Psychology: Clinical –Methods (AJW)



An example of the use of the CASE STUDY as a research method for investigating schizophrenia-39757823871What do I need to know before I tackle this study?METHODS KNOWLEDGEWhat are the key features of a case study?What is meant by credibility?What is triangulation and how does this affect the credibility of data?What is meant by nomothetic versus the ideographic approach in psychology? How do these terms relate to the use of case studies and other research methods in psychology??What is meant by primary and secondary data? Why is it helpful to have both types of data?What are the ethical guidelines for practitioners such as the therapist who runs the psychotherapy group described by Lavarenne e al (2013)CONTENT KNOWLEDGEWhat is group therapy? Why might group therapy be more effective than individual therapy?What is meant by psychotic, schizophrenia, schizoaffective disorder?00What do I need to know before I tackle this study?METHODS KNOWLEDGEWhat are the key features of a case study?What is meant by credibility?What is triangulation and how does this affect the credibility of data?What is meant by nomothetic versus the ideographic approach in psychology? How do these terms relate to the use of case studies and other research methods in psychology??What is meant by primary and secondary data? Why is it helpful to have both types of data?What are the ethical guidelines for practitioners such as the therapist who runs the psychotherapy group described by Lavarenne e al (2013)CONTENT KNOWLEDGEWhat is group therapy? Why might group therapy be more effective than individual therapy?What is meant by psychotic, schizophrenia, schizoaffective disorder?Lavarenne et al (2013): Containing psychotic patients with fragile boundaries: A single-session group case studyIndependent preparation and group work:What is meant by …sense of selfego boundariesemotional insulationporous boundariesUse images and text from the magazines to create collages to illustrate the issues for each group member relating to their ego boundaries; use samples of their speech (qualitative data) during the group session to illustrate.Aim: A previous study reported that psychosis has been conceptualised to involve aweak ego boundary, so the study attempts to investigate how the out-patientsuse the group session to provide firm boundaries which give them support during their illness. Examples of weak ego boundaries include a person fearing that they will break apart, be annihilated or wishing to be a part of someone else. The suggestion is that the individual retreats into a fantasy world as they are unable to cope with reality. Firm boundaries are believed to moderate psychotic angst; the study therefore aims to explore some of the group's core therapeutic actions against psychosis.Background: The group had been running since 1985 and pre-doctoral psychology interns have trained as group therapists every year since 1997. Group members have attended for various time scales and the leaders’ role is to bear the illness with the individual during the session to minimise isolation, and allow the individuals to choose their own level of intimacy and closeness during the session. These are a focus as it is suggested by the researchers that separation, isolation, and intimacy are associated with psychological crises. Sessions are not tape-recorded or video-taped but instead coded (since 1998) where the therapists’ record:? Whether members express psychotic, manic, or depressed thoughts andbehaviours? The emotions observed (e.g. joy, anger, anxiety, sadness, guilt)? Verbal expressions of loneliness, loss, dreams, current or past relationships, humour, illness, activity in their lives, helplessness, hopefulness, hopelessness, sexual preoccupation? If members make supportive or insightful comments? If members engaged or participated in the groupPrevious assessment of the coded data (over a seven-year period) suggested that when enough time, support and acceptance is offered, participants in the group increase their maturation and functioning in a group setting.Procedure: a single session of out-patient group therapy for six individuals suffering with schizophrenia or schizoaffective illness, which was characterized by numerous manifestations of fragile Ego boundaries. The group session usually had 10 members but only six attended the 45 minute session which was led by the three researchers. They were called the “Thursday Group” as this was the day of the week when they regularly met.Findings: The researchers point out that the six members of the group in the single session which the study refers to all had fragile ego boundaries, which were expressed in different ways by the different members of the group. This is shown in the table below.GroupmemberRecorded behaviourWhat this reportedlyshows/representsBrett,Schizophrenic,Irish-Catholic,CaucasianGave out a Christmas card and calendar.Wants the group to be linked together and connected to reinforce the group boundary, to help solidify his Ego boundary.Divides humanity into black, white, yellow (referring to skin colours) and speaks of threesTo give structure and boundaries to his fragmented inner world during psychoticdecompensation.Told the group he received a gift of CDs from his sister and wouldkeep it wrapped on the shelf to look at.Possibly a way of holding himself together for a time over the Christmas holiday.Earl, Schizophrenic, African American, Born in Texas and lived in Africa with his adoptive American parents beforemoving to Canada.Rejected gifts from Brett. Earl has an underlying fear of being annihilated and accepting the gift may have triggered fragmentation fears.Showed grandiose, delusional ideas about a large-scale multinational engineering project.The delusion is holding the fragmented pieces of Earl’s self together, so symbolises a boundary between Earl’s self and the selves of others.Claimed to be ‘a Falasha’(Ethiopian Jew) after beingtreated in a Jewish hospital.He has a porous Ego boundary as he absorbed a false identity.Deena Reported having nightmares for which her psychiatrist suggested she be tested for sleep apnea. She refused and said shepreferred her sleep issues to