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Initiating action research in the Dr. Henri van der Hoeven Kliniek, Utrecht, The Netherlands
lnternatfonal Journalof Law and Psychiatry, Printed in the U.S.A. All rlghis reserved.
Vol 4. pp 457-460. 1381
0160.2527/81/030457-04$02.00/O CopyrIght 1962 Pergamon Press Ltd
Initiating Action Research in the Dr. Henri Van Der Hoeven Kliniek, Utrecht, The Netherlands Julie T.T.M.
Feldbrugge”
This paper deals with an attempt by the Dr. Henri van der Hoeven Kliniek to set in motion an action research programme and discusses problems attendant with such an approach. The impetus for putting such a programme into practice arose from a consideration of how best the Kliniek could contribute to the resocialisation of its patients. This question has many aspects and cannot be reduced to the quality of clinical work. Subjects such as the interaction between the patient and his milieu and the tolerance level of society in general must also be considered. “Action Research” “Action research” is defined as “to work together with the people immediately involved, towards a process of change and to accompany that process with research”, and its primary focus is to work purposefully and efficiently towards the resocialisation of patients. The secondary focus is on what must be known and done in order to work in a purposeful and efficient fashion. (Twain & Mervin, 1970). The process consists of problem analysis and data collection concerning that problem, conceptualisation, formulation and execution of a plan of action, evaluation, the gathering of new data, and so on, in a spiral-shaped process. The model was first described by Kurt Lewin as a result of his involvement in a programme aimed at changing American eating habits. According to Lewin, the most effective way of gaining insight into a problem is by working with it and then monitoring what appears to be happening, and he further extrapolated this method to form a theoretical framework for understanding human interactions (Sanford, 1970). Action research is aimed at promoting the practical interests of those who wish to change their situations. It is also intended to make a contribution to the social sciences. This dual aspect is clearly recognised by all the parties involved (Clark, 1972). Consequently, the researcher is not primarily investigating the character of a phenomenon; rather, he is aiming at both practical and theoretical relevance.
This article Uppula,
i5 a
revised, condensed version
of a lecture
Sweden in 1978. The original version.
delivered at the 9th World Congrc~~ ol’Sociology.
listing
mcthodolo~ical
proce?
and difficulties,
tained from the author. *Sociologist,
Dr. Henri van der Hoeven
Kliniek.
Portbus
457
174, 3500 AD Utrecht,
held in
may be ob-
The Netherlandr.
458
JULIE T.T.M. FELDBRUGGE
Background The van der Hoeven Kliniek is a psychiatric hospital for 72 adults committed for treatment by the Criminal Court. The youngest, committed on the strength of a Youth Order, are in the 15-16 age range. Female patients constitute lo%-15% of the total. The treatment staff consists of professionals who have completed their training: there are no trainees. Research has always been considered important, especially by the former director, Dr. A.M. Roosenburg, and her predecessor, Dr. P.A.H. Baan. Expectations regarding research have always been the documentation and evaluation of the treatment process, and the building from experience of a valid store of knowledge. The management leaves the research team a great deal of freedom to organise its work, but also provides real support through regular discussions and by providing resources and allowing time to attend courses and conferences. In the past the treatment staff has not concerned itself with research work. The work climate is strongly defined by the immediate nature of the required support. The stimulant to change this attitude will have to come from the research team itself. It was during a visit to the United States in 1965 that Dr. Roosenburg saw action research functioning, in particular those projects of Marguerite Warren and Douglas Grant. Warren’s project was set up by order of the Department of Corrections in California, the intent being to create a more differentiated treatment approach to problem children while at the same time obtaining reliable information. The project was structured in such a way that it responded to several different interests: 1. Change was inititated and the process was well supervised. 2. The staff working with the children experienced the researchers as a real help and contributed actively to the gathering of relevant research data. 3. The project supplied data which could be used both in research and in the formulation of policy (Warren, 1969). Together with the long-term prisoners, Grant developed the “New Careers Programme,” and, in cooperation with the local police, managed to reduce drastically the number of violent incidents between police and citizens (Grant et al., 1975). To Dr. Roosenburg this type of research seemed eminently suitable for the Kliniek. However, since in those days in the Netherlands little or nothing was known about it, its introduction failed. When I rejoined the Kliniek in 1974, the management decided to put the research activities into a new framework. The research team received the explicit instruction to undertake action research; in concrete terms, the team was expected to introduce into the Kliniek the procedure of Goal Attainment Scaling (GAS), starting with the new patients, and to accompany and stimulate this process through action research. GAS is a method of evaluating individual treatment programmes (Hart & Lange, 1972), and seemed to fit well into the aims and working procedures of the Kliniek: 1 . At patient method.
