Download A systematic single case study of dissociative identity disorder

Title: The potential of case study methodology in psychotherapy research:
exploring the possibilities
Presenters: Mattias Desmet, Reitske Meganck, Shana Cornelis, Jochem
Willemsen
Discussant: Shigeru Iwakabe
Although single case studies have a long-standing image of being pseudoscientific, it is argued that they are crucial for advancements in understanding
the process of psychotherapy (APA, 2006; McLeod & Elliott, 2011; Iwakabe, 2013).
Within this context more systematic ways of doing case study research (e.g.
rigorous registration, independent research team) were conceptualized. It
becomes increasingly accepted that single case studies provide a necessary
method to investigate psychotherapeutic process in their context and in that way
provide evidence that can result in clinically relevant knowledge.
Different approaches are outlined in the literature to use single case research to
boost evidence-based practice in psychology. In this panel we elaborate three
specific ways of using single case methodology to study psychotherapy and to
aggregate findings from single case research. The first presentation will argue
why the dominant nomothetic paradigm fails to capture psychic processes as the
mainly correlational group designs reduce the human subject to a static system
while we need methods that appreciate its complex and dynamic qualities.
Second, a theory-building case study on a case of dissociative identity disorder is
presented to illustrate how such a complex and dynamic system can be grasped
and how single case studies can elaborate, falsify and refine theory. In a third
presentation, it is discussed how the aggregation of several theory-building cases
can take a step further in refining theory. Finally, another way to aggregate
findings of case study research by means of a meta-study of published cases on
depression is presented.
Keywords: single case study, complex and dynamic systems, methodology,
meta-study
Paper in a panel
Title: How psychotherapy case studies contribute to practice-based evidence
Authors: Mattias Desmet (presenter), Reitske Meganck, Jochem Willemsen,
Shana Cornelis
Abstract
Aim: Contemporary psychological research is more and more confronted with
severe methodological problems, such as incapability to replicate findings. This
presentation will show that these problems are based on a more fundamental
problem at the level of measurement of psychological phenomena. In its turn,
this is related to a fundamentally wrong implicit assumption on the nature of
psychological phenomena. Specifically, mainstream academic psychology starts
from the nomothetic paradigm (i.e. relying heavily on standardized
measurement of psychological phenomena in group designs and computing
correlations between the different measurements) and conceives psychological
phenomena as static systems.
Method: A review of the most important findings on validity and reliability of
measurement in the nomothetic paradigm and concrete examples form
psychotherapy research.
Results: The results of empirical research clearly show that psychological
phenomena are structured, not as static systems, but as complex and dynamic
systems.
Discussion: We argue that academic psychology will have to move to research
methods adequate to investigate complex and dynamic systems. This inevitably
implies a focus on the level of the single case (since, in complex and dynamic
systems, it makes no sense to separate a single characteristics from the totality of
the system to which it belongs) and focus on narrative and mathematical
description instead of quantitative description. Furthermore, implications of the
required paradigm shift at the level of academic psychology’s ambition to
generalize and to predict will be discussed.
Keywords: method, psychotherapy research, case studies, systems theory
Paper in a panel
Title:
Authors: Reitske Meganck (presenter), Mattias Desmet, Ruth Inslegers, Jochem
Willemsen, Shana Cornelis
Title: A systematic single case study of dissociative identity disorder: memory
integration without working with alters?
Abstract
Aim: Dissociative identity disorder (DID) has always captured fascination, yet
remains a highly debated diagnosis. Debate centers on the veracity of the
diagnosis. The dominant model considers trauma as a direct etiological factor
and proposes a therapeutic model where alter personalities are directly
addressed. In this paper we question the necessity of working with alters to
facilitate integration
Method: A theory-building single case study is proposed where theoretical
assumptions concerning interventions addressing integration can be examined
in detail. Session transcripts of a successful psychodynamic psychotherapy of a
patient with DID will be analyzed using the Consensual Qualitative Research
method (Hill, 2012).
