Case Study Research in Counselling and Psychotherapy (McLeod 2010)
作者: kc / 3396次阅读 时间: 2010年10月01日
标签: ETHICALLY DYNAMIC
www.psychspace.com心理学空间网如何在無法控制變項的前提下 研究一個字 一句話 一個狀態 一個經驗 一個過程 一個人 一個人和另一個人的關係 一個人和另一個人的關係所透露出的雙方個自的狀態 (1) Ethically problematic (2) Better proceed as a team, yet if no team, so be it (3) Cf QR interviewing vs. dynamic psychotherapeutic interviewing (4) 4 Hours (a la 61 Hours, Lee Child) 初始的四小時 如果不將那四小時界定為治療 是否可解決上述倫理上的難題 而那四小時要問的是 dynamic formulation是什麼 精神病理之歷史經驗結構為何(5) Regarding case study research, IPA can be the underlying methodology (6) In my present understanding, case study research is the only meaningful way to do empirically systematic observation and reflection upon the consulting room. This project embodies the spirit of P-H-E too
Case Study Research in Counselling and Psychotherapy (McLeod 2010)

Oct 30, 2010
KC

• This book has been written at a point in the history of counselling and psychotherapy at which there is enormous external pressure on the profession to produce evidence of its effectiveness.
• The aim of this book is to provide the conceptual understanding and practical tools required to conduct systematic, high-quality therapy case studies.
A Few Purposes in Mind
• To make a contribution to shared professional and scientific knowledge, by presenting carefully documented and rigorously analysed case-based evidence
• To enable users of therapy and practitioners to gain an understanding of what actually happens in different forms of therapy for different client problems
• To provide a structure for personal and professional development in therapists, in the form of opportunities to reflect on practice
The advantages of case study methods
• The case study as a form of narrative knowing
• The case study as a means of representing complexity
• Contexuality as an essential feature of case study research
• Describing and analyzing practical expertise in action
• Developing a critical perspective
• Flexibility
• Analysing and reporting innovative practice
• Learning from unusual cases
• Integration into training and practice

Questions
• Are case studies necessary?
• How is it possible to do case studies well?
• What is best practice in case study research and inquiry?
• How is it possible to assess whether a case study is plausible and credible, or biased and worthless?
Traditional clinical case study
• Most of the counselling and psychotherapy cases that have ever been written up are based on information derived from therapist notes and recollections, that have been interpreted and analysed solely by the therapist.

• However, these case studies do not provide reliable evidence about what actually happens in a case, because they are not able to supply data that can be subjected to any kind of independent scrutiny.
• In addition, there is good reason to believe that the information that is provided in a typical clinical case study may be constructed around selective remembering and reporting on the part of the therapist-author.
Limitations
• It is impossible to recall everything that happened in a therapy session: it seems inevitable that important information may have been lost
• Writing a retrospective account of a session introduces the possibility that the writer has reconstructed events in line with his or her pre-existing assumptions

• There is an absence of other perspectives – for instance, the views of the client regarding the helpfulness of the therapy
• There is no way of checking whether the interpretation of the material that has been collected is rigorous, systematic and comprehensive

• Donald Spence (1989, 2001) has argued that the methodology of clinical case study leads to a process of ‘narrative smoothing’, in which aspects of therapy are selectively recalled, in line with the therapist’s pre-existing theoretical framework of personal interests, while contradictory evidence is overlooked.
• The tendency for contemporary therapy writers to publish case examples or vignettes, rather than full-blown case studies, serves to exacerbate these difficulties, because only selected segments of case materials are presented.

• The history of case study research in counselling and psychotherapy can be viewed a struggle between a desire to retain the valuable qualities of traditional therapist-generated clinical case studies, while introducing some elements of methodological rigour.
Criticisms of case study methods
• Case studies are biased, and merely function as vehicles for publicizing the pre-existing assumptions of those who carry them out
• It is not possible to generalize on the basis of single cases
• Case studies are merely descriptive, and tell us nothing about causality

• Case studies are ethically problematic; it is impossible to guarantee anonymity to participants
• Case studies can provide fascinating, detailed accounts of human experience, but are hard to summarize in a form that can lead to an accumulation of evidence
• Case studies may be informative for practitioners, but do not generate evidence that is relevant for policy-making

