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

Abstract

The present paper presents a case study of long-term (121 sessions over three years), integrative therapy with "Cora," a client with a history of severe relational trauma that had led to difficulty in forming close relationships, and a history of hospitalization resulting from a series of suicide attempts. Despite these challenges, Cora reported a highly satisfactory outcome at the end of therapy. Using the format of a theory-building case study (McLeod, 2010;Stiles, 2007), qualitative analysis of session evaluations, session transcripts, and post therapy interviews were used to investigate how both the client and therapist understood the process of therapy and why it had been successful. Data from quantitative process and outcome measures were analyzed to provide contextual information. In spite of repeated challenges and difficult therapeutic situations, Cora and the therapist were able to establish a recurring pattern of interaction that they found relevant and productive and that was characterized by persistence. Other helpful aspects of the therapy process included acting with courage, and the use of symbolic representations of their accomplishments. The results contribute to our understanding of the process of therapy with clients who have been exposed to severe relational trauma. The discussion includes reflection on methodological issues associated with mixed-methods case study research in psychotherapy.

Considering "Cora"

“…Halvorsen, Benum, Haavind, and McLeod's (2016) case study of Cora," we note the valuable questions it raises with regards to identifying and conveying effective elements of the therapeutic process when expert clinicians treat difficult cases, integrating the narrative case study with formal qualitative research in a relatively large sample of cases, and case study methodology in general. We examine the unique authorial voice of the case study, in this instance not that of the treating clinician; and we review some of the difficulties that arise from the authorial voice chosen for readers seeking to understand treatment process and its results.…”

The Life-Saving Case of "Cora": A Rogerian Perspective

“…A second superordinate theme Halvorsen et al (2016) found was that of courage. I am pleased to see that their case of Cora found evidence of client courage.…”

“…As noted by the Halvorsen et al (2016), Elliott et al (2009) have also noticed that quantitative and qualitative results do not always coincide. Elliott et al studied a client with a fear of driving over bridges.…”

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ABSTRACTHalvorsen, Benum, Haavind, and McLeod's (2016) A Life-Saving Therapy: The Theory-Building Case of "Cora" is rich in ideas and findings. My reflections fall into four categories.

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“…First, as Halvorsen et al (2016) argue, the objective rating scales may not be sensitive to the kinds of changes Cora has undergone. Perhaps, for instance, there has been no reduction in symptoms on the OQ-45.…”