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Phenomenological Pedagogy in Higher Education of Mental Health Workers: An Example From Norway

Phenomenological Pedagogy in Higher Education of Mental Health Workers: An Example From Norway This article describes the use of phenomenological pedagogy in the higher education of mental health workers. The mental health field is an immensely complex professional field. To create access, the conventional education of mental health professionals compartmentalizes the field according to traditional professional boundaries. Personal–professional expertise and user preference are thereby lost. Such personal experience is privileged in a pedagogy based on Giorgi’s descriptive phenomenological method. Students learn systematically to describe a mental health phenomenon of their interest and reflect on this using each other’s professional insights as well as relevant research literature. Phenomenological description and reflection are repeated several times in the curriculum. Kegan’s subject–object theory of adult development explains how this repetition may support transformation of insight in rather than an accumulation of information about mental health work. The complexity of the mental health field thus emerges as a source of knowledge to exploit rather than merely a rugged landscape to navigate. Keywords mental health, transformative learning, subject–object psychology Higher education of mental health professionals faces the In its effort to handle this complexity, professional higher overwhelming complexity of the mental health field—a field education of mental health workers creates access to this infested with personal distress, professional disagreement, field by excluding large parts of it and including only a few conceptual confusion, cultural clashes, political and ideo- preferred areas—compartimentalization is preferred to inter- logical debate, and commercial competition (Bracken & disciplinarity (cf. Hillocks, 1999). Compartmentalization Thomas, 2005). Human existence colors the field’s surface supports established professional boundaries and is sustained and determines its depth. The phenomena involved are as by conventional pedagogy, that is, pedagogy that teaches human as can be; everything in the mental health field is information and skills based on accepted theory without spe- about man and thus as complicated as we are (May, Angel, & cific regard to the student’s own experience from the field Ellenberger, 1958). This is reflected in the plethora of profes- and his or her individual learning process (Dahlberg, sions and sciences that act and reflect on mental health in Ekebergh, & Ironside, 2003; Ironside, 2001). In this article, some shape or form. Philosophy, theology, sociology, social we present an alternative solution to accessing the mental work, the psy-sciences, medicine, neurobiology, and others health field in the higher education of adult students. contribute with influential perspectives on mental health; Phenomenology provides both the rationale that undergirds these perspectives are influential, but not necessarily compat- our pedagogy and the research method that the students learn ible or mutually reducible. The history and theory of mental to use to advance the knowledge base of their practice. We health is inflamed with debate and controversy, within and first describe and then reflect on our phenomenology-based between the sciences, professions, and clients (cf. Coppock & curriculum that teaches adult students how to use their own Hopton, 2000; Szasz, 2008). These debates often extend to life and work experiences as a privileged starting point for politics and ideology: At stake is not only what is healthy or professional development. In conclusion, we suggest that pathological, effective or relevant, but also what is normal or asocial, morally good or bad. In short, between the mutuality Telemark University College, Norway of human existence and mental health, and the related scien- Corresponding Author: tific-professional debates, emerges a field that is of over- Rob Bongaardt, Department of Health Studies, Telemark University whelming complexity for any scientist, professional care College, Kjølnes Ring 56, Porsgrunn, 3918, Norway. worker, and educator. Email: rob.bongaardt@hit.no 2 SAGE Open phenomenological pedagogy promotes the integration of evidence-based medicine, where research-based knowledge personal, relational and research-based knowledge, which is often takes precedence over client experience, the state cur- invaluable for crossing traditional professional boundaries riculum promotes EBP in which the client’s individual and transforming the student’s professional competency. “resources, wishes and needs” are the starting point for care and treatment (Forskrift til rammeplan for videreutdanning i psykisk helsearbeid, 2005, Section 2; authors’ translation). Interdisciplinarity and Evidence-Based Client collaboration, empowerment, and relational work Practice (EBP) in the Norwegian State become obligatory teaching topics. The client is placed at the Curriculum core of mental health work, along with interdisciplinarity and EBP. To overcome profession-based compartmentalization, the Although the main intention of the state curriculum is to Norwegian government has decreed a national standard cur- ensure a higher and stable standard of teaching countrywide, riculum for all postgraduate education in mental health work it leaves room for developing educational solutions depen- (Forskrift til rammeplan for videreutdanning i psykisk hel- dent on regional circumstances. We have embraced this room searbeid, 2005; henceforth referred to as the “state curricu- because neither “interdisciplinarity” nor “EBP” reduce the lum”). The backdrop for this state curriculum was a complexity of the field sufficiently; there is still too much mid-1990s report (the first of its kind in Norway) about the uncertainty for a postgraduate 1-year program. How does our Norwegian mental health services that concluded that these pedagogical approach simplify the complexity that remains services had “cracks at all levels.” The treatment levels, from after the state curriculum? prevention and community services to institution-based treatment and follow-up after discharge, were so weak that the users of the services missed out on help needed, and the Embedded Alternation of Description health care workers could not work satisfactorily (Norwegian and Reflection in Our Curriculum Government White Paper No. 25, 1996-1997). Later, it was Our postgraduate program at a university college in the pointed out that the report could even have understated the southeast of Norway is the equivalent of 1 year’s full-time situation, missing out on problems such as one-sided (bio- study, divided equally over four semesters part-time. About medical) views of mental illness and treatment, upholding 35 adult students are enrolled annually. Almost all have prac- societal us–them distinctions, and skewed power balances in tical experience from a health or social care profession. face-to-face treatment situations (Østravik, 2008); all of Many of them return to higher education with the aim to sat- these are consistent with compartmentalization and conven- isfy personal–professional or, in some cases, employer inter- tional pedagogy. There was enough ground, in other words, ests. The typical expectation is to acquire more and newer for the development of a new national curriculum in mental information about mental illness and how to treat it. However, health work at the postgraduate level. we consider that meeting the expectation of providing more The state curriculum aims to improve and equalize the information would imply a pedagogy that sustains compart- standard of the mental health work competency of all profes- mentalization: It would force us to determine beforehand sional groups within Norway’s health and social services. which themes to include and exclude in our program, regard- Mental health is to be understood as a relational phenome- less of the enrolled student group. Furthermore, we do not non, making compulsory a relational perspective on the cli- regard our students and the professional field as separate ent, and his or her social network and environment. The units that must be bridged by an information load. That is curriculum emphasizes the relationship between and among because our students are already part of the field. Therefore, workers and clients. The psychiatric perspectives on mental we see it as our task to teach students how to emerge from illness and psychiatric nursing are thus to become subservi- their embeddedness in this complex field—that is, how to ent to a larger constellation bringing together the perspec- transform their way of knowing the field (Mayo, 2003). tives of many professions and approaches (such as social Each student brings into our program experiences at the work, psychomotor therapy, child care, and psychiatric nurs- personal, relational, and organizational levels of work and ing), and the services at various levels of organization within life. They are all much more simply human than otherwise the health care system. A vision of interdisciplinary collabo- (Sullivan, 1953, p. 32; italics in original) and, between them, ration hence underpins the program. the students personify the mental health field as it transpires With hindsight, we recognize that the state has also cre- in Norway. These professional and personal experiences may ated a platform for learning EBP. The best available research not be representative of how we prefer professionals to act knowledge from various academic fields is to be applied by and reflect after completion of their studies. But then, we do the professional expert who, preferably together with col- not aspire to teach people what they already know; the stu- leagues, judges the demands of the actual clinical situation in dents’ existing knowledge rather forms a solid base on which concordance with the client’s expressed preferences (Melnyk to build our teaching. Therefore, we anchor our pedagogy in & Fineout-Overholt, 2005). But in contradiction to Bongaardt et al. 3 phenomenology. Phenomenology sets out to grasp our exis- health; and Please describe in detail your first encounter tence from the inside out, where its passionate roots lie, on with