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by: Miss Francisca Cummings


Miss Francisca Cummings
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This 18 page Class Notes was uploaded by Miss Francisca Cummings on Thursday September 17, 2015. The Class Notes belongs to ADE 5385 at Florida State University taught by Staff in Fall. Since its upload, it has received 31 views. For similar materials see /class/205621/ade-5385-florida-state-university in Human Development at Florida State University.




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Date Created: 09/17/15
PERSPECTIVE TRANSFORMATION OVER TIME A 2 YEAR FOLLOW UP STUDY OF HIV POSITIVE ADULTS BRADLEY C COURTENAY SHARAN MERRIAM PATRICIA REEVES LISA BAUMGARTNER University ofGeorgia Thepurpose 39 v ho 39 39 in study ofthe centrality of 39 7 39 in 39 39 39 39 7 years later theirperspectives ofmaking meaning il contributions through service to others or ifthe advent ofprotease inhibitors would have resulted in their reverting to previously he sef oriented and materialistic views ofthe world Fourteen ofthe original 18 participants were interviewed Twurmju 39 Firstforall 39 39 39 mations that they had undergone 2 years previously had held Second there were changes in 39 vh in 7 H4 I f G 39 39 greater attention to care of the self and an integration of the HIVpositive status into their selfde nition The lifechanging nature of transformational learning the stability of its outcomes and ongoing changes 39 39 39 39 39 Most people would agree that a considerable amount of learning takes place in adulthood Much of this learning is additive in nature that is we add on to what we already know and what we already can do Less common but more significant is transformational leaniing which involves a fundamental change in the way we see ourselves and the world in which we live As presented by Mezirow 1981 1990a 1991 a chief theorist of transformational learning this type of leaniing involves critically re ecting upon our lives and becoming aware of why we attach the meanings we do to reality especially to our roles and relationships 1981 p 11 emphasis in original The process of transformational learning is developmental BRADLEY C COURTENAY is an acting director at the School ofLeadership and Lifelong Learning University of Georgia SHARAN MERRIAM is a professor in the Department of Adult Education University of Georgia PATRICIA REEVES is an assistant professorin the Department of Counseling and Human Development University of Georgia LISA BAUMGARTNER is a graduate assistant in the Department of Adult Education University of Georgia ADULT EDUCATION QUARTERLY Vol 50 No 2 February 2000 1027119 2000 American Association for Adult and Continuing Education 102 Courtenay et al IPERSPECTIVE TRANSFORMATION 103 Seeing how our presuppositions have come to constrain the way we perceive understand and feel about our world leads to reformulating these assumptions to permit a more inclusive discriminating permeable and integrative perspective Mezirow l990b p 14 The past decade has witnessed a burgeoning of both empirical research and philosophical critique in regard to Mezirow s theory Recently Taylor 1997 re viewed some 39 empirical studies using Mezirow s transformative learning as the theoretical framework The focus of most of these 39 studies was on the process of transformational learning either in its entirety or with respect to a particular com ponent of the process Taylor notes that whereas there is much support for Mezirow s theory there is also a need 39 39 39 context the varying na ture of the catalyst of the process the minimization of the role of critical re ection andincreasedrole of other ways of knowing and relationships and overall broadening f d f quot39 far p 39 39 Taylor 1997 abstract It is the outcome of a perspective transformation that most interests us not in terms of what might be an outcome but rather what happens to the perspective transformation over time The purpose of this study was to explore just that ques tion by reinterviewing 2 years later the 18 HIVpositive adults who were partici pants in our original study of the centrality of meaningmaking in transformational learning Courtenay Merriam amp Reeves 1998 THE ORIGINAL STUDY In the fall of 1995 we interviewed 18 HIVpositive adults all of whom with one exception were 23 to 45 years of age We purposely chose young adults because we assumed that the prospect of death at an unnaturally early age challenges assump tions and values about the meaning of life Participants Tcell counts were 500 or less indicating a compromised immune system that renders medical intervention likely To our knowledge none were on protease inhibitors The purpose of the study was to understand how HIVpositive adults made sense of their lives in the face of a potentially lifethreatening illness Qualitative analysis of the interview data revealed a fivestage process of meaningmaking The initial reaction to the diagnosis lasted from 6 months to 5 years and consisted of affective cognitive and behavioral responses A cata lytic experience initiated movement from initial reaction to the three phases of meaningmaking exploration of other ways of thinking feeling acting and per ceiving their situation consolidation of new ways of being and stabilization of the new perspective This new perspective was characterized by the opportunity to make a meaningful contribution by a heightened sensitivity to life and other peo ple and by service to others 104 ADULT EDUCATION QUARTERLY February 2000 Two years later we wondered about the stability of these perspectives Were they maintained over time Did participants undergo further transformations If so what was the nature of these transformations For those using protease inhibi tors what effect has the remissionsuppression of HIV had on their perspectives WHAT THE LITERATURE SUGGESTS Although no empirical studies focusing on the stability of perspective transfor mations could be found based on Mezirow s and others writings we first specu lated that participants would not have regressed to a lessinclusive integrated or discriminating perspective and second that they would have