Pragmatic Case Studies in Psychotherapy

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October 16, 2016 -- From the Editor 


 A Life-Saving Therapy: The Theory-Building Case of "Cora"

*** Margrethe Seeger Halvorsen, Kirsten Benum, Hanne Haavind, & John McLeod, Department of Psychology, University of Oslo, Norway


***  Arthur C. Bohart, Department of Psychology, California State University Dominguez Hills   

*** Ladislav Timulak, School of Psychology, Trinity College Dublin, & Daragh Keogh, Positive Care Ireland

*** Alexandra Jessup Altman, Howard Center for Human Services, Burlington, VT, & Ronald B. Miller, St. Michael’s College, Colchester, VT

 Response to Commentaries 

*** Margrethe Seeger Halvorsen, John McLeod, Kirsten Benum, & Hanne Haavind, Department of Psychology, University of Oslo, Norway

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The compelling case of “Cora” looks at therapy in a distinctive way. It asks: What can we learn—both clinically and theoretically—when a practitioner who is expert in therapeutic-relationship-building engages for a long time (121 sessions over 3 years) with a highly depressed and, at times, suicidal client?

Cora is a woman in her late forties with a “childhood history of severe emotional, physical, and sexual abuse by her mother and her mother’s friends, [resulting in] … extreme difficulty in trusting other people and forming relationships, problems in maintaining work roles, previous unsuccessful therapy, and repeated life-threatening suicide attempts that had resulted in several hospitalizations” (p. 159).

The therapist, who was in his mid-sixties and highly regarded by his colleagues and supervisees after 31 years of experience, describes himself theoretically as “integrative: drawing on narrative, systemic, humanistic and psychodynamic perspectives” (p. 163). The four authors who did Cora’s case analysis are highly experienced clinically and also describe their theoretical approach as integrative with a substantial humanistic component.

Cora and her therapist are a pair of participants in a larger research study of 50 client-therapist dyads directed by Michael Helge Ronnestad and his colleagues at the University of Oslo, who include Margrethe Seeger Halvorsen and the other authors of the case of Cora. The focus of this research is to develop theoretical ideas about the successful interpersonal process of expert therapists by using continuously collected qualitative and quantitative data taken from multiple perspectives, including recordings of the sessions.

Applying the method of “Interpretative Phenomenological Analysis (IPA)” to the case of Cora, Halvorsen and her colleagues develop a theoretical understanding of major themes that seemed to be causally connected to Cora’s positive outcome. These include their finding of a recurring pattern of interaction in both Cora and her therapist that was characterized by distinctively humanistic themes of “[showing] persistence, … acting with courage, and the use of symbolic representations of their accomplishments” (p. 158).

The three sets of commentators all express admiration for the researchers’ in-depth collection and analysis of a very rich case record, and for the heroic, compassionate, committed, and successful efforts of the therapist.

On the other hand, the commentators raise important, critical questions to consider. These include such issues as (a) whether Halvorsen et al.’s method met the criteria for a true “theory-building” case study with the goal for which this method was originally developed; (b) whether crucial perspectives in the case were lost by having it written by “outside” researchers rather than by the therapist himself; (c) how to explain the fact that while the client and therapist’s self-reports in open-ended qualitative interviews indicated a highly satisfactory outcome, Cora’s responses on standardized quantitative measures showed little change over the three years of therapy; and (d) how to understand the special circumstance of the therapy in which the client demanded the right to retain the option of committing suicide as a condition of continuing in the therapy.

Halvorsen et al. rise to the occasion of responding to the commentaries by more fully spelling out the rationale for their method and by expanding upon the interpretation of their clinical findings. 

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** Manuscripts. Two types of manuscripts are desired: those consisting of one or more case studies, and those consisting of case method articles.

** Suggested Author Guidelines. These can be found by clicking on the link Instructions for Authors, as described above. Note that we suggest 11 common headings for case study manuscripts:
1. Case Context and Method
2. The Client
3. Guiding Conception with Research and Clinical Experience Support
4. Assessment of the Client's Problems, Goals, Strengths, and History.
5. Formulation and Treatment Plan
6. Course of Therapy
7. Therapy Monitoring and Use of Feedback Information
8. Concluding Evaluation of the Therapy's Process and Outcome
9. References
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11. Figures (optional)
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Vol 12, No 3 (2016)

Table of Contents

Case Study

A Life-Saving Therapy: The Theory-Building Case of "Cora" Abstract PDF
Margrethe Seeger Halvorsen, Kirsten Benum, Hanne Haavind, John McLeod 158-193
The Life-Saving Case of "Cora": A Rogerian Perspective Abstract PDF
Arthur C. Bohart 194-206
The Case of "Cora": Clinical and Methodological Perspectives  Abstract PDF
Ladislav Timulak, Daragh Keogh 207-214
Considering "Cora": A Critical Appreciation Abstract PDF
Alexandra Jessup Altman, Ronald B. Miller 215-223
Conceptualizing the Complexity of Change in Psychotherapy: The Case of "Cora" Abstract PDF
Margrethe Seeger Halvorsen, John McLeod, Kirsten Benum, Hanne Haavind 224-237