mental suffering. There is no need to use theoretical exactly those grounds that many of our students based their concepts or professional jargon in your descriptions. We ask choice of profession (cf. Jager, 1989). Rather than taking pri- for “experience” to focus on a specific situation or encounter macy in rational accounts of life and living, phenomenology as a bearer of personal meaning and to avoid ending up with suspends the use of concepts and brackets common-sense generic “reflections” that may have been formed later else- idioms. Within this so-called phenomenological reduction, where. Through a detailed account, we hope to tease out one withholds from existential claims: Instead of pondering exhaustive descriptions that make visible the smallest expe- the reality status or truth of the phenomenon within the world rienced happenings (Stern, 2004). We use the “good mental of measurable biology, psychology, or sociology, phenome- health” descriptions as a base for a plenary discussion in nology opts to linger with how a phenomenon’s form and class about what mental health workers expect of their own content constitute meaning in the consciousness of the per- mental health and what they expect service users to achieve son who experiences it. However, it is not correct to con- through care or treatment (Tangvald-Pedersen & Bongaardt, clude that phenomenology is a mere solipsistic or solitary 2011). The “meeting mental suffering” descriptions typically enterprise. It can involve a number of people; phenomeno- contain (in a class of 35) five to six main themes, such as logical researchers within psychology collect descriptions depression, family care, incest, therapeutic power balance, from various experiencing persons that, via systematic anal- and professional uncertainty. These themes form the basis ysis, reveal the essence of the phenomenon (Giorgi, 2009). for further analysis and hence are the starting point for the The analysis process can also be a joint venture—and it is critical-analytical part of the program, which runs until the especially in this way that phenomenology can reach out to last day of teaching. pedagogy (e.g., Dall’Alba, 2009; Østergaard, Dahlin, & We divide the class into six interdisciplinary groups, and Hugo, 2008; van Manen, 1990). assign one theme to each group. Then the groups select four We apply Husserl’s phenomenology as modified by or five texts (from about 35) concerning their respective Giorgi (2009) for use in psychology. Giorgi’s phenomeno- themes. Next, each group analyzes these descriptions along logical research method leads to descriptions of human phe- clearly demarcated steps as recommended by Giorgi (2009). nomena relevant for psychology, such as learning, depression, We urge the students to refrain from theoretical or common- or becoming a parent. These descriptions are preferably min- sense interpretation during the analysis and to dwell on the imally colored by theoretical or common-sense understand- data to let the phenomenon “speak for itself.” We explain ing of the phenomenon at hand—Husserl spoke of returning that this so-called “phenomenological attitude” is not unlike to the “thing itself.” Giorgi’s phenomenology doubles as a “withholding judgment” in therapeutic settings, which are research method that our students learn to enable them to discussed later in the study. Step 1 in the analysis consists of analyze data derived from first-person experiences and a each group member reading carefully all selected descrip- rationale that shapes our curriculum. We explicate this fur- tions to get a sense of the entire phenomenon at hand. In Step 2, ther in what follows, where we describe the six-phase com- the students jointly mark each text every time they sense a position of one large part of our program, which we refer to shift in the meaning of the writer’s subject matter, resulting as the critical-analytical part. The other parts of our program in a division of each text into so-called meaning units. In pertain, respectively, to practicing relational skills and the Step 3, these meaning units are rewritten in a language typi- national laws and formal regulations of Norwegian mental cal of the mental health field as understood by the group. The health work. A full discussion of these two other parts is result is that the texts under analysis are rewritten in similar beyond the scope of this article, but we sketch “practicing and more easily comparable language. In Step 4, the result- relational skills” in our description of Phase 5. ing rewritten meaning units may now be clustered across the texts forming core constituents of the phenomenon at hand. Step 5 involves the students writing a summary of what the Phase 1: Describing Experiences of Good Mental phenomenon entails. In this summary, the phenomenon’s Health and Meeting Mental Illness core constituents are related to each other, and as parts of a whole form one meaning structure. This task completes the Collection of data and analysis are related yet distinct parts initial phase. of any research process. In our curriculum, we also distin- guish between these two parts. Early in the program, we col- lect the students’ previous experiences of “good mental Phase 2: Reflecting Theoretically on a Theme health” and “meeting mental suffering.” These two phenom- Within the Phenomenological Description ena represent key experiences in the mental health field at opposite ends of a long continuum. We invite students to Here, we leave the phenomenological reduction and open up write a response to the following stimuli: Please describe in for reflection on the description. The three modes of reflec- detail a situation in which you experienced good mental tion presented are from a cause–effect, social context, and 4 SAGE Open human-existential perspective. The groups choose one per- may still be embedded in one of these perspectives. In Phase spective and are advised to use the library under supervision 4 of the program, we explicitly address EBP to help students to find up-to-date research that, from their chosen perspec- emerge from this embeddedness. We present the “who’s tive of reflection, can shed further light on the phenomenon first” debate in the field; which of the three sources of knowl- at hand. For instance, if the described phenomenon was “liv- edge should have primacy in daily practice. We also present ing in a family where one of the parents is diagnosed with a the “best evidence” debate, which takes place within each of major depression,” one of the following reflections is possi- the knowledge source areas: Which research method has ble: Epidemiological research shows an increased risk of highest status? Which expert judgment carries most weight? children becoming depressed later in life when one or two or Which user experience is trustworthy? parents have a diagnosed major depression—a cause–effect Then, we ask the students to sum up the debate in an indi- perspective. Or qualitative research demonstrates that living vidual paper and take a stand based on their experiences with with a depressed parent may be experienced positively, lead- past clinical practice or their expectations about future clini- ing the individual to spread a message of hope among others cal practice. They are encouraged to describe and analyze in the same situation—a human-existential perspective. Or it these experiences or expectations using the phenomenologi- may be pointed out that such family experiences are seldom cal method. We offer individual supervision to help the stu- reported in the popular media, which prefer to uphold a cul- dent focus on a specific theme that somehow links his or her tural image of happy nuclear families, implicitly evoking understanding of the EBP debate to what he or she considers shame among those who do not meet such societal stan- relevant in clinical practice. “Who are you as a professional dards—a (critical) social context perspective. mental health worker, viewed from the angle of evidence- This phase is completed with a group paper, which must based practice?” “Where do you stand, or prefer to stand?” incorporate the phenomenological meaning structure and When we grade these papers, we are less interested in clear research-based reflection, and largely follow the IMRAD overviews of the EBP debate or univocal statements about format: introduction, method, result, and discussion (Day, who the student is in a practice situation. We rather evaluate 1989). how the student approaches the issue: To what extent is he or she able to negotiate the ever-present ambiguity of practice situations with the inherent uncertainty in the debates? In Phase 3: Comments by a Professional Expert on other words, does the student challenge the assumptions in the Paper the debate or challenge the perception of himself or herself at When we know the direction of the papers, we invite local work, as a result of the tension between the two issues? We mental health work experts to come to class and comment on contend that such an exploration of the edges of knowledge one paper each. The experts receive the papers two weeks promotes the way of learning that is required in this field (see before the classroom session. They are asked to offer a also the “Discussion” section). broader perspective or deeper insight into the theme from their expert point of view. Phase 5: Practicing EBP Each group presents its paper to the whole class, directly followed by the expert commentary. This situation easily The students have a 10-week placement in the field where generates discussion among everyone present—students, they can practice what they have learned so far. At this point, teachers, and experts—because reflections and descriptions the “practicing skills” part of our program becomes involved. from different professional, experiential, and research per- This runs parallel with Phases 1 to 4, and focuses on practic- spectives may not easily align or may even be mutually ing dialogue in student groups, using role-play, video, and exclusive and controversial. This is the first time in the pro- written descriptions of actual situations from clinical prac- gram that the students engage in a discussion in an interdis- tice. These descriptions are analyzed in plenary class ses- ciplinary group of professionals about EBP that is anchored sions, with special emphasis on human relational