#[p255] Appendix C. On Reflection.
The article reproduced below makes fleeting reference to a "reflective methodology". This was my earlier attempt to encapsulate the emerging "messy method", explained in more detail in chapters 6 and 11.
As I explain elsewhere, the main purposes of including the paper here are to complete my account of the by-ways of the project (this one being rather more productive than others); and to further illustrate my concerns with frankness, in this instance about practice related issues (see the discussion in chapter 7). The arguments over the nature of reflection and knowledge outlined below are not, however, offered as arguments of the thesis. I also do not provide an additional summary beyond that contained in the original article.
On Reflection: one psychologist's explorations around an episode of reflecting (Mellor 1998a: Educational Psychology in Practice, 14(3) p.167-175).
This article offers a model for reflection on practice, not a model of practice. A detailed example is drawn from a recent project involving reflective research into one psychologist's involvements with children exhibiting emotional and behavioural difficulties. Comments on the process of reflecting, lines of further research and a "short form" for reflection are outlined. Finally, the challenge of reflection for day to day work is highlighted.
#[p256] Over many years I have had an interest in children who display emotional and behavioural difficulties. Intervention via parents always appeared to me to be the most useful strategy in tackling such problems. Maintaining this type of casework has been difficult, however, with changes in legislation, rising requests for formal assessments of special educational needs (Gregory, 1993) and growing demand as other support services to schools have reduced (Bennathan, 1994).
I became curious about this family-based work, which I had learnt in an apprentice-like way from a very experienced colleague (see Beaver, 1996 for an outline of the method), and decided to research it using a reflective methodology (Mellor, 1996). Increasingly throughout the project I became aware of weaknesses in my approach, particularly in my direct work with the children in these cases. The example below focuses on this aspect.
It would be possible to reflect on confident, successful interventions. My belief is, however, that candid (and sometimes painful) exploration of less positive episodes offers the most potential for personal development. In any case, the aim of this paper is not to illustrate good practice but to provide an exemplar for reflection. The transcript of diary notes (see below) which makes up the bulk of the article departs from the normal style of academic writing. This is deliberate. These were my immediate thoughts as I struggled with my uncertainties and failings. In addition the transcript is more or less complete. This is not indulgence, but an attempt to provide an adequate specimen for those who wish to try their hands. We all reflect, could we reflect more deeply?
One special influence on the development of the research was the writing of Schön (Schön, 1983, 1987) and his accounts of the "reflective practitioner" and the concept of "reflection-in-action". These topics are addressed in Mellor (1996). However, of more relevance to the current paper, Schönís writing raised for me the simple question : "What is reflection?".
#[p257] Attempts to describe reflection have a history stretching back to ancient Greece (Maranhao, 1991). Knowles (1993), in consolidating many definitions, asserts that:
...reflection is an intra-personal process...through which personal and professional knowing can occur... Reflection is seen as a process and method of informing practice with reason... Reflection is not seen as being static; implicit in its meaning is action...It is seen as a vehicle for promoting changed behaviours and practices... and a means of improving foresight...lessening the chances of taking inappropriate lines of action. (p. 83, emphasis in original)
A wide range of issues need to be considered in developing a framework to understand fully the process of reflection. Annexe1 includes many of the relevant aspects (and the list is by no means exhaustive). Any attempt to draw all these together would be a mammoth undertaking but could open up a field for further research. I will concentrate here, however, simply on the basic practicalities of reflection -how to do it - and offer one model I found useful. This can both inform ongoing work and help change future practice and could, with great care, be built into supervision and support processes. It could also provide the opportunity to go beyond specific casework to a systems level and to examine different modes of intervention.
As a word of caution, it is not clear that the exercise of reflection is guaranteed to promote better practice: as Hammersley points out "Might not reflection on our activities sometimes result in incapacity rather than improvement?" (Hammersley, 1992 p.154). In my case, the starting point of the research referred to above was a simple curiosity about a way of working that I had acquired, rather than any desire to "improve" as such. However, early reading starkly highlighted the rut I had fallen into and triggered a desire to change. Schön captures this well:
A structure for reflection
In exploring practice and the uncertainties surrounding it, Holly (1989) strongly recommends the keeping of a reflective diary. Initially my reflections were unstructured and brief: a few minutes in the car recording whatever struck me as interesting about an interview before returning to the office. These were extra to the normal case notes. Then I began to follow themes, for example how I had worked with the pupil, or to focus on "critical incidents" (Tripp, 1993). Soon, however, I began to look for a way to reach a greater depth of analysis. There appeared to be few articles referring to structures for reflection in the educational psychology literature (e.g. Filtness and Hobbs, 1990) but eventually I adopted the framework described by Palmer et al (1994) based on Carper (1978). This was chosen on practical grounds as it appeared to provide a comprehensive set of specific questions and a clear breakdown of areas, rather than general "topics to reflect on". In addition, the questions seemed challenging in that they were somewhat beyond the routine.
