Qualitative Interviewing Using Interpersonal Process Recall: Investigating Internal Experiences during Professional-Client Conversations

Abstract

Interpersonal process recall (IPR) interviewing uses video-assisted recall to access conscious yet unspoken experiences in professional caregiving interactions. Although IPR has been employed across the helping professions, little has been written about effectively conducting IPR interviews. Drawing on their IPR-based counseling research on hope, the authors provide a framework for the use of IPR interview strategies and for addressing challenges unique to IPR. Specific issues include (a) preparing the research team and setting, (b) issues specific to IPR interviewing, including framing IPR questions, (c) working with heightened emotion, and (d) negotiating professional/researcher roles. Finally, they discuss participant experiences and potential applications of IPR.

Effective professional practice requires a deep understanding of client experiences as they occur during the process of interacting with professional caregivers. Accessing in-the-moment experience of specific professional interactions and processes has proved challenging for researchers. To date, most qualitative research on client-caregiver interactions has solicited client recollections of care by retrospectively exploring client memories of complex care interactions, weeks, months, and even years after they have taken place (e.g., Cutcliffe, 2004; Levitt, Butler, & Hill, 2006; Wilcox-Matthew, Ottens, & Minor, 1997). Issues related to client recall can become an issue of serious concern to researchers when employing these delayed types of interview methods.

Interpersonal process recall (IPR) is a qualitative interview approach designed to access client and caregiver experiences as close to the moment of interaction as possible. It is used to access individuals' conscious yet unspoken experiences as they occurred at the time of the interpersonal interaction under investigation. A typical IPR application involves video-recording a single caregiving interaction, which is then viewed shortly thereafter by the client and/or professional caregiver with a research interviewer during the IPR interview. Although IPR has been used most commonly to investigate counseling and psychotherapy (e.g., Clarke, 1997; Crews et al., 2005; Griffith & Frieden, 2000; Levitt, 2001; Lokken & Twohey, 2004; McLeod, 2001; Timulak & Lietaer, 2001; West & Clark, 2004), it has also been employed in the study of other professions, such as schoolteaching (Bloom, 1954), social work (Naleppa & Reid, 1998), medicine (e.g., Bartz, 1999; Winefield, Murrell, & Clifford, 1994; Yaphe & Street, 2003), management (Marsh, 1983), and competitive athletics (Rhea, Mathes, & Hardin, 1997). Although nurse researchers have employed video-recording in conjunction with qualitative research methods (Griffin, 2004; Hansebo & Kihlgren, 2004; Haugh & Salyer, 2007; Limacher & Wright, 2006), video-assisted interview techniques do not appear to have been used extensively within nursing. IPR might therefore represent a useful addition to the ways in which video-recording is used in nursing research. In addition, IPR holds potential for the exploration of numerous other professional applications, including social work and rehabilitation therapies.

As a process-focused interview method IPR allows researchers to obtain firsthand insights into professional interactions through observation and by directly asking the client and the professional caregiver to comment independently on professional interactions as they unfold. Although IPR interviewing has been used in numerous research studies and offers a rare window on human interaction processes, the literature is silent on issues related to the applications and challenges of conducting IPR interviews. In this article we outline our use of IPR interview strategies relative to our recent research on hope during the counseling process.

The article is intended as a primer for those interested in conducting IPR interviews and offers practical considerations and technical details in the use of IPR.^1,2 We begin with an overview of IPR, followed by a short case description of its use in our study of hope during counseling interactions. Research team training, preparing the setting, and considerations related to creating interviewee safety during the interview are outlined. In addition, various issues unique to conducting IPR interviews are discussed with special attention given to framing IPR questions, working with heightened emotional content, and negotiating potentially complex dual roles as interviewers. With IPR's intense focus on process and recall, the role of reflexivity is also clearly evident and is addressed herein. Finally, the benefits and future of applications of IPR are considered.

What is IPR?

Initially developed as a systematic research method to study college students' thought processes during class discussions (Bloom, 1954), interpersonal process recall (IPR) interviewing as it is currently applied grew out of a now well-established health skills training program of the same name (Kagan, 1980, 1984). IPR training programs require that trainees (i.e., students in medicine and other mental health programs) be video-recorded during interaction with clients. While viewing a video-recording of these interactions, trainees are asked by skilled interviewers to describe underlying thoughts and feelings as they occurred during their interactions with the clients. A key feature of the IPR training interview is to focus trainees on their thoughts and feelings as they remember these to have occurred during the session rather than encouraging critique or self-confrontation while viewing the video-recorded session. The result is that trainees become more sensitive to and explicit about their internal processes during human interactions.

