Handling Multiple Levels of Data and Multiple Research Questions in an Embedded Case Study: Methodological Challenges

Abstract

Hougaard et al. (2008) report an embedded case study in which nine socially phobic clients were treated as part of a therapy program, which incorporated individual and group therapy and which was largely delivered by trainee clinicians. An important focus of the report is on the effectiveness of their treatment model. This commentary draws attention to the size and complexity of the available data, and it suggests ways in which the use of a more explicitly interpretative methodology can draw out additional dimensions of the data and allow a more systematic contribution to be made to the development of clinical theory.

Further Reflections on the Therapy Training Program in Aarhus, and the Role of Case Studies in Psychotherapy Research

“…In line with Edwards, Datillio, and Bromley (2004), Edwards (2008) argues for a more prominent place for case studies within EBP as a complement to randomized clinical trials and other group studies. Huppert et al (2008) propose an intriguing idea on the relationship between individualized EBP (Sackett, Straus, Richardson, Rosenberg & Hayness, 2001;American Psychological Association, 2006) and case-based reasoning (Prentzas & Hatzilygerudis, 2007).…”

“…If this line of reasoning is correct, systematically and rigorously documented case studies might improve the idiographic aspects of EBP, making a clinician's intuitively developed expertise explicitly and transparently formalized, conceptualized, articulated, and critically reflected upon. There are, of course, other rationales for the use of case studies in theory testing (e.g., Stiles, in press) and in the inductive generation of best practice guidelines from aggregated case studies of the same type (Edwards 2008;Fishman, 2005;Watson, Goldman, & Greenberg, 2007). Both Edwards (2008) and Huppert et al (2008) raise the question of whether our Aarhus Anxiety Clinic is based on the best available evidence.…”

“…The complexity of the project only gradually became clear to me during the process, and it is further clarified now after its completion by the keen commentaries by Edwards (2008) and Huppert et al (2008)-as are the many implicit assumptions we had taken for granted in writing our case study. Thus my experience with writing the case study reflects some of the problems inherent in clinical reasoning, and therefore indirectly supports the value of one of the objectives of Pragmatic Case Studies in Psychotherapy (Fishman, 2005)-to develop a database of systematic, clearly articulated, and methodologically sound case studies as a resource for helping clinicians to use empirically informed and scientifically disciplined reasoning in their clinical practice.…”

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ABSTRACTThis paper responds to commentaries by Edwards (2008) and Huppert, Carmeli and Gilon (2008) on the case study of a special format of intensive, group cognitive-behavioral therapy for social phobia in an Anxiety Clinic run by the Department of Psychology of the University of Aarhus in Denmark . My response addresses the following topics: 1) case studies and evidence-based practice; 2) the evidence-basis of the Aarhus treatment program; 3) mechanisms of change in psychotherapy; 4) the Aarhus clients and their treatment in the program; 5) the Aarhus trainees and their learning; and 6) differences between the training program of Huppert et al in Jerusalem and our Aarhus program.

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“…Both commentaries ask for more information on the educational part of the program, and Edwards (2008) raises the question of why it was not more formally evaluated in the case study, since the primary purpose of the treatment program is to train student therapists. I agree that this is a weakness of the study, and consequently I have initiated plans for a case study next year focusing on the students and their training in the social phobia part of our program.…”