continued making meaning Mezirow l 99 l is quite clear that once a transformation has taken place there is no going back to an earlier position quotThe transformative leanring process is irre versible we do not regress to levels of less understanding p 152 Kegan 994 im rly character39 quot39 1 noting that each successive principle subsumes or encompasses the prior principle The new principle is a higher order principle more complex more inclusive that makes the prior princi ple into an element or tool of its system p 33 We found only one study that included a followup of perspective transformation Williams 1986 examined the role of transformational leanring in changing the behavior of male spousal abusers Using an evaluation form and exit interview he assessed the degree of perspective transformation at the end of a 12week intervention In followup interviews with 6 of the 19 participants 3 months later Williams found that four ratings for perspec tive transformations were slightly higher and two were lower Little information was given about the nature of these perspective transformations or how they were measured A veteran researcher who has studied traumch life events suggests that although survivors usually retain the newfound appreciation for life that it might be more apparent at certain moments rather than functioning as a general glaze over all of one s experience R JanoffBulman personal communication March 17 1998 She also indicated that she knew of no work addressing the stability of a changed perspective over time It seems that once a perspective transformation has occurred reversion to a less developed state is not possible However one has not necessarily reached an end state Development is continuous and is more than change over time it is change in a positive direction toward a more complex integrated inclusive and tolerant per spective Brew l993 Daloz 1986 Kegan 1994 Mezirow l990a 199 l Tennant 1993 Indeed Mezirow l990a equates changes in meaning perspectives with stages of moral ethical and ego development Each stage involves a develop mentally advanced and progressively more functional meaning perspective Courtenay et al IPERSPECTIVE TRANSFORMATION 105 p 359 Daloz 1986 concurs stating that the later stages are by definition more conceptually inclusive and discriminating are better in some sense than earlier ones 137 Although we could speculate that participants would have maintained their transformed perspectives we could also surmise that there would be continual changes in meaningmaking Mezirow 1990b differentiates between meaning schemes and meaning perspectives Meaning schemes are the specific beliefs assumptions values feelings and concepts our habitual implicit rules for inter preting experience Mezirow 1990b p 2 emphasis in original They change through content process or premise reflection Premise reflection can lead to changes in the meaning perspective whereas content and process reflection result in changes in meaning According to Cranton 1994 as soon as the leanier asks why her reflection begins taking place on the level of a meaning perspective rather than a meaning scheme Asking why takes account of the larger framework within which an assumption exists p 67 emphasis in original Mezirow 1990b defines meaning perspectives as the overarching structure of assumptions within which new experience is assimilated and transformed p 2 Changes in meaning perspectives may occur through an accretion of such transformed meaning schemes Mezirow 1990b p 13 That the process of a perspective transformation is recursive and ongoing has been supported in both the research and theoretical literature Coffman 1991 Laswell 1994 Pope 1996 Saavedra 1995 Usher 1993 for example notes that at any one point in time a meaning has to be fixed but that s not the only meaning possible for all time p 172 Furthermore meaningmaking is highly contextual When we interpret our experience we do so from a particular context or stand point Usher 1993 p 170 Thus we anticipated that individuals in our followup study may have adjusted modified or changed particular meaning schemes and that the accumulation of these changed meaning schemes may have led to perspec tive transformations Similar to the way an HIVpositive diagnosis functioned as the disorienting dilemma precipitating a perspective transformation that we doc umented in the original study protease inhibitors may have served as a disorienting dilemma effecting yet another perspective transformation In summary the literature on transformational learning suggests that it is not possible to regress to lessdeveloped perspectives Whether set in motion by the accumulation of changed meaning schemes or by a disorienting dilemma with the passage of time perspective transformations lead to more inclusive mature com plex integrative perspectives that are not constricted by old ways of thinking How ever meariingmaking or making sense of our experiences is an ongoing process evidenced over time in changes in meaning schemes and possibly meaning perspectives 106 ADULT EDUCATION QUARTERLY February 2000 DATA COLLECTION AND ANALYSIS The basic question of how participants perspectives had changed over time framed this followup study of HIVpositive adults Specifically we were inter ested in the stability of a perspective transformation and the nature of ongoing meaningmaking As with the original study a qualitative approach was deemed most apprupr quot liuw 1 39 391 r r 39 may h 4 over time However although the design was qualitative and thus primarily inductive in nature one aspect of our study was an implicit test of Mezirow s 1991 contention that perspective transformations are stable and irreversible As Glaser and Strauss 1967 note there is no fundamental clash between the purposes and capacities of qualitative and quantitative methods or data We believe that eaehform ofdata is useful for both veri cation and gene ration of theory whatever the primacy of emphasis Primacy de pends only on the circumstances of research pp 1718 emphasis in original The final sample consisted of 14 8 men and 6 women of the original 18 partici pants All respondents except one 59yearold male ranged