interaction, in first-person experiences. In doing so, many may still be such as how to exert good judgment in the situation. embedded—unwittingly and exclusively—in the perspective Before the clinical placement, the students learn a super- of only the experiencing person, professional expert, or vision technique called “reflecting team” (Andersen, 1994). researcher. A student group is divided into three functional units: One person who describes a challenging situation from work from a first-person perspective, one supervisor who guides Phase 4: Dialoguing Between the Rationale of the process, and the rest of the group that first listens to the EBP and Hands-On Practical Experience description and then reflects on it. The group is not to jump Through the first three phases, the students slowly build up a to conclusions or offer solutions. It simply reflects on the sense of how three different sources of knowledge, that is, situation described. The supervisor guards these boundaries personal experience, expert judgment, and research, mingle and will not comment on content. After the explorations, the and merge in a mental health issue. Many students, however, first person returns to the stage and conveys how his or her Bongaardt et al. 5 understanding has advanced as a result of the group’s reflec- primarily concerned with the traditional placement of this tions; he or she thus engages with the group in metacommu- phenomenon in the professional mental health field. As long nication about himself or herself in the situation at hand. as they first systematically dwell with the phenomenon, and Within clinical practice, each student receives an obliga- then capitalize on each other’s professional insights as well tory assignment to define his or her learning goals, which is as library services to find relevant research literature and evaluated halfway and on completion of the placement. The reviews, they can effectively cross knowledge boundaries learning goals express how the student aims to shift focus that previously may have constrained them. We assist adult between acting in the situation exercising relational compe- students in formulating an experience-based entry point and tency and reflecting on the situation using relevant theory. to set out a path through the space of professional inquiry. The student is expected to use judgment to situate himself or The complexity of the field thereby becomes a rich source of herself correctly within the organization of the workplace knowledge rather than a rugged landscape impossible to and in relation to the client. Thus EBP—balancing expert navigate. judgment, theoretical knowledge, and clients’ expressed needs—is practiced and evaluated individually. Discussion In short summary, the rationale of our curriculum is as fol- Phase 6: Advancing EBP Through a Research and lows: An individual’s experience with a phenomenon is Development (R&D) Project opened up by systematic phenomenological description Work experiences are the starting point for an R&D project. stripped of theory or common sense, and closure is sought Groups of four to six students are invited to write a summary by reflection on the phenomenon guided by its essential of a phenomenon of their own interest stemming from a clin- features—theory follows phenomenon, not vice versa. In ical or work situation. This assignment is aimed at providing structuring this article, we have tried to stay true to this a deeper understanding of this situation through theoretical rationale. Above, we have described the background and reflection. The overall objective is to contribute to EBP in structure of our curriculum. In this section, we reflect on mental health work. The difference from Phases 1 and 2 is using phenomenological description in higher education as that this phase implies collecting original data from respon- well as on using reflection as a means of promoting trans- dents in the field. For practical reasons, the respondents are formative learning in mental health work. not clients but other professionals (applying for approval Spiegelberg (1975), a philosopher and important historian from the medical research ethics committee is not feasible and developer of phenomenology, describes in his book within the time frame of this phase). The data can be col- Doing Phenomenology how he toyed with the thought of a lected and analyzed using the phenomenological research possible “joint phenomenologizing” and then actually tried method that we have introduced earlier in the program, but out “cooperative phenomenology” (p. 24). At Washington not necessarily so. Students may also opt for a theoretical University, during five summers between 1962 and 1972, he analysis of, for example, an existing mental health promo- brought together between 7 and more than 20 persons to a tion program or other interventions from the field. Strong workshop. Each workshop was dedicated to the exploration personal–professional engagement with the chosen phenom- and determination of essential structures of phenomena cho- enon means that the papers may approach or even push the sen beforehand or in the workshop. Spiegelberg’s approach frontiers of professional knowledge about the phenomenon may not have been as structured as we have described above at hand. We often point out that the students’ daily involve- in Phase 1. “Steps,” as in Giorgi’s method, had then not been ment in professional practice makes them preferred research- defined as such. And the phenomenological analyses were to ers or developers of projects about current pressing issues in be performed by the participants exclusively on their own the field. experiences. The vicarious phenomenological method, This six-step repeated alternation between experience- which makes possible the study of other persons’ experi- based description and research-based reflection is the how of ences, was not as established as it is today. Nevertheless, the program. We discuss the “how” further below. The stu- some of Spiegelberg’s insights are important to note because dents determine the what of the program; they determine the of their pedagogical value. Retrospectively, he listed the pos- themes in focus during the various steps of the program, in itive outcomes of cooperative phenomenology: It catalyzes writing, practice, and supervision. As to the “what,” it is new perspectives; it sobers less-critical participants into worth noting that we are still not able to cover all themes clear communication; it “intersubjectivizes,” allowing for within mental health work as deemed relevant by the state univocal results in spite of a subjective base; it enriches the curriculum. And most certainly, we cannot cover all the joint exploration, formulation, and reformulation of the themes relevant to mental health work at large. Our phenom- essences of a phenomenon; and it attunes participants’ aware- enological approach, however, enables adult students to ness of each other’s insights (Spiegelberg, 1975, pp. 32-33). access any phenomenon of relevance without being He states that 6 SAGE Open one of the most meaningful and revealing occurrences may be an option at hand at all times in real life beyond university when one of the partners suddenly exclaims “aha” in a tone of college (cf. Giorgi, 2000). voice indicating that he has not only just become aware of How then to achieve closure? When adopting the phe- something new but also realizes that he has discovered what the nomenological attitude, students are submerged in the other partner meant all along. (Spiegelberg, 1975, p. 33) description of a phenomenon. But they must surface as well: “It doesn’t suffice that you unfold an experience. . . . The Such outcomes of group dwelling on a phenomenon are scientific act is to take responsibility to ‘milk’ the descrip- important contributions to any curriculum, including the cur- tion, ‘dig’ for its meaning, reflectively analyze, synthesize, riculum we have described above. However, the strength of or interpret the descriptions” (Alapack, 2000, p. 7; italics in Spiegelberg’s workshops may also have been their weak- original). We understand reflection on phenomenological ness: Their focus on the process of doing “joint phenomenol- descriptions as getting to know better what we know and ogizing” came with the price of a reduced focus on core what we do not know. existential phenomena such as death, freedom, control, and, Kegan (1982, 1994) conceptualizes what is at stake in the most relevant here, health. simplest of terms: What is subject must become object. In the context of health care, the use of phenomenology in Piaget’s conceptual pair of assimilation and accommodation higher education is discussed in Teaching the Practitioners forms the inspiration of his approach (Lahey, Souvaine, of Care (Diekelmann, 2003). Dahlberg et al.’s (2003) article Kegan, Goodman, & Felix, 1988). It addresses how people in this anthology compares so-called “narrative pedagogy,” structure meaning in their world and how this structuring developed by Diekelmann in the United States, with life- may change throughout life. Kegan distinguishes different world pedagogy, developed by Ekebergh in Sweden. Both qualitative levels of complexity in meaning making; we are ways of teaching were developed from research for nursing at any point in our life subject to (embedded in) one level of education. They have in common an emphasis on openness, complexity, and we can make object (emerge from) a lower which “means that teachers and students make themselves level of complexity. For instance, we can be subject to the receptive and sensitive to the phenomenon of interest as it ideology that shapes our experience of self, which is firmly presents itself” (Dahlberg et al., 2003, p. 34). An important fenced off from another person’s different ideology of self; phenomenon under study is the reciprocity between and here, we do not easily open up to “negotiation” because we among teachers and students, with a special focus on the role do not have the metaview of our ideology that is required. of the teacher. Dahlberg et al. emphasize that narratives, But then, we can take as object the way another person’s whether oral or written stories, anecdotes or illustrations, can feelings and emotions influence our own, always letting our capture challenging situations stemming from teaching prac- sense of