Self-care in User Research

We were honoured to be asked to be part of User Research Explained- a charity collection of essays for the Covid-19 charity ‘Doctors without Borders’. This is our contribution.

Introduction

Exposure to the trauma of others is toxic .

The term for this harmful effect is known as ‘vicarious trauma’ and it’s what happens to those who hear harrowing stories as part of their work. They’re exposed to the pain, fear and stress that survivors have endured.

There are different fields of work where such harmful effects can be experienced. In this essay, we explore the growing area of User Research and the support those researching areas that involve forms of trauma received. We explore this through Jane’s story. We then compare this support to that received by Janice, working as a psychodynamic therapist. This will provide a comparison of the support provided in each field and indicate the transfer of learning needed from one to another.

Traumatic situations — User Research

User research is a complex and highly skilled discipline, one which can take many years of the appropriate training, coaching, mentoring and experience to master. That amounts to a lot of hours spent hearing other people’s stories.

Moreover, because user researchers are part of a process attempting to improve people’s lives, they’re often highly empathetic people.

User researchers are often faced with situations where they need to conduct repeated, in-depth interviews with people who have had traumatic experiences. These experiences can include:

• homelessness
• poverty
• bereavement
• female genital mutilation (FGM)
• childhood sexual abuse
• rape or sexual assault
• domestic abuse
• trafficking and human slavery
• asylum
• conflict and war

As a result of trauma, people can develop problems like post-traumatic stress disorder (PTSD), mental health issues, chronic illnesses, drug and alcohol addiction, self-harm, eating disorders and suicidal thoughts. They may then discuss these as part of user research sessions.

Vicarious trauma

The vicarious trauma user researchers can suffer is sometimes conflated with ‘burnout’. However, it is different and it does present its own distinct issues.

The physical, behavioural and psychological signs for researchers can include:

• flashbacks
• nightmares
• depression
• emotional exhaustion
• insomnia
• suicidal thoughts
• heart palpitations
• increased use of alcohol or drugs
• anger and irritability at home and/or work
• avoiding colleagues and staff gatherings
• feeling helpless when hearing a difficult client story
• imposter syndrome

However, despite being very much at risk of vicarious trauma, they often don’t have the skills to protect their own psychological safety. This can result in user researchers feeling they have no option but to leave the profession they love.

It’s not just user researchers. As user research is best done as a team sport, colleagues from other disciplines are encouraged to get involved by observing and taking notes. This therefore exposes others to ‘vicarious trauma’.

Let’s now explore this through the stories of two researchers, Jane and Janice. They describe how, without the proper skills, training and support, their own psychological wellbeing was affected. They then describe the strategies they developed to help minimise the problems they had faced and new practices they built into their User Research methodologies.

Jane’s story

Background

I have been conducting user research in the public sector for many years, mostly in an agile environment and with people from disadvantaged backgrounds and who were often experiencing multiple problems e.g. drugs and alcohol addiction, homelessness, domestic abuse, poverty, criminality and inter-generational unemployment. Before moving into this role, I had received excellent training as a front-line worker in the public sector, which taught me how to be empathic and also the importance of not crossing organisational boundaries in a bid to go the extra mile for someone.

I cannot say that I always stuck to the advice I was provided, but any line I did cross was an internal one — finding a way around rules that might have pushed someone even further down a black hole that they were struggling to get out of. The people I was helping were never aware of me doing this, as that would have been crossing a boundary and they may have interpreted this as me being their friend and thought that I could do it again. I was fortunate to have received excellent training at the Department for Work and Pensions in the UK, (DWP), that ranged from diversity and inclusion to personal safety, the latter I vividly remember; insights into the local area we were operating in provided by community police officers for when conducting home visits and carrying out outreach sessions in the local community, areas to never visit alone and self-defence techniques.

Whilst I don’t, however, recall receiving any training on how to maintain my psychological safety per se, I believe that the training I received on how to handle difficult situations, interviews and on not crossing organisational boundaries has without doubt played a huge part in me not experiencing burnout or vicarious trauma as result of hearing traumatic stories at my work on an almost daily basis.

