Knowledge generation processes and the role of the case study method in the field of psychotherapy

The present thesis seeks to explore knowledge generation methods in the field of psychotherapy, with a focus on qualitative clinical and systematic case study narratives. Currently, evidence–based practice (EBP) in psychotherapy prioritises quantitative methods (e.g., systematic reviews and meta–analytic reports, which summarise the findings of randomised controlled trials; RCTs). However, recent studies exploring psychotherapists’ decision–making processes in clinical practice suggest that there are significant difficulties in applying randomised and decontextualized statistical findings onto individual patients and their specific mental health experiences. Some of the concerns about large–scale quantitative findings include overlooking complex individual differences in treatment processes and outcomes. This contributed to an ongoing issue of research–practice gap: a lack of integration between the findings disseminated by researchers and the practical decisions made in the consulting room by therapists. To aid with these issues, this thesis considers the role of the case study method in psychotherapy research. From its inception, psychoanalysis used case studies to produce complex, longitudinally sensitive and detailed narratives to discuss clinical decision–making processes and theoretical advancements. However, criticisms about researcher’s subjective bias, unclear research focus, and lack of generalisability continue for both classic psychoanalytic and contemporary psychotherapy case studies. Whilst there have been several historical misconceptions about case studies, there are also persisting methodological issues, such as lack of epistemic guidance for hypothesis generation and generalisability of case study findings. Crucially, there are currently no research appraisal tools for psychotherapy case studies. The thesis therefore seeks to i) address the long–standing criticisms directed at the case study method, ii) develop epistemic knowledge generation strategies for case study researchers, iii) address the philosophical underpinnings of thinking in cases as a scientific style, and iv) introduce a novel Case Study Evaluation–tool (CaSE), which will improve the evidential status of systematic psychotherapy case studies

Appraising psychotherapy case studies in practice-based evidence: introducing Case Study Evaluation-tool (CaSE)

AbstractSystematic case studies are often placed at the low end of evidence-based practice (EBP) due to lack of critical appraisal. This paper seeks to attend to this research gap by introducing a novel Case Study Evaluation-tool (CaSE). First, issues around knowledge generation and validity are assessed in both EBP and practice-based evidence (PBE) paradigms. Although systematic case studies are more aligned with PBE paradigm, the paper argues for a complimentary, third way approach between the two paradigms and their ‘exemplary’ methodologies: case studies and randomised controlled trials (RCTs). Second, the paper argues that all forms of research can produce ‘valid evidence’ but the validity itself needs to be assessed against each specific research method and purpose. Existing appraisal tools for qualitative research (JBI, CASP, ETQS) are shown to have limited relevance for the appraisal of systematic case studies through a comparative tool assessment. Third, the paper develops purpose-oriented evaluation criteria for systematic case studies through CaSE Checklist for Essential Components in Systematic Case Studies and CaSE Purpose-based Evaluative Framework for Systematic Case Studies. The checklist approach aids reviewers in assessing the presence or absence of essential case study components (internal validity). The framework approach aims to assess the effectiveness of each case against its set out research objectives and aims (external validity), based on different systematic case study purposes in psychotherapy. Finally, the paper demonstrates the application of the tool with a case example and notes further research trajectories for the development of CaSE tool.</jats:p

A Qualitative Exploration of CBT and Psychodynamic Therapists’ Views, Experiences and Perceptions of Integrating Different Therapeutic Modalities into their Private Practice with Adult Clients: Study Protocol