The reflexive stance that IPR interviewing fosters has drawn the attention of counseling process researchers (e.g., Rennie, 1990). Indeed, in a comprehensive review of qualitative research methods in counseling, McLeod (2001) described IPR-based research as “a jewel in the crown of qualitative psychotherapy research” (p. 81). For research purposes, the basic IPR technique of video-recorded replay to stimulate recall is modified to become a specialized qualitative interview procedure (e.g., Elliott, 1986; Martin & Stelmaczonek, 1988; Rennie, 1990) wherein a session is video-recorded and subsequently played back while the client and/or therapist participates in a research interview focused on the participant's internal experiences during the session (Elliott, 1986). The method was initially developed to focus on clients' perspectives of therapy because counselor perspectives on counseling dominated the literature (Bergin & Lambert, 1978; McLeod, 1990; Rennie, 1994a, 1994b). In subsequent years, IPR interviewing has been used to explore both client and counselor perspectives on the counseling process. If both parties are participating in research interviews, interviews are conducted separately.

Why use IPR interviewing methods?

Using IPR, researchers are able to access clients' unspoken in-session experiences as they are remembered to have occurred during the session. These are processes that are usually inaccessible via other data collection methods. As clients and therapists work together to build a therapeutic relationship, they are often thought to work toward a set of shared understandings which help to shape the meaning of what transpires between them (Spence, 1982). IPR takes this context into account and allows the researcher to observe and explore the interactions occurring within the counseling session, with firsthand clarification from the actual participant(s). Hence, a defining feature of IPR is that it lends both client and therapist perspectives to the interpretation of the conversational process.

The complexity and range of conversation that takes place within any single counseling session (commonly a 50-minute session) is extensive, making detailed recall of the session challenging for any participant. In many qualitative counseling research projects clients are asked to recall, unassisted, their experiences across a series of sessions (e.g., Anderson, & Niles, 2000; Cutcliffe, 2004; Levitt et al., 2006; Wilcox-Matthew et al., 1997). Although important aspects of counseling process are accessed by these means, the concern is that clients will recollect and comment on only selected moments from a counseling session, moments that are immediately accessible to the client's memory. In contrast, the extensive recall associated with IPR is thought to be facilitated by a number of factors (Elliot, 1986).

First, by viewing a video-recording of their actual session during IPR, interviewees are cued to remember various reactions and ideas that occurred during the session but might not readily come to mind unassisted. Second, memories of a counseling session might be influenced by recency. As a result, IPR interviews typically take place within 48 hours of the video-recorded conversation. The closer the recall is to the original conversation, the more vividly and easily activated the memories are expected to be. Third, the IPR process slows down the interview conversation, giving interviewees time to meditate on and verbalize complex experiences. In one moment of therapy a client might be thinking several different thoughts, attending to the therapist, and formulating his or her next statement. Allowing clients to take their time during the IPR interview gives them space to sort out these thoughts and articulate their experience. Finally, during IPR the interviewer might attempt to focus the interviewee on specific moments during the video-recorded interaction. Attending to specific interactions elicits interviewees' thoughts and feelings regarding a particular moment (e.g., “When the therapist said that, it made me realize that I'm stronger than I think”) and avoids potentially less useful broad generalizations about the session (e.g., “I liked the session. It was helpful.”).

A counseling case example: Employing IPR

In our program of research (Larsen, Edey, & LeMay, 2007) ³ we employ IPR interview techniques to explore client and counselor experiences of hope during a single session of therapy early in the counseling process. Previous research suggests that hope is an element crucial to counseling effectiveness (Asay & Lambert, 1999; Hanna, 2002; Lopez, Floyd, Ulven, & Snyder, 2000; Snyder, Michael, & Cheavens, 1999; Yalom, 1998) and that client and counselor experiences of hope might differ in important ways during the counseling conversation. Hence, we chose to interview both clients and their counselors about a single counseling session in which they had both participated. We conducted the IPR interviews with each counselor and client separately. In addition, we assigned two different research interviewers: one for client-participant IPR interviews and another for counselor-participant IPR interviews. Accessing both client and counselor perspectives during the therapy interaction (Rennie, 1990) is important, especially as counselor and client might come away from the same interaction with vastly differing experiences (Angus & Rennie, 1988; Gershefski, Arnkoff, Glass, & Elkin, 1996; Paulson & Worth, 2002).

Preparing for IPR interviewing

Drawing on our IPR interviewing experience with 11 client-counselor pairs (21 interviews in total as one participant did not complete an IPR interview), in the following sections we address the practicalities and many of the subtleties of preparing for IPR interviews, data recording principles, informed consent, creating a safe interview space, and crafting IPR interview prompts and questions.

Research team training and practices

Our collaborative research team consisted of the primary investigator (DL) and two senior-level master's students (KF and RS), both enrolled in an accredited counseling psychology program, working as research assistants. Aspiring to an egalitarian team research approach, members were expected to engage fully in the research process, voice their opinions, and openly discuss aspects of the project. The team was aware of the potential for valuable insights offered by various team members' perspectives on the interview process, particularly those of the research assistants serving as interviewers (Beale, Cole, Hillege, McMaster, & Nagy, 2004). Regular team meetings, e-mail dialogues, and a secured Internet research blog provided forums for ongoing discussions.