in age from 25 to 47 Eight of the 14 participants were Caucasian five were African American and one was Hispanic The level of educational attainment spanned Grade 10 to master s de gree Ten were currently employed and 10 of the 14 reported being on protease in hibitors Respondents were given 30 to participate in interviews of approximately 90 minutes in length Data were collected through semistructured interviews In preparation for the followup interviews each transcript from the NovemberDecember 1995 round of interviews was read studied and discussed by two members of the research team This procedure served two purposes First it reacquainted the researchers with each respondent s particular story and the nature of his or her perspective transfor mation second phrases or statements were occasionally read back to the partici pants during the second interviews as memory prompts or for their comments The interview schedule contained openended questions regarding how participants were making sense of their lives today the impact of protease inhibitors current physical and emotional health the extent to which they were still involved in ser viceoriented activities the spiritualfaith dimension of their lives how they were coping with the infection and so on Interviews were held in January and February of 1998 more than 2 years after the 1995 interviews All were taperecorded and transcribed For 10 of the 14 inter views two of the team s four researchers were present for the interview itself This proved advantageous during our data analysis as two people were able to confirm each other s recollection of contextual affective and nonverbal factors this helped to illuminate the team s understanding of particular comments Courtenay et al IPERSPECTIVE TRANSFORMATION 107 With regard to the question of the stability of perspective transformations we considered each participant s responses in light of the three components of their perspective transformation found in the earlier study These were whether they con tinued to a make meaningful contributions b maintain a heightened sensitivity to life and c be of service to others Each participant s responses were analyzed in reference to the three components of the transformed perspective reported 2 years prior Interview data from all 14 participants verified the maintenance of the per spective transformation no negative cases were found that would have led us to conclude otherwise B ogdan amp Biklen 1998 Merriam 1998 T M c j 39 of h fongoing 39 m kin data from the transcripts were analyzed inductively using the constant comparative method Glaser amp Strauss 1967 In this method data analysis proceeds simultaneously with data collection Each member of the research team individually read reread and coded the transcripts for key points regarding our questions The research team met on a regular schedule to compare each member s analysis of individual tran scripts and to compare analyses across transcripts Intensive analysis involved moving between the data and the interpretations within the same transcript and across different transcripts Eventually a common pattern of responses across the 14 interviews with regard to the stability of perspective transformation continued meaningmaking and the effect of protease inhibitors was identified FINDINGS Two major findings emerged from the data First as speculated the perspective transformation proved irreversible People continued to make meaningful contribu tions and to appreciate their lives and the lives of others They maintained the more integrated inclusive and discriminating perspective that they had attained earlier Second there were changes in meaning schemes which included the adoption of a futureoriented perspective on life greater attention to issues pertaining to care of the self and integration of one s HIVpositive status into selfdefinition Irreversibility of the Perspective Transformation Over time the perspective transformation was neither lost rej ected nor reversed Maintenance of the perspective transformation was evidenced in three ways Participants continued a to view their HIV status as an opportunity to make a meaningful contribution b to maintain a heightened sensitivity to life and c to be of service to others Opportunity to make a meaningful contribution In the first study the new per spective was evidenced by the participants beliefs that their HIVpositive status served as an opportunity to make a meaningful contribution Infection with HIV 108 ADULT EDUCATION QUARTERLY February 2000 facilitated the use of their lives in a purposeful way Two years ago Steve then 39 noted I m real grateful to be here I think there s a reason and I don t really have to know what the reason is l have a hunch thatif there s you know if anything can come from this to help anybody else that s reason enough Pat when first interviewed recognized that being HIVpositive was a blessing because she could touch a lot of people She added My job is to help That s my jouniey When we first spoke to Jeffrey he also had a great need to contrib ute and wanted to pass along his knowledge and skills During the second interviews it was evident that respondents retained the desire to make a meaningful contribution Steve for instance said he was pleased to be able to be on this planet and have an impact whether it meant helping friends or family Pat reiterated her sense of purpose by saying I have a mission this is my path this is my road in life and my road in life could not go this way unless Iwas positive Jeffrey s continued desire to make a meaningful contribution led to AIDS education work which he found rewarding and fulfilling He added I know I In doing something that s worthwhile Often this sense of purpose was expressed in terms of spirituality as with Jamie who said during the initial interview that his HIV status was pan of God s plan because God knew good could come out of it not only for me but for others Two years later Jamie underscored this connection to spirituality I mnot 439 quot Uou ithmeuntill quot 041 or whatnot that He put me here to do I still think there s a plan andl still think that I m an active participant in it whether I