From Pathological Dependence to Healthy Independence: An emergent grounded theory of facilitatingindependent living...

Liz Jamieson, Ph.D; Pamela J. Taylor, F Med Sc; Barry Gibson, Ph.D. Abstract People with mental disorder are admitted to high security hospitals because of perceived risk of serious harm to others. Outcome studies generally focus on adverse events, especially reoffending, reflecting public and government anxieties. There is no theoretical model to provide a better basis for measurement. There have been no studies examining discharge from the perspectives of those involved in the process. This paper begins to fill this gap by generating a grounded theory of the main concerns of those involved in decisions to discharge from such hospitals. Data were collected by semi-structured interviews with staff of various clinical and non-clinical disciplines, some with a primary duty of care to the patient, while mindful of public safety, and some with a primary duty to the public, while mindful of patients’ rights. The data were analysed using a grounded theory approach. Their main concern was ‘pathological dependence’ and that was resolved through the process of ‘facilitating independent living’. Clinicians and non-clinicians alike managed this by ‘paving the way’ and ‘testing out’. The former begins on hospital admission, intensifies during residency, and lessens after discharge. Testing out overlaps, but happens to a greater extent outside high security. Factors within the patient and/or within the external environment could be enhancers or barriers to movement along a dependence-independence continuum. A barrier appearing after some progress along the continuum and ending independence gained was called a ‘terminator’. Bad outcomes were continuing or resumed dependency, with ‘terminators’, such as death, re-offending or readmission, modelled as explanations rather than outcomes per se. Good outcomes were attainment and maintenance of community living with unconstrained choice of professional and/or social supports. Although this work was done in relation to high security hospital patients, it is likely that the findings will be relevant to decision making about departure from other closed clinical settings. KEYWORDS: pathological dependence, independent living, grounded theory, mentally disordered offenders, high security (special) hospitals Background Most countries have special secure healthcare facilities for people with a major mental disorder thought to pose a serious threat of harm to others, generally after at least one serious criminal conviction. It is difficult, however, to compare outcome studies between different countries because laws, policies, social structures and service availability may each vary widely. Facilities may be entirely within the health services, entirely within prisons, or a mixture of the two. Not all countries provide every level of security, and there may be international differences in definitions of ‘high’, ‘medium’ and ‘low’ security. There is, though, common ground in being held in such a secure institution – in constraints to freedom and autonomy within and outside the unit and long enforced proximity to others with grave health and behavioural problems. In England and Wales, people with a major mental disorder, detainable under mental health legislation and thought to pose a high risk of serious and imminent harm to the public, may be admitted to a high security, or ‘special’ hospital. Median length of stay there is over six years (Butwell, Jamieson, Leese & Taylor, 2000). Perhaps the most common ground to date between studies internationally and over time is in choice of outcome measures. Studies in both the United Kingdom and North America, for example, have focused almost exclusively on re-offending (Jamieson & Taylor, 2004; Steadman & Keveles, 1972; Steadman & Cocozza, 1974; Thornberry & Jacoby, 1979; Pruesse & Quinsey, 1977). There is less common ground between nations,...

