Digests - March 2011
Special Issue: The Contribution of Systematic Case Study Research to Building an Evidence Base for Counselling and Psychotherapy
- Systematic case studies represent a valuable source of insight and learning into the processes and outcomes of different types of therapy
- Reviews can be a useful tool for both counsellors and clients
- Early relationship struggles can be worked through, resulting in successful therapy
- Supportive, open therapeutic relationship key for clients with interpersonal relationship difficulties
- Therapeutic alliance is generally positive and follows a positive trend
- Person-centred therapy can bring change for socially anxious clients
- Discontinuous change can be regarded as reflecting therapeutic progress
1. Systematic case studies represent a valuable source of insight and learning into the processes and outcomes of different types of therapy
The systematic case studies published in the special issue of Counselling and Psychotherapy Research represents a valuable source of insight and learning into the processes and outcomes of different types of therapy. Each of the case studies goes far beyond what could be achieved by a practitioner writing a clinical case study based on his or her notes of what happened in sessions.
This is the finding of John McLeod and Robert Elliott who provide an overview of the characteristics of rigorous case study research, introduce a set of studies that exemplify these principles, and review the relevance of systematic case study inquiry for policy, practice and training.
If case study research is to fulfil its potential in respect of the evidence base for counselling and psychotherapy, it is essential that practitioners in a wide range of therapy settings carry out more systematic case studies. However, it is important that the quantity and quality of case study research is further developed.
Systematic case study research: A practice-oriented introduction to building an evidence base for counselling and psychotherapy
John McLeod and Robert Elliott
2. Reviews can be a useful tool for both counsellors and clients
This paper deals with the inter-relationships between reviews and endings. It shows how reviews can be experienced as useful for both counsellors and clients, and that their usefulness might depend upon their design and the manner in which they are implemented.
The focus of this paper is just one aspect (not a conclusion – simply what was noticed!) of narrative case study research by Kim Etherington and Nell Bridges of the University of Bristol, which looked into ex-clients’ experiences of counselling.
The usefulness of the review process seems to be in: helping clients to think about what they might need to have achieved by the completion of therapy; encouraging them to complete those tasks; and enabling them to develop their ability to ask for what they want.
In addition, the process of this study illustrates how narrative inquiry can be empowering for those who take part in it. Feedback from ex-clients about their involvement emphasised their pleasure in having their views taken seriously, and being treated as ‘experts’ on their own experiences.
This paper also notes the therapeutic importance of mutuality and negotiation in decision-making about endings based upon the belief that therapists and clients are able to make appropriately responsive decisions about length of therapy.
Narrative case study research: On endings and six session reviews
Kim Etherington and Nell Bridges
3. Early relationship struggles can be worked through, resulting in successful therapy
Around two thirds of the public perceive the professional title ‘counsellor’ to be distinct from the professional titles ‘psychotherapist’ and ‘psychological therapist’ and for these latter two titles to be almost identical.
This is the key finding of study to investigate public opinion concerning the differentiation between the professional titles ‘counsellor’ and ‘psychotherapist’.
The results have implications for the debate concerning the structure of the Health Professions Council (HPC) Register in the regulation of counsellors and psychotherapists.
On the one hand, it might be argued that the finding that the majority of the public perceive a difference between the professional titles ‘counsellor’ and ‘psychotherapist’ supports the present recommendations by the PLG to differentiate between these titles on the HPC register.
On the other hand, it should not be forgotten that the HPC’s primary purpose is to protect the public (Crown Copyright, 2002); consequently, it must be seriously considered whether the decision to differentiate or not will bring clarity to the public’s mind about the roles and purpose of the different professionals or could actually increase confusion.
It might be considered that not differentiating between the titles on the register may have the potential to bring about increased clarity rather than confusion to the two thirds of the public who currently perceive the titles to be distinct.
Based on the findings of this study further research upon the topic of public understanding of the professional titles ‘counsellor’, ‘psychotherapist’, and ‘psychological therapist’ is recommended.