In addition, research team members maintained research journals in which they regularly recorded their emerging understandings, wonderings, and discussion points for the team.

Both interviewers had advanced training in qualitative research methods and advanced coursework and experience in interviewing and active listening (Ivey & Ivey, 2003). They obtained specific training in the IPR method by reviewing IPR literature and by participating in a simulated, practice IPR interview before conducting the formal research interviews. The practice IPR interview involved video-recording a simulated counseling session between the primary investigator, as the client, and a counselor-consultant to the project. To create rich interview material, the primary investigator shared a real personal issue from her past that she felt comfortable sharing. After the simulated counseling session, IPR interviews were facilitated with both the principal investigator “client” and with the counselor-consultant. Both interviewers-in-training reported finding the practice IPR interview extremely valuable in helping them learn the procedural details (obtaining consent and complexities of setting up multiple recording devices), receiving feedback on structuring the IPR conversation to target interviewees' memories of the counseling process (i.e., “there and then” research interview focus), and “getting the feel” of taking on the role of the IPR interviewer. Following the hands-on training, interviewers were able to ask more informed questions about the process of facilitating IPR interviews. The interviewers also found that the primary investigator's willingness to take risks and actively participate created an environment of trust and cohesion in the research team.

Counseling session and IPR interview recording principles

Preparing the interview setting for IPR interviews involves several steps. After formal agreement to participate has been secured from both the client and the counselor, the interview setting and recording protocols must be prepared to ensure that all aspects of the counseling session and the IPR interviews are adequately recorded. In the current study one video camera, one digital audio recorder, and one backup analog audio recorder were used to ensure that the counseling session under investigation was captured. External microphones, plugged into the video camera and the analog audio recorder, were used to enhance sound quality for the IPR interview (see the appendix for considerations for recording). Digital audio recorders were found to possess superior sound quality, especially when combined with digital transcription software (we used the Olympus AS-4000 PC program), which permitted easy and secure data storage and facilitated ease of transcription. For the purposes of video-recording, we employed an analog video camera, as our facility was equipped with a VCR to be used for playback during the IPR interview. With respect to video-recording the counseling session, we found that both individuals involved in the counseling interaction needed to be visible on the screen to capture both verbal and nonverbal content in the session. Although both clients and therapists sometimes felt nervous or embarrassed about the prospect of being video-recorded, once the counseling session began, they appeared to forget about the recording equipment quickly and entered fully into the counseling process. In our research we chose to video-record and interview participants only about a single counseling session. This practice is common in psychotherapy research (Elliot & Shapiro, 1988) as this has been found to be less intrusive to the therapeutic process than conducting multiple IPR interviews across the course of therapy with a single client. Clearly, ethical responsibilities for client care take precedence over any benefit that multiple IPR interviews might offer to research findings.

Informed consent

Scheduling counseling sessions and IPR interviews and gaining informed consent are logistical aspects of IPR interviewing that are more complex than in most qualitative interviewing. They involve coordinating the schedules of several parties, including client, professional caregiver, and research interviewers. We were especially aware that qualitative research involves a process of ongoing consent for participants, and we were concerned that we be especially careful about reducing any possibility of coercion or harm to participants (Magolda & Weems, 2002). As a result, we found that creating a protocol for ethically appropriate contact and follow-up with prospective interviewees was helpful. ⁴ In our research all therapist-participants agreed in principle to participate before any of their clients were approached with a request for participation. Prospective client-participants were informed of the study via a research information sheet and were directed to let their therapist know if they were interested in participating. To minimize any issues of coercion, we instructed the therapist-participant not to discuss the study in detail with the client. Instead, when potential client-participants told their therapist that they were interested in learning more about our IPR research study their contact information was forwarded, with their permission, to the client-interviewer (KF).

On her initial contact with potential interviewees, KF would introduce herself, outline the study, and respond to any questions a prospective client-participant might have. If the prospective client-participant provided verbal consent to participate, KF confirmed the time of the next counseling appointment with the client-participant, requested to meet with the participant 15 minutes prior to the counseling appointment to formally provide the details of informed consent, and scheduled the IPR interview. This ensured that formal permission to video-record the counseling session had been granted by the client-participant. The introductory phone call and informed consent meeting between the client-participant and research interviewer prior to the counseling session not only served to inform and protect the participant's rights but also offered valuable time for the participant and the interviewer to connect and begin building the relationship necessary for facilitating IPR. Because the study also included IPR interviews with therapist-participants, a similar process was conducted with these individuals. Finally, because the counseling session was video-recorded, it was impossible to prevent both client and counselor from knowing that both had initially volunteered to participate in the study. Furthermore, subsequent to our video-recording the counseling session, neither the therapist nor the client was informed by the research team about each other's possible ongoing participation in the research. Indeed, one participant did not complete a full IPR interview because of illness.

