Handbook of Qualitative Research in Communication Disorders

Martin J. Ball, Nicole Müller, Ryan L. Nelson, Martin J. Ball, Nicole Müller, Ryan L. Nelson

• Publisher: Psychology Press
• Year: 2014
• ISBN:
  9781134187553
• Edition: 1
• Topic: Psychologie
• Subtopic: Geschichte & Theorie in der Psychologie

This volume provides a comprehensive and in-depth handbook of qualitative research in the field of communication disorders. It introduces and illustrates the wide range of qualitative paradigms that have been used in recent years to investigate various aspects of communication disorders.

The first part of the Handbook introduces in some detail the concept of qualitative research and its application to communication disorders, and describes the main qualitative research approaches. The contributions are forward-looking rather than merely giving an overview of their topic. The second part illustrates these approaches through a series of case studies of different communication disorders using qualitative methods of research.

This Handbook is an essential resource for senior undergraduate and graduate students, researchers and practitioners, in communication disorders and related fields.

I

Qualitative Approaches to Research

1

Case Studies and Their Frameworks

Positivist, Interpretive, and Emancipatory

JUDITH FELSON DUCHAN

Case studies have had a strong presence in the study of communication disorders throughout its history. And they continue to do so. Their historical importance has been extraordinary, given that they often appear in the lower rungs of researchers’ status hierarchy. This form of research has typically been regarded as less valid and less generalizable than studies that have many subjects and that are carefully controlled (Gillam & Gillam, 2006; Oxford Centre for Evidence-Based Medicine, 2001). This set of criticisms, I will argue, arise from unfairly levied positivistic assumptions about the nature of reality and about the purpose of research.

In this chapter I will describe the importance of case studies as an investigative mode and will show that case studies are designed to achieve different research goals and that these goals differ depending upon the philosophical framework used by the researcher. The frameworks most often brought to bear by case study researchers are positivist and interpretive. But there is a third framework, emancipatory, that is coming into its own. I will argue that emancipatory studies, though not often done by researchers, have the greatest potential for achieving far-reaching benefits. Furthermore, I argue, there are both moral and political reasons for shifting our thinking and our research practices to become more emancipatory.

Positivist research favors multiple subject designs, especially those using randomized controlled trials. The assumption of researchers using this framework is that truth exists in the world outside theories, interpretations, or value judgments by the researcher. Indeed, positivist researchers go to great lengths to eliminate subjectivity of researchers so as to allow them to discover the truths in the objective reality. Their research involves creating controlled experiments in which they identify and isolate independent and dependent variables so as to prove or disprove their research hypotheses. Case studies done within the positivist framework typically rely on quantitative analyses and experimentally controlled conditions.

Researchers working with an interpretive framework, unlike positivists, see the world as being interpreted or socially constructed. Reality in this view is different for different people and under different conditions. The phenomena under study are regarded as complex, interdependent, and necessarily subjective. Those doing case studies in the interpretive framework prefer qualitative methods over quantitative ones and prefer working within naturally occurring conditions rather than experimentally controlled ones.

Emancipatory case studies are done to right the imbalances in power relations between the powerful and powerless in society, including the unequal relationships between researchers and those researched. The case study methods of emancipatory research are designed to give voice and social and communicative access to the powerless. The goals, in this framework, are those of participants. Participants are also involved in the choosing, design, and implementation of the research endeavor. Emancipatory case studies often use action research, participatory research, and phenomenology. Commonplace among emancipatory case studies are the personal narratives written by people with disabilities. Authors of such studies do not call what they have done a “case study” but rather regard themselves as storytellers who are portraying their personal life experiences.

Throughout this chapter I will give examples of case studies from within each of the three frameworks. I will also show the long lasting contributions of case studies in our field by pointing to some historic examples. I will argue that case study researchers need to respond to a moral imperative raised by the emancipatory framework to make our work more liberating and relevant to those we study and support. This shift would involve a different set of skills and new sensibilities. I will end with a set of suggestions for how to develop these skills and sensibilities by drawing from the life-long body of work of Jack Damico and his colleagues.

The Nature of Case Study Research

Let me begin by outlining what case study research has come to mean over the years. Case studies, like nouns, are usually studies of people (a child, an adult, someone with a communication disability); places (a classroom, nursing home, speech clinic); or things (a treatment, interaction, social service, or historical event). Case studies are most often thought of as in-depth investigations of singular instances of a phenomenon, but they also often involve comparisons across several cases.

Studying single cases can afford the researcher with a variety of insights. For positivists, case studies are used as pilot investigations or so-called fishing expeditions, as an early stage in research. For researchers working within the interpretive framework, case studies can offer an in-depth understanding of a participant or issue. And for those working within an emancipatory framework, case studies can provide a voice and redress inequities experienced by the disempowered. Besides individually focused stories, case studies designed in the emancipatory framework are sometimes aimed at institutions and sometimes conditions that result in social control and oppression.

Case studies can make use of a variety of research methods and strategies. Positivists prefer controlled experiments. Those working in the interpretive and emancipatory frames lean toward in-depth interviews, ethnographic observations, story gathering, text or artifact selection, and collaborative action research groups. The data, once acquired, can be analyzed in a variety of ways, using both quantitative and qualitative methods, micro as well as macro analyses, grounded theory and phenomenological approaches. (See other chapters in this volume for details on these various qualitative methodologies.)

Examples of Case Studies Done within Different Philosophical Frames

Positivists are inclined to use quantitative methods when analyzing case study information. Many studies done in this vein involve quantifying categories of information found in the case study data so as to track, say, the impact of a treatment on a client’s performance. When doing case studies positivists are inclined to place experimental controls on the case, so as to test the impact of an independent variable.

