Case Study Research: Importance and Applications in Therapy

Case Study Research: A Primer Mark Widdowson, TSTA (P) University of Leicester

Workshop Outline Why case study research?

Why are case studies important? We work with cases . The case represents the most fundamental, basic unit of analysis Case studies provide rich, contextualised, practice-relevant information Captures complexity (multiple methods) Tells a story, shows process unfolding over time

Why is case study research so important to TA? Case study research represents perhaps the single most promising and accessible research method open to the TA community As an approach it draws upon skills we already have The accounting for context and unique features are congruent with TA philosophy The methodological philosophy is congruent with TA philosophy, theory and practice

More reasons Case study research is efficient Ease of replication Sensitive to individual differences Can be compared to other cases Can be used to investigate both process and outcome- even within the same study

What can we discover from case study research? What are your thoughts?

Aims of Case Study Research (McLeod, 2010) Outcome questions: How effective has therapy been in this case? Theory-building questions: How can the process of therapy in this case be understood in theoretical terms? How can the data in this case be used to test and refine Pragmatic questions: What strategies did the therapist use in this case, that contributed to the eventual outcome? What are the principles of good practice that can be derived from this case? Experiential or narrative questions:What was it like to be the client or therapist in this case? What is the story of what happened, from the client or therapist point of view?

Pragmatism- A philosophy for case study research Pragmatism synthesises positivism and constructivism Sees both quantitative & qualitative approaches as having something to offer Truth is seen as an evolving process of what is most true at this time Statements evaluated on their usefulness and applicability

Methodological Issues: Generalisability Good research enables us to generalise the findings to other cases The contextual information contained in the case study enable very specific generalisations to be made: What treatment, by whom, is most effective for this individual, with that specific problem, and under which set of circumstances? (Paul, 1967: 111)

Generalisability II By combining multiple cases, each replication builds up an incremental degree of confidence in the approach tested and also highlights exceptions to its effectiveness, thus enhancing generalisability

Methodological Issues: Focus of Case Study Research case study research is usually interested in a specific phenomenon and wishes to understand it completely, not by controlling variables but rather by observing all of the variables and their interacting relationships (Dooley, 2002: 336) Generally has high external validity but low internal validity

Methodological Issues: validity Trustworthiness : credibility (parallel to internal validity- related to internal consistency); Transferability (parallel to external validity/ generalisability); Dependability (parallel to reliability- consistency of analysis method); Confirmability (parallel to objectivity- do the findings represent the phenomena?).

Pragmatic perspective on validity: Pragmatism holds that an understanding of the context of knowledge is essential to making sense of, and using that knowledge- what is true in one context does not necessarily mean it is true in all. Truth is considered to be the explanation or theory that is most true at this present time, as opposed to being a fixed truth Scientific statements are evaluated on their usefulness and applicability

Transferability and legitimation Legitimation : combination of validity and quality checking using criteria from both quantitative and qualitative approaches Legitimation: is the theory which emerges practical and transferable? Specific aspects which can be transferred are named and identified as within a particular context Onwuegbuzie and Johnson (2006)

Ethics in case study research Three main issues: Confidentiality Informed consent Avoidance of harm or exploitation/ client protection

Types of Case Study Research Outcome/ Efficacy Case Studies (e.g. HSCED) Pragmatic Case Studies Qualitative Case Studies Theory-Building Case Studies Narrative Case Studies

Hermeneutic Single-Case Efficacy Design A Quasi-Legal method of case study analysis Rich case record compiled Case analysed and affirmative and sceptic arguments are developed The rich case record and affirmative and sceptic arguments are sent to independent judges for adjudication

What data should I collect? Quantitative Minimum of: 2 outcome measures (e.g. CORE, BDI-II, PHQ-9, GAD-7) 1 process measure (e.g. HAT, SEQ, WAI, SRS) Qualitative data: For example client interview, client open- ended feedback forms

Guidelines for enhancing Case Study Research Why this case? What is significant about it? Compile a detailed case record. Tell the story. Provide the context Use multiple tools Use a team-based data analysis approach Make a good-faith attempt to examine alternative explanations

Use a member checking procedure-ask the client to comment What are the theoretical and practice implications of the case? How does the case link to existing theory/ research How have the ethical aspects of the case study been addressed? Researcher reflexivity Account for the limitations of the case