Core ethical issues
• Obtaining informed consent from clients, in relation to being a subject of a therapy case study
• Maintaining confidentiality
• Avoiding harm to case study participants
• (Because the relative neglect of systematic case study methods in counselling and psychotherapy research, over the past 30 years there has been little work on the specific ethical challenges arising from case study investigations.)
Ethical Guidelines for Case Study Research in Counselling and Psychotherapy
• The conduct of all case study research and inquiry in counselling and psychotherapy should adhere to the research ethics codes of the professional groups to which the authors of the case reports are affiliated
• Authors of therapy case studies should be transparent about the ethical procedures that have been conducted in relation to their studies, and provide details of these procedures within all case publications

• The ethical procedures used within any case study project must always be subject to expert external scrutiny, in the form of an institutional approval committee or board, or an equivalent consultative process
• It is advised that, wherever possible, prospective informed consent for in-principle case study participation should be obtained from clients before the commencement of therapy, and then at all further stages of the inquiry cycle up to and including the final release to publish (process consent). The person who undertakes the informed consent procedure must not be the therapist conducting the case

• In situations where prospective informed consent is not feasible, alternative consent procedures must be approved by an appropriate institutional approval committee or board, or an equivalent consultative group, and include the involvement of an independent consultant who will undertake all negotiations with the client

• In situations where informed consent is not possible, at least two independent expert consultants should audit all aspects the inquiry process, as advocates of the client
• Good practice in case study research involves providing the client with an opportunity to comment on a draft of the case report, and to stipulate the deletion or disguising of material for confidentiality purposes. Good practice involves encouraging the client to make a personal statement about the case report to be included in the final published version

• Clients must be offered support, from an expert independent consultant as well as the researcher and/or therapist, at the point at which they are invited to comment on the draft report. If possible, this support should continue to be available to the client for a period of 5 years following publication of the study

• In case study research where the principal investigator is not the therapist for the case, the therapist should undergo an informed consent and release process similar to that of the client
• In case study research where the therapist is the principal investigator, the therapist must engage in clinical supervision or personal therapy with the explicit contracted aim of examining personal factors associated with the case study work, as a means of ameliorating the impact of these factors on (a) the client, (b) bias within the case report and (c) the well-being the author
Principles of systematic case study research
• Creating as rich a data set as possible, based on multiple sources of information, including description of the context within which the therapy took place
• Engaging the interest of the reader by telling the story of what happened within the case
• If possible, using standardized process and outcome quantitative measures that allow comparisons to be made with data from other cases

• Provide enough information within the report, or in appendices, so that the reader can make up their own mind about the interpretation of the case
• Use multiple analysts, rather than depending on a single perspective on the data. Also, if possible, more than one person should be involved in data collection

• Do some kind of time-series analysis, to enable the process of change to be explored in a systematic manner
• Critically examine alternative interpretations of the data – be critical and scholarly, rather than using the case study to ‘sell’ an approach to therapy
• Take theory seriously, on the grounds that generalization is based on the establishment of cross-case theoretical principles

• Try to find out what the client thinks about the therapy he or she has received, and about the analysis of the case data
• Be reflexive – provide relevant information about the author(s), to allow readers to take potential sources of bias into account
• Use a standard format, to make it easier for future scholars to conduct meta-analysis, and for current readers to find their way around your case report
Toolkit for collecting and analysing case material
• Therapist notes
• Outcome measures
• Process measures
• Therapy session recordings
• Client and therapist interviews
• Other sources of information
• Specifying the therapeutic approach that was used in the case
Five types of case studies
• 1. Pragmatic case studies
• 2. Single subject designs
• 3. Hermeneutic single case efficacy design (HSCED)
• 4. Theory-building case studies
• 5. Narrative case studies
Documenting everyday therapeutic practice: Pragmatic case studies
• Pragmatism focuses on case studies that address particular practical problems in local and time-specific contexts rather than on the abstract, universal, quantitative knowledge of timeless laws and principles (Fishman 1999, p. 131)
Pragmatic Case Studies in Psychotherapy
• http://pcsp.libraries.rutgers.edu (Dan Fishman 2005)
• A model of professional activity as disciplined inquiry (Peterson 1991)
• GOALS OF THE JOURNAL
• 1) To generate a growing database of systematic, rigorous, and peer-reviewed therapy case studies across a variety of theoretical approaches.
• 2) To pilot-test the special advantages of online, case study journals in applied psychology generally by exemplifying in detail their ability to make large amounts of qualitative and quantitative, peer-reviewed information particularly timely, accessible, searchable, and pragmatically and theoretically valuable.
• 3) To act as a vehicle for progress in therapy case-study method through the process of example, critical dialogue, and cross-case analysis.