don t always understand it or not A continued heightened sensitivity to life When respondents were interviewed 2 years ago they expressed gratitude for their lives and evidenced a newfound appreciation for nature and people Sam who works as a handyman described his life as heavenly and said I feel like I m on the verge of crying tears of gratitude Dawn commented on how fragile life is and Tracy concluded that she had previ ously taken life and people for granted She said quotToday I don t Itake each second each hour each minute and try to make somebody else happy just for that day or just for that moment Steve and Mynia recognized the value of nature Mynia said I m more selfconscious even when it gets cloudy out there and the clouds and the sun shining at certain points Ivalue life a little bit different Steve found happi ness in driving these streets again and seeing these trees and seeing the seasons and seeing the leaves tuni In the second interviews the heightened sensitivity to life was shown in partici pants continued appreciation for their lives the lives of others and nature John a former Episcopalian priest spoke of his gratitude by saying I am a very blessed person and I don t take that for granted I am really grateful to the supreme being to Courtenay et al PERSPECTIVE TRANSFORMATION 109 my doctor to my partner to my family to my profession Kenneth remarked I acknowledge my blessings and I acknowledge who they come from They re not just for me only They are for me to share Nicole a customer service supervisor stated When the New Year rolled in I was like Thank you Jesus for letting me see another year Jeffrey age 41 continued to feel very blessed and merry A continued need to be of service to others The importance of the participants relationships with others drove their need to be of service During the first inter views most worked for or volunteered at AIDS service organizations ASOs and engaged in activities such as peer counseling or educational speaking Steve s elo quent quote captured his desire to help I just want to hold a candle to where maybe somebody two steps behind me can make it to that point and then perhaps go a couple more steps if I can t go I just feel like we re all helping each other walk through this Thestrongd 39 t fserquot c t39 4 U inthesecond interviews Many were still working or volunteering at ASOs serving in a variety of roles Pat diagnosed HIVpositive more than 12 years ago discussed her contin ued service to others I volunteer for Outreach I sit on aboard I mapatient advocate for alocal AIDS group I sponsor a lot of women in in recovery that are struggling to stay clean but the ones thathave HIV you know I work with their minds and try to keep them on a positive plane about the disease Likewise Joe continued editorship of a newsletter for HIVpositive readers L in L IJC Juial area of L that feedback that you touched my life that s a signi cant job to me not how much money I get from it or how much fame I get from it or anything like that Is it gonna make some kind of signi cant change in society that will bene t other people even if it s just one person at a time and it s just one guy who helps Jamie also continued to reach out to everybody from teenagers to nurses and doctors this past week I spoke to a group of pharmacists a group of first year medi cal physicians assistants then spoke to an AIDS 101 class Jeffrey maintained his service to others by serving on the board of a local ASO In the first interview he talked about a circle of giving and in the followup interview noted I affirm the circle of giving It s so true Once you begin to give things away it comes back and if you stop that then you become stagnan Interestingly participants themselves recognized the irreversibility of their per spective transformation Jamie realized that the way he viewed the world had changed and he expressed concern about reverting to his previous worldview llO ADULT EDUCATION QUARTERLY February 2000 I m afraid of somebody snatching me away to become somebody that I never wanted to be and never would have been probably HIV did hit me and it taught me a whole lot I don t want to lose what I ve learned andI don t want to lose what I ve got I don t want to become less Iwanna become more Similarly Steve recognized the permanence of his new perspective In the first in terview he asserted My world has been shattered I think it had to be shattered in order to fall back together During the second interview he said Well I don t feel like my world is shattered at all I feel like it s in a constant state of healing almost I really don t think I wouldhave as much fearif things were to shat ter again If things were to I don t think the shattering would be as deafening When Joe rekindled his interest in a comic book collection because he realized that he would continue to live he recognized how his worldview had changed And it was like Oh cool you know I m gonna be around another 20 years to enjoy this maybe So uh I did go through a short time where Iwas buying things and felt kind ofmaterialistic but it didn t last You know it was like I hadn t forgotten all the lessons I dlearnedil was kind of indulging in it for alittle while just to get that feel ing back I used to have But I d changed too much Ultimately I realized these are just things If I m collecting it to have just number 1 through 20 or something you know why amI doing it It didn thave the same meaning anymore as that itwas one of those unimportant things ultimately In summary there was ample evidence for the irreversibility of the perspective transformation The desire to make a meaningful contribution continued and was manifested in a wide variety of ongoing service activities Additionally respon dents continued heightened sensitivity to life was evidenced in their appreciation for nature their families and friends Participants also recognized the irreversibil ity of their perspective transformation Changes in Meaning Schemes Over time the participants in this study evidenced changes in their meaning schemes These changes can be characterized in three ways a adoption of a futureoriented perspective to life b greater attention to