Public perception of the professional titles used within psychological services
Pavlo Kannellakis and Jennefer D’Aubyn
4. Supportive, open therapeutic relationship key for clients with interpersonal relationship difficulties
To enable clients to resolve and work through difficulties with interpersonal relationships, a supportive, open therapeutic relationship is key, within which the client develops a secure attachment to the therapist and is then able to explore inhibited and painful issues.
This is the finding of Clara Hill and colleagues of the University of Maryland, College Park, Maryland, USA, which looked at one case study of a 44 year old, single, middleclass,
woman. Her presenting problems were concerns about loneliness and lacking a long-term romantic partner.
The study also revealed that long-term therapy in such cases is sometimes required, as progression of time and intimacy between a client and therapist is likely to provide a therapeutic relationship that endures the rupture and repair process, and remains a secure base from which the client can generalise the experience of interpersonal change to other relationships.
Future research and conceptualisation of interpersonal change can benefit from a focus on both cognitive and emotional features of interpersonal interactions.
Hitting the wall: A case study of interpersonal changes in psychotherapy
Clara E. Hill, Harold Chui, Teresa Huang, John Jackson, Jingqing Liu and Patricia Spangler
5. Therapeutic alliance is generally positive and follows a positive trend
The therapeutic alliance is generally positive and follows a positive trend, and including short episodes of rupture and resolution of the alliance. The patient and therapist evaluate the alliance as increasing in strength during the therapeutic process
This is the conclusion of a case study of a PhD student, examining the alliance evolutions over the course of short-term psychodynamic therapy.
Secondly, the research highlights that the alliance assessed by the client and the nature of the transference, as assessed by the therapist, vary within four phases of the therapeutic process.
The authors recommend the use of self-reported, and observer-rated, process information over the course of psychotherapy. This is particularly useful to monitor the development of the relationship, session by session, and link this information to wider clinical development.
Alliance evolutions over the course of short-term dynamic psychotherapy: A case study
Luc Michel, Ueli Kramer and Yves De Roten
6. Person-centred therapy can bring change for socially anxious clients
A person experiencing social anxiety difficulties can achieve considerable change through participating in person-centred therapy (PCT), with change being attributable to key aspects of PCT and the client’s own resources.
This is the conclusion of a study undertaken by Susan Stephen and colleagues from the University of Strathclyde.
The research showed that the key processes within the therapy which appear to help are: the weekly practice of being able to talk about one’s own problems; being ‘heard and not destroyed’; the therapist’s sensitivity and responsiveness, and their ability to create a safe space in which the client can open up.
This case study establishes the possibility that PCT can be helpful for clients with social anxiety and self-esteem issues, and has identified the processes within the therapy that the client in this case found most beneficial. However, replication of this study is required in order to find out if this case is representative of other socially anxious clients’ experience of PCT.
Person-centred therapy with a client experiencing social anxiety difficulties: A hermeneutic single case efficacy design
Susan Stephen, Robert Elliott and Rachel Macleod
7. Discontinuous change can be regarded as reflecting therapeutic progress
Discontinuous change can be regarded as reflecting therapeutic progress at an individual emotional level.
This is the conclusion of a case study assessing three aspects of emotional expression over 120 hours of therapy to identify trends and discontinuous changes in the dynamic of the therapeutic relationship.
The hypothesis of an increase in the proportion of positive emotions mentioned was not supported in this case study. However, discontinuous changes in the characteristic of the curve course were evident.
The number of verbalised emotions and the variability of the emotional profile increased as expected during the course of the therapy.
The presented results show that the Clinical Emotions List (CEL) is a suitable instrument for assessing changes in emotional expression within the therapy process.
However, the study suggests that the Clinical Emotions List needs to be modified for direct use in the therapeutic process.
The CEL has the potential to be widely used in case study research as a means of identifying processes of emotional transition in individual therapy.
Verbal expression of emotions in the stage-wise progress of a case of long-term psychodynamic therapy
Antje Gumz, Johanna Lucklum, Anja Herrmann, Michael Geyer and Elmar Brähler
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