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

Abstract

Systematic 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.

‘Meeting the Client Where They Are Rather Than Where I'm At’: A Qualitative Survey Exploring CBT and Psychodynamic Therapist Perceptions of Psychotherapy Integration

“…Finally, our data reveal a further need for a dialogue between different research methods, that is, qualitative strategies, in particular, case studies, and more traditional quantitative strategies, such as randomised controlled trials (RCTs). This call corresponds with existing debates about the 'validity' of current evidence-based research standards in psychotherapy, with many authors asking for a mixed-method approach, in which qualitative methods are seen as just as valuable as statistical studies (see, e.g., Kaluzeviciute, 2021;Truijens et al, 2022).…”

What is preventing psychotherapy case studies from having a greater impact on evidence-based practice, and how to address the challenges?

“…The research-practice gap in the field of psychotherapy has been described as a lack of integration between the findings disseminated by researchers and the decisions made in the consulting room by therapists ( 19 ). This gap has negative consequences for the application of research findings in mental health services as well as on the development of research—supported psychological treatments.…”

“…Truijens et al ( 18 ) argue that a precondition for EBP is the development of a theory of evidence that is clear on what should be evidenced to be useful and valid for psychological interventions. An important step toward the development of a framework is Kaluzeviciute's ( 19 ) Case Study Evaluation-tool (CaSE), the first tool that offers a framework and a checklist to evaluate the evidential value of case studies in the field of psychotherapy. This tool needs to be completed, disseminated, and implemented more broadly.…”

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

“…It is nevertheless important to consider how PAR study findings might be generalisable (or transferrable) between different school environments; which cultural, demographic, economic factors are specific to one school, but are less pertinent to other school contexts? Epistemological guidance for identifying such important variations in PAR studies is yet to be developed, although similar epistemic considerations have been put forth for other qualitative methods, such as case studies in mental health and psychotherapy (Kaluzeviciute, 2021).…”