Moral Positioning: A formal theory

Thomas Aström, Ph.D. Abstract This article presents the main outlines of a theory of moral positioning, contributing to the analysis of moralizing as a social phenomenon. It is a formal theory in several of its aspects. The discovered patterns help to explain social interaction in conflicts and how ordinary people use these patterns in relation to others. Moral positioning is frequently occurring in social situations were imbalances and conflicts arise among individuals and groups. Moral positioning is here theorized concurrently with a supporting conceptualization of social positioning. The model here presented can be used to explain the positioning process and is possible to use in order to become aware of, and in a better way, manage a conflict. The core variable in moral positioning theory has the form of a triadic pattern, built on the moral positions Good, Evil and Victim (GEV-pattern). The moralizing process is easily understood as socially and dynamically constructed patterns of positions. Those identities are related in three basic and complementary dimensions of meaning; Existence, Interest and Moral dimensions (EIM-pattern), each one with its own conflict pattern. The classic grounded theory method was used and the results were first presented in my dissertation in 2003. KEY WORDS: Conflict, Moral, Positioning, Identity, Interaction, Grounded theory. Introduction Originally the purpose of this project was to find out why there are so many complicated relations in a disabled person’s life. In my first attempts to research the psychosocial aspects of being disabled and belonging to a family with a disabled child, I met a barrier that prevented me from entering that field and getting access to field data. The strong gate-keeping from officials in bureaucracy that protected persons living their lives with or near disabilities also “protected” them from researchers, without even giving them the option to take a standpoint of their own. Being an experienced therapist, I was well aware of the field’s debates and controversies, and I was also aware of some tabooed areas where the dialogue on psychosocial matters was restricted even among professionals. Some of the professionals I interviewed felt uneasy answering this type of questions. The resistance among professionals to open insight was surprisingly strong. Why is that? Wouldn’t a search for knowledge about these problematic issues benefit the clients? Why were the obstructions to openness so strong and feelings of conflict so tense? Why were well informed and experienced professionals afraid of such issues? But on the other hand, parents and persons with disability were often ready and sometimes anxious to give their version. An example referred to by a researcher from an interview with a grown man with disabilities: “One day one of the participants asked me how far I dared to go in my report. He was worried that I in overdone consideration to parents and staff, or because of my personal fear and cowardice, didn’t dare tell about all the hard stuff that had happened in his and the others … life.” An urge for plain speaking. In contrast I met the hesitant attitude in the claims of professionals I interviewed on anonymous cases of psychosocial problems: “Can you assure me you will burn these tapes afterwards?” and another: “I don’t want to be quoted!” or a third: “I feel nasty telling you about this”. Information control seemed to be central in the interaction on such intricate matters. I could later use bureaucrats’ and other professionals’ reactions on the subject as useful data. They indirectly told me what I...

Growing Open: The transition from QDA to Grounded Theory...

Astrid Gynnild, Ph.D. Abstract Doing a PhD can principally be carried out in three ways; firstly by applying existing theories on new data, secondly by theoretically comparing existing theories and thirdly by generating a new theory. Choice of approach of course depends on awareness and accessibility of alternatives. In essence, most PhD studies are exploratory journeys in a jungle of descriptive methodologies based on very uniform data. In this paper, the author elaborates the exploratory research process that subconsciously, and later consciously, required a shift from the initial QDA approach to grounded theory. The cutting point was discovering the multifaceted implications of the all-is-data dictum in GT. Introduction Data collection and data analysis is crucial for the way research is conducted. It concerns research methods, research settings, data sources, amounts of data collection and what to look for in the data. The implications of ”all is data”, as conceptualized by Barney Glaser, can therefore not be overestimated. In practice, the ”all is data” statement brings us right to the core of grounded theory methodology. Its power in capturing change-in-process, which probably is the only steady aspect of modern work life, is immense and incompatible with any other methodology. Like many other PhD candidates, I started out with a qualitative approach intended to result in applying existing theories on new data – and ended up with a grounded theory. The area of study was news professionals in multimedia and crossmedia companies in Norway, and how they coped with rapidly changing conditions for work. Reflecting back on the exploratory processing that lead to the sudden and definite switch in methodology, it appears that the transition from QDA to a grounded theory approach required a parallel process of growing open. After several months of concentrated qualitative efforts, I had come to a point where I was unconsciously searching for a methodology that could include a more diverse range of data sources than the typical quantitative or qualitative approaches. It was a troublesome period during which a main concern was loss of time and lack of meaningful, productive progress in the study. By the time, I did not know grounded theory. Consequently, options for theory generation instead of descriptive verification of existing theory were out of sight. In the ensuing paragraphs, I will provide some of the reflections and questions that lead to the transition from QDA to a grounded theory approach, followed by a further elaboration of some all-is-data implications. By the time of methodological shift, the data already collected included hundreds of pages of statements illuminating more facts and details than could possibly be handled in a highly detailed, descriptive dissertation. My initial aim had been to study the development of multimedia journalists in three large Norwegian multimedia houses, descriptively comparing similarities and differences. So far, all the data stemmed from qualitative interviewing of news reporters in these news corporations. The in-depth, semi-open interviews, as the genre is called in qualitative research, were taped and transcribed verbatim. Some of the interviews had been factor analyzed according to q-methodological principles, a branch within phenomenology. Two typologies had come out of analyzing the six first interviews. Now the question was whether to continue on the same track with the 14 next interviews. Incubating At this point, I had been through the preparing and concentrating stages of exploratory processing, which is a basic process in any kind of knowledge work. Now incubating was reached, or rather, the chaos stage. I was in a state...

