Case Study Analysis In Psychology

Case Study Analysis #1

In this Case Study Analysis, Bob is a 47-year-old Native-American man who comes to you with his wife of 15 years. He appears agitated and complains that he feels anxious. His wife reports that Bob has had a lot of trouble sitting still, frequently jumping up and pacing. While he has been this way throughout their marriage, it is getting increasingly worse. Bob tells you that he is a lot like his abusive father, who died of alcoholism.  Bob feels that if he drank, he’d be able to relax, but swore he would never be like his father. The wife tells you that the children are frightened when Bob gets agitated as he has punched holes in walls. You notice the wife looks frightened when you ask her if she feels the children are safe in the home.

Diagnostic Possibilities and Etiology

The Diagnosis must be in concordance with outside assistance which will primarily come from the medication prescriber. To begin with this Case Study Analysis, I utilize the information that I am given to explore possible problems and to get an idea of the disorder that the person might be suffering if there is one. I use the DSM-5 to help guide me in this area. From (American Psychiatric Association, 2013) I have options in what disorder this may be. I have to use this and outside information to help.

Although I know that incidence of Post-Traumatic Stress Disorder (PTSD) is greater in the Native population, (Beals et al., 2005) the ideas contained in (American Psychiatric Association, 2013) lead me to believe at this time that I should look into generalized anxiety disorder (GAD). There may be components of PTSD but there is not a specific incident that is showing up as causal. I would reserve this as more information comes forth.

With the evidence I have so far, I am looking at GAD through the differential diagnosis from PTSD. The fact that the clients father suffered from similar issues leads me to believe that there is a genetic component. One third of the risk for having GAD is a genetic risk(American Psychiatric Association, 2013). This is one reason why I would rule out PTSD or look at it as s secondary issue.

Some pharmacological interventions that have been known to work with GAD when the etiology is either psychogenic or biological are certain antidepressants. Often there is not a neurobiological issue so the underlying physiology with the use of medications is not well understood(Preston, O’Neal, & Talaga, 2013).

 

Personal bias or stereotypes

The client is a Native American Male aged 47 presenting with symptoms of anxiety and agitation. In looking through my own lens of bias I must attempt to understand the person from his own perspective. This is important so that I do not solely look at the client from my cultural viewpoint. I also realize that I have a bias in regard to the workings of the mental health system.

One other important area in Case Study Analysis is that I recognize is my stereotypes. I have the idea that the native population is affected by alcoholism and addiction more so than my culture of European American. This stereotype is born from a lack of understanding and knowledge of the native populations. I really want to be aware of this view so that it does not cloud my judgement and impede the work that I must do.

 

Cultural and ethical concerns

Although I believe that the system does well enough to assist in guiding therapy through the use of diagnostic tools, I also believe that the tools have been primarily geared from their outset to deal with Euro-American populations. This is cultural and ethical concern that is addressed in the ethical guidelines specifically in (American Psychological Association, 2010) 9.06 Interpreting Assessment results. The concern is the potential bias of majority cultural values built in to the assessment devices. I want to take care to introduce the Native American view into this context.

 

Legal Concerns

There may be a legal issue in that when asked, the mother seemed to be frightened when the topic of harm to the children was discussed. I will need to watch carefully for any signs of abuse and to delve further into this topic from the basis of her initial response.

 

Treatment with pharmacological coordination

In this Case Study Analysis, I would also look at the types of treatments that have been shown to be beneficial that are also using psychopharmacological interventions. From (Rosnick et al., 2016) it is apparent that an effective means of combined therapy is the use of SSRI medications and cognitive behavioral therapy (CBT). In this case I would have to use information provided by the primary prescriber but I will assume this stance for now.

CBT such as psychoeducation, group therapy and also cognitive reframing could be very beneficial in this area. The most current mindfulness practices could also be administered to alleviate symptoms of the obsessive thoughts that often trigger GAD symptoms. In general one way to measure stress which can lead to anxiety is through measuring levels of cortisol in the blood stream. In (Rosnick et al., 2016) the use of pharmacology to reduce cortisol levels and the use of behavioral techniques to mediate stress which also lowers cortisol levels, have been found to be more effective than either treatment alone in persons suffering from anxiety disorders.

Coordination of treatment using the information from the prescriber of pharmacological interventions is quite important. Once the proper diagnosis is made, then both types of treatment should happen concurrently. In this way the therapist has the best chance to have the most effect on the client. In this case there are areas of culture, bias and stereotype to be addressed. In the end the treatment can be the best care possible.