Setting up the IPR interview

IPR interviews with both the counselor-participant and client-participant were scheduled within 48 hours of the video-recorded counseling session. A maximum 48-hour window for conducting IPR interviews following a counseling session is common (e.g., Elliot, 1986; Rennie, 1990). During the IPR interview participants are asked to recall as clearly as they can their there-and-then thoughts, feelings, and sensations as experienced during the counseling session. In our study we usually conducted IPR interviews on the day following client-participants' counseling session, thus permitting participants time to rest between the counseling session and research participation. IPR, like therapy, is often fatiguing. A 2- to 3-hour IPR interview is commonly required to review a 50-minute counseling session. Rennie (1990) reported similar IPR interview lengths in his study.

IPR interviews should be conducted in a quiet, comfortable, and private space. A system for video playback (in our case a television and VCR) is required, and seating for both the interviewee and the interviewer should permit a clear view of the screen. Sharing a remote control allows both parties to pause the video-recording easily. During the current study the client-interviewer (KF) found that making lighthearted jokes about remembering to share the remote control broke the tension and gave the client-interviewee release to use the remote control more freely. During IPR both the interviewee and the researcher have control over stopping the video-recording and commenting on specific segments. For example, if the interviewer notes a long pause of silence, she or he can stop the video-recording to inquire, What was happening for you in that moment? In addition, when an interviewee remembers internal experiences that were unspoken at a particular point in a session, she or he can stop the video-recording to share their recollections with the interviewer.

Creating a safe interviewing relationship for IPR interviews

Relationship-mediated variables, including caring, warmth, acceptance, and encouragement of risk taking, account for about 30% of the variance in successful counseling outcomes (Asay & Lambert, 1999; Lambert, 1992). Numerous qualitative interviewers have identified similar relational attributes as vital to the creation of a warm, trusting research alliance when conducting in-depth qualitative interviews as well (Berg, 2001; Kvale, 1996; Merriam, 1998; Rubin & Rubin, 2005). Establishing a relationship worthy of participant trust is especially important during IPR interviewing for a number of reasons. First, clients seeking counseling are struggling with personal issues. During IPR client-participants are being asked to share the intensely personal content of their counseling session with the research interviewer. Second, in viewing their counseling video-recording, they encounter their personal challenges and counseling session from the vantage point of observer, an experience that initially causes most individuals some concern about how they will “look” on camera and how they will be perceived by the IPR interviewer. Finally, the participant and the researcher interviewer typically have a relatively short time together, usually only long enough for informed consent and the actual interview. Participating in IPR requires significant courage and trust on the client's behalf. Hence, a trusting relationship— or, at least, one that shows every indication of promise—must be established early and quickly with prospective client-participants.

Conducting IPR interviews

Interviewees as investigative partners

During IPR interviews we find that participants often become very curious about their processes and experiences as they occurred during the counseling session that they are viewing. As participants reflect and comment on the process of their counseling session, they work with the interviewer to make experiences that were implicit during the counseling session explicit during the research conversation. Charmaz (2006) has recognized the implicit world of meaning that qualitative interviews often access, suggesting that interview conversations are often shared attempts to make implicit experiences explicit through interview dialogue. As such, IPR participants are integral partners in the conversational process and have the opportunity to share in the work and the excitement of discovery and meaning making (Rubin & Rubin, 2005).

To honor this key role that participants have in helping to make the implicit explicit, we requested that our participants view themselves as co-investigators with the research interviewer. While viewing the video recording of the counseling session, we specifically asked participants to help us explore their inner, unspoken experiences. We also found that framing the IPR interview in this manner assisted client-participants in shifting from the role of a client seeking therapeutic assistance to that of a research participant offering valuable knowledge from their own experience.

Preparing participants to focus on process

One of the key facets of IPR is that the interview conversation focuses on process rather than content. In everyday conversation we most commonly focus on the content of a conversation— that is, what is being said—rather than the underlying experiences that the speakers might be having during the conversation. An explicit focus on process during everyday conversation is much less common. The converse is true of IPR interviews. IPR interviewers are less concerned with the content of what is said during the counseling session under review and instead focus intentionally on the experiences of the speakers as they engaged at various points in the counseling session. For example, a process focus during an IPR interview is an attempt to access the participant's inner thoughts, feelings, and bodily sensations as they might have fluctuated and shifted during the counseling session. These are processes that might have remained unspoken until the IPR interview. For example, a process focus might lead an interviewer to ask questions like What was happening to you when your counselor said that? or How did you feel when you told that story to your counselor?

Because everyday conversations tend to focus on content (e.g., What did you do next? What did he do?), process-focused interviews can be difficult for participants to grasp initially. They might require some encouragement and support from the interviewer to articulate their inner and unspoken experiences as they occurred during the session under investigation. We find that talking about process as a skill to be learned is useful in helping participants attend to process. In our research interviewers suggest that participants be gentle with themselves because reflecting on and discussing inner processes can feel foreign or strange initially. Interviewers also share the simple observation that although talking about process sounds as though it might be difficult, we have found that participants tend to pick up on it quite quickly. Indeed, in our research we found that all participants were able to talk about processes as they remembered them from the counseling session. Here are some suggestions for focusing on process:

• Place the primary responsibility for facilitating a process-focused interview on the interviewer. It is the interviewer's responsibility to prompt or ask for further clarification when a process focus is not clear. The client does not have to worry about whether they are getting the process focus “right” throughout the interview.

