Theory Development via Single Cases: A Case Study of the Therapeutic Relationship in Psychodynamic Therapy

Abstract

The goals of this paper are (a) to demonstrate how study of the therapeutic alliance in single cases of psychodynamic therapy can exemplify and instantiate theoretical concepts and lead to the development or refinement of psychotherapy theory, research and practice, as illustrated in the case of Ron and in Hans Strupp's classic analyses of pairs of comparable successful and unsuccessful cases; (b) to point out methodological challenges of case studies as a source of reliable and valid data; and (c) to illustrate the greater influence of clinical case studies compared to research reviews of the psychotherapy literature on the practitioner.Key words: clinical case studies; case studies; therapeutic relationship; psychodynamic therapy; methodological challenges of case studies; case study vs. statistical findings ___________________________________________________________________________ Theories are necessary devices for making meaning of observations and predicting the presence of yet-undiscovered facts. We want our theories to be comprehensive, logically sound and coherent. An important way of gauging the utility and accuracy of a theory is its correspondence to events in the real world. As applied to psychotherapy, a theory can be gauged by how well it aids practitioners in their day-to-day clinical work and moment-to-moment transactions with patients. In fact, the very meaning of theoretical concepts derives, in part, from how well they intersect with the experience of practitioners conducting individual cases. Stated differently, there is an interplay between the propositions of the theory and the facts on the ground; each informs and alters the other. This can be described by what is known as the hermeneutic circle wherein the parts of a theory take meaning from the individual statements and these derive their meaning from the whole. Similarly, there is a reciprocal relationship between clinical observations and the theory within which the practitioner operates, each informing and giving meaning to the other. For the psychotherapist, a theory is not merely an abstract device or an object of elegance and beauty, but is a way to think concretely about clinical cases.The interrelated goals of this paper are (a) in line with the introduction above, to demonstrate how study of the therapeutic alliance in single cases can exemplify and instantiate theoretical concepts and lead to the development or refinement of psychotherapy theory, practice and research; (b) to address methodological challenges of case studies as a source of reliable and

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