self guide these feelings and emotions. tice in nursing. They extract from these narratives that teach- ers have a special responsibility to be sensitive to the We have object; we are subject. We cannot be responsible for, student’s learning process. The application of phenomenol- or in control of, or reflect upon what is subject. . . . “Object” ogy in these approaches thus seems to direct attention to nar- refers to those elements of our knowing or organization that we ratives concerning the learning experience itself in higher can reflect on, handle, look at, be responsible for. (Kegan, 1994, p. 32) health care education. The emphasis in our own program is on first-person expe- The transformation from subject to object is often gradual riences with mental health that come from the student’s per- and comes in discernible intermediate stages: We get to sonal or professional life. That emphasis is possible because know what we do not know slowly, only step-by-step adjust- we are privileged to work with adult students who all have ing our overall way of making meaning to new situation- such significant experiences. Naturally, our students are bound insights. challenged by our request—presented on their first day in the Kegan’s (1994) main point in In Over Our Heads: The program—to capitalize on these experiences and at the same Mental Demands of Modern Life is that society has defined time shortcut their reflex action of judging the clinical situa- curricula for parenting, partnering, conflict resolution, adult tion, which has often been painstakingly acquired in the education, and other arenas of life that demand a complexity field. The impact that our approach may have on students is of mind that may be of a higher level than a large proportion made explicit by narrative and lifeworld phenomenological of the population has reached so far. In our curriculum, we pedagogy as described above: We are aware of our responsi- deliberately use the alternation of complexities as a catalyst bility as teachers carefully to balance the request for suspen- for learning. As described in the six phases above, we repeti- sion of judgment (openness) with practice-directed reflection tively create and help dissolve the students’ sense of being on the phenomenon under scrutiny (closure). A postmodern “in over their heads.” Reflection is imperative if one is to “Open 24/7,” as a celebration of differences or an opposition learn; it is a structural property of the learning process. But to traditional power relations (cf. Burbules & Rice, 1991), is the content of the reflection is inherent in the content of the not an option for the higher education of professionals in the description, which is different in each phase described above. mental health field, as neither care worker nor client has such Bongaardt et al. 7 Therefore, we give students a choice about how they sub- Coppock, V., & Hopton, J. (2000). Critical perspectives on mental health. London, England: Routledge. stantiate their reflections—we cannot prescribe what only Dahlberg, K., Ekebergh, M., & Ironside, P. M. (2003). Converging they can account for (see Phases 2, 4, 5, and 6). In our cur- conversations from phenomenological pedagogies: Toward riculum, students may experience closure every time subject a science of health professions education. In N. Diekelmann becomes object, but all the while, they are creating new sub- (Ed.), Teaching the practitioners of care: New pedagogies for ject matter to start pondering. Hence, we speak of a repeated the health professions (pp. 22-58). Madison: The University of alternation of description and reflection. Wisconsin Press. Dall’Alba, G. (2009). Phenomenology and education: An introduc- tion. Educational Philosophy and Theory, 41, 7-9. Conclusion Day, R. A. (1989). The origins of the scientific paper: The IMRAD We argue for the primacy of simplifying complexity in the format. American Medical Writers Association Journal, 4, higher education of mental health workers by appropriating 16-18. Diekelmann, N. (Ed.). (2003). Teaching the practitioners of care: descriptive phenomenology. Such simplification derives in the New pedagogies for the health professions. Madison: The first instance from a curriculum decreed by the Norwegian gov- University of Wisconsin Press. ernment and in the second instance from a “self-simplification” Forskrift til rammeplan for videreutdanning i psykisk helsearbeid. based on the students’ own experiences with life and work (cf. (2005). Utdannings- og forskningsdepartementet [Regulatory Pattee, 1972). While a conventional pedagogy may emphasize framework for post graduate education in mental health work what students should be informed about, we focus on how stu- 2005; The Norwegian Ministry of Education and Research]. dents can transform their way of making meaning in their Giorgi, A. (2000). The similarities and differences between descrip- actions and reflections (Kegan, 1994; Kreber, 2001). tive and interpretative methods in scientific phenomenological Phenomenological pedagogy avoids traditional compartmen- psychology. In B. Gupta (Ed.), The empirical and the tran- talization of the field. It rather profits from the field’s com- scendental: A fusion of horizons (pp. 61-75). New York, NY: plexity by treating it as a rich source of knowledge. The adult Rowman & Littlefield. Giorgi, A. (2009). The descriptive phenomenological method in student’s personal–professionally experienced sense of rele- psychology: A modified Husserlian approach. Pittsburg, PA: vance forms the starting point for navigating the field with the Duquesne University Press. purpose to contextualize experiences and deepen understand- Hillocks, G. (1999). Ways of thinking, ways of teaching. New York, ing. This promotes a work practice that integrates personal, NY: Teachers College Press. relational, and research sources of knowledge, and endorses Ironside, P. M. (2001). Creating a research base for nursing educa- the interdisciplinary nature of the field. Ours is a way of teach- tion: An interpretative review of conventional, critical, femi- ing that relies on adult students being grounded in their profes- nist, postmodern, and phenomenological pedagogies. Advances sional identity yet willing to float freely during periods of life. in Nursing Science, 23, 72-87. The clients they work with, who may have been floating freely Jager, B. (1989). Transformation of the passions: Psychoanalytic in life longer than desired, demand and deserve that. and phenomenological perspectives. In R. S. Valle and S. Halling (Eds.), Existential-phenomenological perspectives in psychology: Exploring the breadth of human experience Declaration of Conflicting Interests (pp. 217-231). New York, NY: Plenum. The author(s) declared no potential conflicts of interest with respect Kegan, R. (1982). The evolving self: Problem and process in human to the research, authorship, and/or publication of this article. development. Cambridge, MA: Harvard University Press. Kegan, R. (1994). In over our heads: The mental demands of mod- Funding ern life. Cambridge, MA: Harvard University Press. Kreber, C. (2001). Learning experientially through case stud- The author(s) received no financial support for the research and/or ies? A conceptual analysis. Teaching in Higher Education, authorship of this article. 6, 217-228. Lahey, L., Souvaine, E., Kegan, R., Goodman, R., & Felix, S. References (1988). A guide to the subject-object interview: Its adminis- Alapack, R. J. (2000). Bookends for an existential approach to ped- tration and interpretation. Cambridge, MA: Subject-Object agogy and academic evaluation: Francis and John. Psykologisk Research Group. Tidskrift, 1, 4-10. May, R., Angel, E., & Ellenberger, H. F. (Eds.). (1958). Existence: Andersen, T. (1994). Reflekterende processer: samtaler og sam- A new dimension in psychiatry and psychology. New York, taler om samtalerne [Reflection processes: Conversations NY: Basic Books. and conversations about the conversations]. Copenhagen, Mayo, P. (2003). A rationale for a transformative approach to edu- Denmark: Dansk Psykologisk Forlag. cation. Journal of Transformative Education, 1, 38-57. Bracken, P., & Thomas, P. (2005). Postpsychiatry: Mental health Melnyk, B. M., & Fineout-Overholt, E. (2005). Making the case in a postmodern world. Oxford, UK: Oxford University Press. for evidence-based practice. Philadelphia, PA: Lippincott Burbules, N. C., & Rice, S. (1991). Dialogue across differences: Williams & Wilkins. Continuing the conversation. Harvard Educational Review, 61, Norwegian Government White Paper No. 25. (1996-1997). Åpenhet 393-416. og helhet: Om psykiske lidelser og tjenestetilbudet. [Openness 8 SAGE Open and wholeness: Mental disorders and mental health services]. Tangvald-Pedersen, O., & Bongaardt, R. (2011). Tid og tilhørighet: Oslo, Norway: Sosial- og helsedepartementet. Opplevelsen av god psykisk helse og dens implikasjoner for Østergaard, E., Dahlin, B., & Hugo, A. (2008). Doing phenomenol- godt psykisk helsearbeid [Time and belonging: The experience ogy in science education: A research review. Studies in Science of good mental health and its implications for good mental Education, 44, 93-121. health work]. Tidsskrift for Psykisk Helsearbeid, 8, 100-108. Østravik, S. (2008). Tid for endring i kunnskap, makt og kultur van Manen, M. (1990). Researching lived experience. Human science [Time for change in knowledge, power and culture]. Tidsskrift for an action sensitive pedagogy. Albany, NY: SUNY Press. for Psykisk Helsearbeid, 5, 111-119. Pattee, H. H. (1972). The evolution of self-simplifying systems. Author Biographies In E. Laszlo (Ed.), The relevance of general systems theory: Rob Bongaardt has a PhD in psychology. He has worked as a Papers presented to Ludwig von Bertalanffy on his seventieth researcher and educator in the fields of motor control, theoretical birthday (pp. 31-41). New York, NY: George Braziller. and developmental psychology, and mental health care. Spiegelberg, H. (1975). Doing phenomenology: Essays on and in phenomenology. The Hague, Netherlands: Martinus Nijhoff. Gro Frøyen is a psychiatric nurse, holds a Master of Health Stern, D. N. (2004). The present moment in psychotherapy and Science, and works as assistant professor in mental health work. everyday life. New York, NY: W. W. Norton. Her research concerns school mental health promotion. Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New Olav Tangvald-Pedersen is an assistant professor and educational York, NY: W.W. Norton. manager of a postgraduate program in mental health work. His Szasz, T. (2008). Psychiatry: The science of lies. Syracuse, NY: research concerns the experience of belonging to the workplace. Syracuse University Press. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png SAGE Open SAGE

