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What Is a Case Study?
Weighing the pros and cons of this method of research
Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."
Cara Lustik is a fact-checker and copywriter.
Verywell / Colleen Tighe
- Pros and Cons
What Types of Case Studies Are Out There?
Where do you find data for a case study, how do i write a psychology case study.
A case study is an in-depth study of one person, group, or event. In a case study, nearly every aspect of the subject's life and history is analyzed to seek patterns and causes of behavior. Case studies can be used in many different fields, including psychology, medicine, education, anthropology, political science, and social work.
The point of a case study is to learn as much as possible about an individual or group so that the information can be generalized to many others. Unfortunately, case studies tend to be highly subjective, and it is sometimes difficult to generalize results to a larger population.
While case studies focus on a single individual or group, they follow a format similar to other types of psychology writing. If you are writing a case study, we got you—here are some rules of APA format to reference.
At a Glance
A case study, or an in-depth study of a person, group, or event, can be a useful research tool when used wisely. In many cases, case studies are best used in situations where it would be difficult or impossible for you to conduct an experiment. They are helpful for looking at unique situations and allow researchers to gather a lot of˜ information about a specific individual or group of people. However, it's important to be cautious of any bias we draw from them as they are highly subjective.
What Are the Benefits and Limitations of Case Studies?
A case study can have its strengths and weaknesses. Researchers must consider these pros and cons before deciding if this type of study is appropriate for their needs.
One of the greatest advantages of a case study is that it allows researchers to investigate things that are often difficult or impossible to replicate in a lab. Some other benefits of a case study:
- Allows researchers to capture information on the 'how,' 'what,' and 'why,' of something that's implemented
- Gives researchers the chance to collect information on why one strategy might be chosen over another
- Permits researchers to develop hypotheses that can be explored in experimental research
On the other hand, a case study can have some drawbacks:
- It cannot necessarily be generalized to the larger population
- Cannot demonstrate cause and effect
- It may not be scientifically rigorous
- It can lead to bias
Researchers may choose to perform a case study if they want to explore a unique or recently discovered phenomenon. Through their insights, researchers develop additional ideas and study questions that might be explored in future studies.
It's important to remember that the insights from case studies cannot be used to determine cause-and-effect relationships between variables. However, case studies may be used to develop hypotheses that can then be addressed in experimental research.
Case Study Examples
There have been a number of notable case studies in the history of psychology. Much of Freud's work and theories were developed through individual case studies. Some great examples of case studies in psychology include:
- Anna O : Anna O. was a pseudonym of a woman named Bertha Pappenheim, a patient of a physician named Josef Breuer. While she was never a patient of Freud's, Freud and Breuer discussed her case extensively. The woman was experiencing symptoms of a condition that was then known as hysteria and found that talking about her problems helped relieve her symptoms. Her case played an important part in the development of talk therapy as an approach to mental health treatment.
- Phineas Gage : Phineas Gage was a railroad employee who experienced a terrible accident in which an explosion sent a metal rod through his skull, damaging important portions of his brain. Gage recovered from his accident but was left with serious changes in both personality and behavior.
- Genie : Genie was a young girl subjected to horrific abuse and isolation. The case study of Genie allowed researchers to study whether language learning was possible, even after missing critical periods for language development. Her case also served as an example of how scientific research may interfere with treatment and lead to further abuse of vulnerable individuals.
Such cases demonstrate how case research can be used to study things that researchers could not replicate in experimental settings. In Genie's case, her horrific abuse denied her the opportunity to learn a language at critical points in her development.
This is clearly not something researchers could ethically replicate, but conducting a case study on Genie allowed researchers to study phenomena that are otherwise impossible to reproduce.
There are a few different types of case studies that psychologists and other researchers might use:
- Collective case studies : These involve studying a group of individuals. Researchers might study a group of people in a certain setting or look at an entire community. For example, psychologists might explore how access to resources in a community has affected the collective mental well-being of those who live there.
- Descriptive case studies : These involve starting with a descriptive theory. The subjects are then observed, and the information gathered is compared to the pre-existing theory.
- Explanatory case studies : These are often used to do causal investigations. In other words, researchers are interested in looking at factors that may have caused certain things to occur.
- Exploratory case studies : These are sometimes used as a prelude to further, more in-depth research. This allows researchers to gather more information before developing their research questions and hypotheses .
- Instrumental case studies : These occur when the individual or group allows researchers to understand more than what is initially obvious to observers.
- Intrinsic case studies : This type of case study is when the researcher has a personal interest in the case. Jean Piaget's observations of his own children are good examples of how an intrinsic case study can contribute to the development of a psychological theory.
The three main case study types often used are intrinsic, instrumental, and collective. Intrinsic case studies are useful for learning about unique cases. Instrumental case studies help look at an individual to learn more about a broader issue. A collective case study can be useful for looking at several cases simultaneously.
The type of case study that psychology researchers use depends on the unique characteristics of the situation and the case itself.
There are a number of different sources and methods that researchers can use to gather information about an individual or group. Six major sources that have been identified by researchers are:
- Archival records : Census records, survey records, and name lists are examples of archival records.
- Direct observation : This strategy involves observing the subject, often in a natural setting . While an individual observer is sometimes used, it is more common to utilize a group of observers.
- Documents : Letters, newspaper articles, administrative records, etc., are the types of documents often used as sources.
- Interviews : Interviews are one of the most important methods for gathering information in case studies. An interview can involve structured survey questions or more open-ended questions.
- Participant observation : When the researcher serves as a participant in events and observes the actions and outcomes, it is called participant observation.
- Physical artifacts : Tools, objects, instruments, and other artifacts are often observed during a direct observation of the subject.
If you have been directed to write a case study for a psychology course, be sure to check with your instructor for any specific guidelines you need to follow. If you are writing your case study for a professional publication, check with the publisher for their specific guidelines for submitting a case study.
Here is a general outline of what should be included in a case study.
Section 1: A Case History
This section will have the following structure and content:
Background information : The first section of your paper will present your client's background. Include factors such as age, gender, work, health status, family mental health history, family and social relationships, drug and alcohol history, life difficulties, goals, and coping skills and weaknesses.
Description of the presenting problem : In the next section of your case study, you will describe the problem or symptoms that the client presented with.
Describe any physical, emotional, or sensory symptoms reported by the client. Thoughts, feelings, and perceptions related to the symptoms should also be noted. Any screening or diagnostic assessments that are used should also be described in detail and all scores reported.
Your diagnosis : Provide your diagnosis and give the appropriate Diagnostic and Statistical Manual code. Explain how you reached your diagnosis, how the client's symptoms fit the diagnostic criteria for the disorder(s), or any possible difficulties in reaching a diagnosis.
Section 2: Treatment Plan
This portion of the paper will address the chosen treatment for the condition. This might also include the theoretical basis for the chosen treatment or any other evidence that might exist to support why this approach was chosen.
- Cognitive behavioral approach : Explain how a cognitive behavioral therapist would approach treatment. Offer background information on cognitive behavioral therapy and describe the treatment sessions, client response, and outcome of this type of treatment. Make note of any difficulties or successes encountered by your client during treatment.
- Humanistic approach : Describe a humanistic approach that could be used to treat your client, such as client-centered therapy . Provide information on the type of treatment you chose, the client's reaction to the treatment, and the end result of this approach. Explain why the treatment was successful or unsuccessful.
- Psychoanalytic approach : Describe how a psychoanalytic therapist would view the client's problem. Provide some background on the psychoanalytic approach and cite relevant references. Explain how psychoanalytic therapy would be used to treat the client, how the client would respond to therapy, and the effectiveness of this treatment approach.
- Pharmacological approach : If treatment primarily involves the use of medications, explain which medications were used and why. Provide background on the effectiveness of these medications and how monotherapy may compare with an approach that combines medications with therapy or other treatments.
This section of a case study should also include information about the treatment goals, process, and outcomes.
When you are writing a case study, you should also include a section where you discuss the case study itself, including the strengths and limitiations of the study. You should note how the findings of your case study might support previous research.
In your discussion section, you should also describe some of the implications of your case study. What ideas or findings might require further exploration? How might researchers go about exploring some of these questions in additional studies?
Need More Tips?
Here are a few additional pointers to keep in mind when formatting your case study:
- Never refer to the subject of your case study as "the client." Instead, use their name or a pseudonym.
- Read examples of case studies to gain an idea about the style and format.
- Remember to use APA format when citing references .
Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach . BMC Med Res Methodol . 2011;11:100.
Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach . BMC Med Res Methodol . 2011 Jun 27;11:100. doi:10.1186/1471-2288-11-100
Gagnon, Yves-Chantal. The Case Study as Research Method: A Practical Handbook . Canada, Chicago Review Press Incorporated DBA Independent Pub Group, 2010.
