doğan Cüceloğlu, between 1998-2001. He was trained on group management in 1999-2000 by Doğan Cüceloğlu. He completed his assistant of psychodrama training by Nevin Eracar, in Abdülkadir Özbek Psychodrama Institute, between 2000-2004. After a break for several years, he continued his training with Inci Doğaner and was certified as a psychodramatist in 2016.
He is an executive member of Izmir Psychodrama Association. He cooperates in the psychodrama work of “GOKENGIN Psychodrama Atelier
Organization: Izmir Psychodrama Association

email: 533 2622808/  hadisagin@prodo.com.tr

Ayşe Altan:  She’s a clinical psychologist (PhD) and psychodrama therapist. She’s working at the Psychiatry Department in Aegean University. She started psychodrama training in 1999 with İnci Doğaner in the Institude of Abdülkadir Özbek. She’s working as a therapist in trainees’ groups.
Organization:  Ege University Faculty of Medicine, Department of Psychiatry

email: 530 7922972 / ayser7@hotmail.com