Through experience, I have built up my own set of techniques that help me avoid situations that could put me at risk, some of which include having phrases at the ready, that will politely get me out of potentially serious situations if I feel I might be in harm’s way — preparation was key to this, whether I was interviewing someone on the phone, face to face in a local social security office or in someone’s home. I have personally experienced trauma and with help from my friend, and now business partner, Janice I have learned a lot of good techniques to help me cope with this.

In addition, I have also brought two other things from my pre-user research days which stand out as being helpful to me that I have carried with me into my career as a user researcher- I was taught good interviewing techniques and also how to handle difficult situations that could arise during interviews. Those supervising me thought that it was significant enough for me to be confident in these areas as they did not allow me to conduct an interview until I was considered ‘ready’. I myself had to feel ready too. I insist that interviewing technique is something people must continue to practice, whether as supervisor or researcher.

It’s easy to skim over this or to get a bit rusty.

Current assumptions made in User Research training

Why am I telling you all this? It is because any user researcher training that I have been involved in, be it delivering training on behalf of an organisation or training that I have attended myself, assumes that people already have these critical skills in self-care and the content tends to focus on how to conduct user research in an agile environment, what types of user research we should be doing and at which phase of the project. Whilst self-care training tends to be absent from user research training, more and more leaders are recognising that they need to look after the mental health of their user researchers. This is a great step in the right direction because, having coached and mentored user researchers, I know that many of them are struggling and want to leave the profession, which is something that we want to avoid. The issue is not simply exposure to sensitive or traumatic content but also the speed at which we are expected to do user research and the repetitive nature of it in an agile environment that puts us at added risk.

Exposure to and managing trauma — a typical six months for me

The Discovery Phase

As user researchers, we are keen to see people use our services in context, therefore interviews can take place in a variety of settings; peoples’ homes, research studios, community centres or local libraries.

If I am brought in at the start of a project, which is referred to as the discovery phase, I usually have around six weeks (which is considered a bit of a luxury in some organisations) to work with a multidisciplinary team in order to understand the problem(s) we are trying to solve. I’ll either be working alone or with another user researcher; standard UK government practice (GDS manual) suggests we aim to speak to 6–8 people per user group, so it’s not uncommon to speak to around thirty people in a six week period.

Preparation is key

The right type of preparation can make the difference between a good interview and a bad interview , and a safe interview and an unsafe interview, for both user researcher and the participant. If, for example, I were to conduct user research that involved speaking to people in rehab for drug and alcohol addiction, I would also need to set up meetings with their support workers to find out what the safest and most appropriate way is for them and me to take part in the research and, more importantly, to gauge whether or not it is appropriate. Many organisations have an ethics committee and ethics checklists, which are really helpful in helping us make these decisions. However, self-care is often absent from ethics guidance too.

If, at the end of the Discovery phase, the evidence shows there is a problem to be solved, we will move to the solution space, which is known as the ‘alpha’ phase.

More research in the alpha phase

The alpha phase typically lasts six months, during which a multi-disciplinary team will work in two week cycles (sprints) and prototypes, for example, will be created and tested with at least five people per sprint, then analysed. Ensuring analysis is robust enough in such a short period of time is very demanding. In total, we could be conducting 65 sessions.

Exposure to traumatic content

Taken together illustrates how tiring my job can be and when sensitive or traumatic content is added to the mix, conducting research becomes another and very different story.

I created this word cloud with my co-author Janice to illustrate the types of content we have both been exposed to over the years. We have calculated that we have conducted approximately 83,000 interviews between us.

Reflections and looking after myself

My work in the area of self-care in user research has given me time to reflect on the state of my own mental health and I am in no doubt that the early training I received at DWP taught me vital skills that I have been able to apply and modify over the years. Additionally, the many conversations with and guidance I have received from my friend and co-author Janice have also played a key part in reinforcing the importance of looking after myself and my participants. This is why I naturally turned to Janice for advice when other user researchers were asking me for help and guidance about mental health.