Phenomenological Pedagogy in Higher Education of Mental Health Workers: An Example From Norway

SAGE Open , Volume 3 (1): 1 – Mar 21, 2013

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Abstract

This article describes the use of phenomenological pedagogy in the higher education of mental health workers. The mental health field is an immensely complex professional field. To create access, the conventional education of mental health professionals compartmentalizes the field according to traditional professional boundaries. Personal–professional expertise and user preference are thereby lost. Such personal experience is privileged in a pedagogy based on Giorgi’s descriptive phenomenological method. Students learn systematically to describe a mental health phenomenon of their interest and reflect on this using each other’s professional insights as well as relevant research literature. Phenomenological description and reflection are repeated several times in the curriculum. Kegan’s subject–object theory of adult development explains how this repetition may support transformation of insight in rather than an accumulation of information about mental health work. The complexity of the mental health field thus emerges as a source of knowledge to exploit rather than merely a rugged landscape to navigate. Keywords mental health, transformative learning, subject–object psychology Higher education of mental health professionals faces the In its effort to handle this complexity, professional higher overwhelming complexity of the mental health field—a field education of mental health workers creates access to this infested with personal distress, professional disagreement, field by excluding large parts of it and including only a few conceptual confusion, cultural clashes, political and ideo- preferred areas—compartimentalization is preferred to inter- logical debate, and commercial competition (Bracken & disciplinarity (cf. Hillocks, 1999). Compartmentalization Thomas, 2005). Human existence colors the field’s surface supports established professional boundaries and is sustained and determines its depth. The phenomena involved are as by conventional pedagogy, that is, pedagogy that teaches human as can be; everything in the mental health field is information and skills based on accepted theory without spe- about man and thus as complicated as we are (May, Angel, & cific regard to the student’s own experience from the field Ellenberger, 1958). This is reflected in the plethora of profes- and his or her individual learning process (Dahlberg, sions and sciences that act and reflect on mental health in Ekebergh, & Ironside, 2003; Ironside, 2001). In this article, some shape or form. Philosophy, theology, sociology, social we present an alternative solution to accessing the mental work, the psy-sciences, medicine, neurobiology, and others health field in the higher education of adult students. contribute with influential perspectives on mental health; Phenomenology provides both the rationale that undergirds these perspectives are influential, but not necessarily compat- our pedagogy and the research method that the students learn ible or mutually reducible. The history and theory of mental to use to advance the knowledge base of their practice. We health is inflamed with debate and controversy, within and first describe and then reflect on our phenomenology-based between the sciences, professions, and clients (cf. Coppock & curriculum that teaches adult students how to use their own Hopton, 2000; Szasz, 2008). These debates often extend to life and work experiences as a privileged starting point for politics and ideology: At stake is not only what is healthy or professional development. In conclusion, we suggest that pathological, effective or relevant, but also what is normal or asocial, morally good or bad. In short, between the mutuality Telemark University College, Norway of human existence and mental health, and the related scien- Corresponding Author: tific-professional debates, emerges a field that is of over- Rob Bongaardt, Department of Health Studies, Telemark University whelming complexity for any scientist, professional care College, Kjølnes Ring 56, Porsgrunn, 3918, Norway. worker, and educator. Email: rob.bongaardt@hit.no 2 SAGE Open phenomenological pedagogy promotes the integration of evidence-based medicine, where research-based knowledge personal, relational and research-based knowledge, which is often takes precedence over client experience, the state cur- invaluable for crossing traditional professional boundaries riculum promotes EBP in which the client’s individual and transforming the student’s professional competency. “resources, wishes and needs” are the starting point for care and treatment (Forskrift til rammeplan for videreutdanning i psykisk helsearbeid, 2005, Section 2; authors’ translation). Interdisciplinarity and Evidence-Based Client collaboration, empowerment, and relational work Practice (EBP) in the Norwegian State become obligatory teaching topics. The client is placed at the Curriculum core of mental health work, along with interdisciplinarity and EBP. To overcome profession-based compartmentalization, the Although the main intention of the state curriculum is to Norwegian government has decreed a national standard cur- ensure a higher and stable standard of teaching countrywide, riculum for all postgraduate education in mental health work it leaves room for developing educational solutions depen- (Forskrift til rammeplan for videreutdanning i psykisk hel- dent on regional circumstances. We have embraced this room searbeid, 2005; henceforth referred to as the “state curricu- because neither “interdisciplinarity” nor “EBP” reduce the lum”). The backdrop for this state curriculum was a complexity of the field sufficiently; there is still too much mid-1990s report (the first of its kind in Norway) about the uncertainty for a postgraduate 1-year program. How does our Norwegian mental health services that concluded that these pedagogical approach simplify the complexity that remains services had “cracks at all levels.” The treatment levels, from after the state curriculum? prevention and community services to institution-based treatment and follow-up after discharge, were so weak that the users of the services missed out on help needed, and the Embedded Alternation of Description health care workers could not work satisfactorily (Norwegian and Reflection in Our Curriculum Government White Paper No. 25, 1996-1997). Later, it was Our postgraduate program at a university college in the pointed out that the report could even have understated the southeast of Norway is the equivalent of 1 year’s full-time situation, missing out on problems such as one-sided (bio- study, divided equally over four semesters part-time. About medical) views of mental illness and treatment, upholding 35 adult students are enrolled annually. Almost all have prac- societal us–them distinctions, and skewed power balances in tical experience from a health or social care profession. face-to-face treatment situations (Østravik, 2008); all of Many of them return to higher education with the aim to sat- these are consistent with compartmentalization and conven- isfy personal–professional or, in some cases, employer inter- tional pedagogy. There was enough ground, in other words, ests. The typical expectation is to acquire more and newer for the development of a new national curriculum in mental information about mental illness and how to treat it. However, health work at the postgraduate level. we consider that meeting the expectation of providing more The state curriculum aims to improve and equalize the information would imply a pedagogy that sustains compart- standard of the mental health work competency of all profes- mentalization: It would force us to determine beforehand sional groups within Norway’s health and social services. which themes to include and exclude in our program, regard- Mental health is to be understood as a relational phenome- less of the enrolled student group. Furthermore, we do not non, making compulsory a relational perspective on the cli- regard our students and the professional field as separate ent, and his or her social network and environment. The units that must be bridged by an information load. That is curriculum emphasizes the relationship between and among because our students are already part of the field. Therefore, workers and clients. The psychiatric perspectives on mental we see it as our task to teach students how to emerge from illness and psychiatric nursing are thus to become subservi- their embeddedness in this complex field—that is, how to ent to a larger constellation bringing together the perspec- transform their way of knowing the field (Mayo, 2003). tives of many professions and approaches (such as social Each student brings into our program experiences at the work, psychomotor therapy, child care, and psychiatric nurs- personal, relational, and organizational levels of work and ing), and the services at various levels of organization within life. They are all much more simply human than otherwise the health care system. A vision of interdisciplinary collabo- (Sullivan, 1953, p. 32; italics in original) and, between them, ration hence underpins the program. the students personify the mental health field as it transpires With hindsight, we recognize that the state has also cre- in Norway. These professional and personal experiences may ated a platform for learning EBP. The best available research not be representative of how we prefer professionals to act knowledge from various academic fields is to be applied by and reflect after completion of their studies. But then, we do the professional expert who, preferably together with col- not aspire to teach people what they already know; the stu- leagues, judges the demands of the actual clinical situation in dents’ existing knowledge rather forms a solid base