Knowledge generation processes and the role of the case study method in the field of psychotherapy

The present thesis seeks to explore knowledge generation methods in the field of psychotherapy, with a focus on qualitative clinical and systematic case study narratives. Currently, evidence-based practice (EBP) in psychotherapy prioritises quantitative methods (e.g., systematic reviews and meta-analytic reports, which summarise the findings of randomised controlled trials; RCTs). However, recent studies exploring psychotherapists' decision-making processes in clinical practice suggest that there are significant difficulties in applying randomised and decontextualized statistical findings onto individual patients and their specific mental health experiences. Some of the concerns about large-scale quantitative findings include overlooking complex individual differences in treatment processes and outcomes. This contributed to an ongoing issue of research-practice gap: a lack of integration between the findings disseminated by researchers and the practical decisions made in the consulting room by therapists. To aid with these issues, this thesis considers the role of the case study method in psychotherapy research. From its inception, psychoanalysis used case studies to produce complex, longitudinally sensitive and detailed narratives to discuss clinical decision-making processes and theoretical advancements. However, criticisms about researcher's subjective bias, unclear research focus, and lack of generalisability continue for both classic psychoanalytic and contemporary psychotherapy case studies. Whilst there have been several historical misconceptions about case studies, there are also persisting methodological issues, such as lack of epistemic guidance for hypothesis generation and generalisability of case study findings. Crucially, there are currently no research appraisal tools for psychotherapy case studies. The thesis therefore seeks to i) address the long-standing criticisms directed at the case study method, ii) develop epistemic knowledge generation strategies for case study researchers, iii) address the philosophical underpinnings of thinking in cases as a scientific style, and iv) introduce a novel Case Study Evaluation-tool (CaSE), which will improve the evidential status of systematic psychotherapy case studies.