issues pertaining to care of the self and c integration of one s HIVpositive status into selfdefinition Adoption of a futureoriented perspective When last interviewed the focus of the participants in this study was on living in the present Many eloquently spoke of the uncertainties of tomorrow and how living for today provided the freedom to do what they felt was really important in life Dawn for instance said that she had watched people all my life around me who someday they re gonna do this and someday they re gonna do that and I try really hard to make my someday today Courtenay et al IPERSPECTIVE TRANSFORMATION 111 John s need to really enjoy today was representative of the positions of others In short1 the participants expressed gratitude for having survived as long as they had and committed their energies to living in the here and now Rarely did they project a future for themselves The orientation of the participants was noticeably different in the followup interviews Protease inhibitors still in clinical trials during the first round of inter views were now included as part of the medication regimens of most of the partici pants and with dramatic results Tcell counts soared as viral loads dropped to nearly undetectable levels for many Experiencing a level of health and vitality believed to be outside of the realm of possibility 2 years ago produced a new out look on life an outlook of hope for a future Participants spoke of this new perspec tive in various ways including having a positive outlook making longrange plans and looking forward to benchmark events in life such as a 30th birth y or retirement Nicole one of the youngest participants in the study said simply and frankly I m not thinking I m going to die any time soon Because she no longer believed that her life would be cut short by HIV Tracy stated that she would now make plans 1 set goals things that 1 would like to do Dawn too could see new possibilities for her life I haven t planted an herb garden and I want to take a pottery class andl want to get back to reading books for fun and some things like that And I think those are some of the things that somebody who thinks they have a future talks about Sam who had just turned 40 also remarked that his life now held promise of a future he had not believed possible Suddenly lhave a future again 1 and a lot of my friends are like Oh my God you know I m not going to die now lneed to start saving for retirement and stuff like tha The thrill that the hope for a future brings however is not without its own trepi dation and challenge as Sam s remark illustrates Also whether the effect of pro tease inhibitors can be sustained is unknown leading several of the participants in this study to be what Steve calls cautiously optimistic in thinking ahead and plan ning for a future Jeffrey for example was quick to note that the prospect of living is precipitating a kind of metamorphosis and that others are experiencing the same things Do I put my energy into living or do I still be safe and keep all the safeguards that l have Do I go out and get the mortgage or do ljust stay These life choices are scary and yet we never thought we d have to deal with them Joe too used the word scary in describing the new mindset toward life created by the promise of protease inhibitors I ve spent my retirement money that was in my 401K for medicine and I don t have any kind of savings account And so everything I had set up in my life for a 112 ADULT EDUCATION QUARTERLY February 2000 longterm future I ve had to cut short And it s kinda like starting all over again and that s really scary Jamie who had been living with HIV for ll years since being diagnosed in his early twenties voiced similar concerns stating that now suddenly things are differ ent I mean it s much easier to plan to die than it is to plan to live He noted that his heretofore practice of considering his longevity in 2year increments had al lowed him to live with intensity and focus In fact he jokingly stated I mean I think I could have lived until Iwas 60 as long as they kept telling me you re gonna be dead in 2 years langhter He added that knowing you might live that s thrown a whole monkey wrench into things You ve got to consider conse quences way down the road I ve never done that before Greater attention to care of the self During the first round of interviews the par ticipants reported that the meaning they had made of their HIV status centered largely on being of service to others Although serving others has continued to be a hallmark in the lives of all the participants in this study data from the second inter views reveal that they evidence an awareness of the need to care for themselves as well an awareness rarely articulated 2 years ago For some like Dawn caring for others had often been in lieu of caring for herself not in conjunction with it She explained it like this Over the years I ve had the privilege ofmeeting tens of thousands of HIVpositive people Istartedrunning back into them laughter and you know the say were such an inspiration I shamefully stand there and say to myself I haven t done any of those things It s time for me to do that too She added Actually Ithink finally I am starting to be fairly important to me for the first time She also noted that what I have found in my efforts to take care of everyone else is that in fact if I don t take care of myself at all then I fail at taking care of other people thatI care about Elise likewise observed that in addition to that blessed feeling of being of service to other people there always has to be a part of me that s taking care of me Otherwise I m of no service to anyone else Several of the participants reinforced this new awareness of attending to their own needs with comments pertaining to an emphasis on ways to improve their health Pat for example stated I don t go buy clothes any more you know to x up the outside But what I do is that I x up my body you know Or I make sure thatI getmore rest orjustpump up on some juices or make sure I eat good Integration of HIVpositive status into selfde nition There was also a notable difference in the centrality of HIV in the lives of the participants