on which concordance with the client’s expressed preferences (Melnyk to build our teaching. Therefore, we anchor our pedagogy in & Fineout-Overholt, 2005). But in contradiction to Bongaardt et al. 3 phenomenology. Phenomenology sets out to grasp our exis- health; and Please describe in detail your first encounter tence from the inside out, where its passionate roots lie, on with mental suffering. There is no need to use theoretical exactly those grounds that many of our students based their concepts or professional jargon in your descriptions. We ask choice of profession (cf. Jager, 1989). Rather than taking pri- for “experience” to focus on a specific situation or encounter macy in rational accounts of life and living, phenomenology as a bearer of personal meaning and to avoid ending up with suspends the use of concepts and brackets common-sense generic “reflections” that may have been formed later else- idioms. Within this so-called phenomenological reduction, where. Through a detailed account, we hope to tease out one withholds from existential claims: Instead of pondering exhaustive descriptions that make visible the smallest expe- the reality status or truth of the phenomenon within the world rienced happenings (Stern, 2004). We use the “good mental of measurable biology, psychology, or sociology, phenome- health” descriptions as a base for a plenary discussion in nology opts to linger with how a phenomenon’s form and class about what mental health workers expect of their own content constitute meaning in the consciousness of the per- mental health and what they expect service users to achieve son who experiences it. However, it is not correct to con- through care or treatment (Tangvald-Pedersen & Bongaardt, clude that phenomenology is a mere solipsistic or solitary 2011). The “meeting mental suffering” descriptions typically enterprise. It can involve a number of people; phenomeno- contain (in a class of 35) five to six main themes, such as logical researchers within psychology collect descriptions depression, family care, incest, therapeutic power balance, from various experiencing persons that, via systematic anal- and professional uncertainty. These themes form the basis ysis, reveal the essence of the phenomenon (Giorgi, 2009). for further analysis and hence are the starting point for the The analysis process can also be a joint venture—and it is critical-analytical part of the program, which runs until the especially in this way that phenomenology can reach out to last day of teaching. pedagogy (e.g., Dall’Alba, 2009; Østergaard, Dahlin, & We divide the class into six interdisciplinary groups, and Hugo, 2008; van Manen, 1990). assign one theme to each group. Then the groups select four We apply Husserl’s phenomenology as modified by or five texts (from about 35) concerning their respective Giorgi (2009) for use in psychology. Giorgi’s phenomeno- themes. Next, each group analyzes these descriptions along logical research method leads to descriptions of human phe- clearly demarcated steps as recommended by Giorgi (2009). nomena relevant for psychology, such as learning, depression, We urge the students to refrain from theoretical or common- or becoming a parent. These descriptions are preferably min- sense interpretation during the analysis and to dwell on the imally colored by theoretical or common-sense understand- data to let the phenomenon “speak for itself.” We explain ing of the phenomenon at hand—Husserl spoke of returning that this so-called “phenomenological attitude” is not unlike to the “thing itself.” Giorgi’s phenomenology doubles as a “withholding judgment” in therapeutic settings, which are research method that our students learn to enable them to discussed later in the study. Step 1 in the analysis consists of analyze data derived from first-person experiences and a each group member reading carefully all selected descrip- rationale that shapes our curriculum. We explicate this fur- tions to get a sense of the entire phenomenon at hand. In Step 2, ther in what follows, where we describe the six-phase com- the students jointly mark each text every time they sense a position of one large part of our program, which we refer to shift in the meaning of the writer’s subject matter, resulting as the critical-analytical part. The other parts of our program in a division of each text into so-called meaning units. In pertain, respectively, to practicing relational skills and the Step 3, these meaning units are rewritten in a language typi- national laws and formal regulations of Norwegian mental cal of the mental health field as understood by the group. The health work. A full discussion of these two other parts is result is that the texts under analysis are rewritten in similar beyond the scope of this article, but we sketch “practicing and more easily comparable language. In Step 4, the result- relational skills” in our description of Phase 5. ing rewritten meaning units may now be clustered across the texts forming core constituents of the phenomenon at hand. Step 5 involves the students writing a summary of what the Phase 1: Describing Experiences of Good Mental phenomenon entails. In this summary, the phenomenon’s Health and Meeting Mental Illness core constituents are related to each other, and as parts of a whole form one meaning structure. This task completes the Collection of data and analysis are related yet distinct parts initial phase. of any research process. In our curriculum, we also distin- guish between these two parts. Early in the program, we col- lect the students’ previous experiences of “good mental Phase 2: Reflecting Theoretically on a Theme health” and “meeting mental suffering.” These two phenom- Within the Phenomenological Description ena represent key experiences in the mental health field at opposite ends of a long continuum. We invite students to Here, we leave the phenomenological reduction and open up write a response to the following stimuli: Please describe in for reflection on the description. The three modes of reflec- detail a situation in which you experienced good mental tion presented are from a cause–effect, social context, and 4 SAGE Open human-existential perspective. The groups choose one per- may still be embedded in one of these perspectives. In Phase spective and are advised to use the library under supervision 4 of the program, we explicitly address EBP to help students to find up-to-date research that, from their chosen perspec- emerge from this embeddedness. We present the “who’s tive of reflection, can shed further light on the phenomenon first” debate in the field; which of the three sources of knowl- at hand. For instance, if the described phenomenon was “liv- edge should have primacy in daily practice. We also present ing in a family where one of the parents is diagnosed with a the “best evidence” debate, which takes place within each of major depression,” one of the following reflections is possi- the knowledge source areas: Which research method has ble: Epidemiological research shows an increased risk of highest status? Which expert judgment carries most weight? children becoming depressed later in life when one or two or Which user experience is trustworthy? parents have a diagnosed major depression—a cause–effect Then, we ask the students to sum up the debate in an indi- perspective. Or qualitative research demonstrates that living vidual paper and take a stand based on their experiences with with a depressed parent may be experienced positively, lead- past clinical practice or their expectations about future clini- ing the individual to spread a message of hope among others cal practice. They are encouraged to describe and analyze in the same situation—a human-existential perspective. Or it these experiences or expectations using the phenomenologi- may be pointed out that such family experiences are seldom cal method. We offer individual supervision to help the stu- reported in the popular media, which prefer to uphold a cul- dent focus on a specific theme that somehow links his or her tural image of happy nuclear families, implicitly evoking understanding of the EBP debate to what he or she considers shame among those who do not meet such societal stan- relevant in clinical practice. “Who are you as a professional dards—a (critical) social context perspective. mental health worker, viewed from the angle of evidence- This phase is completed with a group paper, which must based practice?” “Where do you stand, or prefer to stand?” incorporate the phenomenological meaning structure and When we grade these papers, we are less interested in clear research-based reflection, and largely follow the IMRAD overviews of the EBP debate or univocal statements about format: introduction, method, result, and discussion (Day, who the student is in a practice situation. We rather evaluate 1989). how the student approaches the issue: To what extent is he or she able to negotiate the ever-present ambiguity of practice situations with the inherent uncertainty in the debates? In Phase 3: Comments by a Professional Expert on other words, does the student challenge the assumptions in the Paper the debate or challenge the perception of himself or herself at When we know the direction of the papers, we invite local work, as a result of the tension between the two issues? We mental health work experts to come to class and comment on contend that such an exploration of the edges of knowledge one paper each. The experts receive the papers two weeks promotes the way of learning that is required in this field (see before the classroom session. They are asked to offer a also the “Discussion” section). broader perspective or deeper insight into the theme from their expert point of view. Phase 5: Practicing EBP Each group presents its paper to the whole class, directly followed by the expert commentary. This situation easily The students have a 10-week placement in the field where generates discussion among everyone present—students, they can practice what they have learned so far. At this point, teachers, and experts—because reflections and descriptions the “practicing skills” part of our program becomes involved. from different professional, experiential, and research per- This runs parallel with Phases 1 to 4, and focuses on practic- spectives may not easily align or may even be mutually ing dialogue in student