 

Case Study Analysis #2

In this Case Study Analysis, Steven is a 7-year-old Asian-American first grade student brought to treatment by his mother. He has been disruptive in class. His teacher and the school counselor are strongly urging that Steven be put on medication for ADHD, but his mother is reluctant to do so.  Steven is described as exceptionally gifted and appears bored in the classroom.  His mother tells you that Steven is impatient and rageful to his younger sisters at home. She is afraid Steven is taking after his abusive father, who no longer lives in the home due to domestic violence. She tells you that their father is allowed to visit the children in the home under her supervision.

 

Diagnostic Possibilities and Etiology

Steven, a 7 year old Asian American presents with disruptive class behavior and impatience and rage at home. His father was abusive and Steven is allowed to see his father but only under supervision. Some of the diagnostic possibilities for this presentation happen as a result of the fact that there are issues occurring in both the home and the school. In this Case Study Analysis, for a diagnosis of ADHD there has to be symptoms manifesting in two or more places (American Psychiatric Association, 2013). This is occurring.

By looking at differential diagnosis in (American Psychiatric Association, 2013) I also note that in ADHD there is not aggression toward others. This may be something to consider for diagnostic reasons. Importance in ADHD diagnosis in a child so young comes mainly with the debate about psychopharmacology. There may be a chemical imbalance that can progressively cause further impairments. In some cases the pharmacologic treatment can actually protect neural pathways from further damage due to excessive neurotransmitters or stress hormones (Preston, O’Neal, & Talaga, 2013).

Personal bias or stereotypes

I have to look at my own personal bias, stereotypes or cultural beliefs in order to ensure that they are not getting in the way of my diagnosis. Although Steven is not of the same ethnicity as myself I see that this is not one of my main concerns. One bias that I do not want to interfere with treatment avenues is that he is very young. I have to really watch out for this. I have often thought that in a young person it is not good to give them medication. I also think that diagnosis should be reserved in young children because these disorders are over diagnosed. The stereotype then is that all children should be kept from medications. This may not be the case. I have to see this objectively. I have to trust that the prescriber of possible medications and other professionals know what is best.

Cultural and ethical concerns

An issue in regard to diagnosis is that the assessments be culturally relevant. There must be psychometric evidence that has come from administration that has been made individually. I have to keep in mind that Steven is of Japanese decent and that this could be a factor in his testing (American Psychiatric Association, 2013).

Another area that can be looked at is where the information is coming from. Perhaps with a Japanese culture there is a measure of respect that must happen. In this case the context of Stevens rage and impatience with is siblings may not be as serious as reported by the mother.

The mother does not want the child to be on medications. The ethical concern is that I have to balance the mothers concerns with treatment. The client has the right to choose treatment and in this case the clients is represented by the mother. The ethics involve informed consent (American Psychological Association, 2010)

Legal Concerns

There may be legal concerns in regard to Stevens’s father. Courts do not normally put restrictions for visitation on persons who have not had problems with the law. This may be an area of concern as well as with diagnosis. This issues has to be explored further.

Treatment with pharmacological coordination

The most widely used treatment is to combine therapeutic interventions in conjunction with medications that are psychostimulants. In (Pelham et al., 2016) it was discovered that by using both low does medication and low dose behavioral therapies such as training parents, treatment programs, teacher involvement and using a student aide in school  gave some of the best responses. One of the best treatments is to combine these modalities but to adjust doses of both medication and therapy. This makes the treatment far more individual and has greater success.

 

 

Case Study Analysis #3

In this Case Study Analysis, Melinda is an exceptionally bright, 17-year-old African-American young woman, in her first year at a state college. Both parents accompany her to your office. When she came home for spring break, she started talking nonsense, saying that the college’s biology department is using a high powered laser to alter the DNA in her brain. She has always been an “A” student and has never shown any sign of psychiatric disturbance prior to this.

 

Diagnostic Possibilities and Etiology

Melinda is a 17 year old college student who presents with bizarre delusions of the persecutory type. She recently returned home from college on spring break. Because of the type of delusions and the time frame the possible diagnoses would be one of the following, brief psychotic disorder, delusional disorder, delirium or schizophrenia.

In this Case Study Analysis, in order for this problem to be diagnosed as schizophrenia, there has to be at least two symptoms one of which must be delusions. The symptoms must impair social functioning. There is currently only one of these so until further, this diagnosis cannot be given.  In order for a delirium diagnosis there has to be a physiological response from another condition. There is not current evidence this is the case. One of the key elements of brief psychotic disorder is that there is a return to baseline normal behavior and that the situation not last for more than a month. Until such time that Melinda returns to baseline behavior the diagnosis for this would be difficult (American Psychiatric Association, 2013).

The most plausible diagnosis is delusional disorder. Although the time frame is difficult, there is presence of delusions, it does not appear to be schizophrenia and the delusions are of the persecutory type with bizarre content. Melinda seems to be able to continue functioning (Preston, O’Neal, & Talaga, 2013; American Psychiatric Association, 2013) .

