Abstract
Metasynthesis is currently considered one of the most promising directions for qualitative research, as it can contribute to the generalizability of qualitative findings and increase their impact. At the same time, single case studies gain attention in the field of psychotherapy research, as they offer unique insights into psychotherapy process and promote theory building. In the following, we will elaborate on a worked example of a metasynthesis of published psychotherapy case studies. Thereby, we investigated the psychotherapeutic process in ten case studies of patients with medically unexplained symptoms (MUS), while focusing on the theoretical concepts of deficit and conflict. The reader will be guided through the dilemmas and choices in research design and data analysis. First, the theory-building approach toward metasynthesis will be discussed. Then, a novel search engine, the Single Case Archive, will be introduced as an easy way to access and systematically search for psychotherapeutic case studies in a database with over 3000 cases. Furthermore, we will share our experience of adapting data analysis procedures for the purpose of a metasynthesis of case studies. As case studies describe the psychotherapy process in its complexity unfolding over time, they cannot be approached in the same manner as interview material, thus asking for methodological innovations. Through the creation of timelines of therapeutic events, process-oriented themes could be detected that would not have been found when only using line-by-line coding. Finally, limitations of the metasynthesis are discussed.
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Notes
- 1.
The notion of the crisis in modern-day psychology refers to multiple issues, such as poor replicability of published findings (Open Science Collaboration, 2015), problematic validity of psychological measurement instruments (Desmet, 2018), conceptual problems of variable construction (Toomela, 2008), as well as disproportional focus on neurobiological instead of essentially psychological phenomena (Derksen, 2012).
- 2.
The numbers in square brackets indicate the number of the case study in which the theme has been found from Appendix A.
- 3.
Punctuation by the author of the original paper.
- 4.
Spelling by the author of the original paper.
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This work was supported by the German National Academic Foundation and the Hercules Foundation; the authors declare no conflict of interest.
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Appendix A: List of Selected Studies with Characteristics of Patients
Appendix A: List of Selected Studies with Characteristics of Patients
The numbers in square brackets [ ] in the text of the manuscript refer to the order in which the case studies were analyzed. The cases were analyzed in the following order: [1] Martínez-Taboas (2005); [2] Baslet and Hill (2011); [3] Holland (1997); [4] Milrod (2002); [5] Ciano-Federoff and Sperry (2005); [6] Küchenhoff (1998); [7] Shapiro (2003); [8] Jacobs and Dinoff (2012); [9] Vranceanu et al. (2008); [10] Weaver et al. (1998).
Study | Country | Patient | Somatic symptoms | Other symptoms | Onset of (somatic) symptoms | Period of symptom onset before therapy | Type of therapy | Inpatient/outpatient | Frequency and duration of therapy | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Name | Age | Sex | ||||||||||
1 | Martínez-Taboas (2005) | Puerto Rico | Nayda | 24 | F | Psychogenic seizures | Memory loss | Traumatic event witnessing the house of her grandmother on fire without calling for help | >5 years | CBT; hypnosis | Outpatient | 22 sessions |
2 | Baslet & Hill (2011) | USA | Anne | 31 | F | Conversion disorder: psychogenic seizures, headaches, paralysis, tremor; fibromyalgia | Depression, anxiety, dissociation | Onset in late childhood, but exacerbation after hysterectomy | >10 years | ACT; MBT | Outpatient and inpatient | / |
3 | Holland (1997) | UK | Ruth | adult | F | Chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME): extreme fatigue, muscle pains, palpitations, insomnia | After developing influenza, being confronted with her father having a life-threatening illness and feeling abandoned by her mother | Psychodynamic psychotherapy | Outpatient | 2–3 sessions a week/3 years | ||
4 | Milrod (2002) | USA | Niccolo | 9 | M | Conversion disorder: tussis nervosa, pain in the ears, inability to walk | / | 4 months | Psychoanalysis | Outpatient | 4 sessions a week/4 years | |
5 | Ciano-Federoff and Sperry (2005) | USA | Amy | 36 | F | Conversion disorder: hand pain, numbness in hand, sores from contact dermatitis | PTSD, dysthymia | / | CBT: Exposure-Based Therapy for PTSD | Outpatient | 10 months + 19 sessions Exposure-Based Therapy | |
6 | Küchenhoff (1998) | Germany | Mrs. X | adult | F | Diarrhea, expiratory bronchial spasm, allergic rhinitis | After moving in with boyfriend | Psychotherapy + psychoanalysis | Outpatient | 1 year + 4 years | ||
7 | Shapiro (2003) | USA | Kai | 13 | F | Fibromyalgia: total body pain | Fatigue | / | Psychotherapy + psychoanalysis | Outpatient | 1 session a week/3 years | |
8 | Jacobs and Dinoff (2012) | USA | David | 90s | M | Undifferentiated somatization disorder (USD): high blood pressure, muscle weakness, malaise, and locking knee joints | Anxiety, depression, dementia, PTSD? | After serving the country in World War II | >10 years | CBT, ACT | Inpatient (nursing home) | not mentioned |
9 | Vranceanu et al. (2008) | USA | Jean | 40s | F | Idiopathic arm pain | Pain started when trying to put a 30-pound box on a shelf, but no fracture of dislocation was observed | 2 months | CBT | Outpatient | 8 sessions | |
Laura | 40s | F | Idiopathic arm and hand pain, mild headaches, fatigue | / | 3 years | CBT | Outpatient | 8 sessions | ||||
10 | Weaver et al. (1998) | USA | Jane | 34 | F | Irritable bowel syndrome | Depression, anxiety attacks, PTSD | Multiple traumatic events | 12 years | CBT: prolonged exposure | Outpatient | 9 sessions |
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Krivzov, J., Hannon, D., Meganck, R. (2021). Approaching Psychotherapy Case Studies in a Metasynthesis: Deficit vs. Conflict in Treatment of Medically Unexplained Symptoms. In: Borcsa, M., Willig, C. (eds) Qualitative Research Methods in Mental Health. Springer, Cham. https://doi.org/10.1007/978-3-030-65331-6_3
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