in the second inter views Most participants 2 years earlier had defined themselves primarily in terms Courtenay et al PERSPECTIVE TRANSFORMATION 113 of their HIV status In the intervening 2year period however the prominence of HIV in their lives had receded Elise for instance noted that I In more integrated with HIV It s as opposed to being as big as I am it sjust a part ofwho I am now Sam similarly remarked that HIV is just a part of me now That HIV has ceased to occupy a dominant role in terms of selfdefinition is fur ther exemplified by John s comment And I would say 2 years ago ifyou said tell me aboutyourself one of the rst things I would say is that I m HIV Now I would talk more about myjob my house my rela tionship with my partner all of which certainly involves HIV but it s not the lead ing characteristic of my l1fe The level of comfort that John now feels with his HIV status was evident in his ref erence to the virus as more of a companion that he didn t particularly want to have but one that is with him nevertheless He noted with a bit of amusement that actually we re old friends I kind of understand the virus and know that it s here and it lives with me Kenneth shared a similar perception of his HIVpositive sta tus calling it more like a petiyou have to take care of it You don t take care of it it starts whining and scratching and doing all sorts of annoying things laughs Infection with HIV occupied an even less conspicuous presence in the lives of two of the participants in this study Mirna who had remarried her husband of almost 30 years stated rather nonchalantly that I don t ignore it HIV I just don t put any emphasis on it Ben similarly noted I really don t even think about being HIV positive today Ireally don t He added I don t deny myself that I m HIV anymore but it s not something I m gonna worry about After 13 years of every body saying you re gonna die in a year or two and then you re still around his HIV status no longer dictates his life or his perception of himself In fact for both Mirna and Ben definitions of the self more closely reflect their histories of substance abuse In summary there were clear indications of changes in meaning schemes for the participants in this study since the first round of interviews Specifically partici pants had become less focused on the present and adopted more of a futureoriented perspective to life Also they evidenced a greater awareness of the need to care for the self striking a healthy balance between attending to their own needs and caring for the needs of others Finally their definitions of self no longer centered on their HIV status Being HIVpositive was just one of many descriptors that characterized their lives DIS CUS S ION For all 14 participants in this study there is evidence of the enduring nature of a perspective transformation Our study thus provides empirical evidence that per spective transformations are irreversible confirming the thinking of Mezirow 1991 114 ADULT EDUCATION QUARTERLY February 2000 and Kegan 1994 However the perspective transformations of our participants were triggered by the highly emotional and traumatic impact of a lifethreatening diagnosis We wonder about the staying power of perspective transformations that emerge from 1 1 f w t in ex PM 4 A re earrh in thi area as a means of illuminating our understanding of the key ingredients of an enduring perspective transformation The second major finding of this study confirmed the expectation that over time meaning schemes do change Our data indicate that the adults in this study experi enced changes in some of their basic beliefs and assumptions For example most participants had become more future oriented Two years ago we found that most of these HIVpositive adults were largely focused on living in the present and if thinking about the future at all they were planning for the short term In the past 2 years they had moved from being present centered to future oriented Thus they had revised the assumption that they would only live for maybe 2 more years to the assumption that they might live a life of normal longevity In our earlier study however one individual claimed to be focused on the present but also looking to the future as evidenced by her plans to enroll in college and complete her degree The comments of two other individuals reflected a stronger futureorientation One participant described her plans for completing a college degree and another spoke of starting a business The other 15 participants were clearly focused on the present The first set of findings is consistent with those of a study focusing on time and positive HIV status Davies 1997 From an examina tion of interviews with 38 HIVpositive individuals who had been living with their diagnosis for 5 years or more Davies 1997 concluded that three views about time are present in adulm with this diagnosis One group lives with a philosophy of the present freed from the responsibilities normally associated with adulthood and enabled to enjoy the present as long as is possible Some individuals in our first study exhibited this temporal orientation The second group like the two individu als in our study lives in the future refusing to accept the possibility of imminent death and maintaining an orientation of life in the future The third group like some participants in our first study were living in the empty present This group is simi lar to the first except that they are so focused on the possibility of an early death that they are unable to enjoy the present Our second set of interviews indicate that all members of our sample shifted their temporal perspective to living in the future unlike those adults interview ed by Davies 1997 We would speculate that the difference in these findings is due to the widespread use of protease inhibitors and their positive effects on our sample It is not clear from Davies s study whether any participants in her sample were using protease inhibitors Our sample of participants also spoke of how they had changed their beliefs about the self Two years ago data from the first interviews with these individuals reflected an other orientation especially with respect to what