Qualitative research interviewing: application and use of free association
Intended for healthcare professionals
Evidence and practice    

Qualitative research interviewing: application and use of free association

Philip John Archard Mental health practitioner, Leicestershire Partnership NHS Trust, Leicester, England
Michelle O’Reilly Associate professor of communication in mental health, University of Leicester, Leicester, England

Why you should read this article:
  • To gain insight into the concept of free association and its role in clinical psychoanalysis and psychoanalytically oriented psychotherapy

  • To consider the application of free association in the context of qualitative research interviewing

  • To critically assess differences and similarities between qualitative research interviewing and psychoanalytic therapy

Background Free association is a core concept of the free association narrative interview method, an approach that is well-known among researchers in the UK who are interested in using psychoanalytic ideas in qualitative psycho-social research.

Aim To examine the relationship between the framing of the psychoanalytic concept of free association in the contexts of qualitative research interviewing, clinical psychoanalysis and psychoanalytically oriented psychotherapy.

Discussion This article considers the definition of free association in psychology and psychoanalysis. It then explores free association’s role in the free association narrative method, in terms of interview technique and the analysis of interview material.

Conclusion Researchers should carefully consider differences in the contexts of research, clinical psychoanalysis and psychotherapy to avoid makeshift integrations of clinical concepts.

Implications for practice The free association narrative interview method is an attractive approach for researchers interested in applying psychoanalytic ideas in their studies. However, researchers should carefully reflect on the meanings of the clinical ideas and terminology they use.

Nurse Researcher. doi: 10.7748/nr.2023.e1875

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

Correspondence

philip.archard@nhs.net

Conflict of interest

None declared

Archard PJ, O’Reilly M (2023) Qualitative research interviewing: application and use of free association. Nurse Researcher. doi: 10.7748/nr.2023.e1875

Published online: 27 July 2023

Introduction

Hollway and Jefferson’s free association narrative interview method (FANIM) (Hollway and Jefferson 2000, 2013) is arguably the most well-known example of the use of psychotherapeutic principles in qualitative social science research of the past 25 years – in the UK at least (Midgley 2006, Hoggett 2015). Hollway and Jefferson (2000, 2013), which set out FANIM, have informed research in various fields including nursing (Elliott et al 2007, Graham 2007, Boyle et al 2009, McAndrew and Warne 2010, Nicholson et al 2012, 2013, Capri and Buckle 2015, Sutton and Gates 2018). FANIM is viewed as providing a helpful framework for research that uses interviews to attend to the emotional complexity of research relationships and illuminate unconscious processes in healthcare work.

This commentary on Hollway and Jefferson’s FANIM work is part of a wider discussion about the relationship between psychoanalysis and qualitative research (Kvale 1999, Parker 2003, Wetherell 2003, 2005, Frosh and Baraitser 2008). It builds on previous articles addressing the use of the principles of FANIM in nursing and social work research (Archard 2020b, 2020c, 2021, Archard and O’Reilly 2022a, 2022b, 2022c), and is concerned with the psychoanalytic concept of free association and the relationship between its framing in the context of qualitative research interviews and psychoanalytic therapy. It focuses on the way free association features as part of FANIM.

Our aim is not to make definitive claims about the compatibility of free association with the qualitative interview. Instead, we wish to consider the parameters of this application and highlight issues of which researchers in nursing and allied fields should be mindful regarding a psychoanalytically informed interview approach.

Background

The psycho-social research approach FANIM represents has been adapted for empirical enquiry that seeks to get close to the psychodynamics of professional practice in social work and healthcare settings (Froggett and Briggs 2012), including nursing. However, there are gaps in the literature regarding how to go about this in practice, including the implications of related methodological debates for nursing and health and social care researchers (Archard 2020b, 2020c). It is this pedagogical concern, as well as the creation of a dialogue between academic scholars and healthcare practitioners, that is of interest to us.

This discussion is founded on a methodologically focused project undertaken by the first author (PJA) as a doctoral researcher. The project enquired into the use of concepts and techniques associated with psychoanalysis, as a broad therapeutic tradition concerned with what is unconscious, in qualitative research and in-depth narrative interviewing specifically. Of interest was how to apply in research the transformations brought about in migrating psychoanalytic concepts away from their traditional consulting room context (Archard 2021, Frosh 2010, Lapping 2011). While exploring various interlinked methodological matters as part the doctoral project, an empirical study informed by FANIM was also undertaken that provided insight into how researchers can understand interview narratives by using a psychoanalytically based epistemological framework (Archard 2020c).