level there was to be a clear description
of problem,
goal and
ACTION
RESEARCH
IN THE VAN DER HOEVEN
KLINIEK
459
2 . At staff level this procedure was to contribute to a more purposeful approach to work. 3 . The method was meant to improve the way in which treatment data was registered, which in its turn could provide a basis for future research. Since neither I nor my colleagues had been trained in action research and were unable to obtain satisfactory supervision, difficulties arose; for example, we were advised that patients and staff had to express a clear need for research, or be willing to free a certain proportion of their time to that end. Consequently, we were faced with the prospect of first having to mount a project investigating the way in which a need for research could be invoked, followed by an analysis of the conditions necessary to foster acceptance and commitment among those involved. Very little literature exists about the difficulties one is likely to encounter in the execution of action research. It is only when talking to action researchers themselves and through observing them in their work that it becomes clear how much everyone is wrestling with the same problems. In the United States and the United Kingdom, action research is set up mostly on a project basis. Consequently, researchers are always dependent on the publication of “successful” projects. From the safety of a permanent appointment it therefore seems sensible to try to contribute to action research by describing the difficulties that are present in such abundance.
Experience with the GAS At an introductory meeting with staff and patients the proposed procedure met with a lukewarm reception. This was not surprising, however, since there was no manifest need for such a programme. Implementation consisted of discussion, among each new patient, the researcher and the treatment team, to isolate problem areas and to formulate concrete goals for a specific time period, following which there would be an evaluation and the beginning of a fresh cycle. Although we had anticipated difficulties in formulating problems and goals, and in patient cooperation, many others became manifest; cooperation between researchers and treatment staff developed laboriously. The staff shift system meant that relevant people were seldom available simultaneously, and since it was the researchers who were most consistently present, patient transference onto them led to friction among the team members. Attempts by the researchers to present monitoring reports and recommendations were met with a thoroughgoing resistance. Consequently, attention was directed towards an investigation of the resistance. More concretely, because it was felt that the GAS approach was worthwhile, a workshop was arranged in 1977 for specific training in the correct procedures, and in 1976 a group was set up in the Kliniek as a model, based on the S.J.P. Dercksencentrum in Amsterdam (Hart, 1975). This project, however, collapsed in one year, due to the staff attempting to realise too many different goals simultaneously. Contact was also made with action researchers in the United States and the United Kingdom.
460
JULIE T.T.M. FELDBRUGGE
Methodology The methodological problems are legion. The issue concerning determination as to who is in fact the researcher’s partner - the patient and his family, or the treatment staff - leads to different perceptual approaches. If the patient is the partner, then every time there is less than direct contact with his needs, there follows the risk of losing sight of these interests and of directing attention and efforts at bureaucratic irrelevancies. If the staff is the prime partner, however, it will then be the researcher’s task to help them discover possibilities and follow up the effects; this is the approach we prefer. Next, there is difficulty in the problem analysis itself. Generally, there is no clear-cut definition of the problem and all kinds of dysfunctions serve as a hindrance: for example, administrative inefficiency, staff inadequacy, unrest on the ward and insufficient patient care. Consequently, the pattern is always changing, and it becomes difficult to focus attention on one specific area: and concomitantly, data collection also becomes problematic. Furthermore, conceptualisation is beset with difficulties, and although hindsight may give a coherency which was lacking at the time, the researcher is still faced with the problem of how best to balance the need for objective distance with the need for staff confidence. Conclusion There are signs which give rise to optimism. In the van der Hoeven Kliniek many more treatment staff now feel that research can be useful and that cooperation with a research worker might be advantageous. After the first impulse in the 1940s one can discover within the circle of social scientists new interest in action research. When the possibilities and the problems of action research are more openly discussed, this method of research will be able to flourish. References Clark, P. Action reseurch und orgunisulionul chunge. London: Harper & Row. 1972. Grant, J., Tech, H., &Calvin, T. AgentsoJ’ctmnge:A srurlyo~poli~erefonn. New York: John Wiley& Sons, 1975. Sanford, N. Whatever happened to action research? Journal of‘Sociu/ Issues, 1970, 26(4), 3-23. Twain, D., Harlow, E. & Mervin, D. Reseurch und human services; a guide IO coltuboru~ion .for progrtrm development, Washington D.C.: N.I.M.H. Stock Number 1724.0223, 1970. van der Hart, 0. Thea Bos en Kees Degenkamp. Een open (narorg) groep; eigen doelen ytellen en uitvoeren. MGV, 1975, 30, 516-528. van der Hart, O., & Lange, A. Goal Attainment Scaling; ten methode tot evaluatie van paychotherapieen. MGl’. 1972, 27, 502-510. Warren, M. The case for differential treatment of delinquents. The Annuls of rhe Ameriwn Acudem~v o.f Political and Social Science, 1969, 38/, 47-60.