Palmer's model seemed to need some adaptations, however, for my particular circumstances. I added extra sections such as celebration (as reflection can be a rather negative experience I placed this near the beginning to maintain motivation), pre-planning or "preflection" (an area I knew was a particular weakness for me), and a consideration of other ways of reflecting to keep the overall inquiry moving. The items were also re-phrased to be more relevant to an educational setting. As the structure can be somewhat daunting at first sight, a "short form" is offered later (see annexe 2).
An outline of reflection (after Palmer et al, 1994)
What planning did I undertake/ could I have undertaken before the event? Plus other more general musings : "what if ...", "how do I feel" etc.
What pleases me about this event?
- The actual experience itself.
- What factors brought it about.
- Significant people in the background.
- Key processes to reflect about.
- What was I trying to achieve?
- Why did I intervene as I did?
- What were the feelings about, and the consequences of, my actions for all parties involved? owHow hHHHHmmmmm fdbbbBHow do I know this?
- What internal factors influenced me? (e.g. intuition, previous experience of similar cases, feelings of enthusiasm, anger etc.)
- What external factors influenced me? (e.g. professional rules, work deadlines, formal procedures etc.).
- What sources of knowledge did influence/should have influenced me?
Could I have dealt differently with the situation?
What other choices did I have and what would be the consequences of those choices? (choices may involve e.g. how I see the problem and take action, and how I see my role).
- How do I now feel about the experience?
- How does this experience relate to past experiences?
- How will this experience influence future practice?
- What broader issues arise from this experience? (ethical, social, political)
- How has this experience changed my understanding of my ways of knowing?
Ethical - knowledge of ethical and moral issues.
Empirics - "scientific" knowledge, drawn from observation and measuremen
#[p260] Aesthetics - the art of professional practice. This involves intuitive knowledge and appreciation of "a sense of form" (Carper, 1978 p.18) and is concerned with producing " a harmonious and pleasing whole" (Jacobs-Kramer and Chinn, 1988 p. 137).
Are there any different forms of reflection I could carry out?
To keep the reflective stance fresh, are there additional/ more useful ways to reflect?
Neil Atkins, age 13, was on roll at a middle school in a pleasant suburb. A review meeting in April revealed that he had not attended school since February. He seemed a bright, sensitive lad, possibly indulged at home (from other information). His mother, Mrs Atkins, had a new partner, Mr Watson. Neil had recently begun to see his natural father, Mr Atkins, again after a long break.
Neil had been bullied, but only outside school. He was brought to a review meeting in school, then I saw him briefly at home. These are the reflections on my first long interview with Neil carried out later in school. This event was chosen to illustrate the process of reflection because of my concern over weakness in this area of practice. Possibly through habit, I had tended to make my main focus working with parents in such cases, rather than with the children. My interviews with the children seemed, in contrast, relatively unfruitful. I hoped by reflection to address these problems openly. I wanted to be honest with myself.
The text is simply notes from the diary with one or two explanations added in square brackets, and some comments inappropriate for publication, grammar and other obvious errors cleaned up. I trust readers will be able to glean from the account something of what I was attempting to do. The purpose of the paper, however, is to focus not on how I acted, but on how I reflected. The practice was relatively poor, the reflection I hope was not.
#[p261] Transcript of reflective diary notes 21.5.96
Although I did, rather unusually, carry out some planning beforehand, my plan was not clearly worked out. I recall wanting to "develop a relationship" with Neil and for instance to find out his attitudes to his father and Mr. Watson and his attitude to attention seeking [which from other information Neil seemed to display] using the "About Me" game, "junk sculpt" and "Alanís story" [a vignette to encourage discussion].
