Is psychotherapy fundamentally threatened, with the demise of published case studies, to become neither an art and/ nor a science?

Abstract

Twenty-five years ago, when this European Journal of Psychotherapy and Counselling (EJPC) was established, we published case studies together with commentaries. Then, this was also a mainstay of other journals in our field – but not now. So how has this come about and what are the consequences? The Greek letter psi (taken to mean: life, soul, heart) gave rise to such words as ‘psychotherapy’, ‘psychoanalysis’, ‘psychology’, and ‘psychiatry’. Indeed, this Greek letter is used as the logo for our journal (though the EJPC deliberately has a flattened version in an attempt to represent both the Greek and, through the menorah, Hebraic influences on European thought). Importantly with the Greeks comes phusus/physis to represent the natural, what comes out of itself and where force would usually be inappropriate. But here’s the rub: When the journal was initiated case studies could be published on being anonymised. There was no requirement, unlike now, to have the permission of the client/patient. Yet for many of us we consider that what we may write in a paper if seen by clients could be detrimental to them. This concern is not just during therapy but afterwards as many of us assume that ex-clients may return to working with us. A popular suggestion as to how to work round this is for authors to construct composite client cases (Duffy, 2010). Yet there are at least two problems here: First there is an argument that the author of the paper should get permission from all those clients making up the composite case study even though, as with an actual single case, the author has changed identifying aspects. Secondly, and of particular significance here, the author can construct the composite case to tell a story to fit the theory being proposed. But this is forced and not phusis – it does not come out of itself. Aren’t such practices examples of the ‘allegiance effect’ (see for example Winter, 2010) par excellence? It has been argued that those, such as Freud, have also misused case studies (Willemsen et al., 2017), whilst simultaneously and not unrelatedly