Yin, Robert K. Case Study Research and Applications: Design and Methods . United States, SAGE Publications, 2017.
By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."
Case Study Research Method in Psychology
Saul McLeod, PhD
Editor-in-Chief for Simply Psychology
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Learn about our Editorial Process
Olivia Guy-Evans, MSc
Associate Editor for Simply Psychology
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
On This Page:
Case studies are in-depth investigations of a person, group, event, or community. Typically, data is gathered from various sources using several methods (e.g., observations & interviews).
The case study research method originated in clinical medicine (the case history, i.e., the patient’s personal history). In psychology, case studies are often confined to the study of a particular individual.
The information is mainly biographical and relates to events in the individual’s past (i.e., retrospective), as well as to significant events that are currently occurring in his or her everyday life.
The case study is not a research method, but researchers select methods of data collection and analysis that will generate material suitable for case studies.
Freud (1909a, 1909b) conducted very detailed investigations into the private lives of his patients in an attempt to both understand and help them overcome their illnesses.
This makes it clear that the case study is a method that should only be used by a psychologist, therapist, or psychiatrist, i.e., someone with a professional qualification.
There is an ethical issue of competence. Only someone qualified to diagnose and treat a person can conduct a formal case study relating to atypical (i.e., abnormal) behavior or atypical development.
Famous Case Studies
- Anna O – One of the most famous case studies, documenting psychoanalyst Josef Breuer’s treatment of “Anna O” (real name Bertha Pappenheim) for hysteria in the late 1800s using early psychoanalytic theory.
- Little Hans – A child psychoanalysis case study published by Sigmund Freud in 1909 analyzing his five-year-old patient Herbert Graf’s house phobia as related to the Oedipus complex.
- Bruce/Brenda – Gender identity case of the boy (Bruce) whose botched circumcision led psychologist John Money to advise gender reassignment and raise him as a girl (Brenda) in the 1960s.
- Genie Wiley – Linguistics/psychological development case of the victim of extreme isolation abuse who was studied in 1970s California for effects of early language deprivation on acquiring speech later in life.
- Phineas Gage – One of the most famous neuropsychology case studies analyzes personality changes in railroad worker Phineas Gage after an 1848 brain injury involving a tamping iron piercing his skull.
Clinical Case Studies
- Studying the effectiveness of psychotherapy approaches with an individual patient
- Assessing and treating mental illnesses like depression, anxiety disorders, PTSD
- Neuropsychological cases investigating brain injuries or disorders
Child Psychology Case Studies
- Studying psychological development from birth through adolescence
- Cases of learning disabilities, autism spectrum disorders, ADHD
- Effects of trauma, abuse, deprivation on development
Types of Case Studies
- Explanatory case studies : Used to explore causation in order to find underlying principles. Helpful for doing qualitative analysis to explain presumed causal links.
- Exploratory case studies : Used to explore situations where an intervention being evaluated has no clear set of outcomes. It helps define questions and hypotheses for future research.
- Descriptive case studies : Describe an intervention or phenomenon and the real-life context in which it occurred. It is helpful for illustrating certain topics within an evaluation.
- Multiple-case studies : Used to explore differences between cases and replicate findings across cases. Helpful for comparing and contrasting specific cases.
- Intrinsic : Used to gain a better understanding of a particular case. Helpful for capturing the complexity of a single case.
- Collective : Used to explore a general phenomenon using multiple case studies. Helpful for jointly studying a group of cases in order to inquire into the phenomenon.
Where Do You Find Data for a Case Study?
There are several places to find data for a case study. The key is to gather data from multiple sources to get a complete picture of the case and corroborate facts or findings through triangulation of evidence. Most of this information is likely qualitative (i.e., verbal description rather than measurement), but the psychologist might also collect numerical data.
1. Primary sources
- Interviews – Interviewing key people related to the case to get their perspectives and insights. The interview is an extremely effective procedure for obtaining information about an individual, and it may be used to collect comments from the person’s friends, parents, employer, workmates, and others who have a good knowledge of the person, as well as to obtain facts from the person him or herself.
- Observations – Observing behaviors, interactions, processes, etc., related to the case as they unfold in real-time.
- Documents & Records – Reviewing private documents, diaries, public records, correspondence, meeting minutes, etc., relevant to the case.
2. Secondary sources
- News/Media – News coverage of events related to the case study.
- Academic articles – Journal articles, dissertations etc. that discuss the case.
- Government reports – Official data and records related to the case context.
- Books/films – Books, documentaries or films discussing the case.
3. Archival records
Searching historical archives, museum collections and databases to find relevant documents, visual/audio records related to the case history and context.
Public archives like newspapers, organizational records, photographic collections could all include potentially relevant pieces of information to shed light on attitudes, cultural perspectives, common practices and historical contexts related to psychology.
4. Organizational records
Organizational records offer the advantage of often having large datasets collected over time that can reveal or confirm psychological insights.
Of course, privacy and ethical concerns regarding confidential data must be navigated carefully.
However, with proper protocols, organizational records can provide invaluable context and empirical depth to qualitative case studies exploring the intersection of psychology and organizations.
- Organizational/industrial psychology research : Organizational records like employee surveys, turnover/retention data, policies, incident reports etc. may provide insight into topics like job satisfaction, workplace culture and dynamics, leadership issues, employee behaviors etc.
- Clinical psychology : Therapists/hospitals may grant access to anonymized medical records to study aspects like assessments, diagnoses, treatment plans etc. This could shed light on clinical practices.
- School psychology : Studies could utilize anonymized student records like test scores, grades, disciplinary issues, and counseling referrals to study child development, learning barriers, effectiveness of support programs, and more.
How do I Write a Case Study in Psychology?
Follow specified case study guidelines provided by a journal or your psychology tutor. General components of clinical case studies include: background, symptoms, assessments, diagnosis, treatment, and outcomes. Interpreting the information means the researcher decides what to include or leave out. A good case study should always clarify which information is the factual description and which is an inference or the researcher’s opinion.
1. Introduction
- Provide background on the case context and why it is of interest, presenting background information like demographics, relevant history, and presenting problem.
- Compare briefly to similar published cases if applicable. Clearly state the focus/importance of the case.
2. Case Presentation
- Describe the presenting problem in detail, including symptoms, duration,and impact on daily life.
- Include client demographics like age and gender, information about social relationships, and mental health history.
- Describe all physical, emotional, and/or sensory symptoms reported by the client.
- Use patient quotes to describe the initial complaint verbatim. Follow with full-sentence summaries of relevant history details gathered, including key components that led to a working diagnosis.
- Summarize clinical exam results, namely orthopedic/neurological tests, imaging, lab tests, etc. Note actual results rather than subjective conclusions. Provide images if clearly reproducible/anonymized.
- Clearly state the working diagnosis or clinical impression before transitioning to management.
3. Management and Outcome
- Indicate the total duration of care and number of treatments given over what timeframe. Use specific names/descriptions for any therapies/interventions applied.
- Present the results of the intervention,including any quantitative or qualitative data collected.
- For outcomes, utilize visual analog scales for pain, medication usage logs, etc., if possible. Include patient self-reports of improvement/worsening of symptoms. Note the reason for discharge/end of care.
4. Discussion
- Analyze the case, exploring contributing factors, limitations of the study, and connections to existing research.
- Analyze the effectiveness of the intervention,considering factors like participant adherence, limitations of the study, and potential alternative explanations for the results.
- Identify any questions raised in the case analysis and relate insights to established theories and current research if applicable. Avoid definitive claims about physiological explanations.
- Offer clinical implications, and suggest future research directions.
5. Additional Items
- Thank specific assistants for writing support only. No patient acknowledgments.
- References should directly support any key claims or quotes included.
- Use tables/figures/images only if substantially informative. Include permissions and legends/explanatory notes.
- Provides detailed (rich qualitative) information.
- Provides insight for further research.
- Permitting investigation of otherwise impractical (or unethical) situations.
Case studies allow a researcher to investigate a topic in far more detail than might be possible if they were trying to deal with a large number of research participants (nomothetic approach) with the aim of ‘averaging’.
Because of their in-depth, multi-sided approach, case studies often shed light on aspects of human thinking and behavior that would be unethical or impractical to study in other ways.
Research that only looks into the measurable aspects of human behavior is not likely to give us insights into the subjective dimension of experience, which is important to psychoanalytic and humanistic psychologists.
Case studies are often used in exploratory research. They can help us generate new ideas (that might be tested by other methods). They are an important way of illustrating theories and can help show how different aspects of a person’s life are related to each other.
The method is, therefore, important for psychologists who adopt a holistic point of view (i.e., humanistic psychologists ).