Background: CBT (Cognitive Behavioural Therapy) and psychodynamic psychotherapy are two most frequently used therapeutic modalities in private and public clinical practice. CBT is currently considered to be a ‘gold standard’ therapy, culminating in a wide scale training and dissemination of research. Psychodynamic psychotherapy has also amassed increasing systematic research, yielding significant longitudinal outcomes. However, the co-existence of the two therapeutic modalities is not without controversies. Although few authors in psychotherapy suggested that CBT and psychodynamic psychotherapy should be viewed as complementary rather than dichotomous paradigms, little is known about how concepts and techniques from these two different approaches are integrated (if at all) by therapists in private practice. Objective: This study protocol paper presents a pilot study, which aims to qualitatively explore how CBT therapists experience and make sense of psychodynamic concepts and vice versa in private practice. Our study is particularly interested in how therapists conceptualise psychodynamic and CBT concepts, and whether they might integrate techniques from different therapeutic modalities in their practice formally or informally. We anticipate that the findings will be relevant for further theoretical and clinical recommendations on how CBT and psychodynamic psychotherapies can be integrated in a pragmatic manner to address individual patient treatment needs. Study Design: A qualitative survey method will be used to explore how qualified BABCP accredited CBT therapists and BCP accredited psychodynamic practitioners understand, perceive and, potentially, integrate, psychodynamic and CBT principles in private practice. The data collected will be analysed using thematic analysis in order to construct themes and generate implications for therapeutic integration and practice. Ethical considerations and dissemination plans are discussed, with awareness of characteristics of our target sample.N/

Things can only get Stranger: theoretical and clinical reflections on Netflix’s Stranger Things

The popularity of Stranger Things lies in its ability to depict the unconscious aspects of personality and the psychological processes constellated during crucial years of development and maturation. First, Jung’s notions of the mother complex and dual mother archetype frame the metamorphoses experienced by Will Byers and El. Second, a psychoanalytic understanding of nostalgia, loss and mourning elucidates the associations audiences make between their own experiences and those of the show’s central characters. Ironically, it is through an exploration of the monstrous and the fantastic that the series draws us closer to what it means to be human; the stranger things get, the closer we come to reality and grasping the operations of the psyche

Theory Paper: Suggesting Compassion-Based Approaches for Treating Complex Post-traumatic Stress Disorder

Complex post-traumatic stress disorder (CPTSD) may develop following interpersonal and cumulative traumatic events, usually during early development. In addition to the core PTSD symptom profile, CPTSD presents emotional dysregulation symptoms that can be resistant to conventional treatments. Compassion-focused therapy (CFT) may be an effective intervention for addressing the more resistant symptoms in the emotional stabilisation phase of treatment rather than the trauma-processing phase. This paper explores the diagnostic validity and prevalence of CPTSD, treatment recommendations and the role of CFT in mediating shame and stabilising emotional dysregulation. We also evaluate current evidence utilising compassion-based interventions for the components of the CPTSD symptom profile and the viability of CFT as a whole. The novelty of CPTSD as a clinical condition means there is limited evidence regarding recommended treatment. Research into the efficacy of CFT and its suitability to target CPTSD’s symptom profile will contribute to the current gap in recommended treatment approaches for this condition

Qualitative Investigation into Therapists' Experiences of Online Therapy: Implications for Working Clients.

Online therapy has increasingly been utilised during the COVID-19 pandemic by many, including working populations. However, few qualitative studies have explored how online therapy is experienced in practice and discussed its implications for those working clients. Semi-structured interviews attended by nine integrative psychotherapists practising in California, the United States, were conducted. Thematic analysis of the transcripts identified three themes: (i) 'Positive experiences of online therapy', (ii) 'Challenges experienced by therapists and clients in online therapy', and (iii) 'Preparation and training for online therapy'. Online therapy was assessed as being helpful, particularly in terms of mitigating against previous geographical and temporal barriers to uptake. However, due to technological disruptions and potential blurring of professional boundaries, online therapy may detract from the emotional salience of therapy, negatively impacting the therapeutic relationship and containment. Considering these positive experiences, participants expected that the demand for online therapy would continue to increase. Particularly in the occupational context, online therapy can offer interventions without fostering shame regarding mental health. The findings provide preliminary qualitative evidence that online therapy can be a useful adjunct to traditional forms of face-to-face therapy. However, therapists require more explicit training in implementing online therapy. Results are discussed in particular regarding the utility of this therapy for working clients

The Psychosocial Impact of Instagram on Female Body Image: Literature Review and Proposal