• We have found that clients will sometimes be reminded of other stories related to the content of their counseling session under review. In IPR it is important to bring the focus back to Were you thinking of that story in the session? Was it related to how you were feeling in that moment?

Pacing the IPR interview

Process interviewers are likely to find that becoming attuned to each interviewee's conversational pace is essential. Providing some wait time for participants as they prepare to respond to video-recorded segments and researcher queries permits the participant to engage in the complex task of remembering, reflecting, and, ultimately, articulating their thoughts. Conscious awareness of past memories is qualitatively different from current awareness of the environment (Tulving, 2002). Research suggests that memory operations are distributed widely throughout the intricately interconnected pathways of the brain (Mesulam, 1990: Nyberg et al., 2000). Gathering and reconstructing these disparate traces of memory can take time. In addition, emotional or somatic experiences might take longer than cognitive material for the interviewee to describe because these experiences are often more challenging for the interviewee to verbalize. In Gendlin's (1981, 1996) and Greenberg, Rice, and Elliott's (1993) work, accessing inner processes, which are not solely cognitive, tends to involve a circular or back-and-forth exercise of speaking, checking the correctness of the verbalization with the inner experience, and then speaking again. Slowing down the interview pace and offering silence might give interviewees needed space to recognize, process, and verbalize the complex internal experiences being requested in the IPR interview.

Uniqueness of the observer role for participants

A central characteristic of the IPR interview is that interviewees are required to take an observer role (Elliott, 1986; Kagan, 1984) or an “attitude of detachment” (Rennie, 1992, p. 212) as they review the video-recording of their counseling session. Although the observer role has been named as a crucial aspect of IPR, the complexities of taking on this position have not been fleshed out in research methodology literature. In our experience, taking on an observer role tends to place a separation between participants' current thoughts and their remembered experiences of the session. Rather than reliving and reflecting in the present on the counseling session as it is being viewed during the IPR interview, the participant is asked to take on an observer role. In stepping back from their in-the-moment experience of viewing their counseling session, they are requested to recall any thoughts, feelings, sensations, or experiences that might have occurred at the time of the counseling session itself and the meanings that they put to these experiences. By refocusing participants' attention onto past experience as much as possible, researchers are provided with the opportunity to access the participants' memories triggered by the video-recording replay rather than the participants' current thoughts, inferences, or generalizations about the session as it is currently being viewed.

Entering the observer role and detaching from the session can be a challenging task for some interviewees. The video-recording of their counseling session represents a very recent, personal, and often emotionally charged experience. We have found that client-participants are sometimes drawn into actively reprocessing and revisiting the issues being discussed on the video-recording. The recency and emotionality of the counseling session means that IPR interviewers must be supportive of the participant and take responsibility for the interview by respectfully helping the participant to return to an observer stance focused on process as it is remembered from the past session by the participant. Here are some suggestions for helping participants maintain an observer stance:

• Use sentence stems like “As you reflect on that moment in therapy …” or “Taking a step back from that moment …” This can help remind clients remember to comment on memories of their session.

• Remember that IPR interviews are lengthy. Taking short breaks during the IPR interview process can help participants maintain the observer role.

Framing IPR questions and prompts

IPR questions focus on participants' experiences as they happened in session and specifically target process. Therefore, attending to how IPR interview questions or guiding prompts can be framed becomes very important. Guiding questions that point participants to rich accounts of inner processes mean that participants do not have to work as hard to guess the focus of the interview. A few principles for framing IPR questions also provide the researcher with a framework for inviting as fulsome a description of process as possible. Nevertheless, before identifying a few general principles for framing IPR questions, we acknowledge that there is always a tension inherent in attempting to articulate interview question techniques (Berg, 2001; Kvale, 1996). In our work we are careful not to ask leading questions regarding participants' experience but do seek to help participants focus on the aspects of their experience that are the focus of our investigation (i.e., there-and-then experiences in session and internal processes that were unspoken at the time of the counseling session itself). We will now outline key considerations in framing IPR questions, including (a) phrasing in the past tense, (b) de-emphasizing content, and (c) framing concise, succinct questions.

Phrasing questions in the past tense

Participants sometimes comment on how they feel in the present moment while watching their video-recorded session. When this occurs, interviewer prompts framed in the past tense help the participant focus on their felt experiences from the time that the session took place. For example, questions employing the words was, did, and then continually bring the interviewees' focus back to their memories of the original session. In this respect, IPR interviews focus on the there-and-then of the interaction under investigation rather than on any current experiences of observing the session (Elliot, 1986). This is important because it helps both the interviewee and the interviewer to distinguish between remembered processes and insights gained during the IPR interview. An example of an interview question for a client-participant with a past focus would be, When your therapist said that recent experience was “just another example of you as a fast learner,” what was that like for you in the session?