is important in life What we found 2 years later are individuals who have realized that concern for the Courtenay et al IPERSPECTIVE TRANSFORMATION 115 self is also important In the past 24 months the majority of adults in this study had integrated their beliefs about the self and others realizing that both are vital for ful filling their purpose in life articipants views of their HIVpositive diagnosis is the third area where we uncovered changes in meaning schemes Whereas 2 years ago being HIVpositive produced anxiety about dying it has currently been integrated into their everyday lives Although the potential for HIV to end life is still imminent it no longer con trols the thoughts and actions of its hosts Thus the previous assumption that one s thinking and behaving are subservient to being HIVpositive has evolved to the belief that the person is greater than the diagnosis These three changes in perspectives about the future self and HIV uphold the expectation that we would find alterations in meaning schemes after 2 years at the data do not reflect are subsequent perspective transformations When asked whether they had experienced a situation or event as in uential as their HIVdiagnosis most of the adults in this study answered that they had not And in those few instances where individuals described an experience that affected them as much as their diagnosis they did not evidence having had another perspective transformation This finding is explained by Mezirow s 1990b distinction between content and process reflection Unlike the HIVpositive diagnosis that was the disorienting dilemma Mezirow 1990b that raised such basic questions as Why am I still alive or Now what is my purpose in life the events over the past 2 years have prompted what Mezirow refers to as content re ection descriptionfacts of an experience or process re ection the strategies one might employ in an experi ence A different view of the self illustrates this distinction Two years ago the adulm in this study explained how an HIVpositive diagnosis forced them to come to grips with what was really important in life and what would be their role in life with HIV and they concluded that they should devote their remaining time helping other people Thus they shifted their meaning perspective from being self to otheroriented The nature of their re ection on those two questions was premise reflection because they were assessing the reasons for their existence and their future Two years later the majority of the sample gave evidence that their thinking had gone from one extreme to a more balanced view that concern for the self is equally important to concern for others By re ecting on their decision to help others and its consequences for their own lives they realized that they could not effectively serve others if they did not care for themselves as well Rather than asking the important question about the purpose of life in the past 2 years the participants in this study discovered that their strategies process re ection for fulfilling their purpose needed adjustment Although protease inhibitors did not prompt additional perspective transforma tions their positive effects do appear to explain at least one of the changes in mean ing schemes The knowledge that Tcell counts rose dramatically and that viral 116 ADULT EDUCATION QUARTERLY February 2000 loads became undetectable accompanied by such physical manifestations as lessfrequent illnesses and weight gain provided hope for a longer life Conse quently the individuals in this study shifted to a more futuristic outlook for their lives and reported that instead of planning for death they were now preparing for life Another question that guided this study was the impact of time on a perspective transformation As indicated by our findings there has not been a reversion in the perspective transformations of the sample during the past 2 years However mean ing schemes the specific beliefs and assumptions of the individuals in this study have changed and time appears to be a contributing factor First the passage of 2 years provided an opportunity to reflect further about being HIVpositive Without the time to act on their new perspectives and to observe the effects of their actions the adults in this study would obviously not have had the space to examine their meaning schemes Second the findings reveal how some members of the sample attributed their revised perspectives to the fact that in the past 2 years they had tunied 30 or 40 years of age ages that are important adult life transitions Bee 1996 Merriam amp Caffarella 1998 Could it be that these new levels of maturity have facilitated the c anges in meaning schemes for some adulm in this study For example did our sample realize that care of self is equally as important as serving the needs of others because they had reached a stage in life where this awareness would ordinarily emerge The third way in which time appears to be related to changes in meaning schemes is the perception by the HIVpositive adulm that they have more time to live This aspect of the importance of time in altering meaning schemes may be unique to this sample or to other individuals who have had a perspective transfor mation as a result of a tragic experience In those instances when a perspective transformation isn t effected by a lifethreatening event the perception of having more time to live is likely to be irrelevant to revisions in meaning schemes A ques tion for further study would be about the perception of time in relation to perspec tive transformations In addition to our interest in knowing whether the participants in this study had experienced further transformations we were curious to learn the directions of ose changes Were they progressive Were they regressive The three changes in meaning schemes all appear to be developmentally positive Rather than living only in the present and planning for death the adults in this study have renewed their concenis for the future and are making plans well beyond 2 to 3 years of life Fur thermore the members of the sample had reached a more integrated view of the relationship between themselves and other individuals by realizing