Limitations
- Lacking scientific rigor and providing little basis for generalization of results to the wider population.
- Researchers’ own subjective feelings may influence the case study (researcher bias).
- Difficult to replicate.
- Time-consuming and expensive.
- The volume of data, together with the time restrictions in place, impacted the depth of analysis that was possible within the available resources.
Because a case study deals with only one person/event/group, we can never be sure if the case study investigated is representative of the wider body of “similar” instances. This means the conclusions drawn from a particular case may not be transferable to other settings.
Because case studies are based on the analysis of qualitative (i.e., descriptive) data , a lot depends on the psychologist’s interpretation of the information she has acquired.
This means that there is a lot of scope for Anna O , and it could be that the subjective opinions of the psychologist intrude in the assessment of what the data means.
For example, Freud has been criticized for producing case studies in which the information was sometimes distorted to fit particular behavioral theories (e.g., Little Hans ).
This is also true of Money’s interpretation of the Bruce/Brenda case study (Diamond, 1997) when he ignored evidence that went against his theory.
Breuer, J., & Freud, S. (1895). Studies on hysteria . Standard Edition 2: London.
Curtiss, S. (1981). Genie: The case of a modern wild child .
Diamond, M., & Sigmundson, K. (1997). Sex Reassignment at Birth: Long-term Review and Clinical Implications. Archives of Pediatrics & Adolescent Medicine , 151(3), 298-304
Freud, S. (1909a). Analysis of a phobia of a five year old boy. In The Pelican Freud Library (1977), Vol 8, Case Histories 1, pages 169-306
Freud, S. (1909b). Bemerkungen über einen Fall von Zwangsneurose (Der “Rattenmann”). Jb. psychoanal. psychopathol. Forsch ., I, p. 357-421; GW, VII, p. 379-463; Notes upon a case of obsessional neurosis, SE , 10: 151-318.
Harlow J. M. (1848). Passage of an iron rod through the head. Boston Medical and Surgical Journal, 39 , 389–393.
Harlow, J. M. (1868). Recovery from the Passage of an Iron Bar through the Head . Publications of the Massachusetts Medical Society. 2 (3), 327-347.
Money, J., & Ehrhardt, A. A. (1972). Man & Woman, Boy & Girl : The Differentiation and Dimorphism of Gender Identity from Conception to Maturity. Baltimore, Maryland: Johns Hopkins University Press.
Money, J., & Tucker, P. (1975). Sexual signatures: On being a man or a woman.
Further Information
- Case Study Approach
- Case Study Method
- Enhancing the Quality of Case Studies in Health Services Research
- “We do things together” A case study of “couplehood” in dementia
- Using mixed methods for evaluating an integrative approach to cancer care: a case study
5 Fascinating Clinical Psychology Case Studies
If you pursue work as a clinical psychologist, you’ll be able to make a major difference in people’s lives. In most cases, these psychologists are the first practitioners to recognize and diagnose mental health disorders. Many clinical psychologists also practice “talk therapy,” where they talk through issues with patients and help them develop better coping mechanisms. But what’s it really like to work in clinical psychology? Take a look at each case study psychology below to get an idea.
A Day in the Life of a Clinical Psychologist
As you might be able to tell from the name, a clinical psychologist applies psychology knowledge in a clinical setting. Using their knowledge of different mental disorders and how they present, clinical psychologists help patients identify and then treat mental health disorders. They also can help patients work through psychological issues even if no disorder is present.
However, it’s important to note that clinical psychologists do not prescribe medication. Often, once a clinical psychologist makes a diagnosis that requires medication, they will refer a patient to a psychiatrist. The psychiatrist handles the medication, but a clinical psychologist will often help a patient manage some of their symptoms through some form of talk therapy. In the case of some complex disorders, a psychologist may be able to coordinate with the patient’s psychiatrist in order to ensure the best care possible.
Some people believe that talk therapy is just a patient talking while the psychologist listens. However, this couldn’t be further from the truth. Clinical psychologists are tasked with assessing each patient and developing an individualized treatment plan. Often, that plan includes delving into the patient’s issues and helping them understand their roots. From there, the psychologist can help the patient develop healthier coping mechanisms for dealing with those issues.
Usually, clinical psychologists primarily work with patients on an individual basis. They do this either as part of a group practice or in private practice. Sometimes, they may teach classes, although this usually isn’t the bulk of their workload. Clinical psychologists often will conduct and publish research that sometimes involves case studies of patients.
Becoming a Clinical Psychologist
To become a clinical psychologist, you will need to pursue a doctoral degree. Most clinical psychologists have either a Ph.D. or a PsyD, though the Ph.D. is more common in the field and will usually afford you more career opportunities. PsyD programs tend to accept more applicants than Ph.D. programs. A PsyD degree places more focus on applying concepts of psychology to the clinical setting. A Ph.D. program certainly applies concepts of psychology as well, but it has much more of a focus on research than PsyD programs do.
Regardless of which program you choose, becoming a clinical psychologist involves a considerable time commitment. The first step is obtaining a four-year bachelor’s degree. From there, some candidates pursue a master’s degree, while others go straight into a Ph.D. training program.
Most PsyD programs take four to five years to complete, while most Ph.D. programs take between five and seven years. In the case of a Ph.D., graduates will need to complete a residency program much like medical doctors. Residency programs usually last about one to three years. During that time, new psychologists are overseen by an experienced psychologist. Upon completion of the residency, a clinical psychologist must also take and pass a licensure exam in order to practice in their state. Most states will also allow you to obtain different certifications in specialized areas.
As you can see, the decision to become a clinical psychologist isn’t one to make on a whim. Usually, though, you’ll be able to get a sense of the field from the undergraduate courses you take early on.
What’s a Case Study?
In a moment, we’ll take you through five interesting case studies from real clinical psychologists. But what exactly is a case study?
Simply put, a case study is a very detailed account of an individual patient’s case. (The case studies below are abbreviated versions of case studies.) Psychologists usually keep notes on all patients, but a case study is much more formal. Each study is an in-depth exploration of a patient’s disorder, and it usually contains information on the patient’s personal history as well as how their disorder presents. Most case studies also have information on treatments that have worked (and those that have not worked) for a given patient.
So why is a single case study valuable, especially when most studies survey larger groups of patients? For one, case studies are extremely valuable in the case of rare conditions. With very rare mental health disorders, it can be near-impossible to find larger studies. With case studies, it’s still possible to get an accurate picture of the disorder and what it looks like in different patients.
Case studies can also help future clinical psychologists to sharpen their diagnostic skills. In a broader study, you might learn about some of the common symptoms of a diagnose. But individual patients have their own quirks, and the same disorder can look different from patient to patient. Reading case studies can be a great way to see how different mental health issues can look in different people.
Lastly, case studies can be useful in supporting or refuting existing research. In some cases, they may point to issues that need to be researched further.
To really start to get a sense of what it’s like to be a clinical psychologist, check out these five interesting case studies reported by actual clinicians:
Wishing for Death
Even if you seem to have a promising future, it’s still possible to deal with severe depression. This is what happened to Jessica, a woman who had successfully completed medical school and obtained a residency at a large hospital. In Jessica’s case, her mental state declined seemingly overnight; she awoke one day feeling especially sad. But instead of lifting, that sadness continued and even worsened.
As is the case with many people with depression, Jessica lost interest in things she had previously enjoyed. She stopped having sex with her husband and even found interacting with her children to be a chore. She even found that her job was in jeopardy, as she stopped caring about work and began missing shifts.
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Often, people suffering from severe depression will consider suicide. Some will go as far as making and going through with suicide plans. Jessica wasn’t considering or fantasizing about suicide. But she did begin to wish she was dead, and these thoughts slowly became all-consuming. Despite feeling drained from her low mood, Jessica still had trouble sleeping at night. This is when her thoughts of death were at their worst.
Jessica continued to insist that nothing was wrong. But her coworkers at the hospital saw that something was off. Jessica wasn’t being lazy or slacking for no reason; it was clear her mental health was suffering. Her colleagues were able to convince Jessica to see a mental health professional. She was diagnosed with major depressive disorder, a mental health disorder that causes severe and persistent sadness and loss of interest.
College Struggles
Many mental health issues present themselves when people are college-aged, and this is what happened to Gerry, a 21-year-old college student who got good grades. Gerry got along well with his friends and roommates until he started having trouble sleeping. At night, his thoughts began to race and felt as though they were spinning out of control.
But that wasn’t all. Gerry was usually a kind and mild-mannered person, but he began calling his friends at all hours of the night, becoming angry if they didn’t give him the attention he wanted. Within a few days, Gerry started to believe his roommates were spying on him. He told them as much. Instead of writing it off as simply a quirk, his friends became very concerned. They talked to Gerry and explained the strange changes they’d been seeing in his behavior. Ultimately, they were able to convince Gerry to seek mental health help.
