The ‘inseparable bond between cure and research’: clinical case study as a method of psychoanalytic inquiry

Abstract

Since Freud's own time, there has been great deal of debate about the most appropriate research methodology for investigating psychoanalytic psychotherapy [Fonagy, Journal of Child Psychotherapy, 29 (2): 129 – 136, 2003 Fonagy, P. 2003. ‘The research agenda: the vital need for empirical research in child psychotherapy’. Journal of Child Psychotherapy, 29(2): 129–136. [Taylor &; Francis Online] , [Google Scholar]; Rustin, Journal of Child Psychotherapy, 29 (2): 137–145, 2003 Rustin, M. 2003. ‘Research in the consulting room’. Journal of Child Psychotherapy, 29(2): 137–145. [Taylor &; Francis Online] , [Google Scholar]]. The single case study, which has a long tradition both within child psychotherapy and the wider research field, has been widely criticised as an approach to research, even while its contribution to clinical practice, the development of new ideas and teaching have been acknowledged. After reviewing the history of case study as a research method, this paper argues that there are a broad range of approaches to the study of the single case, each of which may be appropriate depending on the particular research question. Each of these approaches, however, must respond to the three perceived weaknesses of the clinical case study as a research method: the ‘data problem’, the ‘data analysis problem’ and the ‘generalisability problem’. This paper outlines the nature of these criticisms and, using many examples of actual research projects, suggests various ways in which the criticisms can be addressed, in order for the single case study to re-gain its place at the heart of psychoanalytic research.     

Probing the effects of individual components in multiple component prevention programs

Assessing the contributions of individual components in multi-component interventions poses complex challenges for prevention researchers. We review the strengths and weaknesses of designs and analyses that may be useful in answering three questions: (1) Is each of the individual components contributing to the outcome? (2) Is the program optimal? and (3), Through what processes are the components of the program achieving their effects? Factorial and fractional factorial designs in which a systematically selected portion of all possible treatment combinations is implemented are used to address question 1. Response surface designs in which each component is quantitatively scaled are explored in relation to question 2. Mediational analysis, a hybrid of experimental and correlational approaches, is considered in relation to question 3. Design enhancements are offered that may further strengthen some of these techniques. These techniques offer promise of enhancing both the basic science and applied science contributions of prevention research.