Developing a grounded hypothesis to understand a clinical process: the role of conceptualisation in validation

This paper argues the case that validation in the clinical process depends to a large extent on being as clear and specific as possible about the hypotheses being put forward. In sessions interpretations are made based on intuitive and quite spontaneous links arising from background orientations and what will be called clusters of observed clinical facts. Outside the session, a wider and more developed set of grounded hypotheses can be developed, intended to illuminate what seem to be the core issues that arise over time and the core problems suffered by the patient. Often such hypotheses will only be in the form of working orientations. If they can be conceptualised more precisely into specific hypotheses explaining sets of observed events and predicting consequences, they can be better evaluated--either by the analyst working alone, or in group discussion through the achievement of genuine consensus. A process of building up a 'grounded' hypothesis, by making comparisons in the process of trying to solve a clinical problem, is described using detailed clinical material. This is also intended to illustrate the argument that it can be useful to consider the basic occurrences reported from sessions as data, distinct from the theory put forward to explain them.