After talking with a clinician, Gerry was ultimately diagnosed with bipolar disorder. It can be an intimidating diagnosis to receive, but Gerry was referred to a psychiatrist who could work with him to find the right medication. The combination of medication and cognitive-behavioral therapy helped him to return back to his normal self.
A Case of Obsession
Plenty of people are fastidious about certain things, but one salesman took it a little too far. The salesman was having trouble leaving his house on time to get to work because he had an overwhelming and obsessive need to follow a set of rituals. Many of them were about securing the home. It started with double-checking and triple-checking that doors were locked.
The salesman also became incredibly worried about the electrical wiring in the home. He began to obsess over whether it would cause an electrical fire. If he didn’t complete the various rituals he felt compelled to do, the man believed he would experience bad luck.
Once he saw a psychologist, the man was diagnosed with obsessive-compulsive disorder. Since this disorder involves holding onto irrational beliefs, cognitive-behavioral therapy is essential. The man’s psychologist worked with him through therapy and helped him to manage and then overcome his obsessive thoughts. Ultimately, the salesman was able to get back to a much more normal life.
Unexpected Panic
Panic disorders and anxiety disorders can seem to poison your life. That’s what it felt like for one forest ranger. Up until his mid-30s, he didn’t suffer from more than normal anxiety. But one day, while standing in line at the grocery store, he suddenly felt an overwhelming wave of panic. His heart rate went up and he started sweating. The panic attack was so bad that the forest ranger thought he would pass out, so he abandoned his shopping cart and returned to the car.
Naturally, the forest ranger didn’t want the same thing to happen again. Because that first panic attack had occurred in a grocery store, he began avoiding supermarkets. But that didn’t help for long. He began to experience intense anxiety in many areas of his life. His symptoms were so severe that his family life began to suffer, so he sought help.
The forest ranger saw a psychologist and was diagnosed with an anxiety disorder. Though some people with anxiety disorders benefit from medication, the forest ranger was able to work through and manage his symptoms through cognitive behavioral therapy.
Bizarre Behaviors
Most severe mental disorders don’t start in childhood. When they do appear, these disorders often involve someone who previously seemed outwardly normal suddenly exhibiting strange behaviors. This is what happened to a 21-year-old business student. He suddenly began becoming agitated for no ostensible reason. During his bouts of agitation, other people heard him whispering angrily to himself.
The young man’s friends and family were very concerned, but they were unable to reach him by phone. He explained that aliens had placed a chip in his brain and that it would explode if he answered his phone.
Sometimes, symptoms like those the young man had can be caused or made worse by abusing alcohol or drugs. However, the young man didn’t abuse either. A family history of mental illness can sometimes be a risk factor, and the man did say he had an aunt who had been treated at psychiatric hospitals several times.
Thanks in part to the concern of his friends and family, the young man talked to a psychologist and gave a detailed account of his symptoms. He was diagnosed with paranoid schizophrenia. This is a difficult diagnosis to receive. But as the young man found, schizophrenia is possible to manage with good care. The young man’s psychologist was able to continue therapy, and he was also referred to a psychiatrist for help with medication. Often, for those diagnosed with paranoid schizophrenia, a combination of therapy and the right medications can effectively manage symptoms.
Each case study psychology above is just a short introduction to the types of cases you may encounter working as a clinical psychologist. And when working in the field, you’ll be asked to write your own case studies, too. While in school, you’ll learn the correct way to write case studies and how sharing case studies with other psychologists can help the field grow as a whole. Hopefully, these case studies have also shed some light on one of the best parts of working as a clinical psychologist — you can help people confront and work through mental health challenges and work toward healthier, happier lives.
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The case study as a research method in clinical psychology, describe… (ao1).
- an in-depth study or one individual or small group, e.g. Bradshaw’s Carol or Lavarenne’s “Thursday Group”
- the person or small group are usually interesting or unusual in some specific way, e.g. a group of patients who a re trialing a particular therapy.
- case studies are often retrospective write ups which make a point or provide an example
- they may be longitudinal, following the course of a disorder or a treatment for example.
- different research methods including observation, interview, questionnaire, standardised test etc are used to collect the data; this is called method triangulation; researchers try to identify common themes from the findings of their different measures
- the case history details the background of the person or small group under scrutiny and provides context
- much of the data may be qualitative but some may also be quantitative as well
- Case studies take an ideographic approach meaning they build a detailed picture that helps us to understand how this one person or one small group constructs their understanding of the world; this is in contrast to the nomothetic approach which involves quantitative data meaning inferential statistics can be used to test hypothesis (sceintific approach)
Evaluate… (ao3)
- the degree of detail and quantity of data collected means they may provide a better reflection of the issue being studied;
- in comparison with laboratory experiments they provide greater insight into the range of individual differences seen within a data set
- ideographic methods which look at individual differences can provide hypotheses which it might be possible to test in more scientific ways in the future
- The person is studied within the context of their family and natural environment ; findings have increased ecological validity; they are not contrived or artificial in any way
- The data collected is not restricted in any way; when the researcher reveals something interesting, every opportunity can be followed up and further measurements taken unlike an experiment, questionnaire or structured interview
- the use of method triangulation and collection of both qualitative and quantitative data means that weaknesses of one type of data or method are counteracted by the strengths of the other type of data and methods used, making for more meaningful, useful and accurate findings.
- if another person was to conduct the tests on the person being studied at the same point then it is likely that the findings would be consistent
- The study reflects the uniqueness of one individual and thus generalisation to others may be unjustified (think about individual differences in the ways our brains work due to neuroplasticity which takes place in interaction with our own unique environmental experiences.
- Replication may be difficult as exact circumstances are impossible to recreate
- As it is difficult to show demonstrate the reliability of the findings, some would say this limits their usefulness and renders the study unscientific
Let’s Revise
- Carefully read this information again and create five multi-choice questions
- Swap your questions with a friend and test yourselves
- Now create a ‘fill in the gaps’ activity by deleting words and putting them into a box at the end of the document
- Swap your fill in the gaps with a friend and test yourselves again.
- Create a flashcard for case studies as used in psychology; do as much as you can from memory but don’t take a mistake on your card!
- Now answer the following question- allow yourself about 15 minutes:
Practice Question: Assess the usefulness of case studies as research method in clinical psychology (8 marks)
Challenge yourself: Compare the use of case studies and experiments as research methods in psychology (8)
This handout forces you to integrate what you know about Lavarenne and /or Bradshaw to root your points clearly in clinical psychology. This is critical for Paper 2: case-studies-in-clinical-1
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What Is a Case Study in Psychology?
A case study is a research method used in psychology to investigate a particular individual, group, or situation in depth. It involves a detailed analysis of the subject, gathering information from various sources such as interviews, observations, and documents. In a case study, researchers aim to understand the complexities and nuances of the subject under…
A case study is a research method used in psychology to investigate a particular individual, group, or situation in depth . It involves a detailed analysis of the subject, gathering information from various sources such as interviews, observations, and documents.
In a case study, researchers aim to understand the complexities and nuances of the subject under investigation. They explore the individual’s thoughts, feelings, behaviors, and experiences to gain insights into specific psychological phenomena.
This type of research can provide great detail regarding a particular case, allowing researchers to examine rare or unique situations that may not be easily replicated in a laboratory setting. They offer a holistic view of the subject, considering various factors influencing their behavior or mental processes.
By examining individual cases, researchers can generate hypotheses, develop theories, and contribute to the existing body of knowledge in psychology. Case studies are often utilized in clinical psychology, where they can provide valuable insights into the diagnosis, treatment, and outcomes of specific psychological disorders.
Case studies offer a comprehensive and in-depth understanding of complex psychological phenomena, providing researchers with valuable information to inform theory, practice, and future research.
In this article
Examples of Case Studies in Psychology
Case studies in psychology provide real-life examples that illustrate psychological concepts and theories. They offer a detailed analysis of specific individuals, groups, or situations, allowing researchers to understand psychological phenomena better. Here are a few examples of case studies in psychology:
Phineas Gage
This famous case study explores the effects of a traumatic brain injury on personality and behavior. A railroad construction worker, Phineas Gage survived a severe brain injury that dramatically changed his personality.
This case study helped researchers understand the role of the frontal lobe in personality and social behavior.
Little Albert
Conducted by behaviorist John B. Watson, the Little Albert case study aimed to demonstrate classical conditioning. In this study, a young boy named Albert was conditioned to fear a white rat by pairing it with a loud noise.
This case study provided insights into the process of fear conditioning and the impact of early experiences on behavior.