Dodd and Bradford (2000) did such a case study with three children who had phonological disorders. In it they compared three therapy methods administered to each child, each involving 12 sessions over a 6-week period. The authors used a multiple base-line design to measure the accuracy of children’s productions over time and across the different interventions.

The Dodd and Bradford (2000) study of three cases qualifies as positivist because it quantifies the data, collects it under carefully controlled conditions, and measures progress using a multiple-base line comparison. The logic of the paradigm also allows one to treat the interventions as the isolable variables that cause the changes in the post treatment measures. The authors of this three-person case study, true to their positivist inclinations, worry about generalizing from the small sample size: “The results of the study should be interpreted with caution due to the small sample size of a heterogeneous group and the cumulative effects of intervention” (p. 205).

Interpretive studies of individuals have been used to motivate new clinical categories, to refute commonly held misconceptions about our clients’ inabilities, and to provide a venue for clients to speak for themselves. Studies of individual clinical cases have revealed unexpected information about particular clients, giving clinicians ways to better advocate for them and to tailor their services to fit their circumstances. Interpretive researchers tend to choose naturally occurring contexts for gathering their data. Once collected, the data is analyzed for themes and patterns, using both obvious and non-obvious (thick) descriptions.

Two fine examples of interpretive case studies can be found in this volume. Fujiki and Brinton (Chapter 17) offer us a study of the life course of a 25-year-old individual who was diagnosed with a language disorder at 4 years of age. Their aim was to “put a face” on the findings of large longitudinal studies. They argue that the child’s story “illustrates the importance of adopting a holistic approach in considering the multiple factors that may be associated with LI.” The authors find, unexpectedly, that the child’s primary problems when he became a teenager were not identified by his family and teachers as language impairment, but rather as social in nature and tied to the boy’s anxiety.

The case study of Hallé and Le Dorze (Chapter 16, this volume) is of the support provided by a daughter to her mother who had severe aphasia. The study provides a counter to the commonly held assumption about the negative impact that aphasia has on family members. According to Hallé and Le Dorze, “These results appear divergent to previous studies of the impact of aphasia in families and of caregiving where positive aspects are not the norm.” The interviews of the daughter, over time, shows her persistent focus on her mother’s competence rather than deficits—a stance that was key to her caregiving strategies. The authors conclude, “This study of caregiving is an example of how complex social phenomena involving communication can be advantageously studied within a qualitative framework.…”

In both of the above interpretive case studies the authors treat the participant in their study as part of a complex milieu. Both studies also serve to “put a face” on previous generalized findings and to make them concrete. And in both studies the face is not what would have been expected from the results of experimental research. The cases thereby serve to make specific, test, and even falsify previous research through counterexample.

Interpretative case studies have also been used to inform clinical practice directly, as exemplified by an article by Nina Simmons-Mackie and Jack Damico (2001) in which the authors provide guidance to clinicians for how to use case study research methods to determine their client’s communicative status or progress. They suggest gathering information through ethnographic interviews, personal journals, and personal encounters and then show how to analyze collected data to find out about the client’s lifestyles and viewpoints. Using a specific case example of a client with aphasia, the authors focused on contexts, people, and feelings associated with her communication. The aim of their example was to find out about this person’s “use of communication as a social tool and her perceptions of herself as a communicator” (Simmons-Mackie & Damico, 2001, p. 27).

Emancipatory case studies of, with, and by people with communication disabilities are but a small part of the case study researcher’s consciousness. That is not to say that there are no such studies. Personal and caregiver narratives, for example, have long been and continue to be an important source for helping understand the lived experiences of those with communication disabilities (Grandin & Scariano, 1996; Hussey, 2010; Johnson, 1930; Park, 1967; Robillard, 1999; Sinclair, 1992). What is also needed, I would argue, are case studies focusing on service delivery that will change the oppressive power relationships between people with disabilities and their service providers—in particular, their speech-language pathologists.

There are two recent sterling examples of such service-directed case studies. The first is by Susie Parr (2004), a speech pathologist and researcher in England. It is an ethnographic study of 20 people with severe aphasia. The aim of the study was “to chart the detail of day-to-day life, the challenges faced by people with aphasia, their families and paid carers, and the degree to which statutory health and social services and other voluntary sector and independent agencies are meeting with their support needs.” The study served to give voice to those who are usually invisible and to reveal their social isolation and the corresponding failure of service providers to meet their needs.

A second study is a textual analysis of the language used to describe cases in case study research. Mitzi Waltz (2005) analyzed classic studies of people with autism. Her study revealed freak-like portrayals of people with disabilities (what she calls “enfreakment”). She also critiques the medical model of disability that objectifies people by portraying them as a medical condition (p. 422). Waltz found that the case study researchers such as those written by Leo Kanner (1943) marginalized the cases they describe. They did this by failing to represent the lived experiences of those with autism and by, instead, using medical discourse that depersonalizes and objectivizes them.

Influential Case Studies From the History of Communicative Disorders

There are a number of classic case studies, like those analyzed by Waltz (2005), that have served a foundational role in the history of communicative disorders. The studies have become classic because they have been pivotal in shifting practices or understandings and thereby have become milestones in the field. The following five are but a sampling of many case study classics. All five are best depicted from within an interpretive framework:

1. In 1802, Jean Marc Itard (1774–1838) published his accou...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Contributors
• Foreword
• Preface
• Introduction: An Appreciation of Jack Damico
• Part I Qualitative Approaches to Research
• Part II Case Studies in Qualitative Research
• Part III Epilogue
• Author Index
• Subject Index