Opportunizing: A classic grounded theory study on business and management...

Ólavur Christiansen Abstract Opportunizing emerged as the core variable of this classic GT study on business and management. Opportunizing is the recurrent main concern that businesses have to continually resolve, and it explains how companies recurrently create, identify, seize or exploit situations to maintain their growth or survival. Opportunizing is the recurrent creation and re-creation of opportunities in business. Opportunizing is basically what business managers do and do all the time. The problematic nature of opportunizing is resolved by a core social process of opportunizing and its attached sub-processes that account for change over time and for the variations of the problematic nature of its resolution. Opportunizing has five main facets. These are conditional befriending (confidence building & modifying behavior), prospecting (e.g. information gaining), weighing up (information appraisal & decision-making), moment capturing (quick intervention for seizing strategic opportunities), and configuration matching (adjusting the business organization to abet the other activities of opportunizing). On a more abstract level, opportunizing has three more organizational facets: the physically boundary-less, the valuehierarchical, and the physically bounded. The first of these called perpetual opportunizing. This emerges from the conjunction of conditional befriending and prospecting. The second facet is called triggering opportunizing. It arises from the coming together of weighing up and moment capturing. The final facet is called spasmodic opportunizing. This happens when moment capturing and configuration matching unite. Thus, the tree facets of opportunizing are sub-core variables, while the five facets of opportunizing are sub-sub-core variables. The five facets can also be seen as stages of the core process of opportunizing. Yet, they are more than stages, because weighing up is involved throughout. Each of the five facets of opportunizing also attach to subprocesses that account for the resolving of still more tangible dimensions of opportunizing. For example, confidence building and modifying behavior are two categories of conditional befriending. It is not possible to create opportunities in business without modifying people’s behavior, but this latter is impossible or difficult without confidence building. The model of opportunizing will assist managers in focusing on the most important and problematic. Practitioners will be able to adopt and adapt the theory according to the variation in the data that their individual contexts manifest. Introduction The methodology used in this research is the set of “classic” GT procedures that Dr. Barney Glaser originated in the beginning of the 1960s and has maintained since (Glaser, 1978; 1992; 1998; 2001; 2003; 2005). It will be assumed that the reader is familiar with this methodology and its terminology (i.e. conceptual levels, substantive concepts and theoretical codes, types of theoretical codes such as basic social process, basic social condition, amplified causal looping, bias random walk, etc; the distinction between a basic social structural and basic social psychological process, and so forth). A few data incidences will be used as examples to illustrate some of the building blocks of the emergent theory. Literature comparisons will be delimited to just a few. The empirical data for this research were collected from a theoretical sample of twelve small and middle-sized companies in the Faroe Islands. Most of the data were qualitative and collected by interviews with company managers, owners, board members and employees. The research was sponsored by BP Amoco Exploration LTD (Faroes). Dr. Andy Lowe was the author’s methodological coach during the critical phases of the research. The Core Variable of Opportunizing The core variable that sums up the most important and the most problematic for those being studied and explains most of the...