Genie’s case study focused on a girl who experienced extreme social isolation and deprivation during her childhood. This study shed light on the critical period for language development and the effects of severe neglect on cognitive and social functioning.
These case studies highlight the value of in-depth analysis and provide researchers with valuable insights into various psychological phenomena. By examining specific cases, psychologists can uncover unique aspects of human behavior and contribute to the field’s knowledge and understanding.
Types of Case Studies in Psychology
Psychology case studies come in various forms, each serving a specific purpose in research and analysis. Understanding the different types of case studies can help researchers choose the most appropriate approach.
Descriptive Case Studies
These studies aim to describe a particular individual, group, or situation. Researchers use descriptive case studies to explore and document specific characteristics, behaviors, or experiences.
For example, a descriptive case study may examine the life and experiences of a person with a rare psychological disorder.
Exploratory Case Studies
Exploratory case studies are conducted when there is limited existing knowledge or understanding of a particular phenomenon. Researchers use these studies to gather preliminary information and generate hypotheses for further investigation.
Exploratory case studies often involve in-depth interviews, observations, and analysis of existing data.
Explanatory Case Studies
These studies aim to explain the causal relationship between variables or events. Researchers use these studies to understand why certain outcomes occur and to identify the underlying mechanisms or processes.
Explanatory case studies often involve comparing multiple cases to identify common patterns or factors.
Instrumental Case Studies
Instrumental case studies focus on using a particular case to gain insights into a broader issue or theory. Researchers select cases that are representative or critical in understanding the phenomenon of interest.
Instrumental case studies help researchers develop or refine theories and contribute to the general knowledge in the field.
By utilizing different types of case studies, psychologists can explore various aspects of human behavior and gain a deeper understanding of psychological phenomena. Each type of case study offers unique advantages and contributes to the overall body of knowledge in psychology.
How to Collect Data for a Case Study
There are a variety of ways that researchers gather the data they need for a case study. Some sources include:
- Directly observing the subject
- Collecting information from archival records
- Conducting interviews
- Examining artifacts related to the subject
- Examining documents that provide information about the subject
The way that this information is collected depends on the nature of the study itself
Prospective Research
In a prospective study, researchers observe the individual or group in question. These observations typically occur over a period of time and may be used to track the progress or progression of a phenomenon or treatment.
Retrospective Research
A retrospective case study involves looking back on a phenomenon. Researchers typically look at the outcome and then gather data to help them understand how the individual or group reached that point.
Benefits of a Case Study
Case studies offer several benefits in the field of psychology. They provide researchers with a unique opportunity to delve deep into specific individuals, groups, or situations, allowing for a comprehensive understanding of complex phenomena.
Case studies offer valuable insights that can inform theory development and practical applications by examining real-life examples.
Complex Data
One of the key benefits of case studies is their ability to provide complex and detailed data. Researchers can gather in-depth information through various methods such as interviews, observations, and analysis of existing records.
This depth of data allows for a thorough exploration of the factors influencing behavior and the underlying mechanisms at play.
Unique Data
Additionally, case studies allow researchers to study rare or unique cases that may not be easily replicated in experimental settings. This enables the examination of phenomena that are difficult to study through other psychology research methods .
By focusing on specific cases, researchers can uncover patterns, identify causal relationships, and generate hypotheses for further investigation.
General Knowledge
Case studies can also contribute to the general knowledge of psychology by providing real-world examples that can be used to support or challenge existing theories. They offer a bridge between theory and practice, allowing researchers to apply theoretical concepts to real-life situations and vice versa.
Case studies offer a range of benefits in psychology, including providing rich and detailed data, studying unique cases, and contributing to theory development. These benefits make case studies valuable in understanding human behavior and psychological phenomena.
Limitations of a Case Study
While case studies offer numerous benefits in the field of psychology, they also have certain limitations that researchers need to consider. Understanding these limitations is crucial for interpreting the findings and generalizing the results.
Lack of Generalizability
One limitation of case studies is the issue of generalizability. Since case studies focus on specific individuals, groups, and situations, applying the findings to a larger population can be challenging. The unique characteristics and circumstances of the case may not be representative of the broader population, making it difficult to draw universal conclusions.
Researcher bias is another possible limitation. The researcher’s subjective interpretation and personal beliefs can influence the data collection, analysis, and interpretation process. This bias can affect the objectivity and reliability of the findings, raising questions about the study’s validity.
Case studies are often time-consuming and resource-intensive. They require extensive data collection, analysis, and interpretation, which can be lengthy. This can limit the number of cases that can be studied and may result in a smaller sample size, reducing the study’s statistical power.
Case studies are retrospective in nature, relying on past events and experiences. This reliance on memory and self-reporting can introduce recall bias and inaccuracies in the data. Participants may forget or misinterpret certain details, leading to incomplete or unreliable information.
Despite these limitations, case studies remain a valuable research tool in psychology. By acknowledging and addressing these limitations, researchers can enhance the validity and reliability of their findings, contributing to a more comprehensive understanding of human behavior and psychological phenomena.
While case studies have limitations, they remain valuable when researchers acknowledge and address these concerns, leading to more reliable and valid findings in psychology.
Alpi, K. M., & Evans, J. J. (2019). Distinguishing case study as a research method from case reports as a publication type. Journal of the Medical Library Association , 107(1). https://doi.org/10.5195/jmla.2019.615
Crowe, S., Cresswell, K., Robertson, A., Huby, G., Avery, A., & Sheikh, A. (2011). The case study approach. BMC Medical Research Methodology , 11(1), 100. https://doi.org/10.1186/1471-2288-11-100
Paparini, S., Green, J., Papoutsi, C., Murdoch, J., Petticrew, M., Greenhalgh, T., Hanckel, B., & Shaw, S. (2020). Case study research for better evaluations of complex interventions: Rationale and challenges. BMC Medicine , 18(1), 301. https://doi.org/10.1186/s12916-020-01777-6
Willemsen, J. (2023). What is preventing psychotherapy case studies from having a greater impact on evidence-based practice, and how to address the challenges? Frontiers in Psychiatry , 13, 1101090. https://doi.org/10.3389/fpsyt.2022.1101090
Yin, Robert K. Case Study Research and Applications: Design and Methods . United States, SAGE Publications, 2017.
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Clinical Case Studies in Psychoanalytic and Psychodynamic Treatment
Jochem willemsen, elena della rosa, sue kegerreis.
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Edited by: Simon Boag, Macquarie University, Australia
Reviewed by: Lewis Kirshner, Harvard Medical School, USA; Horst Kächele, International Psychoanalytic University, Germany; Anne Worthington, Middlesex University, UK
*Correspondence: [email protected]
Received 2016 Nov 29; Accepted 2017 Jan 16; Collection date 2017.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
This manuscript provides a review of the clinical case study within the field of psychoanalytic and psychodynamic treatment. The method has been contested for methodological reasons and because it would contribute to theoretical pluralism in the field. We summarize how the case study method is being applied in different schools of psychoanalysis, and we clarify the unique strengths of this method and areas for improvement. Finally, based on the literature and on our own experience with case study research, we come to formulate nine guidelines for future case study authors: (1) basic information to include, (2) clarification of the motivation to select a particular patient, (3) information about informed consent and disguise, (4) patient background and context of referral or self-referral, (5) patient's narrative, therapist's observations and interpretations, (6) interpretative heuristics, (7) reflexivity and counter-transference, (8) leaving room for interpretation, and (9) answering the research question, and comparison with other cases.
Keywords: clinical case study, methodology, psychotherapy research, psychoanalysis, psychoanalytic schools, theoretical pluralism, review
Introduction
Psychoanalysis has always been, according to its inventor, both a research endeavor and a therapeutic endeavor. Furthermore it is clear from Freud's autobiography that he prioritized the research aspect; he did not become a doctor because he wished to cure people in ill health (Freud, 2001 [1925] ). His invention of the psychoanalytic approach to therapy, involving the patient lying down and associating freely, served a research purpose as much as a therapeutic purpose. Through free association, he would be able to gain unique insight in the human mind. Next, he had to find a format to report on his findings, and this would be the case study. The case study method already existed in medicine (Forrester, 2016 ), but Freud adjusted it considerably. Case studies in medical settings were more like case files, in which the patient was described or reduced to a number of medical categories: the patient became a case of some particular ailment (Forrester, 2016 ). In Freud's hands, the case study developed into Kranken Geschichten in which the current pathology of the patient is related to the whole of his life, sometimes even over generations.