The theoretical and practical areas associated with the broader project yielded important insights and valuable pedagogical directives (Archard 2020b, 2020c, 2021, Archard and O’Reilly 2022a, 2022b, 2022c). It also highlighted other issues, including how free association is framed in qualitative interviews. This concern arose after PJA started analysing the interview transcripts in the empirical study – he became aware that other researchers had queried Hollway and Jefferson’s use of the language of free association and questioned its application in research interviews (Cartwright 2004, McAndrew and Warne 2010, Holmes 2013, Archard 202a). However, he was uncertain about what this debate meant for his analysis. It is this language around the concept of free association that is the focal point of this article.

Free association and psychoanalytic therapy

Defining free association

A conceptualisation of free association that many people recognise is of the psychoanalytic patient or psychotherapy client being encouraged to talk about whatever comes to mind. Some may also describe free association as a means of bringing into conscious thought what was hitherto unconscious by way of new connections between previously unrelated thoughts, feelings, or imagery. Consistent with such a description is the definition of free association as ‘a basic tool of data gathering’ for the psychoanalyst and patient that provides insight into the nature of unconscious conflicts, desires and motivations (Hoffer and Youngren 2004).

Implications for practice

  • Free association is the idea of the patient in psychoanalysis or psychotherapy client giving voice to whatever comes to mind, bringing into consciousness new connections between previously unrelated thoughts, feelings or imagery

  • Free association is a central concept of Hollway and Jefferson’s ‘free association narrative interview method’ (FANIM) – an approach that is well-known among researchers in the UK

  • The role of free association in qualitative research can be examined by reference to the different ways in which it features in psychoanalysis and psychotherapy

For example, Burgo (2013) discussed clinical psychoanalytic practice and gave a simple but instructive illustration, describing the case of a patient who was a successful businessperson working long hours. In one session, the patient spoke at length about the demands of his work while also making light of his frustrations with these pressures. After he had talked in this way for some time, the narrative shifted abruptly when he recounted a story he had heard about a friend’s acquaintance whose son had recently died by suicide. The patient recalled how the family had resolved almost immediately after the son’s death to move from the area, which they did. This abrupt shift in the narrative provided Burgo with an avenue to consider aspects of the patient’s emotional experience – specifically, the ‘split off and neglected part’ of him that was in great pain and his unconscious or semi-conscious preference to ‘stay busy’ or ‘move away’ to seek distance from his suffering.

Freud (1958) famously gave an analogy for free association of the self-observant psychoanalytic patient as train passenger, ‘describing to someone inside the carriage the changing views which you see outside’, with no concern for censorship or coherence, however nonsensical, seemingly trivial, wrong, or unpleasant it feels to relate. For him, free association was an act of passivity to oneself, of giving voice to whatever ‘freely falls’ into one’s mind – relinquishing the idea one knows consciously what is important or relevant to say and instead placing faith in ‘the spontaneous activity of the unconscious’ (Smith 1984).

Free association in different traditions of psychoanalysis and psychotherapy

Two things stand out relatively swiftly when you read literature about free association in psychoanalysis. The first is the fundamental significance that free association holds in the history of psychoanalysis and extent to which it is considered definitional to the field. Freud described his abandonment of an early use of the technique of hypnosis to pursue free association as ‘the most momentous step’ in the discovery of psychoanalysis (Freud 1961); he also referred to it as the ‘methodological key’ of psychoanalysis (Gin 2003). Likewise, Laplanche and Pontalis’s well-known dictionary of psychoanalytic terminology (Laplanche and Pontalis 1973) characterised ‘the procedure of free association’ as ‘fundamental to psychoanalytic technique’.