Deemphasizing content

As discussed previously, participants are often drawn in by the content being discussed as they watch their video-recorded counseling session. As such, the ability to deemphasize content and focus on process is a key consideration in framing IPR questions. However, we believe that when participants are drawn to discussing content, it is important that the interviewer empathically validate the participant's experience before gently redirecting the participant back to inner processes. For example, after the client offers a content-related statement relative to a specific video-recorded segment, the interviewer can bring the interview focus back to process, as illustrated in this example:

Client-participant: Well, with my wife having a stroke, I retired within a year after that … my daughter divorced that year, my father passed on. It was quite a handful of stuff going on anyway.

Interviewer: Yes, it sounds very tough. It also sounds as though your therapist is kind of bringing a new thought forward, too.

Client-participant: Yes. She did. To see the situation in a new light.

Interviewer: What do you remember thinking at that point in the session?

Framing concise, succinct questions

Although most instructions on framing interview questions emphasize crafting short, succinct questions that are easily understood (Berg, 2001; Kvale, 1996), this can be a challenge for IPR interviewers. Although some questions outlining potential topics of interest can be constructed prior to the interview, it is essential that the interviewer focus primarily on establishing a flexible interview conversation that honors the natural unfolding of the conversation. In doing so, interviewers maintain responsibility for focusing prompts and questions intended to help participants maintain a focus on the research question at hand. For example, in our recent study interview questions had to include references to the past, inner process and the specific moment on the video-recording being viewed. For example, simply asking participants about their process without reminding them that we were interested in their inner process specifically at the time of the counseling session seemed to elicit present-focused reflections and distracted them from the focus of the interview.

Furthermore, interviewers tried to connect each discussion point verbally with the moment on the video-recording being explored to facilitate transcription. Although IPR questions can be wordy at times, participants seem to internalize the focus of the study quickly, facilitating a smooth conversational flow to the interview. The following is an excerpt drawn from one of our transcripts to illustrate a reasonably succinct IPR question that includes reference to a specific video-recorded segment, a focus on process, a reference to the past, and a focus on hope.

Interviewer: Being able to bounce those positive words around in the session, what did that do for your hope in that moment?

Working with heightened emotion

IPR interviewers must draw on their intuitive and instructed knowledge of human interaction and behavior. As is common in other qualitative interviewing, attending to interviewees' nonverbal behavior, both on the video-recording and in the IPR interview, can reveal times of heightened emotion or inner processing as interviewees communicate their experiences, not only through words but also using tone of voice, expressions, pauses, and gestures (Kvale, 1996). The interviewer is the research instrument (Kvale, 1996; McLeod, 2001). Process interviewers must have the ability to facilitate in-depth, process interviews in a manner that gathers rich information and promotes the psychological safety and well-being of interviewees. In our counseling process and hope research study, we have found that interviewers need to be comfortable with displays of strong emotion from interviewees. Although these displays are rare, possessing skills to work with interviewees who might experience emotional distress during process interviewing is essential. In addition, in our research we ensure that readily available, free-of-charge, qualified counseling is available to any participant who might need this service. Hence, our participants may return to their counseling therapist or another counselor to debrief any issues of concern following IPR. Of course, the nature and potential for participant distress will be related to the nature of the process being examined. For example, our research reviewing recent counseling sessions might elicit quite different emotional content than an IPR interview focused on a patient education session at hospital discharge.

In addition to preparing themselves for participants' emotional reactions during IPR, interviewers need to prepare themselves to work through any of their personal reactions following IPR interviews. The psychological and physical impact of facilitating qualitative interviews on the interviewer can be significant (Cowles, 1988; Dunn, 1991; Higgins, 1998, Lalor, Begley, & Devane, 2006; Sullivan, 1998). The impact of in-depth qualitative interviewing on graduate research assistants working with emotionally intense interview content can include the need to make sense of the inexplicable as well as experiencing difficult comparisons to one's own life (Beale et al., 2004). Support systems such as debriefing sessions (i.e., both scheduled and as needed) offer space to work with interviewers' emotional responses, surprising reactions, and potential biases (Morrell-Bellai, Goering, & Boydell, 1997). Established debriefing procedures also allow the interviewer to consult if there are ethical or safety concerns that stem from the interview. During our research project our interviewers (KF and RS) met regularly with each other and the principal investigator (DL) to discuss their reactions, concerns, and questions regarding both IPR interviewing and any emotional impacts they were experiencing resulting from interviews.

