Considering "Cora"

Abstract

This discussion examines Halvorsen, Benum, Haavind, and McLeod's (2016) case study of "Cora," from a perspective both appreciative and at times critical of certain mixed-study methods it employs. While impressed with the clinical alliance it illustrates between therapist and challenging client, we find the study raises more theoretical questions than it answers in terms of our ability to enumerate the conceptual elements necessary to convey valuable clinical truths. The case study does indeed provide systematic data on the presence of dyadic courage, persistence, and symbolic expressions of trust during treatment from which there is much to be learned. As readers we were left marveling at an account of a therapist's clinical acumen with a client who had faced unbearable childhood trauma, and at the same time wondering how much more we might have learned about how to actually do such work from a comprehensive narrative written in his own voice.Key words: case-study methodology; practical knowledge; trauma; clinical case study; case study _____________________________________________________________________________ In this discussion of Drs. Halvorsen, Benum, Haavind, and McLeod's (2016) case study of Cora," we note the valuable questions it raises with regards to identifying and conveying effective elements of the therapeutic process when expert clinicians treat difficult cases, integrating the narrative case study with formal qualitative research in a relatively large sample of cases, and case study methodology in general. We examine the unique authorial voice of the case study, in this instance not that of the treating clinician; and we review some of the difficulties that arise from the authorial voice chosen for readers seeking to understand treatment process and its results. Finding there exist some "missing pieces" to the case conceptualization, we suggest other useful frameworks in which it might be regarded. Finally, in the light of what we do not know, we discuss the valuable and unique lessons derived from Dr. X's interactions with Cora and hers with him.

Conceptualizing the Complexity of Change in Psychotherapy: The Case of "Cora"

“…For example, Altman and Miller (2016) were disappointed that "the case itself feels strangely ephemeral" (p. 217) because the personal experience of the therapist and client was not sufficiently highlighted. Bohart (2016) and Timulak and Keogh (2016) suggest that important dimensions of the case might have been better understood through the application of a jury method, or the use of Hermeneutic Single Case Efficacy Design (Elliott, 2002).…”

“…These would certainly be interesting and valuable projects, but to do either of them properly would probably require the use of an additional team of researchers who were able to concentrate solely on those aspects of the data that were most relevant to their goals. Altman and Miller (2016) point out that our study "raises more theoretical questions than it answers in terms of our ability to enumerate the conceptual elements necessary to convey valuable clinical truths" (p. 215). They seem to favor a different type of case study, written by the therapist himself, rather than us as external researchers.…”

“…We wish to thank the commentators (Altman & Miller, 2016;Bohart, 2016;and Timulak & Keogh, 2016) for their thoughtful and stimulating reviews of our case of Cora (Halvorsen, Benum, Haavind, & McLeod, 2016). Although the three commentaries differ somewhat in respect of the specific aspects of the case on which they have chosen to focus, we believe that each of them draws attention, in their own way, to fundamental issues associated with the challenges associated with conceptualizing complex change processes in psychotherapy.…”

“…In the discussion that follows, we treat both methodological and clinical aspects of the case of Cora as inter-connected aspects of a more general professional task of conceptualizing or "making sense". Rather than adopting a rigid distinction between the methodological issues and the substantive/clinical issues raised by Altman and Miller (2016), Bohart (2016), and Timulak and Keogh (2016), we illustrate some of the ways in which clinical-theoretical assumptions and choices shaped our approach to analyzing the data in this case, and epistemological choices shape our approach to the clinical meaning of the case.…”

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ABSTRACTIn this article we respond to the commentaries by Altman and Miller (2016), Bohart (2016), and Timulak and Keogh (2016) on our case of "Cora," which involved over 121 psychotherapy sessions with a client with a history of severe relational trauma that had led to difficulty in forming close relationships, as well as a series of suicide attempts (Halvorsen, Benum, Haavind, & McLeod, 2016). The commentaries differ in their view of the value of Cora's case, interpretations of the material, and methodological preferences.

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