Etiology is left to guess at this point. The diagnosis of one of the Schizophrenia Spectrum disorders presumes a physiological response to either substance or medical condition. It does not appear that any substances have been involved which leaves the possibility that there is some medical condition or biological issue which is causing this problem (American Psychiatric Association, 2013; Preston, O’Neal, & Talaga, 2013)

 

Personal bias or stereotypes

I have been attempting to look at my own personal bias to ensure a proper diagnosis. It appears that there is a higher rate of diagnosis of schizophrenia with African Americans. This is one area of bias that I want to ensure does not cloud my diagnosis. This diagnosis happens in particular in black communities because of a lack of health care options. This is something that occurs since diagnosis is made from persons who are not in the field of mental health such as primary care physician. There is an overdiagnosis of schizophrenia which causes the mistaken belief that African Americans have a greater instance of schizophrenia (Helwick, 2012).

 

Cultural and ethical concerns

As for a cultural concern the same issue from above, that black are over diagnosed with schizophrenia comes up (Helwick, 2012). Ethically I am obligated to provide that same level of care for all persons. It would appear that there is a disproportionate amount of African Americans that suffer from poverty or lowered socioeconomic status. This does not seem to be a problem with Melinda but it is a concern that I would want to give her the same treatment as any of my other clients.

 

Legal Concerns

There may be legal concerns in that Melinda is underage. There might be concerns over records and even issues with access to information on the part of the parents (American Psychological Association, 2010). Another possible legal and ethical concern not addressed earlier is that at this time some of the more difficult to treat options of diagnosis have not surfaced. It would be wise to temper any diagnosis with an amount of information that allows for a later diagnosis if such an event occurs.

 

Treatment with pharmacological coordination

The primary treatment for the condition of delusional disorder is through psychotherapy and medication. The type of medication most often prescribed is antipsychotics (Webmd.com LLC, n.d.). Many of the newer antipsychotics block dopamine and serotonin receptors to reduce delusions.

The type of psychotherapy is normally cognitive behavioral treatment or family therapy. The therapeutic modalities can assist Melinda to deal with the stress which could come from her delusions as they will have an impact on her life (Webmd.com LLC, n.d.).  The family therapy could assist the family in giving support to Melinda, while also helping them to understand and cope with her issues.

 

 

 

 

 

References Case Study Analysis

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5 ed.). Arlington, VA: American Psychiatric Publishing.

American Psychological Association. (2010). Ethical principles of psychologists and code of conduct (2010 ed., Rev.). Washington, DC: American Psychological Association.

Helwick, C. (2012, July 31). Schizophrenia May Be Overdiagnosed in Black Patients. Retrieved November 23, 2016, from http://www.medscape.com/viewarticle/768391

Olson, J. (2015). Clnical Pharmacology Made Ridiculously Simple (4 ed.). Miami, FL: Medmaster, Inc.

Pelham, W. E., Fabiano, G. A., Waxmonsky, J. G., Greiner, A. R., Gnagy, E. M., Peham, W. E.,…Murphy, S. A. (2016). Treatment Sequencing for Childhood ADHD: A Multiple-Randomization Study of Adaptive Medication and Behavioral Interventions. Journal of Clinical Child & Adolescent Psychology, 45(4), 396-415. doi:10.1080/15374416.2015.1105138

Preston, J. D., O’Neal, J. H., & Talaga, M. C. (2013). Handbook of Clinical Pharmacology for Therapists (7 ed.). Oakland, CA: New Harbinger Publications.

Webmd.com LLC. (n.d.). Delusional Disorder. Retrieved November 23, 2016, from http://www.webmd.com/schizophrenia/guide/delusional-disorder

Case Study Method

Saul McLeod published 2008


Case studies are in-depth investigations of a single person, group, event or community. Typically, data are gathered from a variety of sources and by using several different methods (e.g. observations & interviews). The research may also continue for an extended period of time, so processes and developments can be studied as they happen.

The case study research method originated in clinical medicine (the case history, i.e. the patient’s personal history).

The case study method often involves simply observing what happens to, or reconstructing ‘the case history’ of a single participant or group of individuals (such as a school class or a specific social group), i.e. the idiographic approach. Case studies allow a researcher to investigate a topic in far more detail than might be possible if they were trying to deal with a large number of research participants (nomothetic approach) with the aim of ‘averaging’.

The case study is not itself a research method, but researchers select methods of data collection and analysis that will generate material suitable for case studies. Amongst the sources of data the psychologist is likely to turn to when carrying out a case study are observations of a person’s daily routine, unstructured interviews with the participant herself (and with people who know her), diaries, personal notes (e.g. letters, photographs, notes) or official document (e.g. case notes, clinical notes, appraisal reports). Most of this information is likely to be qualitative (i.e. verbal description rather than measurement) but the psychologist might collect numerical data as well.