Vol 4. pp 457-460. 1381
0160.2527/81/030457-04$02.00/O CopyrIght 1962 Pergamon Press Ltd
Initiating Action Research in the Dr. Henri Van Der Hoeven Kliniek, Utrecht, The Netherlands Julie T.T.M.
Feldbrugge”
This paper deals with an attempt by the Dr. Henri van der Hoeven Kliniek to set in motion an action research programme and discusses problems attendant with such an approach. The impetus for putting such a programme into practice arose from a consideration of how best the Kliniek could contribute to the resocialisation of its patients. This question has many aspects and cannot be reduced to the quality of clinical work. Subjects such as the interaction between the patient and his milieu and the tolerance level of society in general must also be considered. “Action Research” “Action research” is defined as “to work together with the people immediately involved, towards a process of change and to accompany that process with research”, and its primary focus is to work purposefully and efficiently towards the resocialisation of patients. The secondary focus is on what must be known and done in order to work in a purposeful and efficient fashion. (Twain & Mervin, 1970). The process consists of problem analysis and data collection concerning that problem, conceptualisation, formulation and execution of a plan of action, evaluation, the gathering of new data, and so on, in a spiral-shaped process. The model was first described by Kurt Lewin as a result of his involvement in a programme aimed at changing American eating habits. According to Lewin, the most effective way of gaining insight into a problem is by working with it and then monitoring what appears to be happening, and he further extrapolated this method to form a theoretical framework for understanding human interactions (Sanford, 1970). Action research is aimed at promoting the practical interests of those who wish to change their situations. It is also intended to make a contribution to the social sciences. This dual aspect is clearly recognised by all the parties involved (Clark, 1972). Consequently, the researcher is not primarily investigating the character of a phenomenon; rather, he is aiming at both practical and theoretical relevance.
This article Uppula,
i5 a
revised, condensed version
of a lecture
Sweden in 1978. The original version.
delivered at the 9th World Congrc~~ ol’Sociology.
listing
mcthodolo~ical
proce?
and difficulties,
tained from the author. *Sociologist,
Dr. Henri van der Hoeven
Kliniek.
Portbus
457
174, 3500 AD Utrecht,
held in
may be ob-
The Netherlandr.
458
JULIE T.T.M. FELDBRUGGE
Background The van der Hoeven Kliniek is a psychiatric hospital for 72 adults committed for treatment by the Criminal Court. The youngest, committed on the strength of a Youth Order, are in the 15-16 age range. Female patients constitute lo%-15% of the total. The treatment staff consists of professionals who have completed their training: there are no trainees. Research has always been considered important, especially by the former director, Dr. A.M. Roosenburg, and her predecessor, Dr. P.A.H. Baan. Expectations regarding research have always been the documentation and evaluation of the treatment process, and the building from experience of a valid store of knowledge. The management leaves the research team a great deal of freedom to organise its work, but also provides real support through regular discussions and by providing resources and allowing time to attend courses and conferences. In the past the treatment staff has not concerned itself with research work. The work climate is strongly defined by the immediate nature of the required support. The stimulant to change this attitude will have to come from the research team itself. It was during a visit to the United States in 1965 that Dr. Roosenburg saw action research functioning, in particular those projects of Marguerite Warren and Douglas Grant. Warren’s project was set up by order of the Department of Corrections in California, the intent being to create a more differentiated treatment approach to problem children while at the same time obtaining reliable information. The project was structured in such a way that it responded to several different interests: 1. Change was inititated and the process was well supervised. 2. The staff working with the children experienced the researchers as a real help and contributed actively to the gathering of relevant research data. 3. The project supplied data which could be used both in research and in the formulation of policy (Warren, 1969). Together with the long-term prisoners, Grant developed the “New Careers Programme,” and, in cooperation with the local police, managed to reduce drastically the number of violent incidents between police and citizens (Grant et al., 1975). To Dr. Roosenburg this type of research seemed eminently suitable for the Kliniek. However, since in those days in the Netherlands little or nothing was known about it, its introduction failed. When I rejoined the Kliniek in 1974, the management decided to put the research activities into a new framework. The research team received the explicit instruction to undertake action research; in concrete terms, the team was expected to introduce into the Kliniek the procedure of Goal Attainment Scaling (GAS), starting with the new patients, and to accompany and stimulate this process through action research. GAS is a method of evaluating individual treatment programmes (Hart & Lange, 1972), and seemed to fit well into the aims and working procedures of the Kliniek: 1 . At patient method.