A Grounded Theory on Helping Behavior and Its Shaping Factors...

Bro. Hans Steven Moran, FSC Abstract In social psychology, the attribution model of helping behavior suggests that beliefs of the helping target’s responsibility for the need for help evoke affective motivators such as feelings of pity, sympathy, or anger. The affective motivation leads to helping or not helping the target. The current emergent theory is an enhancement of this theory by incorporating other personal and situational variables. Through the use of classic grounded theory, I interviewed 80 participants from different De La Salle Schools in the Philippines. This yielded over 1300 individual incidents that were compared and contrasted to form codes, categories and subcategories. A theory on the decision making process of helping emerged that incorporates the helper’s personal conviction, and rational deliberations of the situation. The desire to help is based on the helper’s rationalemotive beliefs (philosophical ideals and values that nurture helping and the knowledge of the nature of risk/problem) and relational-emotive ties (with the one who needs help and with a social group that nurtures helping). The desire to help undergoes a process of rationalpragmatic-deliberations on the appropriateness of the recipients need of help, the cost of helping, the helper’s capability of helping, and the logistics of helping before the actual helping occurs. The theory has implications for current social psychological theories of helping, and the use of classic grounded theory research. Introduction The Brothers of the Christian School is a congregation of religious men founded in the 1700’s in France by Jean Baptiste De La Salle. The integral purpose of the congregation is education of youth, particularly the marginalized. The group grew to become of one of the pillars of Catholic evangelization through school education in at least 80 countries around the world. De La Salle Brothers, as they are popularly known in the Philippines, reached Philippine soil in 1910 and presently has 12 schools offering basic and higher education. In the 1980s there was a strong impetus to rekindle the foundational philosophy of reaching more needy young people. The rallying cry popularized by the head of Brothers was “risking your lives to youth at risk”. The past 10 years ushered movements towards translating this adage into specific programs and activities of the schools. However, the idea of “youth at risk” is at its best a conjuncture of notions with sociological and theological underpinnings. Most members of the Lasallian community are in a quandary on this and how it translates operationally into the leadership and management of schools. This led to the present study of unraveling the various meanings attached to the concept of youth at risk by different members of De La Salle Schools in the Philippines (abbreviated Lasallian community in this study). I employed a qualitative epistemology, and started out with the simple inquiry on what youth at risk means to members of the Lasallian community. Method Participants The 80 participants were religious members (La Salle Brothers), administrators, teachers and students of seven De La Salle Schools in the Philippines, representing the three major archipelagic clusters of Luzon, Visayas and Mindanao. These islands are likewise distinguished by socio-political and economic variances. Data-Gathering Procedure I used conversations with consent of respondents as opposed to formal interviews to harvest the raw and spontaneous sentiments of the respondents. The interaction climate of conversations are less formal or structured, allowing the nuances of deviating from other topics, which later was found useful. I felt that conversations were more authentic and truer to the precepts of grounded theory...

The Postmodern Turn: Shall Classic Grounded Theory Take That Detour? A Review Essay...