Results: Detailed analysis of turning points in therapy show that elaborating
conflicts and preserving space for the fundamental division of human psychic
functioning result in an integration of memory and a disappearance of anxiety
and the dissociative episodes.
Discussion: We conclude that fine-grained analyses of single cases allow moving
beyond general theoretical statements and question taken for granted ideas
about effective therapy approaches for specific disorders like DID. The case
study illustrates that, at least in this case, working with unconscious conflicts
rather than addressing alters dissolved dissociative symptomatology.
Keywords: Case study, Dissociative Identity Disorder, theory-building, process
Paper in panel
Title: Interactions between symptomatic and interpersonal changes during
supportive-expressive psychodynamic therapy: Integration of four theorybuilding case studies
Author: Shana Cornelis (presenter), Mattias Desmet, Reitske Meganck, Ruth
Inslegers
Abstract
Aim: In contemporary psychotherapy literature, the symptom specificity
hypothesis (SSH; Blatt, 2004) claims that specific types of neurotic symptoms are
related to specific modes of interpersonal functioning. Yet, findings from crosssectional group studies on symptom specificity don’t converge (Desmet,
Vanheule & Verhaeghe, 2006), possibly indicating an underestimation of the
complexity of associations. Integrating the findings from four evidence-based,
theory-building case studies, this paper aims at refinement of the classical SSH
through suggesting complexities.
Method: Standardized outcome and process data, and session transcripts from
four empirical case studies (different patients, same therapist) were
systematically compared with respect to the longitudinal clinical interplay
between symptomatic and interpersonal changes throughout supportiveexpressive psychodynamic therapy (Luborsky, 1984). Consensual Qualitative
Research for Case Studies (CQR-c, Jackson, Chui, & Hill, 2011) was used as an
overarching data-analytic method. Interpersonal functioning was assessed by
means of the Core Conflictual Relationship Theme method (Luborsky & CritsCristoph, 1998).
Results: For all patients, close associations were observed between
interpersonal and symptomatic changes throughout therapy, and
psychodynamic interventions focusing on interpersonal dynamics proved
effective in reducing symptomatology. Complaints were strongly embedded into
disturbing struggles in the interpersonal sphere: bodily symptoms largely covaried with dependent interpersonal styles, for obsessional complaints, strong
ambivalences between autonomy and dependency were observed.
Discussion: Preliminary results indicate a higher complexity in associations
between neurotic symptoms and interpersonal dynamics than predicted by the
classical symptom specificity hypothesis, especially for obsessional complaints,
suggesting a need for refinement. Conceptual and methodological
considerations, limitations and future research indications are discussed.
Keywords: multiple case study, theory building, change mechanisms, core
conflictual relationship theme, process
Paper in a panel
Title: A decade of case study research on psychotherapy for depression: A metastudy on the methodology
Authors: Jochem Willemsen (presenter), Reitske Meganck, Mattias Desmet, Ruth
Inslegers
Abstract
Aim. Single case research makes an important contribution to the field of
psychotherapy research (APA, 2006), but there are huge variations in the
methodological quality and evidential value of case studies. In this presentation,
we will discuss the results of a meta-method study into the methodological
qualities of recent case studies on depression.
Methods. A meta-method study (Patterson et al., 2001) is a research approach
involving the analysis of methods of previously conducted studies in order to
examine methodological presuppositions, evaluate research methods in terms of
weakness and limitations, and codify new procedural norms for research in the
area. The current meta-method study focuses on case studies of depressive
patients, treated with any type of psychotherapeutic approach, and published
between 2005 and 2015.
Results. The results will be summarized in separate tables for 1) research
question, 2) researcher and setting, 3) case selection, 4) data collection. The
findings of this study allow us to consider how different case study
methodologies have been applied in recent years and how this has influenced the
emergent insight in the field: which questions are asked, by whom, how are
patients selected, and how are data collected?
Discussion. The conclusions will be relevant both for future case studies and for
meta-syntheses in which the knowledge gained from individual case studies is
synthesised in more generalizable knowledge.
Keywords: Case study, depression, meta-study