Whats in a therapy room?A mixed-methods study exploring clients and therapists views and experiences of the physical environment of the therapy room

METHOD

| Study design

The study was a mixed-methods study, using a concurrent triangula- tion design (Creswell et al., 2003), with quantitative and qualitative data analysed separately and then combined to form a discussion addressing the research questions. A mixed-methods approach can help to build a more complete picture through complementarity and through combining quantitative and qualitative methods, and the strengths of each of the respective methods can be drawn on and weaknesses offset (Bryman, 2006). Other than for comple- mentarity, a mixed-methods design was also chosen for two further reasons: firstly, in order to give a wider and triangulated account (convergence) of the role of the physical environment of therapy rooms and capture the whole experience of therapy rooms, which is a complex area; and secondly, to look for any differences (interro- gation) between the quantitative and qualitative data. Divergence between different types of data in mixed-methods studies is not, in itself, a weakness, and curiosity towards the divergence can bring greater insight and understanding. Brannen and Moss (2012, p. 2) outline that a mixed-methods study works best when exploit [ing] the potential to see different things.

The mixed-methods design also effectively enabled the different research questions to be addressed. Quantitative data enabled an identification of which variables (aspects of rooms) therapists and clients thought were the most important. The qualitative data gave more context to the way that the individual variables were experi- enced and allowed a deeper understanding of why room variables might be rated more importantly by clients or therapists. This is im- portant, given the wide range of client groups, issues and therapy settings. Furthermore, the qualitative data also provided data relat- ing to how the individual variables combined to provide a helpful/ unhelpful setting.

3.2 | Data collection and mixed-methods consideration

Quantitative and qualitative data were collected at the same time, with equal value given to both. The study made use of three data sets: the quantitative survey data (NHS and non-NHS strand), the qualitative survey data (NHS and non-NHS strand) and the qualita- tive interview data (non-NHS strand). These data sets were analysed separately, before being compared and contrasted with each other for the purposes of convergence, complementarity and interroga- tion. The qualitative data from the surveys were not combined with the qualitative interview data, in recognition that the data were gathered in different contexts, which will likely have an effect on the data. The qualitative survey data were collected within a quan- titative survey, where specific prior questions about features of the room have been posed to participants, whereas the interview data were collected within a qualitative framework and coconstructed (Mann, 2011) with the interviewer.

3.3 | Participants

The participants were recruited using a combination of opportu- nity, purposive and snowball sampling. In the NHS strand, Health Research Authority (HRA) approval for the study was obtained and a local NHS mental health trust agreed to act as a study site for the research. To recruit NHS therapists to the study, managers of pri- mary and secondary care services delivering talking therapies were emailed details about the study and the survey URL and were asked to distribute these to staff via email. All qualified counsellors, psy- chotherapists, counselling/clinical psychologists and high-intensity therapists with at least two years experience (to capture a wider experience of therapy rooms) were invited to take part in the survey anonymously. Trainees were excluded.

To recruit clients, an advert was placed on Facebook. Client par- ticipants were over 18 years old and had received at least six sessions of therapy. The exclusion criterion for client participants was that they were not currently receiving therapy, to avoid interaction with therapy or distress to clients still within a therapy process. There was no re- quirement regarding how recently the therapy had been.

3.4 | Survey

Quantitative and qualitative data were gathered from 24 clients and 21 therapist participants, using an online survey.

The first part of the survey comprised Likert scales asking par- ticipants about their opinion on the importance of aspects

Survey data

Quantitative survey data were downloaded from Online SurveysTM into SPSSTM software. The data were analysed for descriptive statis- tics, and a statistical analysis of differences between room features and participant group responses was performed.

The qualitative survey data were analysed using Braun and Clarkes (2006) six-stage approach to thematic analysis. A deductive approach to the thematic analysis was chosen (as explained above), with themes chosen that answered the research questions.

Qualitative interview data

Transcription of the interview data was carried out by the re- searcher shortly after the interviews took place. The transcripts were coded and analysed using Braun and Clarke's (2006) approach to thematic analysis. The analysis was done in an inductive way.

Semi-structured interviews

Further qualitative data from two therapists and two clients were collected through four 45 min semi-structured interviews, con- ducted via Skype or face to face and recorded by dictaphone. Six open-ended questions were developed from findings from the current author's previous research (Sinclair, 2013), and the three qualitative questions from the survey (see above) were also used.

Quantitative survey data

The data gathered were Likert-scale responses to 22 questions on particular aspects of the room from 45 clients and therapists (clients n = 24). The Likert scales ranged from 1 (strongly disagree) to 6 (strongly agree). To examine which aspects of the room were most important, the percentages of participants who responded from 4 (slightly agree) to 6 (strongly agree) using the Likert scales were calculated for each question, related to the individual as- pects.

Qualitative survey data

The qualitative data gathered from the two online surveys (NHS strand and non-NHS strand) consisted of free text answers to three open-ended questions: Thinking about the physical environment of counselling/therapy rooms that you have experienced,

Data set comparison and divergence

In terms of complementarity, the data within this data set explain and flesh out some of the answers that respondents gave to the quantitative questions. In terms of divergence, although 100% of clients and therapists agreed that soundproofing was important in the quantitative data, therapists (particularly those in the NHS) overwhelmingly chose to write about this within the qualitative an- swers, in comparison with few clients. Therapists spend more time in therapy rooms than clients, and NHS staff may be more likely to share rooms with other services, with resulting noise.

Data set comparison

Although there was much convergence with the quantitative and qualitative survey data, in comparison with the qualitative survey data, interviewees did not simply give long lists of features of rooms, but instead rooted and described features of the room within their own experiences. This storied account allowed for a deeper under- standing of why particular features were helpful or unhelpful; this is also a difference to previous research in this area.

Q.1.1. Demonstrate your understanding of paradigms, methodologies and research practicalities by considering the impact were the authors are to use an alternate paradigm to that represented original article. You will need to select a different alternate paradigm.

Q1.1.1 The data collection method (including a clear explanation of and motivation for, choosing that data collection method);

Q.1.1.2 The data analysis method (including a clear explanation of, and motivation for, choosing that data analysis method).