Following client interviews, KF, the client-interviewer in the current study, found journaling to be a very helpful way to process her experience of each interview. Journaling allowed time to reflect on potentially emerging ideas or themes, new questions, and the personal impact of the interview. Regularly scheduling time to journal offered a moment to focus and reflect on her practice as an interviewer and her underlying intentions in the interview. For KF, journaling became an integral activity to think reflexively about potential ethical issues, refine issues for further discussion in research meetings, and process her emotional responses to facilitating the interviews. KF also found it important to know that she was free to contact the study's primary investigator or the other research assistant for debriefing or with questions following client-interviews.

Closing the IPR interview

At the end of IPR interviews it is important for interviewers to debrief with interviewees to ensure that they feel comfortable with the experience. IPR can put interviewees in a sensitive and vulnerable position where they have shared not only the content of their counseling session but also their private inner experiences. Participating in IPR can also bring up emotional responses elicited by reviewing the counseling session. Nevertheless, client-interviewees as well as therapist-interviewees in our study report that participating in IPR proved overall to be either neutral or additive to their counseling experience.

Negotiating counselor/researcher roles

Dual roles in the researcher and client-participant relationship

In our research the IPR investigators are also professional counselors. Being trained counselors is both helpful and challenging to the IPR interview process. We suspect that practitioners from other disciplines who become IPR interviewers are likely to recognize benefits and challenges similar to those we have encountered. With respect to the benefits of selecting interviewers from within the profession under investigation, we found that being sensitized to the work of counseling allowed the interviewers to approach the IPR interviews with a broad foundational knowledge of the counseling context, therapeutic approaches, and common client issues. They also approached the task of IPR interviewing with training and experience in developing in-depth interview relationships, advanced listening skills, following the interviewee lead, and various questioning techniques (most notably leading/nonleading and open/closed questioning). These background skills and experience were invaluable in approaching the task of IPR interviewing.

The interviewers' counseling training also raised challenges that needed to be addressed, as this training introduces the possibility of engaging in dual-role relationships with client-participants. The boundary between being an empathic, respectful interviewer and offering counseling was sometimes less than clear. In our research it was essential for the interviewer to remember that IPR is a research interview, not an opportunity to continue counseling from the session under review. As client-participants respond to questions about their remembered experiences from their counseling session, they sometimes begin reprocessing issues in the interview. In these cases, interviewers can seek to validate participants' feelings and gently redirect them to focus on their remembered processes from the session. In addition, we have found that at the end of IPR interviews interviewers must debrief with participants to ensure that they have not become distressed from participating in the interview. Participants are also reminded that they can bring anything they learn or experience during the IPR interview back to their therapist if they so choose. A research journal entry from IPR interviewer KF highlights her work in addressing these issues:

When I encounter painful material with a participant, I'm finding it helpful to tell myself “It's okay to let that go. That's not my role right now [being a counselor].” Yet, I still feel the responsibility to check with clients [participants] to make sure they aren't overly distressed by the interview experience. I'm finding that safety planning techniques are helpful sometimes. If a participant is distressed I might ask “Who can you talk to about these feelings once you leave/get home?”, “What will you do if you find yourself struggling with this as you leave/later?” I also remind them that they can contact a therapist on the support sheet and that they can contact their own therapist. (Feb. 20, 2007)

Maintaining a collegial researcher and therapist-participant relationship

In our research therapist-participants also contribute to our data collection. Issues between interviewer and therapist-participants differ somewhat from those encountered between interviewer and client-participants. To provide their contribution to the research, therapist-participants make themselves vulnerable by opening up the intimacy of the counseling process and the therapeutic relationship to exploration by an outside observer. To assist therapist-participants in feeling comfortable with the IPR interview, it can be helpful to acknowledge their contribution gratefully and to clarify the role of the interviewer. Therapist-participants might feel more comfortable knowing that the interviewer will approach the IPR interview as a researcher, from a place of curiosity, not from one of judgment. The IPR interviewer is interested in the therapist-participants' experiences and how these experiences guide their clinical choices. The focus is not on clinical skills or judgment of those skills. In addition, it is helpful to discuss that boundaries regarding professional roles are important and will be maintained. We seek to assure therapist-participants that we will not be providing clinical interventions with their clients. Any requests that their client-participants might make for professional care will be redirected to the clinician for discussion. Furthermore, our research focuses on a single session. Hence, as researchers we take no responsibility for follow-up and do not track any follow-up with the client. This is entirely the responsibility of the counselor working with the client. We have found that communicating these parameters for our interviews helps to relieve any concern that the clinical care provided by therapist-participants will be compromised or that their clinical skills and/or judgment will be critiqued by the research investigators.