The second thing that stands out in this literature is the debate regarding free association and how psychoanalysts can understand it differently. Spacal (1990) described this aptly as the concept’s ‘re-elaboration’ by different traditions of psychoanalytic thought as part of a shifting relationship with other methodological principles. Spacal considered the Kleinian tradition of psychoanalysis, which is the tradition that follows the influential work of psychoanalyst Melanie Klein – most notably in extending the reach of psychoanalysis from adults to children. Spacal (1990) described how Klein’s analogising of children’s play with free association set in motion radical changes in how such play was conceived in the field. Importantly, Klein considered children’s play to be a form of communicative material that is freer than adults saying whatever comes into their minds. Play conveyed much about the nature of the child’s internal world but was not a self-observative activity as Freud regarded the adult patient engaged in free association.

The Kleinian standpoint led to an increased emphasis on the psychoanalyst sharing interpretations with the child patient as a means of fostering insight. As Klein’s work became increasingly influential in analysis with adults, free association became viewed less a ‘curative’ method in and of itself and more as a ‘diagnostic’ or evaluative way of considering everything communicated in sessions (Racker 1968). This positioning of the ‘associations’ in analysis as, primarily, material for interpretation about the patient’s phantasy experience of the psychoanalyst constrained the relevance afforded to free association via a ‘prime epistemic position… bestowed on the introspective subject’ in the work of Freud (Spacal 1989).

This mutable quality is worth emphasising at this point in our article, because just as psychoanalysts can mean different things when using the term ‘free association’, so too can researchers. Before reflecting further – and at the risk of stating the obvious – it is important to clarify that the practice of free association in clinical psychoanalysis is inevitably going to be different from that which might take place in the qualitative interview.

For one thing, it is far from easy for patients to say all that comes to mind in psychoanalysis. However, they are assisted by certain alterations in the therapeutic environment. The most notable of these is the supine position they take on the analytic couch, facing away from the analyst, which encourages them ‘to diminish conscious control of the associations more readily’ (Kris 1996). It also frees the psychoanalyst to listen, unperturbed by any demands for a response that the patient’s facial expression or body language may communicate – the analyst can choose to respond only when they deem it therapeutically necessary.

In this way, free association in clinical psychoanalysis is very different to free association in other clinical and non-clinical contexts. For example, in psychoanalytically oriented psychotherapy, the patient typically does not use the couch and has fewer sessions – usually two a week rather than five or six. This setup ‘does not necessarily interfere with all components of the free association process’ and the patient being honest about what arises in their mind (Kris 1996). However, it does change ‘the sense of continuity and rhythm’ that might otherwise be realised through more frequent sessions in which the couch is used (Kris 1996). The patient is also unable to build a tolerance for – or even satisfaction in – the uncertainty and unpredictable revelations that result from being led by free associative activity on an ongoing basis. This means there is a greater need for therapist intervention to seek resolution in the form of formulation and understanding. Such intervention also takes precedence over the functions derived from engaging in free association in and of itself, which is possible when sessions are more frequent.

Word association tests

Something similar can be said in relation to word association tests. These may involve the participant being surprised by associations that particular words, a series of words or visual stimuli call to mind; this can sometimes lead them to contemplate the personal or unconscious significance of what they said. Nevertheless, such activity is a much more ‘primitive means’ of tapping into what is unconscious (Jung 1968) and a long way from the sort of exploration one commits to long-term when undergoing psychoanalysis.

Free association and FANIM

Hollway and Jefferson’s work (Holloway 2000, 2013) positions free association as being central to FANIM’s approach to interviews. However, it is also peculiarly under-explained by them. FANIM’s title communicates the central role the concept affords it, as do statements Hollway and Jefferson made when describing it. For instance, discussing a research project that makes use of FANIM, Hollway (2007) rather peremptorily refers to the interviews as, ‘as their name suggests, based on the psychoanalytic principle of free association’ and seeking ‘to go beyond the intentional narratives that are in danger of only revealing what interviewees consciously wish to know or show about themselves’.

The most comprehensive account Hollway and Jefferson provide of their method, Hollway and Jefferson (2000, 2013), construes free association in the same way clinical psychoanalysis does, broadly speaking, in terms of the nature of a specific type of discourse and how this discourse is elicited and understood. A participant-centred approach to interviewing is advocated. Open, experience-focused questions are encouraged to prompt responses that go beyond factual, predictable answers and involve storytelling and accounts that may be thought of as ‘free associative’ in nature. For example, in research into fear of crime through which Hollway and Jefferson developed the method, this work involved not assuming participants were victimised and leaving scope for other pathways to be taken. They used prompts such as ‘Tell me about your experiences of fear’ or ‘Tell me about a time that you were fearful’ rather than prompts like ‘What do you most fear?’ (Hollway and Jefferson 2000, 2013).

