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Case Study Research and Applications: Design and Methods

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This site is intended to enhance your use of  Case Study Research and Applications, Sixth Edition,  by Robert K. Yin. Please note that all the resources on this site are especially geared toward maximizing your understanding of the material. 

Recognized as one of the most cited methodology books in the social sciences, the  Sixth Edition  of Robert K. Yin's bestselling text provides a complete portal to the world of case study research. With the integration of 11 applications in this edition, the book gives readers access to exemplary case studies drawn from a wide variety of academic and applied fields. Ultimately,  Case Study Research and Applications  will guide students in the successful use and application of the case study research method.

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The case study approach

Sarah crowe.

1 Division of Primary Care, The University of Nottingham, Nottingham, UK

Kathrin Cresswell

2 Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK

Ann Robertson

3 School of Health in Social Science, The University of Edinburgh, Edinburgh, UK

Anthony Avery

Aziz sheikh.

The case study approach allows in-depth, multi-faceted explorations of complex issues in their real-life settings. The value of the case study approach is well recognised in the fields of business, law and policy, but somewhat less so in health services research. Based on our experiences of conducting several health-related case studies, we reflect on the different types of case study design, the specific research questions this approach can help answer, the data sources that tend to be used, and the particular advantages and disadvantages of employing this methodological approach. The paper concludes with key pointers to aid those designing and appraising proposals for conducting case study research, and a checklist to help readers assess the quality of case study reports.

Introduction

The case study approach is particularly useful to employ when there is a need to obtain an in-depth appreciation of an issue, event or phenomenon of interest, in its natural real-life context. Our aim in writing this piece is to provide insights into when to consider employing this approach and an overview of key methodological considerations in relation to the design, planning, analysis, interpretation and reporting of case studies.

The illustrative 'grand round', 'case report' and 'case series' have a long tradition in clinical practice and research. Presenting detailed critiques, typically of one or more patients, aims to provide insights into aspects of the clinical case and, in doing so, illustrate broader lessons that may be learnt. In research, the conceptually-related case study approach can be used, for example, to describe in detail a patient's episode of care, explore professional attitudes to and experiences of a new policy initiative or service development or more generally to 'investigate contemporary phenomena within its real-life context' [ 1 ]. Based on our experiences of conducting a range of case studies, we reflect on when to consider using this approach, discuss the key steps involved and illustrate, with examples, some of the practical challenges of attaining an in-depth understanding of a 'case' as an integrated whole. In keeping with previously published work, we acknowledge the importance of theory to underpin the design, selection, conduct and interpretation of case studies[ 2 ]. In so doing, we make passing reference to the different epistemological approaches used in case study research by key theoreticians and methodologists in this field of enquiry.

This paper is structured around the following main questions: What is a case study? What are case studies used for? How are case studies conducted? What are the potential pitfalls and how can these be avoided? We draw in particular on four of our own recently published examples of case studies (see Tables ​ Tables1, 1 , ​ ,2, 2 , ​ ,3 3 and ​ and4) 4 ) and those of others to illustrate our discussion[ 3 - 7 ].

Example of a case study investigating the reasons for differences in recruitment rates of minority ethnic people in asthma research[ 3 ]

Example of a case study investigating the process of planning and implementing a service in Primary Care Organisations[ 4 ]

Example of a case study investigating the introduction of the electronic health records[ 5 ]

Example of a case study investigating the formal and informal ways students learn about patient safety[ 6 ]

What is a case study?

A case study is a research approach that is used to generate an in-depth, multi-faceted understanding of a complex issue in its real-life context. It is an established research design that is used extensively in a wide variety of disciplines, particularly in the social sciences. A case study can be defined in a variety of ways (Table ​ (Table5), 5 ), the central tenet being the need to explore an event or phenomenon in depth and in its natural context. It is for this reason sometimes referred to as a "naturalistic" design; this is in contrast to an "experimental" design (such as a randomised controlled trial) in which the investigator seeks to exert control over and manipulate the variable(s) of interest.

Definitions of a case study

Stake's work has been particularly influential in defining the case study approach to scientific enquiry. He has helpfully characterised three main types of case study: intrinsic , instrumental and collective [ 8 ]. An intrinsic case study is typically undertaken to learn about a unique phenomenon. The researcher should define the uniqueness of the phenomenon, which distinguishes it from all others. In contrast, the instrumental case study uses a particular case (some of which may be better than others) to gain a broader appreciation of an issue or phenomenon. The collective case study involves studying multiple cases simultaneously or sequentially in an attempt to generate a still broader appreciation of a particular issue.