Although Freud's case studies have demonstrably provided data for generations of research by analysts (Midgley, 2006a ) and various scholars (Pletsch, 1982 ; Sealey, 2011 ; Damousi et al., 2015 ), the method of the case study has become very controversial. According to Midgley ( 2006b ), objections against the case study method can be grouped into three arguments. First there is the data problem: case studies provide no objective clinical data (Widlöcher, 1994 ), they only report on what went right and disregard any confusion or mistakes (Spence, 2001 ). Second, there is the data analysis problem: the way in which the observations of the case study are analyzed lack validity; case studies confirm what we already know (Spence, 2001 ). Some go even so far to say that they are purely subjective: Michels calls case studies the “crystallization of the analyst's countertransference” (Michels, 2000 , p. 373). Thirdly, there is the generalizability problem: it is not possible to gain generalizable insight from case studies. Reading, writing and presenting case studies has been described as being a group ritual to affirm analysts in their professional identity, rather than a research method (Widlöcher, 1994 ).
These criticisms stand in contrast to the respect gained by the case study method in the last two decades. Since the 1990s there has been an increasing number of psychoanalytic and psychodynamic clinical case study and empirical case studies being published in scientific journals (Desmet et al., 2013 ; Cornelis et al., in press ). It has also been signaled that the case study method is being revived more broadly in the social sciences. In the most recent, fifth edition of his seminal book on case study research, Yinn ( 2014 ) includes a figure showing the steady increase of the frequency with which the term “case study research” appears in published books in the period from 1980 to 2008.
KEY CONCEPT 1. Clinical case study.
A clinical case study is a narrative report by the therapist of what happened during a therapy together with the therapist's interpretations of what happened. It is possible that certain (semi)-structured assessment instruments, such as a questionnaire or a diagnostic interview are included in clinical case studies, yet it is still the therapist that uses these, interprets and discusses them.
KEY CONCEPT 2. Empirical case studies.
In an empirical case study data are gathered from different sources (e.g., self-report, observation,…) and there is a research team involved in the analyses of the data. This study can take place either in a naturalistic setting (systematic case study) or in a controlled experimental environment (single-case experiment).
In addition to the controversy about the case study method, psychoanalysis has developed into a fragmented discipline. The different psychoanalytic schools share Freud's idea of the unconscious mind, but they focus on different aspects in his theoretical work. Some of the schools still operate under the wings of the International Psychoanalytic Association, while others have established their own global association. Each school is linked to one or several key psychoanalysts who have developed their own version of psychoanalysis. Each psychoanalytic school has a different set of theories but there are also differences in the training of new psychoanalysts and in the therapeutic techniques that are applied by its proponents.
Based on this heterogeneity of perspectives in psychoanalysis, a research group around the Single Case Archive investigated the current status of case study research in psychoanalysis (Willemsen et al., 2015a ). They were particularly interested to know more about the output and methodology of case studies within the different psychoanalytic schools.
KEY CONCEPT 3. Single case archive.
The Single Case Archive is an online archive of published clinical and empirical case studies in the field of psychotherapy ( http://www.singlecasearchive.com ). The objective of this archive is to facilitate the study of case studies for research, clinical, and teaching purposes. The online search engine allows the identification of sets of cases in function of specific clinical or research questions.
Our survey among case study authors about their psychoanalytic school
In order to investigate and compare case studies from different psychoanalytic schools, we first had to find a way of identifying to which school the case studies belonged. This is very difficult to judge straightforwardly on the basis of the published case study: the fact that someone cites Winnicott or makes transference interpretations doesn't place him or her firmly within a particular psychoanalytic school. The best approach was to ask the authors themselves. Therefore, we contacted all case study authors included in the Single Case Archive (since the time of our original study in 2013, the archive has expanded). We sent emails and letters in different languages to 445 authors and received 200 replies (45% response rate). We asked them the following question: “ At the time you were working on this specific case, to which psychoanalytic school(s) did you feel most attached? ” Each author was given 10 options: (1) Self Psychology (1.a Theory of Heinz Kohut, 1.b Post-Kohutian Theories, 1.c Intersubjective psychoanalysis), (2) Relational psychoanalysis, (3) Interpersonal psychoanalysis, (4) Object relational psychoanalysis (4.a Theory of Melanie Klein, 4.b Theory of Donald W. Winnicott, 4.c Theory of Wilfred R. Bion, 4.d Theory of Otto F. Kernberg), (5) Ego psychology (or) “Classic psychoanalysis” (5.a Theories of Sigmund Freud, 5.b Ego psychology, 5.c Post-Ego psychology), (6) Lacanian psychoanalysis, (7) Jungian psychoanalysis, (8) National Psychological Association for Psychoanalysis (NPAP) related theory, (9) Modern psychoanalysis related to the Boston or New York Graduate School of Psychoanalysis (BGSP/NYGSP), (10) Other. Respondents could indicate one or more options.
Analysis of the responses indicated that the two oldest schools in psychoanalysis, Object-relations psychoanalysis and Ego psychology, dominate the field in relation to case studies that are published in scientific journals. More than three quarters of all case study authors (77%) reported these schools of thought to be the ones with which they considered themselves most affiliated. Three more recent schools were also well-represented among case studies: Self Psychology, Relational Psychoanalysis, and Interpersonal Psychoanalysis. Lacanian Psychoanalysis, Jungian Psychoanalysis, NPAP related Theory and Modern Psychoanalysis related to the BGSP/NYGSP were only rarely mentioned by case study authors as their school of thought. This does not mean that clinicians or researchers within these latter schools do not write any case studies. It only means that they publish few case studies in the scientific journals included in ISI-ranked journals indexed in Web of Science. But they might have their own journals in which they publish clinical material.
Our survey demonstrated that the majority of case study authors (59%) feel attached to more than one psychoanalytic school. This was in fact one of the surprising findings in our study. It seems that theoretical pluralism is more rule than exception among case study authors. There were some differences between the psychoanalytic schools though in terms of pluralism. Case study authors who feel attached to Self Psychology and Interpersonal Psychoanalysis are the most pluralistic: 92 and 86%, respectively also affiliate with one or more other psychoanalytic schools. Case study authors who feel attached to Object Relations Psychoanalysis are the “purest” group: only 69% of them affiliate with one or more other psychoanalytic schools.
KEY CONCEPT 4. Theoretical pluralism.
A situation in which several, potentially contradicting, theories coexist. It is sometimes interpreted as a sign of the immaturity of a science, under the assumption that a mature science should arrive at one single coherent truth. Others see theoretical pluralism as unavoidable for any applied discipline, as each theory can highlight only part of reality.
Psychoanalytic pluralism and the case study method
We were not really surprised to find that Object Relations psychoanalysis and Ego psychology were the most dominant schools in the field of psychoanalytic case studies, as they are very present in European, Latin-American and North-American psychoanalytic institutes. We were more surprised to find such a high degree of pluralism among these case study authors, given the fact that disputes between analysts from different schools can be quite ardent (Green, 2005 ; Summers, 2008 ). Others have compared the situation of psychoanalytic schools with the Tower of Babel (Steiner, 1994 ).
It has been argued that the case study method contributes to the degree of theoretical pluralism within psychoanalysis. The reason for this is situated in the reasoning style at the basis of case study research (Chiesa, 2010 ; Fonagy, 2015 ). The author of a psychoanalytic case study makes a number of observations about the patient within the context of the treatment, and then moves to a conclusion about the patient's psychodynamics in general. The conclusion he or she arrives at inductively gains its “truth value” from the number and quality of observations it is based on. This style of reasoning in case study research is very similar to how clinicians reason in general. Clinicians look for patterns within patients and across patients. If they make similar observations in different patients, or if other psychoanalysts make similar observations in their patients, the weight of the conclusion becomes greater and greater. The problem with this reasoning style is that one can never arrive at definite conclusions: even if a conclusion is based on a large number of observations, it is always possible that the next observation disconfirms the conclusion. Therefore, it could be said, it is impossible to attain “true” knowledge.
The above argument is basically similar to objections against any kind of qualitative research. To this, we argue with Rustin ( 2003 ) that there is not one science and no hierarchy of research methods. Each method comes with strengths and weaknesses, and what one gains in terms of control and certainty in a conventional experimental setup is lost in terms of external validity and clinical applicability. Numerous researchers have pleaded for the case study approach as one method among a whole range of research methods in the field of psychoanalysis (Rustin, 2003 ; Luyten et al., 2006 ; Midgley, 2006b ; Colombo and Michels, 2007 ; Vanheule, 2009 ; Hinshelwood, 2013 ). Leuzinger-Bohleber makes a distinction between clinical research and extra-clinical research (Leuzinger-Bohleber, 2015 ). Clinical research is the idiographic type of research conducted by a psychoanalyst who is working with a patient. Unconscious phantasies and conflicts are symbolized and put into words at different levels of abstraction. This understanding then molds the perception of the analyst in subsequent clinical situations; even though the basic psychoanalytic attitude of “not knowing” is maintained. The clinical case study is clinical research par excellence . Extra-clinical research consists in the application of different methodologies developed in the natural and human sciences, to the study of the unconscious mind. Leuzinger-Bohleber refers to empirical psychotherapy research, experimental research, literature, cultural studies, etc. We believe that the clinical case study method should step up and claim its place in psychoanalytic research, although we agree that the method should be developed further. This paper and a number of others such as Midgley ( 2006b ) should facilitate this methodological improvement. The clinical research method is very well-suited to address any research question related to the description of phenomena and sequences in psychotherapy (e.g., manifestation and evolution of symptoms and therapeutic relationship over time). It is not suitable for questions related to causality and outcome.