Janice’s story

Background

I am a Cosca-accredited psychodynamic therapist with over 20 years of experience working therapeutically in the field of trauma, specifically with people with complex needs in public, private and third sector organisations. This includes, for example, domestic abuse, childhood sexual abuse, addiction, PTSD, vicarious trauma, burnout, self harm, grief and loss, depression, human trafficking, suicidal ideation, poverty and sexual identity.

Prior to this I worked alongside Jane in DWP, which was previously known as The Benefits Agency and Social Security Office, is where my journey of working with vulnerability in the community and on the front line began. It was within this central government organisation that I, like Jane, received excellent training. This provided a solid foundation for building and developing my career.

Through my therapeutic practice, I also conduct research in order to understand the complexity of people, as well as their motivations, behaviours and the different challenges they face. I use this insight to assist my clients in their personal recovery by empowering them to identify solutions.

A typical therapeutic relationship that I establish usually lasts for me for six months and, during this time, I would meet my client for an hour on a weekly basis. My goal is to maintain professional boundaries and, without bias, to emphatically listen to the client in order to assist them in the identification of their personal problems or pain points and to explore solutions. The client is often unaware of the specific problem, as it is often expressed as a behaviour. Therefore, the initial process and intention is to help the client identify the problem or pain point and, once this has been established, we will jointly start the journey of the exploration of the potential solution.

The therapeutic relationship I establish with my client is primarily centred around the identification of their problems or pain points (as we refer to them in the field of user research). It is during this early phase of relationship building that I explore any frustrations, thoughts and feelings my clients are currently experiencing and where I gain further awareness of the problem space. This influences my future interventions, providing me with valuable insight as to what the next steps are likely to be in the therapeutic journey.

Comparisons with User Research

I realised that the focus of my initial interventions with my clients is similar in many ways to that of user researchers in the discovery phase of research. Both the therapist and user researcher have the common goal of acquiring a deeper understanding of the problem, pain point and needs of the client. The therapeutic interventions I mention are peppered through the entire six month relationship I have with my client. I will always be alert to new and relevant information and, similar to user researchers, who are always in the discovery phase of research, being open to new insights and findings which will influence outcomes.

Due to the similarities I have mentioned and other important factors, it was evident that I had many key transferable skills which would enable me to professionally conduct user research. I therefore decided to undertake an intensive course specific to user research and use my existing skill set to move into the user research arena. I am currently conducting user research in an agile environment for the UK Government.

Supporting User Researchers

Furthermore, I am also a Cosca-accredited clinical supervisor, which involves ensuring the safe and ethical practice of other therapists in their therapeutic relationships with clients. I am also a coach and emotional intelligence assessor.

Over the years, Jane and I have worked closely together in different capacities, including mentoring and coaching. I have supported Jane in a coaching capacity and provided therapy to many user researchers. This was due to the emotional and psychological difficulties they faced when researching sensitive issues.

Having explored feelings and emotions through a combination of therapy and coaching, these user researchers returned confidently to the job they loved. They had a renewed sense of wellbeing and felt equipped with the required skills to enable them to conduct research on sensitive issues in a safe and appropriate manner. This empowered them to conduct sensitive interviews, utilising the correct interventions whilst maintaining safe boundaries, as well as practicing their own personal self-care.

Many user researchers felt vulnerable when tasked with researching sensitive topics and expressed the different feelings and emotions they experienced, which included feeling silenced, stuck, angry, tearful, frightened, shocked, fearful, useless, sad, and incompetent. They also talked about having overwhelming feelings of wanting to help the participant. Some actually did help the participants by buying sleeping bags for homeless people and others took participants in their cars to the food banks. They also spoke about the difficulties they faced when participants verbalised vivid accounts of a traumatic experience. Consequently, the user researchers had intrusive nightmares and flashbacks from these sessions. I have supported user researchers in a therapeutic capacity with the effects of burnout and vicarious trauma.