These are however not necessarily mutually exclusive categories. In the first of our examples (Table ​ (Table1), 1 ), we undertook an intrinsic case study to investigate the issue of recruitment of minority ethnic people into the specific context of asthma research studies, but it developed into a instrumental case study through seeking to understand the issue of recruitment of these marginalised populations more generally, generating a number of the findings that are potentially transferable to other disease contexts[ 3 ]. In contrast, the other three examples (see Tables ​ Tables2, 2 , ​ ,3 3 and ​ and4) 4 ) employed collective case study designs to study the introduction of workforce reconfiguration in primary care, the implementation of electronic health records into hospitals, and to understand the ways in which healthcare students learn about patient safety considerations[ 4 - 6 ]. Although our study focusing on the introduction of General Practitioners with Specialist Interests (Table ​ (Table2) 2 ) was explicitly collective in design (four contrasting primary care organisations were studied), is was also instrumental in that this particular professional group was studied as an exemplar of the more general phenomenon of workforce redesign[ 4 ].

What are case studies used for?

According to Yin, case studies can be used to explain, describe or explore events or phenomena in the everyday contexts in which they occur[ 1 ]. These can, for example, help to understand and explain causal links and pathways resulting from a new policy initiative or service development (see Tables ​ Tables2 2 and ​ and3, 3 , for example)[ 1 ]. In contrast to experimental designs, which seek to test a specific hypothesis through deliberately manipulating the environment (like, for example, in a randomised controlled trial giving a new drug to randomly selected individuals and then comparing outcomes with controls),[ 9 ] the case study approach lends itself well to capturing information on more explanatory ' how ', 'what' and ' why ' questions, such as ' how is the intervention being implemented and received on the ground?'. The case study approach can offer additional insights into what gaps exist in its delivery or why one implementation strategy might be chosen over another. This in turn can help develop or refine theory, as shown in our study of the teaching of patient safety in undergraduate curricula (Table ​ (Table4 4 )[ 6 , 10 ]. Key questions to consider when selecting the most appropriate study design are whether it is desirable or indeed possible to undertake a formal experimental investigation in which individuals and/or organisations are allocated to an intervention or control arm? Or whether the wish is to obtain a more naturalistic understanding of an issue? The former is ideally studied using a controlled experimental design, whereas the latter is more appropriately studied using a case study design.

Case studies may be approached in different ways depending on the epistemological standpoint of the researcher, that is, whether they take a critical (questioning one's own and others' assumptions), interpretivist (trying to understand individual and shared social meanings) or positivist approach (orientating towards the criteria of natural sciences, such as focusing on generalisability considerations) (Table ​ (Table6). 6 ). Whilst such a schema can be conceptually helpful, it may be appropriate to draw on more than one approach in any case study, particularly in the context of conducting health services research. Doolin has, for example, noted that in the context of undertaking interpretative case studies, researchers can usefully draw on a critical, reflective perspective which seeks to take into account the wider social and political environment that has shaped the case[ 11 ].

Example of epistemological approaches that may be used in case study research

How are case studies conducted?

Here, we focus on the main stages of research activity when planning and undertaking a case study; the crucial stages are: defining the case; selecting the case(s); collecting and analysing the data; interpreting data; and reporting the findings.

Defining the case

Carefully formulated research question(s), informed by the existing literature and a prior appreciation of the theoretical issues and setting(s), are all important in appropriately and succinctly defining the case[ 8 , 12 ]. Crucially, each case should have a pre-defined boundary which clarifies the nature and time period covered by the case study (i.e. its scope, beginning and end), the relevant social group, organisation or geographical area of interest to the investigator, the types of evidence to be collected, and the priorities for data collection and analysis (see Table ​ Table7 7 )[ 1 ]. A theory driven approach to defining the case may help generate knowledge that is potentially transferable to a range of clinical contexts and behaviours; using theory is also likely to result in a more informed appreciation of, for example, how and why interventions have succeeded or failed[ 13 ].