Participant experiences of IPR

Participating in qualitative research focused on personally meaningful topics often leads to positive feelings or a sense of personal growth from the experience (Kvale, 1996). Qualitative research interviews, as well, can feel therapeutic in nature (Hutchinson, Wilson, & Wilson, 1994; Tatano Beck, 2005). They offer interviewees the opportunity to reflect on their experience, explore personal values, and create new meanings. IPR interviews are no different. Interviewees tend to delve deeply into the memories and inner experiences of the issues they examined in the session. They are invited to reflect back on themselves and their actions both inside and outside of the session. In the current study interviewees reported that their IPR interview was helpful and enhanced their perception and understanding of their counseling session. As one client-participant described, “Well, this has been extremely, extremely powerful. Because I'm hearing myself think.” Indeed, most client-participants in our current study reported that the IPR experience felt therapeutic. Similar effects are reported in other IPR studies. For example, in Rennie's (1990) seminal counseling process study exploring the client's covert experiences of therapy, all 12 interviewees indicated that the IPR inquiry had affected them. Several suggested that they had gained a different or enriched view of the therapy session as a result of participating in the IPR interview.

Therapist-participants in our research also report positive experiences with the IPR process. All five therapist-participants in our research have indicated that they acquired knowledge from the research experience that they find valuable in their clinical practice. Reviewing the video-recorded session in a systematic and disciplined way assists many therapist-participants in attaining a clearer view of the client and of the counseling process in a particular session. Therapist-participants have reported that these new understandings can then be carried into subsequent sessions with the client. Participants further stated that taking part in the IPR interview was an affirming experience and confirmed the value of their work. Finally, many therapist-participants indicated that they had learned about their own hope and their own process as a therapist.

Final considerations and uses of IPR

IPR interviewing methods provide a unique way of accessing aspects of human interaction that are difficult to approach via other research means (i.e., conscious but undisclosed thoughts, feelings, and sensations during professional care interactions). Because of the uniqueness of video-assisted interviewing and a focus on process, some final implications for the use of IPR, for participant selection, and for use in various disciplines must also be noted.

First, as with many professional practices employing conversation (e.g., Rober, 1999), research interviewing (Fontana & Frey, 2000) is increasingly recognized as a reflexive activity; that is, an activity in which personal reflections and constructions play a significant role in research understandings. With its intense focus on process and reflection, the role of reflexivity in IPR interviewing is clearly important and worthy of further exploration and research.

In a related issue, with respect to participant selection, the nature of IPR interviews requires interviewees to delve into, reexperience, and describe their inner cognitive, affective, and somatic experiences and processes. In our experience, participating in IPR interviews tends to be easier for “psychologically minded,” reflective participants. Nevertheless, even our seemingly less self-reflective client-participants have provided rich insight and description of various aspects of the counseling process from their perspective.

Also with respect to participant selection, taking part in an IPR interview can be an emotional experience for the interviewee. At times the focus on underlying process might even elicit a more visibly emotional response than the therapeutic session under investigation does. Individuals who are currently experiencing acute crisis, suicidal ideation, or other potentially overwhelming situations are not considered suitable candidates for IPR. In addition, because participants observe their own behavior on screen during the IPR interview, this interview method is not advisable for use with individuals struggling with psychoses.

Finally, our experience confirms the usefulness of IPR interviewing in enhancing our understanding of the professional interaction between counselor and client. Our IPR interviews offer convincing evidence that client and professional caregiver experiences over the same session often differ. Rather than becoming distressed by these differences, we must establish an in-depth knowledge of these important differences in perspective as they are likely to offer insights regarding improved client care. Although the focus of our research has been on professional counseling interactions, previous research has also focused on the use of IPR in educational contexts, social work, medicine, management, and competitive athletics. IPR interviewing can offer valuable, and otherwise inaccessible, insight into any professional health interaction in which relationship and interpersonal communication serve as the primary vehicles for providing excellent care (e.g., psychiatric nursing outpatient visits, occupational therapy sessions, etc.). As is clear from our work, choices can be made about how IPR is to be applied (e.g., sessions to be recorded, length of time between video-recorded session and IPR interview). Furthermore, depending on the research focus, IPR interviews may be conducted with only clients or professional caregivers.

Summary

Investigating client experiences as they occur in professional caregiving interactions adds richness and depth to the work that professional caregivers, such as counseling psychologists, offer in their helping relationships. Interpersonal process recall (IPR) is a qualitative interview method designed to access clients' and caregivers' conscious but often unspoken experiences as they occurred during the interpersonal interaction under investigation. IPR offers insights into the processes underlying professional helping interactions via direct observation and by asking clients and professional caregivers to comment on the therapeutic process itself.

Despite the use of IPR interviewing in a number of research studies, little has been recorded about the use and challenges of facilitating IPR interviews. In this article we have outlined key considerations in implementing IPR interviewing. Employing our recent research investigating hope in early counseling sessions, both practical considerations and technical issues are addressed, including the importance of initial preparation to conduct IPR interviews, research team training, preparing the interview setting, and informed consent. Issues unique to conducting IPR interviews, such as framing IPR questions and working with heightened emotional content, are highlighted as key aspects of the IPR interview. Finally, in our experience, both clients and professionals participating in IPR interviews commonly find it to be a very positive opportunity to reflect on themselves and the session under review. As a flexible, fruitful qualitative research method IPR offers rich possibilities to explore the complex interpersonal processes underlying many types of professional interactions.