level there was to be a clear description
of problem,
goal and
ACTION
RESEARCH
IN THE VAN DER HOEVEN
KLINIEK
459
2 . At staff level this procedure was to contribute to a more purposeful approach to work. 3 . The method was meant to improve the way in which treatment data was registered, which in its turn could provide a basis for future research. Since neither I nor my colleagues had been trained in action research and were unable to obtain satisfactory supervision, difficulties arose; for example, we were advised that patients and staff had to express a clear need for research, or be willing to free a certain proportion of their time to that end. Consequently, we were faced with the prospect of first having to mount a project investigating the way in which a need for research could be invoked, followed by an analysis of the conditions necessary to foster acceptance and commitment among those involved. Very little literature exists about the difficulties one is likely to encounter in the execution of action research. It is only when talking to action researchers themselves and through observing them in their work that it becomes clear how much everyone is wrestling with the same problems. In the United States and the United Kingdom, action research is set up mostly on a project basis. Consequently, researchers are always dependent on the publication of “successful” projects. From the safety of a permanent appointment it therefore seems sensible to try to contribute to action research by describing the difficulties that are present in such abundance.
Experience with the GAS At an introductory meeting with staff and patients the proposed procedure met with a lukewarm reception. This was not surprising, however, since there was no manifest need for such a programme. Implementation consisted of discussion, among each new patient, the researcher and the treatment team, to isolate problem areas and to formulate concrete goals for a specific time period, following which there would be an evaluation and the beginning of a fresh cycle. Although we had anticipated difficulties in formulating problems and goals, and in patient cooperation, many others became manifest; cooperation between researchers and treatment staff developed laboriously. The staff shift system meant that relevant people were seldom available simultaneously, and since it was the researchers who were most consistently present, patient transference onto them led to friction among the team members. Attempts by the researchers to present monitoring reports and recommendations were met with a thoroughgoing resistance. Consequently, attention was directed towards an investigation of the resistance. More concretely, because it was felt that the GAS approach was worthwhile, a workshop was arranged in 1977 for specific training in the correct procedures, and in 1976 a group was set up in the Kliniek as a model, based on the S.J.P. Dercksencentrum in Amsterdam (Hart, 1975). This project, however, collapsed in one year, due to the staff attempting to realise too many different goals simultaneously. Contact was also made with action researchers in the United States and the United Kingdom.
460
JULIE T.T.M. FELDBRUGGE
Methodology The methodological problems are legion. The issue concerning determination as to who is in fact the researcher’s partner - the patient and his family, or the treatment staff - leads to different perceptual approaches. If the patient is the partner, then every time there is less than direct contact with his needs, there follows the risk of losing sight of these interests and of directing attention and efforts at bureaucratic irrelevancies. If the staff is the prime partner, however, it will then be the researcher’s task to help them discover possibilities and follow up the effects; this is the approach we prefer. Next, there is difficulty in the problem analysis itself. Generally, there is no clear-cut definition of the problem and all kinds of dysfunctions serve as a hindrance: for example, administrative inefficiency, staff inadequacy, unrest on the ward and insufficient patient care. Consequently, the pattern is always changing, and it becomes difficult to focus attention on one specific area: and concomitantly, data collection also becomes problematic. Furthermore, conceptualisation is beset with difficulties, and although hindsight may give a coherency which was lacking at the time, the researcher is still faced with the problem of how best to balance the need for objective distance with the need for staff confidence. Conclusion There are signs which give rise to optimism. In the van der Hoeven Kliniek many more treatment staff now feel that research can be useful and that cooperation with a research worker might be advantageous. After the first impulse in the 1940s one can discover within the circle of social scientists new interest in action research. When the possibilities and the problems of action research are more openly discussed, this method of research will be able to flourish. References Clark, P. Action reseurch und orgunisulionul chunge. London: Harper & Row. 1972. Grant, J., Tech, H., &Calvin, T. AgentsoJ’ctmnge:A srurlyo~poli~erefonn. New York: John Wiley& Sons, 1975. Sanford, N. Whatever happened to action research? Journal of‘Sociu/ Issues, 1970, 26(4), 3-23. Twain, D., Harlow, E. & Mervin, D. Reseurch und human services; a guide IO coltuboru~ion .for progrtrm development, Washington D.C.: N.I.M.H. Stock Number 1724.0223, 1970. van der Hart, 0. Thea Bos en Kees Degenkamp. Een open (narorg) groep; eigen doelen ytellen en uitvoeren. MGV, 1975, 30, 516-528. van der Hart, O., & Lange, A. Goal Attainment Scaling; ten methode tot evaluatie van paychotherapieen. MGl’. 1972, 27, 502-510. Warren, M. The case for differential treatment of delinquents. The Annuls of rhe Ameriwn Acudem~v o.f Political and Social Science, 1969, 38/, 47-60.