Vivian B. Martin, PhD Situational Analysis: Grounded Theory after the Postmodern Turn, Adele E. Clarke, 2005, Sage Publications. 408 pp., paperback/hardcover Constructing Grounded Theory: A Practical Guide through Qualitative Analysis, Kathy Charmaz, 2006, Sage Publications. 224 pp., paperback/hardcover Adherents to classic grounded theory have gotten used to spotting the pretenders working under the grounded theory banner. Some of these faux-GT researchers have worked in a fog, misunderstanding fundamentals of the method; these are the studies that leave us shaking our heads and wondering about the doctoral committee and peer reviewers who did not bother to find out more about the method they were evaluating. More infuriating are the authors who are claiming to improve on grounded theory, to reground it, to quote one notable British author who, lack of handson grounded theory experience aside, manages a booklength critique of the method. Two recent books in the “remaking grounded theory” genre are from sociologists with some years of grounded theory projects behind them. Adele E. Clarke, author of Situational Analysis, was a student and colleague of Anselm L. Strauss at the University of California San Francisco. Kathy Charmaz, author of Constructing Grounded Theory, is among the few grounded theorists who studied with Barney G. Glaser and Strauss at UCSF. Although the pedigree of both authors gives more traditional readers comfort that these are not just people wielding the term grounded theory and conflating it with any old interview study, the vision for grounded theory offered in these two books are a challenge to more orthodox notions. Both authors treat a sacrosanct element of classic grounded theory, the core category or concept, as unnecessary or, worse, a barrier to understanding the phenomenon under study. Both accuse classic grounded theory of a lack of reflexivity about the research process, insensitivity to difference and variation, and oversimplification in its quest to create an integrative theory. The overall indictment is that grounded theory is out of step with the ways of thinking and talking about research brought about by postmodernism and other changes in scholarship through the 80s and 90s. Clarke’s stated goal is to “push grounded theory more fully around the postmodern turn” (p. xxi), a shift in the social sciences and humanities that has focused on the fragmentation, tentativeness, and complexities of social life and the need to adopt different methods and ways of gaining entry to these fragments, not to bring about wholeness—that is not possible within the postmodern frame—but to at least begin articulating the possibilities and their connections. If this sounds vague and possibly contradictory, such is the nature of postmodernism. The goal of both authors is to make grounded theory more responsive to it. Toward this end, Clarke proposes changes that pretty much create a new method. Charmaz, though better informed about how the different variants of grounded theory converge and diverge and how they have coexisted,nonetheless endorses a sometimes impressionistic, interpretative approach which, I suspect, grounded theorists who are seeking to utilize grounded theory to bring about understanding and change in practical disciplines would find less desirable and accountable. The daily worlds of nursing, management, information systems, and other fields, I would argue, very much privilege an “objective” reality where phenomena are defined and measured. In posing the question in the title of this review essay, I am asking whether classic grounded theory can and should avoid the postmodern turn, which would be a detour off its main path, which has yet to be fully explored. I...

The Roots of Grounded Theory

[From a keynote presentation given to the 3 rd International Qualitative Research Convention, Johor Bahru, Malaysia 23 rd August 2005] Barney G Glaser, Ph.D.; Hon Ph.D. I studied sociology at Stanford 1948 to 1952, which was partially fine but limited in those days. But then I knew I wanted to be a sociologist. Returning to the USA from the army in 1955 to study sociology at Columbia confirmed my goals. I bought the program 100% on doing sociology as my life work. All I do is sociology in every facet of life; work, recreation, family etc. My life is sociology driven and directed. Now let me give you a quote from Barton’s (1955, p.246) article of Paul F. Lazarsfeld [PFL], “Analyzing the logic of research operations to clarify concepts remained a key to PFL’s life”. It has been the key to my life also. “All is data” – that now sloganized tenet of Grounded Theory [GT] – clearly came from PFL per Barton’s words. Robert K. Merton’s [RKM] brief flicker of light – to admit to emergence (see Barton, p. 255) – became the key to GT’s theoretical stance. The Four Dimensions of being a Sociologist In buying the program 100%, I bought the four dimensions of doing sociology – autonomy,originality, contribution and the power of sociology. All dimensions are interrelated; they became a part of my sociological identity and led eventually to my originating GT. Now let’s consider each of these dimensions of my training, how they affected me, subsequently found their way into GT and how they may serve as food for thought in your training. Autonomy PhD training is a training for autonomy. One becomes the doctor, so to speak. One claims one’s own pacing. One claims one’s own ideas and the connections between them. One becomes the theorist and/or research author. Therefore, one must stand on what one has said and achieved. This puts a call on one’s seniors, on faculty and the social structure of departments to allow the PhD candidate to do his own thing, irrespective of faculty and supervisor desires to have the candidate work on their ideas. It puts a call on author idol worship of “grand theorists”; it puts a call on theoretical capitalism; it puts a call on supervisor control and ownership of the candidate’s work in favour of giving him/her full freedom and license. It is a claim that the candidate must stand for irrespective of senior or supervisor obstruction and efforts to the contrary. Try it; you will like it. Please remember, I did my dissertation totally on my own on secondary data from the survey research center at the University of Michigan. It passed easily. My supervisor Hans Zetterberg was delighted. PFL was overjoyed by the core variable and the development of new method analytic techniques. RKM was confounded since it cast grave doubt on his famous paper; “Recognition in Science”. My dissertation was published immediately, given the recalcitrant forces of action. It was requested, not sold by me – since I did not have a clue. Throughout my whole training I resisted the efforts of both PFL and RKM to co-opt me to work for them and those who did were not very smart. I had no time for them personally, just their ideas. It was clear in RKM’s writings on the sociology of science that the key to creativity was to study ideas with autonomous freedom in order to put them together by seeing...