Example of a checklist for rating a case study proposal[ 8 ]

For example, in our evaluation of the introduction of electronic health records in English hospitals (Table ​ (Table3), 3 ), we defined our cases as the NHS Trusts that were receiving the new technology[ 5 ]. Our focus was on how the technology was being implemented. However, if the primary research interest had been on the social and organisational dimensions of implementation, we might have defined our case differently as a grouping of healthcare professionals (e.g. doctors and/or nurses). The precise beginning and end of the case may however prove difficult to define. Pursuing this same example, when does the process of implementation and adoption of an electronic health record system really begin or end? Such judgements will inevitably be influenced by a range of factors, including the research question, theory of interest, the scope and richness of the gathered data and the resources available to the research team.

Selecting the case(s)

The decision on how to select the case(s) to study is a very important one that merits some reflection. In an intrinsic case study, the case is selected on its own merits[ 8 ]. The case is selected not because it is representative of other cases, but because of its uniqueness, which is of genuine interest to the researchers. This was, for example, the case in our study of the recruitment of minority ethnic participants into asthma research (Table ​ (Table1) 1 ) as our earlier work had demonstrated the marginalisation of minority ethnic people with asthma, despite evidence of disproportionate asthma morbidity[ 14 , 15 ]. In another example of an intrinsic case study, Hellstrom et al.[ 16 ] studied an elderly married couple living with dementia to explore how dementia had impacted on their understanding of home, their everyday life and their relationships.

For an instrumental case study, selecting a "typical" case can work well[ 8 ]. In contrast to the intrinsic case study, the particular case which is chosen is of less importance than selecting a case that allows the researcher to investigate an issue or phenomenon. For example, in order to gain an understanding of doctors' responses to health policy initiatives, Som undertook an instrumental case study interviewing clinicians who had a range of responsibilities for clinical governance in one NHS acute hospital trust[ 17 ]. Sampling a "deviant" or "atypical" case may however prove even more informative, potentially enabling the researcher to identify causal processes, generate hypotheses and develop theory.

In collective or multiple case studies, a number of cases are carefully selected. This offers the advantage of allowing comparisons to be made across several cases and/or replication. Choosing a "typical" case may enable the findings to be generalised to theory (i.e. analytical generalisation) or to test theory by replicating the findings in a second or even a third case (i.e. replication logic)[ 1 ]. Yin suggests two or three literal replications (i.e. predicting similar results) if the theory is straightforward and five or more if the theory is more subtle. However, critics might argue that selecting 'cases' in this way is insufficiently reflexive and ill-suited to the complexities of contemporary healthcare organisations.

The selected case study site(s) should allow the research team access to the group of individuals, the organisation, the processes or whatever else constitutes the chosen unit of analysis for the study. Access is therefore a central consideration; the researcher needs to come to know the case study site(s) well and to work cooperatively with them. Selected cases need to be not only interesting but also hospitable to the inquiry [ 8 ] if they are to be informative and answer the research question(s). Case study sites may also be pre-selected for the researcher, with decisions being influenced by key stakeholders. For example, our selection of case study sites in the evaluation of the implementation and adoption of electronic health record systems (see Table ​ Table3) 3 ) was heavily influenced by NHS Connecting for Health, the government agency that was responsible for overseeing the National Programme for Information Technology (NPfIT)[ 5 ]. This prominent stakeholder had already selected the NHS sites (through a competitive bidding process) to be early adopters of the electronic health record systems and had negotiated contracts that detailed the deployment timelines.

It is also important to consider in advance the likely burden and risks associated with participation for those who (or the site(s) which) comprise the case study. Of particular importance is the obligation for the researcher to think through the ethical implications of the study (e.g. the risk of inadvertently breaching anonymity or confidentiality) and to ensure that potential participants/participating sites are provided with sufficient information to make an informed choice about joining the study. The outcome of providing this information might be that the emotive burden associated with participation, or the organisational disruption associated with supporting the fieldwork, is considered so high that the individuals or sites decide against participation.

In our example of evaluating implementations of electronic health record systems, given the restricted number of early adopter sites available to us, we sought purposively to select a diverse range of implementation cases among those that were available[ 5 ]. We chose a mixture of teaching, non-teaching and Foundation Trust hospitals, and examples of each of the three electronic health record systems procured centrally by the NPfIT. At one recruited site, it quickly became apparent that access was problematic because of competing demands on that organisation. Recognising the importance of full access and co-operative working for generating rich data, the research team decided not to pursue work at that site and instead to focus on other recruited sites.