be treated in a ‘psychological way’ through thinking ‘good thoughts’ before bedtime.Her focus between being awake and asleep is blurred and she therefore has a fragile Ego boundary.DanThe previous evening had ‘an out-of-body experience and was very scared’ he would not be able to get his ‘spirit back into his body’.He felt his Ego boundary to be very fragile during this frightening experience.Showed the group burns on his arms he had got from being distracted while cooking. He wascurrently trying to cope with a change in nature of his relationship with his girlfriend (a former fiancée).He felt his Ego boundary to be extremely fragile and was asking for the boundaries of his relationship to be clearly defined.DillonAgreed with a former member from a previous session about people staying in his house (anAunt had moved in with the previous member), and that over Christmas he would struggle to cope with relatives staying. He suggested he would cope by going for a walk orshovelling snow.His ability to be aware of how much closeness he could tolerate shows insight. The limited tolerance to personalspace and closeness indicates a fragile Ego boundary.Andy, a sexuallyrepressed and very competent mother of a daughterWas offended by sexualreferences a former member had stated during a previous session. It is noted that she copes by swimming rigorously each day and limits her food intake, and she also helpsseveral young relatives with homework each day after school.The self-sacrificing andrestrictive behaviours enables her to deal with her fragile Ego boundaries.Conclusions:The conclusion made by the authors regarding the session is that each group member struggles daily with the environmental, social, and biological factors in their schizophrenia. They report that the sessions enable development of stronger Ego defences for each member through object relations, which enables a relationship between ‘self’ and ‘others’ to form. The authors saw their role as allies to the patients and that the group can serve as a buffer to prevent psychological crises which may lead to subsequent breakdown and rehospitalisation. In this way the group is serving as ‘an auxiliary Ego-structuring mechanism’ to offer the members a stabilising force and promote psychological growth. Secondly the groups acts as containing object by establishing firm boundaries and by mentalizing patients' psychotic productions, and finally the group may become a solid object representation introjected by individuals wrestling with porous ego boundaries and a poor sense of self.7950127966Further reading: A brief review of the history of psychoanalytic perspectives on Schizophrenia (Koehler, 2006).020000Further reading: A brief review of the history of psychoanalytic perspectives on Schizophrenia (Koehler, 2006).Assessment tasks: Psychologists often use case studies as a research method to investigate mental disorders in clinical psychology. You will have learnt about one study in detail that uses the case study as its research method. Evaluate this study with reference to the research method of “case study” (5)this is a points based question as it is only worth 5 marks; be sure to get straight into your strengths and weaknesses without describing the study firstdon’t just evaluate the study willy –nilly, i.e. a full GRAVE; the question is asking you about this study, in terms of it being a case studythink about the strengths and weaknesses of case studies in general and then makes your points relate to this particular case study.you don’t need a conclusion in a point marked questionyou also don’t have to achieve a balance of strengths and weaknesses although it is good to have a combination of bothLet’s write an essay…Psychologists often use case studies as a research method to investigate mental disorders in clinical psychology. You will have learnt about one study in detail that uses the case study as its research method. Evaluate the use of case studies in clinical psychology with reference to one research study (12)this is a 12 marker and therefore will be band marked (ATCHOO-BC)you need a paragraph of description that focuses on the key features of the case study as a research method in clinical psychology, where you illustrate your point s with examples from Lavarenne et al (2010). you then need a block of evaluation where you look at the strengths and weaknesses of the case study as a research method in clinical psychology where you draw particularly on issues with this case study, Lavarenne et al (2010)if you are running out of time it makes good sense to describe a key feature of case studies with a Lavarenne based example and then give the strengths and weaknesses of that feature, before moving onto the next key feature and carry on with that pattern; whether way you need to establish a balance of AO1/AO3 in your answer.Let’s try an applied essay question …with command term “Assess”Dr Si Cottick works with offenders in a high security psychiatric hospital. He has developed a new intervention to try and help patients to develop their social and emotional skills. He has been working intensively with two patients, Hal and Del for several months. He wants to summarise the effectiveness of his new method and decides to write up his work in the form of a case study.Assess Dr Cottick’s decision to use the case study as the research method to investigate the effectiveness of his intervention in comparison with one other research method. You may refer to published research studies in your answer. (12)Remember assess means: “Give careful consideration to all the factors or events that apply and identify which are the most important or relevant. Make a judgement on the importance of something, and come to a conclusion where needed”Think: What are the key features of a case study?How would Dr Cottick actually set about doing his case study?What are the strengths and weaknesses of this research method and how do they app, to Dr Cottick’s research?What other research methods could be used to investigate the effectiveness of Dr Cottick’s intervention?How would this research method compare with the use of the case study? ................
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