I did not have a clear idea of the use of the interview itself as a return to school strategy at that point, although I "wanted to have the interview in school to keep the link with school" in a very vague way. I now think the various "investigations" such as the junk sculpt and About Me game etc. were just "positive activities" to keep him "happy in the school setting" and also to boost his self-esteem a bit.
I was very positive towards Neil during this session. I kept the session moving and I had plenty for him "to do". I did not talk in the "failure zone" about getting him back to school or dealing with the bullies. I also came up with a strategy.
- The actual experience: The education welfare officer (EWO) brought Neil and Mrs Atkins to school for 2.30 appointment. I talked to Neil alone in the deputy headís room, mother was downstairs in the foyer (why leave her out at this point?).
- What factors brought it about: My last attempt at an interview in school was a failure when I wanted Mrs Atkins to bring him and he refused to come, therefore I arranged this with the EWO. This follows on from the very first meeting with mother, Neil, EWO and head teacher, which had been in school and Neil had attended (although he said little). It also follows a second meeting at home where Neil was quite cheerful until he clammed up when I started talking to him about return to school. Thus I thought of building on "success" and having this appointment in school where he seemed happy to come and see me.
- Significant people in the background: Teacher, siblings, mother, her new partner, grandfather, bullies, EWO, natural father. Note: Looking at the whole ecology of the intervention, Mrs Atkins could change this radically simply by moving house as she said she might. Also considering my influence in this ecology - if I see him out of school does that reinforce him being out of school and could I use the spin-off of our interview to keep him in school for at least a period?
#[p262] - Key process to reflect upon: How important is it to try to "discover information" about Neil by interviews and questionnaires etc. These, from experience, donít actually lead to discovering the "magic key" to solve his problem or even a clear "diagnosis" to be able to tell other people "what the problem is". Associated with this is the ethical issue of the use of interview techniques as "rewards" rather than for information gathering [see below].
What was I trying to achieve?
I wasnít clear initially. There was a confusion of ideas about finding his attitudes to his natural father and Mr. Watson which might "explain it all", his attitude towards attention seeking and any changes of behaviour from last time (I had tried some brief therapy ideas of getting him to notice changes etc.) I wanted Neil to "develop a trusting relationship" with me. I also wanted school to be a "comfortable" event for him.
Why interview as I did?
I felt that working individually with Neil would "unearth information" and that our conversation would "create a bond" and create a comfy time in school. Basically, however, I didnít have a very clear plan.
What were the consequences and feelings for all parties?
- Neil: He obviously felt happy, he smiled and chatted and didnít clam up or appear on the verge of tears as he had in the past. I believe that as a consequence he had a positive experience in school and is more than likely to want to repeat this.
- Mrs Atkins: She was probably bored and I even forgot to thank her for her important role in accompanying him that afternoon.
- The EWO: was probably happy that I saved him a return journey as I offered to take Neil home. He remains involved (he brought homework for Neil and also used his car to bring the family). However, I am sure he does not feel "responsible" now having referred the case to me and so far, I am not sharing the problem with him as much as I could.
- School staff: They will probably retain ownership of Neil as they are seeing him on the premises but continue to see me as solving the problem. I need to talk to them a bit more about what I am trying to do, to maintain their commitment.
- Me: I clarified my strategy, which is this plan of getting him into school ostensibly to "see me" [this initially felt slightly "devious" but colleagues later referred me to not too dissimilar suggestions in Blagg (1987)]. This made me feel positive as at least I had an idea and the consequences are I am likely to carry on with this at least for a while. My feeling during the session was I was pleased I was active and doing something, but unsure exactly of what I was doing. This #[p263] wasnít counselling really and I was going through the motions of something else i.e. "finding out about him" in order to reinforce his attendance.
- Internal : I felt relatively helpless and unsure how to proceed and what I wanted to get out of what I was doing. From previous examples of such work I felt unsuccessful with children in this situation: fairly intelligent, apparently sensitive adolescents [although cases had often worked out]. I also felt compelled to "do something", thinking the longer he is out of school the worse it will get.
- External influences: School staff and Neilís mother obviously were looking for "a solution" and looking to me for this.
- Sources of knowledge: I could have discussed this with colleagues and read up a bit more (I did skim a book on brief therapy).
Could I have dealt differently with the situation?
- I could have referred to Child and Family Therapy. This would have been "off my plate" but I would have continued to feel inadequate with such cases. In addition they may try to work "in the clinic" which I am not sure would be successful.