The data collected can be analyzed using different theories (e.g. grounded theory, interpretative phenomenological analysis, text interpretation, e.g. thematic coding) etc. All the approaches mentioned here use preconceived categories in the analysis and they are ideographic in their approach, i.e. they focus on the individual case without reference to a comparison group.

Case studies are widely used in psychology and amongst the best known were the ones carried out by Sigmund Freud. He conducted very detailed investigations into the private lives of his patients in an attempt to both understand and help them overcome their illnesses. 

Freud's most famous case studies include Little Hans (1909a) and The Rat Man (1909b). Even today case histories are one of the main methods of investigation in abnormal psychology and psychiatry. For students of these disciplines they can give a vivid insight into what those who suffer from mental illness often have to endure.

Case studies are often conducted in clinical medicine and involve collecting and reporting descriptive information about a particular person or specific environment, such as a school. In psychology, case studies are often confined to the study of a particular individual. The information is mainly biographical and relates to events in the individual's past (i.e. retrospective), as well as to significant events which are currently occurring in his or her everyday life.

In order to produce a fairly detailed and comprehensive profile of the person, the psychologist may use various types of accessible data, such as medical records, employer's reports, school reports or psychological test results. The interview is also an extremely effective procedure for obtaining information about an individual, and it may be used to collect comments from the person's friends, parents, employer, work mates and others who have a good knowledge of the person, as well as to obtain facts from the person him or herself.

This makes it clear that the case study is a method that should only be used by a psychologist, therapist or psychiatrist, i.e. someone with a professional qualification. There is an ethical issue of competence. Only someone qualified to diagnose and treat a person can conduct a formal case study relating to atypical (i.e. abnormal) behavior or atypical development.

The procedure used in a case study means that the researcher provides a description of the behavior. This comes from interviews and other sources, such as observation. The client also reports detail of events from his or her point of view. The researcher then writes up the information from both sources above as the case study, and interprets the information.

Interpreting the information means the researcher decides what to include or leave out. A good case study should always make clear which information is factual description and which is an inference or the opinion of the researcher.


Strengths of Case Studies

  • Provides detailed (rich qualitative) information.
  • Provides insight for further research.
  • Permitting investigation of otherwise impractical (or unethical) situations.

Because of their in-depth, multi-sided approach case studies often shed light on aspects of human thinking and behavior that would be unethical or impractical to study in other ways. Research which only looks into the measurable aspects of human behavior is not likely to give us insights into the subjective dimension to experience which is so important to psychoanalytic and humanistic psychologists.

Case studies are often used in exploratory research. They can help us generate new ideas (that might be tested by other methods). They are an important way of illustrating theories and can help show how different aspects of a person's life are related to each other. The method is therefore important for psychologists who adopt a holistic point of view (i.e. humanistic psychologists).


Limitations of Case Studies

  • Can’t generalize the results to the wider population.
  • Researchers' own subjective feeling may influence the case study (researcher bias).
  • Difficult to replicate.
  • Time consuming.

Because a case study deals with only one person/event/group we can never be sure whether the conclusions drawn from this particular case apply elsewhere. The results of the study are not generalizable because we can never know whether the case we have investigated is representative of the wider body of "similar" instances

Because they are based on the analysis of qualitative (i.e. descriptive) data a lot depends on the interpretation the psychologist places on the information she has acquired. This means that there is a lot of scope for observer bias and it could be that the subjective opinions of the psychologist intrude in the assessment of what the data means.

For example, Freud has been criticized for producing case studies in which the information was sometimes distorted to fit the particular theories about behavior (e.g. Little Hans). This is also true of Money’s interpretation of the Bruce/Brenda case study (Diamond, 1997) when he ignored evidence that went against his theory.

References

Diamond, M., & Sigmundson, K. (1997). Sex Reassignment at Birth: Long-term Review and Clinical Implications. Archives of Pediatrics & Adolescent Medicine, 151(3), 298-304

Freud, S. (1909a). Analysis of a phobia of a five year old boy. In The Pelican Freud Library (1977), Vol 8, Case Histories 1, pages 169-306

Freud, S. (1909b). Bemerkungen über einen Fall von Zwangsneurose (Der "Rattenmann"). Jb. psychoanal. psychopathol. Forsch., I, p. 357-421; GW, VII, p. 379-463; Notes upon a case of obsessional neurosis, SE, 10: 151-318.


How to reference this article:

McLeod, S. A. (2008). Case study method. Retrieved from www.simplypsychology.org/case-study.html

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