Authors Sheilagh Hynd

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Identity, Post Natal Depression, and the use of
Video Interaction Guidance
A Discourse Analytic Approach

• Authors Sheilagh Hynd Sara Khan

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Introduction

• This presentation briefly describes research
• which aimed to
• Explore womens changing identities in the
  context of Post Natal Depression (PND).
• And to narrate processes of change in relation to
  Video interaction Guidance (VIG).

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This structure of this talk

• The research orientation
• Methods
• Main findings

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Research Orientation

• This research began from a position that rejected
  the pathologisation of womens experience.
• Therefore explicitly interested in processes of
  regeneration and empowerment.
• An exploration of troubled identities must also
  honour the subjective pain and distress

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Women's Subjective Experience discourses of
motherhood

• Basic premises of this research is that all of
  our identities are situated within broader socio
  cultural discourses that we are often unaware
  of how these broader meanings affect us.
• Discourses are not neutral either some are
  suffused with power moral valueothers are
  marginalised constrained and contradictory.
• Motherhood is an ascribed identity that carries
  very potent but often contradictory associations
• PND as a toxic identity carrying many negative
  associations

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So why VIG?

• Working from a social constructionist
  perspectiveinterested in how identities are
  constructed within relationships
• Significantly VIG is based on intersubjectivity
  research which places relational ways of being
  at the heart of our identities.
• We were also interested in processes of
  empowerment.
• VIG - focus on the positive interactions within
  troubled relationships intuitively appealing

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Post Modernism many stories of the self

• .
• VIG seemed to have the potential to tell a
  different story of PND one that might allow and
  encourage a generative sense of self.
• VIG also seemed to have a very different
  perspective on the the mother and child
  relationship -a story that wasnt premised on
  dysfuntionality

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Participants and Data

• Participants Two women with a diagnoses of
  postnatal depression and receiving psychological
  interventions within the community.
• Data This came from two sources
• i. Transcripts of in depth interviews with the
  women exploring feelings about the self about
  motherhood and about relationships (past and
  present)
• ii. VIG transcripts of practitioner giving
  feedback to the women

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Discourse Analysis How we did it

• From reading the entire transcripts we selected
  extended pieces of text where something
  meaningful was being said about identities.
• From these we identified discursive themes.
• Initial themes were replaced and amended
  throughout the analytic process as we gained a
  closer acquaintance with the text.
• We now made a close reading of individual and
  interactive turns, asking ourselves three
  questions
• 1. What actions are being done here?
• 2. How is this done?
• 3. What makes me think this?

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Focus and Research Questions

• In considering the data, the analytic focus
  became increasingly defined by identities
  change.
• Relational Identities what part did participant
  relationships (present and past) play in identity
  constructions?
• Shifting Selves How did participants sense of
  self change in relation to depression, and to the
  experience of VIG?
• Mothering Selves an identity ascription of
  postnatal depression carries with it a host of
  negative assumptions how then did particpants
  work to construct a valued sense of self as
  mother?

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From Data to Meaning

• The first stage of analysis had drawn down four
  themes from the text each represents four
  important ways in which participants identities
  are constructed.
• 1. Parenting Style 3. Rejection of Self
• 2. Self in Relationship 4. Integrating
  Past and Present

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Discourse Analysis

• The second phase of analysis involved a close
  reading of interactive conversational turns
  which privileged the act and process of
  narration over content.
• The following examples of text say something
  about the subjective experience of post natal
  depression, and how difficult it is for the
  clients to to be heard from within that
  experience.

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Discourse Analysis Worked Examples

• PARTICIPANT 1
• I really wanted my mum to take me and hold me
  and say everything's going to be alright () I
  needed that and it just wasn't there. Even when
  I told her about the PND it didn't make any
  difference (.) again was () you've just got
  to get on
• PARTICIPANT 2
• and I filled this questionnaire in () I ticked
  all the boxes put 110 of how I was feeling or
  whatever and she just looked at it and said
  yeah you have got a bit of postnatal depression
  don't worry you'll be fine () and she sent me
  away.

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A sample of the Analysis

• Within social constructionist thought it is
  assumed that identities are something to be
  struggled after disputed, and perhaps
  achieved
• In these two extracts the participants cannot
  find a listener in their respective audiences and
  they are denied not only a voice, but also the
  identities they have offered.
• The discourses in which we situate our identities
  are suffused with moral values. In the above
  extract the participant's mother effectively
  situates her own talk within a discourse of
  autonomy and self-sufficiency (a discourse which
  brings with it a certain moral clout). By
  contrast, her daughter's unguarded discourse of
  dependence weakness and vulnerability, is easily
  denigrated and dismissed You've just got to get
  on.

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Extract 3 VIG feedback session

• VIG P Do you appreciate all the skills you use
  there? Have you been aware of that?
• CLIENT No I haven't
• VIG P No no-aha-yeah
• CLIENT .but I mean I've always been
  I've always been a chatty person ..
• I've been a bubbly person always so
  maybe that's rubbed off on my child
• Analysis
• Client makes a series of stable and internal
  attributions as regards her self-identity
• Earlier in this sequence the participant did not
  accept the invitation to appreciate her mothering
  skills
• However the practitioners open non directive
  utterance allows enough space for the participant
  to shift her previous identity construal.
• The VIG practitioner focuses on skills and
  behaviours -but the participant makes sense this
  by attributing these to her essential character.
  The participant then extends this positive
  construction into a narrative that includes
  aspects of her potential future as well as her
  past, and includes her child's identity as well
  as her own maybe that's rubbed off on my child

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Discourse Analysis Main Findings

• This research was able to narrate some of the
  subtle and seemingly inconsequential interactive
  exchanges within the process of VIG that
  signalled some small but important shifts in
  narratives of the self.
• VIG stands apart from the deficit orientated
  discourses of many therapeutic interventions
  -its focus on the small particulars of our taken
  for granted interactions sets it apart from some
  of the solutions focussed approaches.
• VIG Reservations? In remaking generative stories
  of the self VIG is predominantly a narrative in
  the present tense. This might not be enough for
  some clients and for some practitioners.

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Concluding thoughts

• Our primary reason for instituting this research
  was to attend to women's subjective experience of
  PND and to explore the use of VIG n that context.
• Despite some small reservations
• VIG is a useful and positive intervention to use
  in PND - where negative and even toxic identities
  of motherhood can undermine the best of
  therapeutic intentions.
• Ref - Hynd,S Khan,S. (2004) Identity and
  the experience of post natal depression the use
  of Video Interaction Guidance Journal of
  Psychiatric and Mental Health Nursing (vol 11
  96)738-741