- Leave it to everybody else to sort out and act as "consultant".This has some attractions in that it gets me off the hook but I wasnít sure that this would be very successful in this case and, anyway, nobody seemed to be coming up with much in the way of ideas and I hadnít got time to set up endless meetings to think about it (with the fear that nothing would come out of them).
- Hypnosis. I have had some success with this in the past but Neil refused this and I didnít feel I should press the case.
- I could try "counselling " with Neil about his problems. I didnít give this a chance this time. During the session I actually felt I was rushing to get through it and moving on from activity to activity which tends to somewhat inhibit the counselling mode. I was also concerned that if I wanted to do any long-term counselling, as usual there wouldnít be enough time.
- I could set up a gradual "de-sensitisation" programme of just gradually returning him to school but he initially rejected the idea of a return to school. At this point my thinking did not include the plan I eventually came up with [of his seeing me in school].
How do I now feel about the situation?
#[p264] I feel okay. The course of action "intervention in school" looks very useful as it gets him into school and also I "get to know him a bit" so I have something to "put in my report".
How does this experience relate to past experiences?
In the past when a situation like that has arisen I have tended to just work with the parents to look at their behavioural strategies and have had some success with that, but this feels safer as I am not just counting on the parents. I also think I am "doing something" directly with the child (which may or may not be helpful) i.e. building up skills in this area which tend to go by the board.
How will this influence future practice?
I think I will try more clearly this idea of "intervention in school" as a tactic to get the child in and to be aware of my possible unwitting reinforcing role of seeing the child in a situation other than at school. I will also try to ensure regular visits to school to see the child with mother, teacher and the education welfare officer also involved in planning these and put them in my appointments diary to ensure they happen. My plan will be somehow to "let them take over" although I am not quite clear how.
What broader issues arise from this experience?
- Ethical: It feels better to "engage" with the child rather than have the usual quick one-off conversation, but am I being deceitful by deliberately organising this at school and using "therapy" and "interview" as a "reward" i.e. a fun time to encourage him to be at school.
- Social: I found I seemed to get to know Neil better than other children by these interviews [my previous contact with pupils in similar situations had been somewhat cursory as I rushed through casework]. I also found I quite got to like him so there was a positive spin off for me in relationships.
- Political: It occurred to me I can exert "power" to get people (adults at least, e.g. EWO, teacher, Mrs Atkins) to do things. I hadnít thought of my self as having "power" in that way and that is an interesting aspect of the situation . However I wonder if this power confers on me the responsibility to "make it work" in some way. I wonder what happens "if it fails", particularly if it fails on a number of occasions with different children, do I then lose the "power" to influence the teacher and EWO to carry out my suggestions?
How has this experience changed my understanding of my ways of knowing?
- Personal: I was pleased I was able to capitalise on a chance happening (noting that Neil came to school and was quite positive there in some settings, i.e. at the initial review meeting). Thus although I donít always think ahead clearly I was pleased that I was able to spot opportunities as they arose with the promise to myself, "Iíll get it right next time". Although it wasnít particularly hard to do I did spot his more positive attitude when we were talking about general matters compared to his being close to tears and clamming up previously when we discussed school and bullies. I also "felt instinctively" that a session in school #[p265] would be acceptable although initially I had no clear plan of what all this was meant to achieve.
- Ethical: I wonder if it is right to use one reasonably ethical procedure (counselling, playing counselling games, working on life story etc.) for another equally but different ethical goal (getting him into school). Does the end justify the means?
- Empirics: I had a vague idea that the longer you are out of school the harder it is to return and that "school phobia" should be treated best by a speedy return (whether Neil is "school phobic" is doubtful). Unfortunately I was unsure how to bring about such a speedy return. In fact this case had very little empirical knowledge other than talks with Neil, teachers and mother and I was working merely on hunches, impressions and luck.
- Aesthetics: This felt like a good juggling act of building on chance, thinking and intuition, so I felt reasonably professional in the sense of being "creative". However, the work was unbalanced in having lack of foresight, consideration of options and clear ideas of procedures from the literature and from similar cases i.e. it was not aesthetically pleasing. In one sense it seemed "unprofessional" (if we take professional to mean carefully planned), although it was close to Schönís account of how professionals actually "think in action" [i.e. having the ability to decide on limited information]. On the positive side also, I was not working as "rigidly and unimaginatively" as I have in the past (I have been used to simply dealing with the parents mainly, taking a behavioural approach to their management in such cases, with very little else in place).