With the interview approach, interviewers also refrain from imposing a structure on a participant’s responses. When they speak, they follow the participant’s ‘meaning frame’, ‘remaining faithful to the order and wording in which they presented their associations’. As Hollway and Jefferson characterised it, there is a parallel between the principle of a gestalt and free association in that, in clinical psychoanalysis, ‘the associations follow pathways defined by emotional motivations, rather than rational intentions’. Free association is about more than just the words of what is being said but the connections between the different aspects of a narrative account and the ‘minute particulars’ of communication (Hobson 1985). Where free association and the principle of a gestalt diverge is, they noted, in the pursuit in psychoanalytic therapy of a type of narrative that is structured ‘according to unconscious logic’ rather than the fashioning of a coherent and understandable perspective. The idea of free association compels researchers to attend to things that may seem, on first impression, insignificant. They should give due attention to the ‘incoherences’ in participants’ accounts, for example, contradiction, digressions, avoidances, and elisions.

Specifying the version of free association in FANIM

Hollway and Jefferson’s linking of free association to a receptivity to the narrative ordering and ‘emotional logic’ or ‘unconscious logic’ of what someone says may seem unremarkable to psychoanalysts, who are invariably convinced of the need to attend (as best one can) to the totality of what is communicated and expressed in dialogue. Yet it can be viewed as adding something to qualitative research (Midgley 2006). Psychoanalysis is a process of looking beyond what is manifest in what the patient says, and Hollway and Jefferson’s stance contrasts how qualitative data is often approached in applied social science and healthcare research simply based on interviewees’ consciously intended meanings. It can be considered an appreciation of the need to avoid taking statements out of context in the coding and analysis of interview material as well as an appreciation of the intersubjective complexity of the encounter between the interviewer and the interviewee.

A view similar to Hollway and Jefferson’s regarding the inspiration drawn from free association for qualitative interviews also finds form elsewhere. Other researchers have appealed to a similar notion of associative processes in interviews, in a manner comparable to theirs; some cite Hollway and Jefferson’s work directly, although they provide less theoretical detail about the concept.

For example, Clarke (2006) reported on a research project involving FANIM-informed life-history interviews. Clarke referred to free association as being ‘central’ to the enquiry, stating that ‘by allowing the participant to structure and guide the interview, we are able to gain insight into the unconscious motivations, forces and anxieties behind the construction of social identity’.

Other researchers describe participants responding to interview questions in a ‘free associative way’ (Roper 2003). They also connect a psychotherapeutic sensibility or psychodynamically inflected approach to researcher reflexivity and the use of ‘associative’ lines of thinking – that is, of giving time to contemplate connections in research material that are not immediately or straightforwardly apparent (Sherwood 1980, Jones 1998, 2003, Meek 2003, Froggett and Chamberlayne 2004, Haaken 2008, Jervis 2011, Skoll 2012, Ainslie 2013, Stein 2017).

Alongside these contributions, parallels can be acknowledged between Hollway and Jefferson’s version of free association and the Kleinian ‘diagnostic’ understanding of the concept in psychoanalysis – the latter emphasises the content of patients’ communications and the phantasy that lies beneath them as compared with free association as a means of self-observation (Archard 2020a).

Problematising the applicability of free association to the qualitative research interview

Despite the similarity with other researchers’ work and the Kleinian understanding of free association, Hollway and Jefferson’s version of free association is, nonetheless - as they themselves characterise it (Hollway and Jefferson 2008), a ‘borrowing’ of the concept. Criticisms can be levelled at the way they use it, notably, that they do not clearly specify the links between their version and psychoanalysis’s version. Arguably, it is also peculiar that they invoke the concept in the way they do, as free association is viewed as marginalised in the Kleinian/post-Kleinian tradition of psychoanalysis (Spacal 1990). This would call for circumspection about the self-evident nature of the connection between free association and the interview gestalt, and it is potentially a tenuous link to unite all the phenomena they do under the term.