We also want to point out that there is a new evolution in the field of psychotherapy case study research, which consists in the development of methodologies for meta-studies of clinical case studies (Iwakabe and Gazzola, 2009 ). The evolution builds on the broader tendency in the field of qualitative research to work toward integration or synthesis of qualitative findings (Finfgeld, 2003 ; Zimmer, 2006 ). The first studies which use this methodology have been published recently: Widdowson ( 2016 ) developed a treatment manual for depression, Rabinovich ( 2016 ) studied the integration of behavioral and psychoanalytic treatment interventions, and Willemsen et al. ( 2015b ) investigated patterns of transference in perversion. The rich variety of research aims demonstrates the potential of these meta-studies of case studies.
KEY CONCEPT 5. Meta-studies of clinical case studies.
A meta-study of clinical case studies is a research approach in which findings from cases are aggregated and more general patterns in psychotherapeutic processes are described. Several methodologies for meta-studies have been described, including cross-case analysis of raw data, meta-analysis, meta-synthesis, case comparisons, and review studies in general.
Lack of basic information in psychoanalytic case studies
The second research question of our study (Willemsen et al., 2015a ) concerned the methodological, patient, therapist, and treatment characteristics of published psychoanalytic case studies. All studies included in the Single Case Archive are screened by means of a coding sheet for basic information, the Inventory of Basic Information in Single Cases (IBISC). The IBISC was designed to assess the presence of basic information on patient (e.g., age, gender, reasons to consult), therapist (e.g., age, gender, level of experience), treatment (e.g., duration, frequency, outcome), and the methodology (e.g., therapy notes or audio recoding of sessions). The IBISC coding revealed that a lot of basic information is simply missing in psychoanalytic case studies (Desmet et al., 2013 ). Patient information is fairly well-reported, but information about therapist, treatment and methodology are often totally absent. Training and years of experience are not mentioned in 84 and 94% of the cases, respectively. The setting of the treatment is not mentioned in 61% of the case studies. In 80% of the cases, it was not mentioned whether the writing of the case studies was on the basis of therapy notes, or audiotapes. In 91% of the cases, it was not mentioned whether informed consent was obtained.
Using variables on which we had more comprehensive information, we compared basic information of case studies from different psychoanalytic schools. This gave us a more detailed insight in the type of case studies that have been generated within each psychoanalytic school, and into the difference between these schools in terms of the kind of case study they generate. We found only minimal differences. Case studies in Relational Psychoanalysis stand out because they involve older patients and longer treatments. Case studies in Interpersonal Psychoanalysis tend to involve young, female patients and male therapists. Case study authors from both these schools tend to report on intensive psychoanalysis in terms of session frequency. But for the rest, it seems that the publication of case studies throughout the different psychoanalytic schools has intensified quite recently.
Guidelines for writing clinical case studies
One of the main problems in using psychoanalytic case studies for research purposes is the enormous variability in quality of reporting and inconsistency in the provision of basic information about the case. This prevents the reader from contextualizing the case study and it obstructs the comparison of one case study with another. There have been attempts to provide guidelines for the writing of case studies, especially in the context of analytic training within the American Psychoanalytic Association (Klumpner and Frank, 1991 ; Bernstein, 2008 ). However, these guidelines were never enforced for case study authors by the editors from the main psychoanalytic journals. Therefore, the impact of these guidelines on the field of case study research has remained limited.
Here at the end of our focused review, we would like to provide guidelines for future case study authors. Our guidelines are based on the literature and on our experience with reading, writing, and doing research with clinical case studies. We will include fragments of existing case studies to clarify our guidelines. These guidelines do not provide a structure or framework for the case study; they set out basic principles about what should be included in a case study.
Basic information
First of all, we think that a clinical case study needs to contain basic information about the patient, the therapist, the treatment, and the research method. In relation to the patient , it is relevant to report on gender, age (or an age range in which to situate the patient), and ethnicity or cultural background. The reader needs to know these characteristics in order to orientate themselves as to who the patient is and what brings them to therapy. In relation to the therapist , it is important to provide information about professional training, level of professional experience, and theoretical orientation. Tuckett ( 2008 ) emphasizes the importance for clinicians to be explicit about the theory they are using and about their way of practicing. It is not sufficient to state membership of a particular group or school, because most groups have a wide range of different ways of practicing. In relation to the treatment itself, it is important to be explicit about the kind of setting, the duration of treatment, the frequency of sessions, and details about separate sequences in the treatment (diagnostic phase, follow-up etc.). These are essential features to share, especially at a time when public sector mental health treatment is being subjected to tight time restrictions and particular ways of practising are favored over others. For example short-term psychotherapies are being implemented in public services for social and economic reasons. While case studies carried out in the public sector can give us information on those short-term therapies, private practice can offer details about the patient's progress on a long-term basis. Moreover, it is important to report whether the treatment is completed. To our astonishment, there are a considerable number of published case studies on therapies that were not finished (Desmet et al., 2013 ). As Freud ( 2001 [1909] , p. 132) already advised, it is best to wait till completion of the treatment before one starts to work on a case study. Finally, in relation to the research method , it is crucial to mention which type of data were collected (therapy notes taken after each session, audio-recordings, questionnaires, etc.), whether informed consent was given, and in what way the treatment was supervised. Clinicians who would like to have help with checking whether they included all necessary basic information case use the Inventory for Basic Information in Single Cases (IBISC), which is freely available on http://www.singlecasearchive.com/resources .
Motivation to select a particular patient
First of all, it is crucial to know what the motivation for writing about a particular case comes from. Some of the following questions should be kept in mind and made explicit from the beginning of the case presentation. Why is it interesting to look at this case? What is it about this case or the psychotherapist's work that can contribute to the already existing knowledge or technique?
“This treatment resulted in the amelioration of his [obsessive-compulsive] symptoms, which remained stable eight years after treatment ended. Because the standard of care in such cases has become largely behavioral and pharmacological, I will discuss some questions about our current understanding of obsessive-compulsive phenomena that are raised by this case, and some of the factors that likely contributed to the success of psychoanalytic treatment for this child (McGehee, 2005 , p. 213–214).”
This quotation refers to a case that has been selected on the basis of its successful outcome. The author is then interested to find out what made this case successful.
Informed consent and disguise
As regulations on privacy and ethics are becoming tighter, psychotherapists find themselves with a real problem in deciding what is publishable and what is not. Winship ( 2007 ) points out that there is a potential negative effect of research overregulation as clinicians may be discouraged from reporting ordinary and everyday findings from their clinical practice. But he also offers very good guidelines for approaching the issue of informed consent. A good practice is asking for consent either at the start of the treatment or after completion of the treatment: preferably not during treatment. It is inadvisable to complete the case study before the treatment has ended. It is also advisable that the process of negotiating consent with the patient is reported in the case study.
“To be sure that Belle's anonymity was preserved, I contacted her while writing this book and told her it would not be published without her complete approval. To do this, I asked if she would review every word of every draft. She has (Stoller, 1986 , p. 217).”
In relation to disguise, one has to strike a balance between thin and thick disguise. Gabbard ( 2000 ) suggests different useful approaches to disguising the identity of the patient.
Patient background and context of referral or self-referral
It is important to include relevant facts about the patient's childhood, family history, siblings, any trauma or losses and relationship history (social and romantic) and the current context of the patient's life (family, working, financial). The context of referral is also key to understanding how and why the patient has come to therapy. Was the patient encouraged to come or had wanted to come? Has there been a recent crisis which prompted the intervention or an on-going problem which the patient had wanted to address for some time?
“Michael was one of the youngest children in his family of origin. He had older brothers and sisters who had been received into care before his birth. His parents separated before he was born. There had been some history of violence between them and Michael was received into care on a place of safety order when he was an infant because his mother had been unable to show consistent care toward him (Lykins Trevatt, 1999 , p. 267).”