that they could most effectively reach out to help others by taking care of themselves as well The views of the participants in this study also evolved with respect to the centrality of Courtenay et al PERSPECTIVE TRANSFORMATION 117 HIV in their lives They no longer felt oppressed and controlled by their diagnosis but had integrated it as part of their daily routine Although they recognized that it still had the potential to end their lives they were not paralyzed to move forward with future plans as they had been 2 years ago IMPLICATIONS FOR ADULT EDUCATION On one hand the fact that we found perspective transformations hold over time is encouraging to those concerned about transfer and stability of learning Transformational learning acknowledged by some as an appropriate goal for adult education Robertson 1996 may endure because it effects a dramatic change in the learner Thus adult educators who purposefully configure adult learning expe riences to bring about a perspective transformation have one empirical indicator that learners experiencing perspective transformations are likely to maintain the change On the other hand that a perspective transformation is stable over time reflects serious concerns for the adult educator Ethical issues regarding the right of the adult educator to intentionally plan for perspective transformation as well as his or her 1 39 iur A impact of r I 39 niaLiun inthe lives of learners are important to consider Robertson 1996 provides a helpful observation about this dilemma when he argues that although transformational learning is an appropriate goal for adult education the field neither adequately prepares nor supports adult educators to manage the dynamics of helping relation ships or the dynamics of transformative learning within the context of those rela tionships pp 4344 Thus whereas the first finding of this study offers hope to those who are interested in longterm change it also raises concern over the moral and ethical implications of deliberately effecting change in the lives of adult learners The second major finding of this study that meaning schemes do change over time and in a developmentally positive direction as indicated by our data also has implications for adult education This evidence offers assurances that fundamental beliefs and assumptions of learners are continuously changing therefore our efforts to configure learning experiences that help learners examine their meaning schemes may be productive for them However that conclusion assumes that changes in meaning schemes are always developmentally positive as was true for our sample The findings of this study do not counter that assumption but neither do they confirm it as a universal experience Thus although we have found that alter ations in meaning schemes are favorable they may not change or change negatively in other situations I f 39 39 39 focus on c d39 39 f change in meaning schemes 118 ADULT EDUCATION QUARTERLY February 2000 REFERENCES Bee H L 1996 Thejourney ofadulthood 3rd ed Englewood Cliffs NJ Prentice Hall Bogdan RC amp Biklen S K 10L 39 39 39 39 gt 39 39 methods 3rd ed Boston Allyn amp Bacon Brew A 1993 Unlearning through experience In D Boud R Cohen amp D Walker Eds Using experiencefor learning pp 8798 Bristol PA Open University Press Coffman P M 1991 Inclusive language and perspective tmnsformation In 32nd AnnualAdult Edu cation Research Conference Proceedings p 4955 Norman University of Oklahoma Courtenay B C Merriam S B amp Reeves P M 1998 The centrality of meaningrmaking in tmnsformational learning How HIVrpositive adults make sense of their lives Adult Education Quarterly 482 6584 Cranton P 1994 Understanding and promoting transformative learning A guide for educators of adu ts San Francisco JosseyrBass Daloz L 1986 E ective teaching and mentoring San Emncisco JosseyrBass Davies M L 1997 Shattered assumptions Time and the experience of longrterm HIV positivity Social Science Medicine 445 5617571 GlaserBGampStmu A1 105 n39 ywm is f 1 Chicago AVC Kegan R 1994 In over ourheads The mentaldemands ofmodern life Cambridge MA Harvard Uni versity Press LaswellTD 199A 39 39 39 39 39 In 8 m4 7 A 39 7 r h ConferenceI uteedii 11112297234 Knoxville Uni versity of Tennessee Merriam S B 1998 Qualitative research and case study applications in education 2nd ed San Emncisco JosseyrBass emamSBamp aFFanella R 199 7 39 39 W an Fun 139 n In rBass ezirow J 1981 A critical theory of adult learning and education Adult Education Quarterly 32 yaui M M 3724 Mezirow J 1990a Conclusion Toward transformative learning and emancipatory education In J Mezirow amp A int Ed 7 39 critical r f7 tim in Ilthnn Aguide to trans formative and emancipatory learning pp 354376 San Francisco JosseyrBass Mezirow J 1990b How critical re ection triggers transformative learning In J Mezirow amp Associr ates EdsFostering 39 39 r 7 Him in Ilthnn Agu e to 39 39 y learning pp 1720 San Emncisco JosseyrBass Mezirow J 1991 Transformative dimensions ofadult learning San Emncisco JosseyrBass PopeSM1996quot 39 39 39 39 39 39 WU will 44 women through the process ofeducation Unpublished doctoral dissertation The Fielding Institute Los Angeles Robertson D L 1996 Facilitating tmnsformative learning Attending to the dynamics of the educar tional helping relationship Adult Education Quarterly 471 4153 Saavedm E R 1995 Teacher transformation Creating text and contests in study groups Unpubr lished doctoml dissertation Un39versity Arizo a Tucso Taylor E W 1997 Building upon the theoretical debate A critical review of the empirical studies of Mezirow s tmnsformative learning theory Adult Education Quarterly 481 3459 TennantMC1993 39 39 and 4 A A r39 39 441 3442 r Courtenay et al IPERSPECTIVE TRANSFORMATION 119 Usher R 1993 Experiential learning or learning from experience Does it make a difference In D Boud R Cohen amp D Walker Eds Using experieneefor learning pp 169 180 Bristol PA Open University Press Williams G H 1986 Perspective tmnsformation as an adult learning theory to explain and facilitate c ange in r L In 7 t 7 A r39 39 7 r h Conference Proceedings pp 320325 Symcuse NY Symcuse University


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