Navigating the clinician-researcher role in health social work: Reflections from practice

This Voices from Practice article shares reflections of two social workers on our dual-role experiences when conducting qualitative health research as trained clinicians. Reflections and considerations are shared for health care social work research trainees to prepare for and navigate the integration of the clinician-researcher role in social work.

boundaries may occur if the researcher and/or participant approaches the relationship as therapeutic, or if participants are motivated to participate or share sensitive information for reasons such as feeling a desperate need for support, believing the researcher has the knowledge and skills to engage therapeutically or fearing that their current supports may be jeopardized by declining to participate (Landau, 2008).
A scoping review conducted by Hay-Smith et al. (2016) summarized the findings of prior studies exploring dual-role experiences of health care clinicians who provide direct patient care while also conducting health research. The authors identified two main 'catalysts' that prompt dual-role experiences among health clinicians: (1) clinical patterns: times when the clinician-researcher acts as a source of clinical expertise for a research participant, and (2) connection: times when the relationship between researcher and participant feels more like a clinician-patient relationship (Hay-Smith et al., 2016).
The majority of the studies (20 out of 28) included in the Hay-Smith et al. (2016) scoping review involved nurse-researchers as participants, and thus may not entirely represent the experiences of social work clinician-researchers. There may be further lessons to learn from social workers who have directly experienced this dual-role phenomenon in practice given our unique position as practitioners in the health care field (Auslander, 2001). To date, there is limited literature on first-person perspectives of social workers navigating clinician-researcher roles (Davis et al., 2002;Hay-Smith et al., 2016;Kraft et al., 2020;Landau, 2008;Mendenhall, 2007). Building on the typology developed by Hay-Smith et al. (2016), this article shares our experiences with clinical patterns and connection as catalysts for dual-role experiences and introduces a third catalyst, disciplinary identity, that may arise specifically for social work clinician-researchers conducting qualitative health research.

Reflection on dual-role catalysts in social work
During our experience as research assistants, we engaged in individual self-reflection, journaling, and discussions and debriefing among ourselves and with the primary investigator of the study. A post hoc analysis of these notes and conversations highlighted a few recurring dual-role challenges. We explored scholarly literature in this area and consulted with two qualitative social work researchers to contextualize our experiences and refine our thoughts in a way that could contribute to existing knowledge gaps.
We found that many of our dual-role experiences were brought on by the clinical patterns and connections catalysts as described by Hay-Smith et al. (2016); though some were triggered differently, specifically by instances when our disciplinary identity as social workers was challenged. As emerging clinician-researchers, we were in a unique position where these moments were palpable, prompting a deep reflection on these catalysts during the learning transfer process of translating humanistic social work theories and values into the heavily biomedically informed context of qualitative health research (Morse, 2010). Hay-Smith et al. (2016) describe the clinical patterns catalyst as times when a clinician-researcher is expected or feels compelled to share their clinical expertise with a participant. We identified with this catalyst particularly when participants shared difficult experiences or expressed complex emotions during the interviews. Similar to findings from the scoping review (Hay-Smith et al., 2016), we experienced discomfort with having limited capacity to use our clinical skills to deeply probe into unexpected sensitive topics without potentially introducing interviewer bias and shifting the narrative. Although clinical assessments and research interviews have a similar question-answer structure, the differing and at times conflicting goals and use of knowledge, skills, and language in clinical versus research interactions (Landau, 2008;Mendenhall, 2007) may have prompted this catalyst to recur frequently. Hay-Smith et al. (2016) describe the connection catalyst as times when the relationship between researcher and participant shifts into more of a clinician-client relationship. We identified with this catalyst especially when we knew that the participant had previous experience working with social workers which may have influenced their expectations of our role. In our post hoc analysis, we noted that our experiences with this catalyst had been helpful in reinforcing a deeper and experiential understanding of the value of articulating to participants what to expect from a researcherparticipant relationship during the informed consent process.

Disciplinary identity
We identified a third catalyst in our post hoc analysis of our reflections, disciplinary identity, which describes times when our thoughts and behaviours became rooted into the underlying theories, assumptions, values, and ethics that define our professional identity as social workers.
Though our training and practice experiences were different, we both noted that our disciplinary identity is deeply embedded in the social justice and relational-oriented theories, values, and ethics that inform our field. Prominent scholars have also noted that even across geographical, political, and cultural differences, social work around the globe is rooted in value-based and evidence-based practice with a prioritization of social justice and client-centered relationships (Davison, 2004;O'Leary and Tsui, 2019). As graduate students we were still deeply immersed in thinking theoretically and through the lens of social work values and theories, which provided the opportunity for us to quite clearly observe during the learning transfer process a stark difference between the paradigms and discourses underlying social work in comparison with those underlying the health care research context.
For example, the discipline of social work is highly influenced and informed by critical and anti-oppressive practice theories, and part of our disciplinary identity includes purposeful engagement in behaviours that actively disrupt hierarchical power dynamics and reinforce client expertise and agency in guiding therapeutic processes (Bogo, 2006;Fook, 2016). Across many interviews we facilitated, we felt a desire to acknowledge and discuss with participants the power differential between us as researcher and them as participant, and then felt the need to resist this the urge to deconstruct and rebalance power in the moment. This brought on a dual-role discomfort as we felt that as researchers, we should instead be maintaining our position as the one who guides the question-and-answer process in the pursuit of gaining specific data from participants and adhering to a traditional notion of researcher as an 'objective' and neutral party in data collection (Holloway and Wheeler, 1995).
The challenge of rebalancing power dynamics while also conforming to a hierarchical connection in the researcher-participant relationship requires the researcher to be purposefully and critically reflective (Karnieli-Miller et al., 2008). Having social work mentors with whom we could debrief our experiences was helpful in deconstructing this catalyst and navigating times where we felt our disciplinary identity prompted a dual-role experience.

Discussion
Our process highlights the significance of practical experience as a tool for deeper learning in social work. This article demonstrates how engagement in research as social work clinicians can foster a procedural-to-declarative transfer of learning, where practical experiences can reinforce the depth of understanding of more abstract concepts such as dual-role experiences (Haskell, 2001). An iterative process of practice and reflection such as the one we engaged in may be a valuable way for social workers to effectively examine and navigate dual-role experiences they encounter as clinicianresearchers, serving to ultimately better support ethical research practices in social work.
Sharing the experiences of health social work clinician-researchers early in their endeavours into research through means such as publication in academic articles may serve as a way to spur reflection and discussion among others entering this space. Our supervisors and mentors, with their deeper level of expertise in conducting this work, expressed surprise at times at their challenge in stepping into the headspace of a trainee navigating this space. Thus, we are hopeful that these reflections can also support supervisors and mentors in getting a sense of potential catalysts of dual-role experiences for emerging social work clinician-researchers in health. In addition, learning about the experiences of emerging social work researchers in various health-related contexts around the globe may serve to educate aspiring clinician-researchers, validate their experience, and reinforce the presence of social work in health care research on a global scale (Andersen et al., 2020;Payne, 2006).