Patient's narrative, therapist's observations, and interpretations
A case study should contain detailed accounts of key moments or central topics, such as a literal transcription of an interaction between patient and therapist, the narration of a dream, a detailed account of associations, etc. This will increase the fidelity of the case studied, especially when both patient's and therapist's speech are reported as carefully as possible.
“Martha spoke in a high-pitched voice which sounded even more tense than usual. She explained that her best friend's mum had shouted at her for being so withdrawn; this made her angry and left her feeling that she wanted to leave their home for good. I told Martha that she often tried to undo her bad feelings by acting quickly on her instincts, as she did not feel able to hold her feelings in her mind and bring them to her therapy to think about with me. Martha nodded but it was not clear whether she could really think about what I just said to her. She then said that she was being held in the hospital until a new foster placement could be found. “In the meantime,” she said in a pleased tone, “I have to be under constant supervision” (Della Rosa, 2015 , p. 168).”
In this example, observations of nonverbal behavior and tonality are also included, which helps to render a lively picture of the interaction.
Interpretative heuristics
In which frame of reference is the writer operating? It is important to know what theories are guiding the therapist's thinking and what strategies he employs in order to deal with the clinical situation he is encountering. Tuckett ( 1993 ) writes about the importance of knowing what “explanatory model” is used by the therapist in order to make sense of the patient and to relate his own thinking to a wider public for the purpose of research. This idea is also supported by Colombo and Michels ( 2007 ) who believe that making theoretical orientations as explicit as possible would make the case studies intelligible and more easily employed by the research community. This can be done by the therapists explaining why they have interpreted a particular situation in the way they have. For example, Kegerreis in her paper on time and lateness (2013) stresses throughout how she is working within the object-relations framework and looking out for the patient's use of projective mechanisms.
“She was 10 minutes late. Smiling rather smugly to herself she told me that the wood supplied for her new floor had been wrongly cut. The suppliers were supposed to come and collect it and hadn't done so, so she had told them she was going to sell it to a friend, and they are now all anxious and in a hurry to get it. I said she now feels as if she has become more powerful, able to get a response. She agrees, grinning more, telling me she does have friends who would want it, that it was not just a ploy. She said she had found it easier to get up today but was still late. I wondered if she had a sense of what the lateness was about. She said it was trying to fit too much in. She had been held up by discussing the disposal of rubble with her neighbors. I said I thought there was a link here with the story about the wood. In that she had turned the situation around. She had something that just didn't work, had a need for something, but it was turned around into something that was the suppliers' problem. They were made to feel the urgency and the need. Maybe when she is late here she is turning it around, so it is me who is to be uncertain and waiting, not her waiting for her time to come. We maybe learn here something of her early object relationships, in which being in need is felt to be unbearable, might lead to an awful awareness of lack and therefore has to be exported into someone else. One could go further and surmise that in her early experience she felt teased and exploited by the person who has the power to withhold what you need (Kegerreis, 2013 , p. 458).”
There can be no doubt reading this extract about the theoretical framework which is being used by the therapist.
Reflexivity and counter-transference
A good case study contains a high degree of reflexivity, whereby the therapist is able to show his feelings and reactions to the patient's communication in the session and an ability to think about it later with hindsight, by himself or in supervision. This reflexivity needs to show the pattern of the therapist's thinking and how this is related to his school of thought and to his counter-transferential experiences. How has the counter-transference been dealt with in a professional context? One can also consider whether the treatment has been influenced by supervision or discussion with colleagues.
“Recently for a period of a few days I found I was doing bad work. I made mistakes in respect of each one of my patients. The difficulty was in myself and it was partly personal but chiefly associated with a climax that I had reached in my relation to one particular psychotic (research) patient. The difficulty cleared up when I had what is sometimes called a ‘healing’ dream. […] Whatever other interpretations might be made in respect of this dream the result of my having dreamed it and remembered it was that I was able to take up this analysis again and even to heal the harm done to it by my irritability which had its origin in a reactive anxiety of a quality that was appropriate to my contact with a patient with no body (Winnicott, 1949 , p. 70).”
Leaving room for interpretation
A case study is the therapist's perspective on what happened. A case study becomes richer if the author can acknowledge aspects of the story that remain unclear to him. This means that not every bit of reported clinical material should be interpreted and fitted within the framework of the research. There should be some loose ends. Britton and Steiner ( 1994 ) refer to the use of interpretations where there is no room for doubt as “soul murder.” A level of uncertainty and confusion make a case study scientifically fruitful (Colombo and Michels, 2007 ). The writer can include with hindsight what he thinks he has not considered during the treatment and what he thinks could have changed the course for the treatment if he had been aware or included other aspects. This can be seen as an encouragement to continue to be curious and maintain an open research mind.
Answering the research question, and comparison with other cases
As in any research report, the author has to answer the research question and relate the findings to the existing literature. Of particular interest is the comparison with other similar cases. Through comparing, aggregating, and contrasting case studies, one can discover to what degree and under what conditions, the findings are valid. In other words, the comparison of cases is the start of a process of generalization of knowledge.
“Although based on a single case study, the results of my research appear to concur with the few case studies already in the field. In reviewing the literature on adolescent bereavement, it was the case studies that had particular resonance with my own work, and offered some of the most illuminating accounts of adolescent bereavement. Of special significance was Laufer's ( 1966 ) case study that described the narcissistic identifications of ‘Michael’, a patient whose mother had died in adolescence. Both Laufer's research and my own were conducted using the clinical setting as a basis and so are reflective of day-to-day psychotherapy practice (Keenan, 2014 , p. 33).”
As Yinn ( 2014 ) has argued for the social sciences, the case study method is the method of choice when one wants to study a phenomenon in context, especially when the boundaries between the phenomenon and the context are fussy. We are convinced that the same is true for case study methodology in the fields of psychoanalysis and psychotherapy. The current focused review has positioned the research method within these fields, and has given a number of guidelines for future case study researchers. The authors are fully aware that giving guidelines is a very tricky business, because while it can channel and stimulate research efforts it can as well-limit creativity and originality in research. Moreover, guidelines for good research change over time and have to be negotiated over and over again in the literature. A similar dilemma is often pondered when it comes to qualitative research (Tracy, 2010 ). However, our first impetus for providing these guidelines is pedagogical. The three authors of this piece are experienced psychotherapists who also work in academia. A lot of our students are interested in doing case study research with their own patients, but they struggle with the methodology. Our second impetus is to improve the scientific credibility of the case study method. Our guidelines for what to include in the written account of a case study, should contribute to the improvement of the quality of the case study literature. The next step in the field of case study research is to increase the accessibility of case studies for researchers, students and practitioners, and to develop methods for comparing or synthesizing case studies. As we have described above, efforts in that direction are being undertaken within the context of the Single Case Archive.
Author contributions
JW has written paragraphs 1–4; ER and JW have written paragraph 5 together; SK has contributed to paragraph 5 and revised the whole manuscript.
Conflict of interest statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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A case study is an in-depth analysis of one individual or group. Learn more about how to write a case study, including tips and examples, and its importance in psychology.
Case study research involves an in-depth, detailed examination of a single case, such as a person, group, event, organization, or location, to explore causation in order to find underlying principles and gain insight for further research.
an in-depth investigation of a single individual, family, event, or other entity. Multiple types of data (psychological, physiological, biographical, environmental) are assembled, for example, to understand an individual’s background, relationships, and behavior.
But what exactly is a case study? Simply put, a case study is a very detailed account of an individual patient’s case. (The case studies below are abbreviated versions of case studies.) Psychologists usually keep notes on all patients, but a case study is much more formal.
In clinical psychology, the term case study as a research approach is traditionally defined as the “intensive investigation of the individual client” (Kazdin, 1981, p. 184), be the client “an individual, group, organization, community, or even a society” (Fishman, 1999, p. 10).
Case study in psychology refers to the use of a descriptive research approach to obtain an in-depth analysis of a person, group, or phenomenon. A variety of techniques may be employed including personal interviews, direct-observation, psychometric tests, and archival records.
The case study can be a comprehensive way of studying psychological phenomena- the degree of detail and quantity of data collected means they may provide a better reflection of the issue being studied; in comparison with laboratory experiments they provide greater insight into the range of individual differences seen within a data set.
A case study is a research method used in psychology to investigate a particular individual, group, or situation in depth. It involves a detailed analysis of the subject, gathering information from various sources such as interviews, observations, and documents.
KEY CONCEPT 1. Clinical case study. A clinical case study is a narrative report by the therapist of what happened during a therapy together with the therapist's interpretations of what happened.
A case study is: “a strategy for doing research which involves an empirical investigation of a particular contemporary phenomenon within its real-life context using multiple sources of evidence” (Robson, ‘Real World Research’, Blackwell, 1993).