Instructions for Authors
• 1. Case context and method
• 2. The client
• 3. Guiding conception with research and clinical experience support
• 4. Assessment of the client’s problems, goals, strengths and history
• 5. Formulation and treatment plan
• 6. Course of therapy
• 7. Therapy monitoring and use of feedback information
• 8. Concluding evaluation of the process and outcome of therapy
• 9. References

Suggestions for improving pragmatic case studies
• Author reflexivity
• More emphasis on the therapeutic relationship
• Transparency around ethical procedures
• Inclusion of the client’s perspective on the case
• Reporting of contextual factors
• Adoption of a dialogical approach
• A more focused publication strategy
Evaluating the effectiveness of therapy: n=1 time-series case studies
• Had its origin in early 20th century behavioral research lab. As a vehicle for hypothesis-testing, based on the following methodological principles:

• Reliable and valid measurement of outcome variables
• Accurate description of the intervention that is being assessed
• Time-series analysis of patterns of change
• The logic of replication
Questions
• Will I be able to identify with confidence, before therapy begins, the key outcome targets that will be the focus of therapy?
• Do I have access to some means of reliably measuring these outcome variables?
• Can I set up a pre-therapy baseline period of at least 3 weeks (and preferably much longer) when my client will complete key assessment measures, but not receive therapy?

• Am I comfortable with my client completing an assessment scale every week during therapy?
• Can my model of therapy be broken down into discrete interventions, or a standard sequence of tasks?
• Can I set up a post-therapy series of follow-up measurement occasions?

• In forms of therapy that are based around an exploratory, meaning-making approach, such as psychodynamic and person-centred, it would not make much sense to identify one, or even a few, behavioural outcomes before therapy has commenced, that would be tracked all the way through treatment.
Using multiple judges in evaluating the effectiveness of therapy: HSCED
• As an alternative to n=1 design, based in a quasi-judicial paradigm for inquiry, the rationales for HSCED are (Robert Elliot 2001, 2002):
• The image of the person in counselling and psychotherapy
• Re-thinking the concept of causality
• Methodical hermeneutics as a means of creating reliable knowledge (Rennie 2000, 2001)
• A quasi-judicial analytic framework
HSCED in action
• To assemble a rich case record, for example comprising factual information about the client and therapist, quantitative questionnaire measures, process measures administered on a regular basis, end-of-therapy interviews, therapist process notes, transcripts of sessions, etc. … The key point is that a variety of sources of information are ready to hand, so that interpretations made on the basis of specific client statements or claims can always be checked.

• The ‘case book’ is interpreted from two competing positions: an ‘affirmative’ position and a ‘sceptic’ position. The rival interpretations can be carried out either by a lone researcher, who formulates each interpretation in turn, or by separate teams of researchers.
• The interpretation of case data is guided by ‘case law’, explicit rules for arriving at an agreed interpretation of evidence.
Theory-building case studies
• In the field of counselling and psychotherapy, virtually all the good ideas have come from practice. There are very few examples of good ideas that have emerged from pure science, laboratory studies. What this means is that practising counsellors and psychotherapists have always used their experience with clients as a means of thinking about theory and coming up with new ideas.
Basic principles of theory-building case study research
• Develop a theoretical starting-point
• Selection of a case
• Construction of a rich case record
• Immersion in the case
• Applying the theory to the case
• Identifying gaps in the theory: applying the case to the theory
• Refining the theory
• Testing the revised version of the theory against further cases
Exploring the meaning of the therapy experience: Narrative case studies
• The aim of a narrative case study is to ‘tell the story’ of the experience of therapy, to convey what it was like to be a participant in therapy. It is successful if it expresses the meaning of therapy.
• Since this kind of case study does not represent a single approach, it is not possible to identify a set of methodological principles that can be followed.
Strategies for constructing a narrative case study
• Writing an autobiographical retrospective account
• Diary or journal entries
• Recordings
• Artifacts created during therapy, or associated with therapy
• Interviews

Exemplar narrative case studies
• Kim Etherington (2000)
• Writing therapy stories (Dan McAdams & Jonathan Adler 2007, 2008)
• Life history approaches to therapy case study research (e.g. Geller, Norcrosis & Orlinsky 2005)
• Autobiographical and fictional narrative case studies (e.g. Yvonne Bates 2006)

• One of the ways in which a professional group can take user narratives seriously is to collect, catalogue and review them, as a means of distilling the wisdom that they contain. It would be a good idea for someone to undertake this task in respect of the counselling and psychotherapy literature. www.psychspace.com心理学空间网
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