What might I be missing in this reflection?
Am I missing the basics? For instance what about just checking out whether Neilís family are in fact moving house as this could avoid all my work, particularly if Neil is moving school as well.
What about some action against the source of the problems, i.e. the bullies? I hadnít thought of that and wasnít sure what to do.
Is there possibly another explanation for his being off school? I am tackling the parental management aspect as well but what about something like "separation anxiety" (although I donít feel it applies) i.e. I am not examining a variety of hypotheses but tending to go along with my first idea.
Are there any different forms of reflection I could carry out?
What about spreading reflection out over a few days, "to get a perspective" on the issue and bring new thinking to bear? (I did do this in this case and it seems as productive as doing the reflection all on the same day). How about some "collaborative reflection" with colleagues? [This was later arranged, quite productively. In most cases, reflective episodes led to only fairly minor changes in the process as I reflected on reflection].
I am not proud of the "faltering reality" (Byng-Hall, 1988) of the casework in this example. How I arrived at this state of affairs, the blind spots in planning and reading and gaps in training; the habits in procedures; the hypotheses and techniques unexplored; the demands of formal assessment and limited time for supervision are all quite legitimate questions. I was, for instance, later reminded of relevant literature on non-attendance, some of which may have, even unconsciously, partly influenced my thinking at the time.
It would be easy to claim work pressure as an excuse "As [professionals] are confronted with waiting clients, loaded in-trays and calls for efficiency gains, plans get 'cobbled together' in a hurry, decisions are made 'on the hoof' " ( Eraut, 1994 p.149). Perhaps a careful reading of Blagg (1987) could have saved me a great deal of anxiety at this point in the case (although matters quickly became more complicated in one sense when Mrs Atkins re-married a few weeks later, moved house and Neil transferred to a school out of my patch).
I could have provided shining examples of previous successful casework in this area (which unfortunately generated little reflection). However, my purpose here is not to engage colleagues in a discussion of professionalism or to explore ways to deal with non attendance, but to demonstrate one model of reflecting openly on such practice, warts and all.
The types of knowledge we draw on in psychological work would seem to be a topic ripe for research (see also Thomas, 1992). As Eraut points out "new knowledge is created also by professionals in practice, though this is often of a different kind from that created by researchers" (p.54). I have no particular commitment to the structure of knowledge employed here which is taken from a different discipline (see comments in Jacobs-Kramer and Chinn, 1988 and Meleis, 1991 and discussions of forms of knowledge in Reid, 1983; Hoyle and John, 1995 and Meerabeau, 1995). The framework, however, pointed up some unexpected findings over a number of cases during the project. I was, for #[p267] instance, surprised to find regular concern over ethical issues - I thought these would be very rare. Celebration seemed a vital component in maintaining the reflective process as throughout I tried, by being very honest with myself, to ward off the "minimisation, denial and delusion which threatens all forms of self-reflection" (Tripp 1993 p.150). My interventions also seemed to rely very little on "scientific" knowledge and more on intuition/ tacit knowledge (Polanyi, 1958; Schön, 1983).
Keeney (1983) proposes in writing about "The Aesthetics of Change" that "A therapist can be described as either an artist or craftsman (sic)" (p.191). The concept of aesthetic knowledge was the most difficult for me to understand in this study, and the one I felt least commitment to, apart from the intuitive aspects which appeared constantly. As Janaway (1995) points out "aesthetics is a rich and challenging part of philosophy, marked by a high level of disagreement even about what its basic problems are" (p.13). Further research is required to clarify the relevance of aesthetics to the work of educational psychologists. Simply in terms of being aesthetically pleasing, however defined, most of my interventions were not. But they worked (sometimes).
During this investigation, I thought I could readily justify the time spent in reflection. However, even when familiar with the structure, the process took over half an hour. As a "short form", to get into the way of reflecting, I would suggest colleagues focus on the outline in Annexe 2.
My belief is that reflection is of intrinsic value and should not require the spur of a research project to take it to greater depth. However, while I was able to maintain a constant flow of reflections during the course of the research into practice (I could manage one or two episodes per week in what was probably a special effort, one or two a month may be more realistic), since moving on to the next phase, reflection, at least in the depth illustrated, has all but ceased. I can make excuses for this such as chronic staff shortages coinciding with the end of this period, but to be of real benefit, regular reflection in detail needs to become an accepted and valued part of the everyday job, with appropriate emphasis and support both emotional and in terms of time. Without this it is in danger of being lost under the pressure of casework.