Instagram is one of the most popular photo sharing social networking platforms used by the younger population. However, research exploring the socio-psychological impact of this platform on younger populations is scarce. It is particularly important to assess how Instagram affects perceptions of body image in female populations who make up the majority of Instagram users. Accordingly, this study will seek to explore the impact engagement with Instagram has on female body image through qualitative semi-structured, one-to-one interviews with young female individuals aged eleven to twenty-five years over a period of three months. The findings from the interviews will be analysed using the interpretative phenomenological analysis framework and disseminated to schools, university teachers, education researchers, health care professionals and social media platforms. We believe the findings from this study will help protect young female populations from experiencing negative impact on their body image via Instagram.N/

Health Benefits of Ikigai: A Review of Literature

Recently, the concept of ikigai has attracted international scholarly attention. Originally, researchers have focused on its impact on longevity; however, contemporary approaches to ikigai include career guidance, wellbeing training and clinical practice. That said, much of the existing literature on ikigai has relied on anecdotal episodes, without a clear focus on scientific or clinical literature. In this chapter, we (a) define ikigai, (b) explore the health benefits of ikigai regarding its impact on both physical health and mental health, and (c) discuss how to enhance ikigai and future research, based on scientific findings. Ikigai— originally identified in difficult life experiences among leprosy patients—is defined as an experiential, everyday life phenomena that relates to a reason for your being. Based on a number of meta-analyses and longitudinal studies, evidence suggests a protective benefit and positive correlation between ikigai and better physical health, and an inverse relationship with all-cause mortality. Psychologically, ikigai may be important in developing one's sense of self-understanding, goal attainability, and problem-solving skills. Interventions such as life crafting are deemed helpful to enhance ikigai, although further research (e.g., cross-culture, longitudinal) needs to be conducted to further support the utility of this construct. Our findings can help healthcare workers and researchers to further advance the science of this experiential wellbeing construct.N/

Studying Mental Health in Schools: A Participatory Action Research (PAR) Approach in Public Mental Health

Despite a rising prevalence of mental health difficulties in the young, existing prior to, but also exacerbated by the current COVID-19 pandemic, mental health needs in this population remain unmet even in economically wealthy countries. Increasingly, supportive school environments have been suggested as having a significant impact on young people's mental health. The idea of health- promoting schools, initiated by the World Health Organisation (WHO), highlights the ongoing need for both health education via the curriculum but also a school environment that is conducive to students' health and emotional well-being. Despite this promising public health measure, existing studies into mental health- related interventions delivered in schools have been found to have a small or no effect. One explanation for this is that previous studies did not sufficiently address or focus on the school environment, which may in itself pose barriers to acceptability and successful implementation of mental health interventions. This paper will highlight a novel methodological approach to public mental health research - Participatory Action Research (PAR). The PAR method is unique in enabling study participants to become co-researchers of their own experiences in a specific context. A growing body of educational PAR research suggests that this method can also generate collaborative and participative processes foundational to positive school culture and mental health outcomes. This paper will provide an overview of such outcomes, as well as outline methodological strengths and challenges common to the PAR approach in educational mental health settings

Studying Mental Health in Schools: A Participatory Action Research (PAR) Approach in Public Mental Health

Despite a rising prevalence of mental health difficulties in the young, existing prior to, but also exacerbated by the current COVID-19 pandemic, mental health needs in this population remain unmet even in economically wealthy countries. Increasingly, supportive school environments have been suggested as having a significant impact on young people's mental health. The idea of health- promoting schools, initiated by the World Health Organisation (WHO), highlights the ongoing need for both health education via the curriculum but also a school environment that is conducive to students' health and emotional well-being. Despite this promising public health measure, existing studies into mental health- related interventions delivered in schools have been found to have a small or no effect. One explanation for this is that previous studies did not sufficiently address or focus on the school environment, which may in itself pose barriers to acceptability and successful implementation of mental health interventions. This paper will highlight a novel methodological approach to public mental health research - Participatory Action Research (PAR). The PAR method is unique in enabling study participants to become co-researchers of their own experiences in a specific context. A growing body of educational PAR research suggests that this method can also generate collaborative and participative processes foundational to positive school culture and mental health outcomes. This paper will provide an overview of such outcomes, as well as outline methodological strengths and challenges common to the PAR approach in educational mental health settings