Comparisons in practice and Gaps in support

It is clear that this was the trigger for the many discussions Jane and I had about the similarities between the work of a user researcher and that of a therapist. The lack of support afforded to user researchers was also another key motivational factor. It also acted as the catalyst for our decision to start our training company ResearchU, which focuses mainly on self-care for user researchers.

When reflecting on the work of a user researcher and that of a therapist, we acknowledged that not only do user researchers hear similar content to that of a therapist but due to the nature of the agile environment, they will also hear it repeatedly.

Furthermore, similar to the therapist, user researchers gently probe for further insight which will assist the client/user in the longer term. However, the main difference is that, unlike user researchers, therapists are safeguarded with regular clinical supervision.

We have had a sketch commissioned to illustrate the dangers a user researcher will face, as opposed to those that a therapist might face. In my six-month therapeutic relationship with my client, I will receive one and a half hours of clinical supervision per month. This is in line with the ethical guidance from COSCA and BACP, which ensures that the client and I are kept safe.

As we know, user researchers hear traumatic content on an individual, face to face basis but they also have to repeat and share traumatic content in various ways, as illustrated earlier.

And as we pointed out in a six month discovery, a user researcher will be exposed to traumatic content over approximately 132 sessions and, assuming each session is an hour, that equates to 132 hours of exposure.

We believe that this repetition puts user researchers at risk and exposes them to burnout and vicarious trauma, which is why it is really important to establish a self-care routine as a priority. This will ensure psychological safety and wellbeing and help in the prevention of burnout or vicarious trauma.

We know that self-care for user researchers is often absent from training and ethical guidance, and that there is no regulated formal professional support, where a user researcher can explore their emotional reactions to complex content. This emotional reaction can adversely influence research findings, and in addition to keeping user researchers and participants safe, this is something we want to avoid.

Our sketch below illustrates what we experience;

Transference

I would now like to introduce you to the concept of transference. Transference describes a situation in which the feelings, desires, and expectations of one person are redirected and applied to another person. Most commonly, transference is unconscious and happens in a therapeutic setting, where a person in therapy may apply certain feelings or emotions towards the therapist. The therapist may unconsciously react to these feelings and emotions.

However, I believe transference can happen in the professional relationship between a user researcher and a participant. I will share an example of transference and, for the purposes of anonymity, I have changed the names of all involved.

Examples of transference — Therapy and User Research

Let’s now talk about a therapeutic relationship in which the client, Paul, is a teenager who was abandoned and neglected by his main caregivers and, due to this, subsequently ended up living in a children’s care home. The therapist, Mary, has two teenage sons at home, whom she very much loves and cares for. Paul reminds her of her son Adam in his looks, stature and shy demeanour. As illustrated in sketch one, Paul shares his harrowing story with Mary at their weekly therapy sessions. As the trust develops, his emotional story is expressed, which fills the therapeutic space with sadness, helplessness and vulnerability.

In this therapeutic relationship, Paul projects his feelings of abandonment, vulnerability and yearning to be loved and cared for onto Mary, which is illustrated in the second sketch — Transference. During this unconscious process, which Mary is unaware of, she reacts with interventions which express the fact that she wants to care for Paul, crossing professional boundaries and offering Paul l longer sessions and offering him her personal phone number and brings him small gifts, simply to show she cares.

However, this is unethical and not safe for both Paul and Mary. An attachment develops, which sets false expectations for Paul, who is a vulnerable teenager. Mary will never be a constant in Paul’s life and it is therefore unfair for him to be led to expect that.

Fortunately, this example of transference was explored in Mary’s clinical supervision. Mary was supported to explore and reflect on her feelings, actions and emotional attachment to Paul. This empowered Mary to get the professional relationship back on track, which ensured both parties were kept safe.

