HSCED as Theory-building Case Study Genre

Entry for 11 May 2008:

Although I have heard Bill Stiles present on theory-building case study research on many occasions, each time I hear something new. At the BACP Research Conference in Cardiff, in his keynote talk, he introduced a nice distinction between Enriching and Theory-building case-study research. Enriching case study research aims to describe and develop explanations/understandings; theory-building case studies use complex case-derived data to create a dialogue with an existing theoretical model, in order to challenge and elaborate it. I have always felt a bit of a disconnect with this idea of starting with a theory, and I suspect that Bill has introduced the idea of an enriching case study to address concerns like mine. However, when I heard this formulation, it had the opposite effect; it propelled me into finally spelling out a sense about the nature of Hermeneutic Single Case Efficacy Design (HSCED) that has been nagging in the back of my mind for some time now:

In fact, HSCED is a theory-building case study genre, with strong parallels to Bill’s Assimilation-model case studies. But what is the theory that is being interrogated and elaborated? In general terms, it is as follows:
• Therapy X causes change in Client Y.

This isn’t much of a theory, which why neither Bill nor I have fully appreciated the theory-building nature of HSCED. However, this general theory actually contains a more elaborate theory, along the following lines:
•Therapy X causes change in Client Y… by Z change processes (=mediating variables), in Q Contexts (=moderator variables, e.g., relevant client characteristics such as resources to make use of the therapy), in R Ways (=specific effects).

This generic version of the theory can then be specified for a given systematic single case study, such as EFT for social anxiety:
1. When Emotion-Focused Therapy is offered
2. To an open, motivated client
3. Who presents with social anxiety,
4. A combination of relationship (warmth, acceptance, genuineness)
5. And task factors (relevant therapeutic tasks such as Empathic Exploration, Anxiety Split work, Self-Soothing work, and Externalization work),
6. Competently and collaboratively delivered,
7. Will provide the client with opportunities to develop better access, express and symbolize their emotional experiences, to regulate their emotions more adequately, and to locate other emotions that can change maladaptive or stuck emotions;
8. This in turn will help the client change problematic behaviours, improve their relationship with themselves and others and become less distressed about their remaining problems.