#[p268] Reflections can be kept private. Sharing seems, however, to add a powerful dimension. Recognition of the merit of reflection and sensitive handling by all staff would appear essential to facilitate this. Both those reflecting and those providing an audience should be aware of the barriers to frank self examination. A judgmental stance or an emphasis on the errors and oversights in the case handling are likely to create a climate of "cover up" rather than exploration. The giant hurdle to overcome is creating the conditions for honesty. Day (1993) calls for encouragement from those with "the practice of reflecting upon their own practice" (p.88): a culture of sharing and openness is vital. Reflection as part of a one-way, critical appraisal system is likely to fail. We can all perhaps relate to this student's comments:
I would like to thank in particular members of my local EP research network for critical comments and emotional support in writing this paper and also the journal's editorial board and referees for suggestions arising from earlier drafts.
Annexe 1 : Facets of reflection
-Basic assumptions (e.g. that reflection leads to better action) (Knowles, 1993; Hammersley, 1992).
#[p269] -Moral and ethical questions (Knowles, 1993; Altrichter et al, 1993; Sockett, 1989).
-The timing of reflection (Brubacher et al, 1994; Hadfield and Hayes, 1993).
-Helpful and non-helpful conditions (Brubacher et al, 1994; Calderhead and Gates, 1993; Elliott, 1991).
-Personal qualities needed (Dewey, 1933; Pollard and Tann 1993).
-The issue of collaborative or solitary work (Oja and Smulyan 1989; Carr and Kemmis, 1986).
-Phases of reflection and the novice-expert distinction (Benner, 1984; Tann, 1993).
-The role of emotions (Boud et al, 1985; Tann, 1993).
-The relationship between reflection and thinking, and processes such as intuition and incubation (LaBoskey, 1993; Kroath, 1989).
-The influence of the act of writing (in addition to other methods) in promoting reflection (Altrichter et al, 1993; Holly 1989).
-Levels of reflection : from awareness of thoughts and feelings to challenging one's underlying assumptions (Mezirow, 1981; Goodman, 1984; Atkins and Murphy 1993)
-The end point of reflection (Schon, 1983; LaBoskey, 1993).
-Analysis of reflection (Winter, 1989; Hart, 1995).
-The impact of reflection on institutions and individuals (Schon, 1983; Leat 1995).
Annexe 2 : A suggested short form for reflection ( Note: colleagues may wish to experiment with different models).
- Celebration. This probably needs to come near the beginning of the process to encourage the candid tackling of painful topics.
#[p270] - What was I trying to achieve? This can facilitate both an examination of initial ideas and the way in which reflection during action influences the course of the intervention.
- Influencing factors. Internal and external factors and sources of knowledge, as outlined earlier.
- Could I have dealt differently with the situation? A consideration of the range of options available and their likely consequences.
Notes (added after publication of the article).
 A number of authors consider the position of knowledge, particularly with regard to practitioner research. Carr and Kemmis (1986) and Somekh (1995) for instance consider Aristotleís views; Somekh also summarises Elliottís position, drawing on Gadamer and Polanyi.
I later came across Belenky et al (1986) on womenís ways of knowing (silence plus received, subjective, procedural and constructed knowledges) and articles further up-dating Carperís original position. Silva et al (1995), for instance, note the confusion between a process of coming to know and an end product of knowledge; the implied mutual exclusivity of Carperís four ways of knowing; and the way in which other authors have tended to take these four as exhaustive and to include in them issues of being as well as knowing.
My own concern centres on the position of Polanyiís (1958) personal
knowledge. He uses this term for tacit knowledge, not in the way Carper
uses the term to refer to knowledge of the self. I initially followed Carper
and included this tacit knowledge with other "intuitive" knowledge under
her heading aesthetics (see also Leddy and Pepper 1989 who follow a similar
path). Increasingly it seemed to "bulge out" and need a section all to
itself. I will not pursue this topic of the most appropriate breakdown
of knowledge, however, important though it is, as my interests developed
elsewhere. I trust epistemologically minded colleagues will take up this
aspect, but in the field of psychology practice, rather than Carperís field
of nursing (see for example Bolton 1990 for a brief consideration of psychologistsí
to return to the contents page.