groups, using role-play, video, and exclusive and controversial. This is the first time in the pro- written descriptions of actual situations from clinical prac- gram that the students engage in a discussion in an interdis- tice. These descriptions are analyzed in plenary class ses- ciplinary group of professionals about EBP that is anchored sions, with special emphasis on human relational interaction, in first-person experiences. In doing so, many may still be such as how to exert good judgment in the situation. embedded—unwittingly and exclusively—in the perspective Before the clinical placement, the students learn a super- of only the experiencing person, professional expert, or vision technique called “reflecting team” (Andersen, 1994). researcher. A student group is divided into three functional units: One person who describes a challenging situation from work from a first-person perspective, one supervisor who guides Phase 4: Dialoguing Between the Rationale of the process, and the rest of the group that first listens to the EBP and Hands-On Practical Experience description and then reflects on it. The group is not to jump Through the first three phases, the students slowly build up a to conclusions or offer solutions. It simply reflects on the sense of how three different sources of knowledge, that is, situation described. The supervisor guards these boundaries personal experience, expert judgment, and research, mingle and will not comment on content. After the explorations, the and merge in a mental health issue. Many students, however, first person returns to the stage and conveys how his or her Bongaardt et al. 5 understanding has advanced as a result of the group’s reflec- primarily concerned with the traditional placement of this tions; he or she thus engages with the group in metacommu- phenomenon in the professional mental health field. As long nication about himself or herself in the situation at hand. as they first systematically dwell with the phenomenon, and Within clinical practice, each student receives an obliga- then capitalize on each other’s professional insights as well tory assignment to define his or her learning goals, which is as library services to find relevant research literature and evaluated halfway and on completion of the placement. The reviews, they can effectively cross knowledge boundaries learning goals express how the student aims to shift focus that previously may have constrained them. We assist adult between acting in the situation exercising relational compe- students in formulating an experience-based entry point and tency and reflecting on the situation using relevant theory. to set out a path through the space of professional inquiry. The student is expected to use judgment to situate himself or The complexity of the field thereby becomes a rich source of herself correctly within the organization of the workplace knowledge rather than a rugged landscape impossible to and in relation to the client. Thus EBP—balancing expert navigate. judgment, theoretical knowledge, and clients’ expressed needs—is practiced and evaluated individually. Discussion In short summary, the rationale of our curriculum is as fol- Phase 6: Advancing EBP Through a Research and lows: An individual’s experience with a phenomenon is Development (R&D) Project opened up by systematic phenomenological description Work experiences are the starting point for an R&D project. stripped of theory or common sense, and closure is sought Groups of four to six students are invited to write a summary by reflection on the phenomenon guided by its essential of a phenomenon of their own interest stemming from a clin- features—theory follows phenomenon, not vice versa. In ical or work situation. This assignment is aimed at providing structuring this article, we have tried to stay true to this a deeper understanding of this situation through theoretical rationale. Above, we have described the background and reflection. The overall objective is to contribute to EBP in structure of our curriculum. In this section, we reflect on mental health work. The difference from Phases 1 and 2 is using phenomenological description in higher education as that this phase implies collecting original data from respon- well as on using reflection as a means of promoting trans- dents in the field. For practical reasons, the respondents are formative learning in mental health work. not clients but other professionals (applying for approval Spiegelberg (1975), a philosopher and important historian from the medical research ethics committee is not feasible and developer of phenomenology, describes in his book within the time frame of this phase). The data can be col- Doing Phenomenology how he toyed with the thought of a lected and analyzed using the phenomenological research possible “joint phenomenologizing” and then actually tried method that we have introduced earlier in the program, but out “cooperative phenomenology” (p. 24). At Washington not necessarily so. Students may also opt for a theoretical University, during five summers between 1962 and 1972, he analysis of, for example, an existing mental health promo- brought together between 7 and more than 20 persons to a tion program or other interventions from the field. Strong workshop. Each workshop was dedicated to the exploration personal–professional engagement with the chosen phenom- and determination of essential structures of phenomena cho- enon means that the papers may approach or even push the sen beforehand or in the workshop. Spiegelberg’s approach frontiers of professional knowledge about the phenomenon may not have been as structured as we have described above at hand. We often point out that the students’ daily involve- in Phase 1. “Steps,” as in Giorgi’s method, had then not been ment in professional practice makes them preferred research- defined as such. And the phenomenological analyses were to ers or developers of projects about current pressing issues in be performed by the participants exclusively on their own the field. experiences. The vicarious phenomenological method, This six-step repeated alternation between experience- which makes possible the study of other persons’ experi- based description and research-based reflection is the how of ences, was not as established as it is today. Nevertheless, the program. We discuss the “how” further below. The stu- some of Spiegelberg’s insights are important to note because dents determine the what of the program; they determine the of their pedagogical value. Retrospectively, he listed the pos- themes in focus during the various steps of the program, in itive outcomes of cooperative phenomenology: It catalyzes writing, practice, and supervision. As to the “what,” it is new perspectives; it sobers less-critical participants into worth noting that we are still not able to cover all themes clear communication; it “intersubjectivizes,” allowing for within mental health work as deemed relevant by the state univocal results in spite of a subjective base; it enriches the curriculum. And most certainly, we cannot cover all the joint exploration, formulation, and reformulation of the themes relevant to mental health work at large. Our phenom- essences of a phenomenon; and it attunes participants’ aware- enological approach, however, enables adult students to ness of each other’s insights (Spiegelberg, 1975, pp. 32-33). access any phenomenon of relevance without being He states that 6 SAGE Open one of the most meaningful and revealing occurrences may be an option at hand at all times in real life beyond university when one of the partners suddenly exclaims “aha” in a tone of college (cf. Giorgi, 2000). voice indicating that he has not only just become aware of How then to achieve closure? When adopting the phe- something new but also realizes that he has discovered what the nomenological attitude, students are submerged in the other partner meant all along. (Spiegelberg, 1975, p. 33) description of a phenomenon. But they must surface as well: “It doesn’t suffice that you unfold an experience. . . . The Such outcomes of group dwelling on a phenomenon are scientific act is to take responsibility to ‘milk’ the descrip- important contributions to any curriculum, including the cur- tion, ‘dig’ for its meaning, reflectively analyze, synthesize, riculum we have described above. However, the strength of or interpret the descriptions” (Alapack, 2000, p. 7; italics in Spiegelberg’s workshops may also have been their weak- original). We understand reflection on phenomenological ness: Their focus on the process of doing “joint phenomenol- descriptions as getting to know better what we know and ogizing” came with the price of a reduced focus on core what we do not know. existential phenomena such as death, freedom, control, and, Kegan (1982, 1994) conceptualizes what is at stake in the most relevant here, health. simplest of terms: What is subject must become object. In the context of health care, the use of phenomenology in Piaget’s conceptual pair of assimilation and accommodation higher education is discussed in Teaching the Practitioners forms the inspiration of his approach (Lahey, Souvaine, of Care (Diekelmann, 2003). Dahlberg et al.’s (2003) article Kegan, Goodman, & Felix, 1988). It addresses how people in this anthology compares so-called “narrative pedagogy,” structure meaning in their world and how this structuring developed by Diekelmann in the United States, with life- may change throughout life. Kegan distinguishes different world pedagogy, developed by Ekebergh in Sweden. Both qualitative levels of complexity in meaning making; we are ways of teaching were developed from research for nursing at any point in our life subject to (embedded in) one level of education. They have in common an emphasis on openness, complexity, and we can make object (emerge from) a lower which “means that teachers and students make themselves level of complexity. For instance, we can be subject to the receptive and sensitive to the phenomenon of interest as it ideology that shapes our experience of self, which is firmly presents itself” (Dahlberg et al., 2003, p. 34). An important fenced off from another person’s different ideology of self; phenomenon under study is the reciprocity between and here, we do not easily open up to “negotiation” because we among teachers and students, with a special focus