Grappling with the literature in a grounded theory study...

[This paper was originally published in Contemporary Nurse (www.contemporarynurse.com) and is reprinted here with the kind permission of the publisher. Reference: McCallin, A. M. (2003). Grappling with the literature in a grounded theory study. Contemporary Nurse, 15(12), 6169.] Antoinette McCallin, Ph.D., RN Abstract Student researchers often struggle to understand how to use literature in a grounded theory study where timing and knowing what to read are critical. Despite substantive theoretical documentation on this topic the reality of working through abstract ideas is more challenging. There is a fine line between not doing a literature review in the area of study and being informed so that a study is focused. In this paper a practical example will be presented illustrating how the student can integrate literature yet stay away from preconceived notions. The topic is interprofessional practice. Key Words Grounded theory, Interprofessional practice, Qualitative literature integration Introduction Over and over again student researchers grapple to understand the place of the literature review in a grounded theory study. While the theoretical ideas are well documented in texts on research methodology (Chenitz, 1986; Glaser, 1978, 1992, 1998; Strauss, 1987; Strauss & Corbin, 1998) integrating abstract concepts in practice is sometimes more challenging. Glaser (1998) recognises that reading the literature is problematic while Strauss and Corbin (1998) expect most professionals are familiar with the literature in the field. Misunderstandings arise from the tendency for novice researchers to take a purist stance whereby they accept the general advice to stay away from the literature literally. While the beginner researcher receives that interpretation happily, supervisors and institutional review committees are rather more nervous of such a simplistic approach. Those responsible for student researchers seek some reassurance that the student knows what they are doing, has a general focus, and is at least safe to enter the field. Preparation for any research study is always essential and some pre-research literature reading is still necessary to “frame the problem in the introduction to a study” (Creswell, 1994, p. 23). At the very least, a literature review is needed to find out if the proposed study or something similar has been done before. In addition, this early literature review may be used to prepare a research proposal for an ethics committee, so sound preliminary work goes some way to demonstrate that the researcher knows exactly what she is doing even if she does not know what she is looking for. Thus the mental wrestle quickens with the need to be general but focused, yes, to look at some literature but no, stay away from the main area of interest. Not surprisingly, student researchers may feel baffled with instructions that are apparently contradictory. This is complicated further, as many qualitative researchers work in an environment where clinicians are increasingly asked to justify decisions with the best evidence (Street, 2001). Such issues serve to emphasise that part of being a qualitative researcher is learning to move beyond the either-or way of thinking, in order to embrace bothand thinking that recognises complex possibilities, many truths and viewpoints, and different ways of experiencing reality (Zohar & Marshall, 1994). In this paper the issues and strategies for grounded theory literature integration will be discussed and illustrated with a practical example. What are the Issues? Clearly literature review in a grounded theory study must include literature on both the topic and the grounded theory method. For example, student researchers grappling with the literature will quickly find the debate about emergence versus sensitisation that arose...