Now I would like you to imagine we have the same scenario, but this time with a user researcher, who was carrying out discovery research regarding the experiences of young people in care. The participants have had similar experiences to Paul and the user researcher, Anne, carried out numerous user research sessions — listening to the same harrowing, traumatic content and having many of the same feelings, emotions and yearnings as Mary. However, user research, unlike therapy, does not have a governing body which stipulates a process similar to clinical supervision as a requirement.

This is worrying as we must protect the psychological safety of user researchers particularly when working with sensitive and complex issues. We must also maintain solid boundaries for the protection of the participants, as the creation of false expectation can be damaging to vulnerable participants.

It is therefore imperative that we, as user researchers, have the skills and knowledge to protect our psychological safety and wellbeing. Therefore, we must have the capacity to gauge when for example we are acting out of character due to hearing too much traumatic content or crossing professional boundaries.

The impact of not addressing self-care

So, when our self-care is at risk, how do we know that we are heading for burnout or vicarious trauma?

In my experience as a therapist, people often talk about bottling up their feelings until they get to the point where they ‘explode’ or ‘pop’. Following on from this, I often find myself using the expression ‘don’t bottle it up’ as a means of empowering people to express how they feel, as well as highlighting the various stages that people will go through prior to the development of burnout and vicarious trauma as illustrated in Sketch 3.

This analogy is relevant to our theme of self-care and is a powerful way of illustrating the dangers user researchers face when regularly hearing traumatic content, with no opportunity to express the difficult feelings and emotions associated with this.

The illustration shows three bottles:

1. Safe
2. Warning Signs
3. Burnout and Vicarious Trauma

When we’re safe, our bottles are filled with mixed emotions and feelings to a level at which we are coping. Whilst we may have some worries, we are managing our home and work life in a positive fashion, and our emotional wellbeing could be described as safe.

However, as we hear more traumatic content, we are overcome with difficult emotions and feelings and we find ourselves moving into an unsafe place, where we will experience the warning signs that indicate that we may be heading for burnout or developing vicarious trauma.

Our emotional, physical and mental health will start to mirror our difficult emotions and feelings — we may start to become depressed, have sleepless nights, behave out of character, use drugs/ alcohol to cope, relationship problems will develop and our physical health will deteriorate. Furthermore, we may experience recurring flashbacks and nightmares of the traumatic content and it will start to take over our minds.

We are also now faced with the issue of Covid 19, the global pandemic, which will bring a host of additional stressful factors that must be considered, and this, combined with existing stressors, will certainly contribute to people reaching the Stage 3 bottle quicker than expected.

And if we don’t address the warning signs, our bottle will explode and we will develop burnout or vicarious trauma

Steps to self-care

At ResearchU, we have developed a 10 step guide to self-care, and we are confident that this, if followed correctly, will assist in protecting the psychological safety of user researchers. Our steps are not listed in order of importance and do not follow a linear process. As user researchers preparing for, responding to and reflecting on user research, your journey will see you travel up and down the steps many times.

1. Be self aware-Transference/ Bias

2. Accept that vulnerability is not a weakness

3. Take time to know your user

4. Respond appropriately to sensitive content

5.Keep up to date with local support networks

6. Maintain professional boundaries

7. Recognise the effects of burnout and vicarious trauma

8. Be aware of safeguarding policies

9. Give yourself permission to end the interview

10. Practise self or group reflection

COVID-19 brings additional challenges to an already demanding role, which are highlighted above. The landscape we are working in has changed overnight and the virus has painted a very different picture for everyone involved in designing services.

The effects of COVID-19 will not be short term. Some experts have estimated that the recovery period may take up to three years, with some people suffering the effects of post-traumatic stress disorder, and others, who have suffered previous trauma, will be re-traumatised by COVID-19.

We have spoken a lot about individuals and what they can do to protect themselves. However, organisations need to take responsibility for protecting the health and wellbeing of their staff by giving staff the time and space to prepare, respond and reflect as well as provide professional support.

In light of our combined professional experience, we fully advocate a cycle of self-care for user researchers, as illustrated in Sketch five.