The differences between the contexts of the research interview and the consulting room should also be given more careful consideration – not least in terms of how the patient’s awareness of the expectation to give voice to whatever comes to mind means their associations are likely to be ‘purer’ and not concentrated on a preconceived topic or area of interest. This line of critique is represented in brief comments McAndrew and Warne made when reporting on a FANIM-based study (McAndrew and Warne 2010). They noted how ‘the feasibility of using free association in the research setting’ is ‘open to criticism’ from a clinical perspective. They argued FANIM has strengths in terms of the opportunities it provides to engage more fully with participants’ narratives as products of their psychosocial worlds. With this, ‘using free association and challenging the unspoken rules of conventional narrative offers participants a platform to freely express unconscious logic’ through which the researcher can ‘pick up on contradictions, avoidance, and incongruities between latent and manifest communication’. However, as they see it, these strengths do not depend on the application of free association but rather relate with the analytic and interpersonal skills of the researcher.

This perspective on free association and FANIM may be reassuring to the researcher enthused about the method. McAndrew and Warne do not disregard the method, but they do question how exactly it is being articulated via a capacious definition of free association that some researchers may be concerned is misconstrued in FANIM anyway. The comments are brief and only resolve so much in the differences between the research interview and clinical articulations of free association. The framework for FANIM would be less vulnerable to critique if links were made more explicitly with the Kleinian/post-Kleinian re-elaboration of the concept. McAndrew and Warne’s comments can equally be criticised for constructing the concept narrowly as a clinical technique.

Interestingly, McAndrew and Warne did not acknowledge that a response McAndrew received regarding the study’s methodology likely influenced their circumspection regarding the concept of free association in FANIM. McAndrew (2008) wrote in her thesis that she came to think of participants’ narratives as ‘quasi free association’, after she submitted a manuscript to ‘an eminent journal for those working in the psychoanalytic field’. Both the manuscript’s reviewers ‘commented on using the “free association” method, questioning the validity of this in the context of research’. Their concerns centred ‘on how a person could freely associate when the research was determined by a specific agenda’.

This is useful to know as it highlights that applications of different psychoanalytic concepts are shaped by various influences. These include not just researchers’ appraisal of clinical and research literature, but also their socialisation into ways of undertaking and writing about research.

Implications for researchers

This article explores the framing of the psychoanalytic concept of free association in the context of qualitative research interviewing. It focuses specifically on Holloway and Jefferson (2000, 2013), through which they developed FANIM. The article addresses what free association is, Hollway and Jefferson’s work regarding FAMIM, parallels between their and other researchers’ framing of free association, and criticism of the way free association features in FANIM (McAndrew 2008, McAndrew and Warne 2010).

With this focus, other perspectives of free association and the qualitative research interview, such as those of Cartwright (2004) and Holmes (2013) have not been considered. Different questions relating to the issue of applying free association in the research context, such as the extent to which a prospective research participant may view an interview as being akin to a psychotherapeutic engagement, have also not been covered (Archard and O’Reilly 2022a).

This exploration establishes that it is not unusual for researchers to use the language of free association when referring to a participant-led or more loosely structured research interview, or when ‘reading’ participants’ accounts by considering ‘meanings inherent in the links, rather than the meanings contained within statements’ (Hollway and Jefferson 2000, 2013). As there are different interpretations of free association in clinical psychoanalysis, there are also different interpretations vis-à-vis the research interview.

Researchers need to reflect on the differences between the contexts of research, clinical psychoanalysis and other psychotherapeutic practices. They should avoid makeshift integrations that add little beyond a conceptual gloss to the actual practice or theorisation of the research. Researchers should also consider why they are drawing on this terminology and whether it adds value for a specific research enquiry.

Conclusion

In considering the relationship between psychoanalysis, psychoanalytically oriented therapy and qualitative research interviewing, changes to the concept of free association can be evaluated as it is applied in research. Hollway and Jefferson’s influential work on FANIM as a psychoanalytically informed approach to research (Hollway and Jefferson 2000, 2013) positions free association as central to their method. This application of the concept is consistent with the way other researchers have used it and its conceptualisation in the Kleinian tradition of psychoanalysis. However, researchers should take care not to rely too heavily on the concept – the free association of the patient in the consulting room is not the same as the participant’s discourse in the research interview.

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