on the role do not have the metaview of our ideology that is required. of the teacher. Dahlberg et al. emphasize that narratives, But then, we can take as object the way another person’s whether oral or written stories, anecdotes or illustrations, can feelings and emotions influence our own, always letting our capture challenging situations stemming from teaching prac- sense of self guide these feelings and emotions. tice in nursing. They extract from these narratives that teach- ers have a special responsibility to be sensitive to the We have object; we are subject. We cannot be responsible for, student’s learning process. The application of phenomenol- or in control of, or reflect upon what is subject. . . . “Object” ogy in these approaches thus seems to direct attention to nar- refers to those elements of our knowing or organization that we ratives concerning the learning experience itself in higher can reflect on, handle, look at, be responsible for. (Kegan, 1994, p. 32) health care education. The emphasis in our own program is on first-person expe- The transformation from subject to object is often gradual riences with mental health that come from the student’s per- and comes in discernible intermediate stages: We get to sonal or professional life. That emphasis is possible because know what we do not know slowly, only step-by-step adjust- we are privileged to work with adult students who all have ing our overall way of making meaning to new situation- such significant experiences. Naturally, our students are bound insights. challenged by our request—presented on their first day in the Kegan’s (1994) main point in In Over Our Heads: The program—to capitalize on these experiences and at the same Mental Demands of Modern Life is that society has defined time shortcut their reflex action of judging the clinical situa- curricula for parenting, partnering, conflict resolution, adult tion, which has often been painstakingly acquired in the education, and other arenas of life that demand a complexity field. The impact that our approach may have on students is of mind that may be of a higher level than a large proportion made explicit by narrative and lifeworld phenomenological of the population has reached so far. In our curriculum, we pedagogy as described above: We are aware of our responsi- deliberately use the alternation of complexities as a catalyst bility as teachers carefully to balance the request for suspen- for learning. As described in the six phases above, we repeti- sion of judgment (openness) with practice-directed reflection tively create and help dissolve the students’ sense of being on the phenomenon under scrutiny (closure). A postmodern “in over their heads.” Reflection is imperative if one is to “Open 24/7,” as a celebration of differences or an opposition learn; it is a structural property of the learning process. But to traditional power relations (cf. Burbules & Rice, 1991), is the content of the reflection is inherent in the content of the not an option for the higher education of professionals in the description, which is different in each phase described above. mental health field, as neither care worker nor client has such Bongaardt et al. 7 Therefore, we give students a choice about how they sub- Coppock, V., & Hopton, J. (2000). Critical perspectives on mental health. London, England: Routledge. stantiate their reflections—we cannot prescribe what only Dahlberg, K., Ekebergh, M., & Ironside, P. M. (2003). Converging they can account for (see Phases 2, 4, 5, and 6). In our cur- conversations from phenomenological pedagogies: Toward riculum, students may experience closure every time subject a science of health professions education. In N. Diekelmann becomes object, but all the while, they are creating new sub- (Ed.), Teaching the practitioners of care: New pedagogies for ject matter to start pondering. Hence, we speak of a repeated the health professions (pp. 22-58). Madison: The University of alternation of description and reflection. Wisconsin Press. Dall’Alba, G. (2009). Phenomenology and education: An introduc- tion. Educational Philosophy and Theory, 41, 7-9. Conclusion Day, R. A. (1989). The origins of the scientific paper: The IMRAD We argue for the primacy of simplifying complexity in the format. American Medical Writers Association Journal, 4, higher education of mental health workers by appropriating 16-18. Diekelmann, N. (Ed.). (2003). Teaching the practitioners of care: descriptive phenomenology. Such simplification derives in the New pedagogies for the health professions. Madison: The first instance from a curriculum decreed by the Norwegian gov- University of Wisconsin Press. ernment and in the second instance from a “self-simplification” Forskrift til rammeplan for videreutdanning i psykisk helsearbeid. based on the students’ own experiences with life and work (cf. (2005). Utdannings- og forskningsdepartementet [Regulatory Pattee, 1972). While a conventional pedagogy may emphasize framework for post graduate education in mental health work what students should be informed about, we focus on how stu- 2005; The Norwegian Ministry of Education and Research]. dents can transform their way of making meaning in their Giorgi, A. (2000). The similarities and differences between descrip- actions and reflections (Kegan, 1994; Kreber, 2001). tive and interpretative methods in scientific phenomenological Phenomenological pedagogy avoids traditional compartmen- psychology. In B. Gupta (Ed.), The empirical and the tran- talization of the field. It rather profits from the field’s com- scendental: A fusion of horizons (pp. 61-75). New York, NY: plexity by treating it as a rich source of knowledge. The adult Rowman & Littlefield. Giorgi, A. (2009). The descriptive phenomenological method in student’s personal–professionally experienced sense of rele- psychology: A modified Husserlian approach. Pittsburg, PA: vance forms the starting point for navigating the field with the Duquesne University Press. purpose to contextualize experiences and deepen understand- Hillocks, G. (1999). Ways of thinking, ways of teaching. New York, ing. This promotes a work practice that integrates personal, NY: Teachers College Press. relational, and research sources of knowledge, and endorses Ironside, P. M. (2001). Creating a research base for nursing educa- the interdisciplinary nature of the field. Ours is a way of teach- tion: An interpretative review of conventional, critical, femi- ing that relies on adult students being grounded in their profes- nist, postmodern, and phenomenological pedagogies. Advances sional identity yet willing to float freely during periods of life. in Nursing Science, 23, 72-87. The clients they work with, who may have been floating freely Jager, B. (1989). Transformation of the passions: Psychoanalytic in life longer than desired, demand and deserve that. and phenomenological perspectives. In R. S. Valle and S. Halling (Eds.), Existential-phenomenological perspectives in psychology: Exploring the breadth of human experience Declaration of Conflicting Interests (pp. 217-231). New York, NY: Plenum. 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May, R., Angel, E., & Ellenberger, H. F. (Eds.). (1958). Existence: Andersen, T. (1994). Reflekterende processer: samtaler og sam- A new dimension in psychiatry and psychology. New York, taler om samtalerne [Reflection processes: Conversations NY: Basic Books. and conversations about the conversations]. Copenhagen, Mayo, P. (2003). A rationale for a transformative approach to edu- Denmark: Dansk Psykologisk Forlag. cation. Journal of Transformative Education, 1, 38-57. Bracken, P., & Thomas, P. (2005). Postpsychiatry: Mental health Melnyk, B. M., & Fineout-Overholt, E. (2005). Making the case in a postmodern world. Oxford, UK: Oxford University Press. for evidence-based practice. Philadelphia, PA: Lippincott Burbules, N. C., & Rice, S. (1991). Dialogue across differences: Williams & Wilkins. Continuing the conversation. Harvard Educational Review, 61, Norwegian Government White Paper No. 25. (1996-1997). Åpenhet 393-416. og helhet: Om psykiske lidelser og tjenestetilbudet. [Openness 8 SAGE Open and wholeness: Mental disorders and mental health services]. Tangvald-Pedersen, O., & Bongaardt, R. (2011). Tid og tilhørighet: Oslo, Norway: Sosial- og helsedepartementet. Opplevelsen av god psykisk helse og dens implikasjoner for Østergaard, E., Dahlin, B., & Hugo, A. (2008). Doing phenomenol- godt psykisk helsearbeid [Time and belonging: The experience ogy in science education: A research review. Studies in Science of good mental health and its implications for good mental Education, 44, 93-121. health work]. Tidsskrift for Psykisk Helsearbeid, 8, 100-108. Østravik, S. (2008). Tid for endring i kunnskap, makt og kultur van Manen, M. (1990). Researching lived experience. Human science [Time for change in knowledge, power and culture]. Tidsskrift for an action sensitive pedagogy. Albany, NY: SUNY Press. for Psykisk Helsearbeid, 5, 111-119. Pattee, H. H. (1972). The evolution of self-simplifying systems. Author Biographies In E. Laszlo (Ed.), The relevance of general systems theory: Rob Bongaardt has a PhD in psychology. He has worked as a Papers presented to Ludwig von Bertalanffy on his seventieth researcher and educator in the fields of motor control, theoretical birthday (pp. 31-41). New York, NY: George Braziller. and developmental psychology, and mental health care. Spiegelberg, H. (1975). Doing phenomenology: Essays on and in phenomenology. The Hague, Netherlands: Martinus Nijhoff. Gro Frøyen is a psychiatric nurse, holds a Master of Health Stern, D. N. (2004). The present moment in psychotherapy and Science, and works as assistant professor in mental health work. everyday life. New York, NY: W. W. Norton. Her research concerns school mental health promotion. Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New Olav Tangvald-Pedersen is an assistant professor and educational York, NY: W.W. Norton. manager of a postgraduate program in mental health work. His Szasz, T. (2008). Psychiatry: The science of lies. Syracuse, NY: research concerns the experience of belonging to the workplace. Syracuse University Press.

Journal

SAGE OpenSAGE

Published: Mar 21, 2013

Keywords: mental health; transformative learning; subject–object psychology

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