Collecting the data

In order to develop a thorough understanding of the case, the case study approach usually involves the collection of multiple sources of evidence, using a range of quantitative (e.g. questionnaires, audits and analysis of routinely collected healthcare data) and more commonly qualitative techniques (e.g. interviews, focus groups and observations). The use of multiple sources of data (data triangulation) has been advocated as a way of increasing the internal validity of a study (i.e. the extent to which the method is appropriate to answer the research question)[ 8 , 18 - 21 ]. An underlying assumption is that data collected in different ways should lead to similar conclusions, and approaching the same issue from different angles can help develop a holistic picture of the phenomenon (Table ​ (Table2 2 )[ 4 ].

Brazier and colleagues used a mixed-methods case study approach to investigate the impact of a cancer care programme[ 22 ]. Here, quantitative measures were collected with questionnaires before, and five months after, the start of the intervention which did not yield any statistically significant results. Qualitative interviews with patients however helped provide an insight into potentially beneficial process-related aspects of the programme, such as greater, perceived patient involvement in care. The authors reported how this case study approach provided a number of contextual factors likely to influence the effectiveness of the intervention and which were not likely to have been obtained from quantitative methods alone.

In collective or multiple case studies, data collection needs to be flexible enough to allow a detailed description of each individual case to be developed (e.g. the nature of different cancer care programmes), before considering the emerging similarities and differences in cross-case comparisons (e.g. to explore why one programme is more effective than another). It is important that data sources from different cases are, where possible, broadly comparable for this purpose even though they may vary in nature and depth.

Analysing, interpreting and reporting case studies

Making sense and offering a coherent interpretation of the typically disparate sources of data (whether qualitative alone or together with quantitative) is far from straightforward. Repeated reviewing and sorting of the voluminous and detail-rich data are integral to the process of analysis. In collective case studies, it is helpful to analyse data relating to the individual component cases first, before making comparisons across cases. Attention needs to be paid to variations within each case and, where relevant, the relationship between different causes, effects and outcomes[ 23 ]. Data will need to be organised and coded to allow the key issues, both derived from the literature and emerging from the dataset, to be easily retrieved at a later stage. An initial coding frame can help capture these issues and can be applied systematically to the whole dataset with the aid of a qualitative data analysis software package.

The Framework approach is a practical approach, comprising of five stages (familiarisation; identifying a thematic framework; indexing; charting; mapping and interpretation) , to managing and analysing large datasets particularly if time is limited, as was the case in our study of recruitment of South Asians into asthma research (Table ​ (Table1 1 )[ 3 , 24 ]. Theoretical frameworks may also play an important role in integrating different sources of data and examining emerging themes. For example, we drew on a socio-technical framework to help explain the connections between different elements - technology; people; and the organisational settings within which they worked - in our study of the introduction of electronic health record systems (Table ​ (Table3 3 )[ 5 ]. Our study of patient safety in undergraduate curricula drew on an evaluation-based approach to design and analysis, which emphasised the importance of the academic, organisational and practice contexts through which students learn (Table ​ (Table4 4 )[ 6 ].

Case study findings can have implications both for theory development and theory testing. They may establish, strengthen or weaken historical explanations of a case and, in certain circumstances, allow theoretical (as opposed to statistical) generalisation beyond the particular cases studied[ 12 ]. These theoretical lenses should not, however, constitute a strait-jacket and the cases should not be "forced to fit" the particular theoretical framework that is being employed.

When reporting findings, it is important to provide the reader with enough contextual information to understand the processes that were followed and how the conclusions were reached. In a collective case study, researchers may choose to present the findings from individual cases separately before amalgamating across cases. Care must be taken to ensure the anonymity of both case sites and individual participants (if agreed in advance) by allocating appropriate codes or withholding descriptors. In the example given in Table ​ Table3, 3 , we decided against providing detailed information on the NHS sites and individual participants in order to avoid the risk of inadvertent disclosure of identities[ 5 , 25 ].

What are the potential pitfalls and how can these be avoided?

The case study approach is, as with all research, not without its limitations. When investigating the formal and informal ways undergraduate students learn about patient safety (Table ​ (Table4), 4 ), for example, we rapidly accumulated a large quantity of data. The volume of data, together with the time restrictions in place, impacted on the depth of analysis that was possible within the available resources. This highlights a more general point of the importance of avoiding the temptation to collect as much data as possible; adequate time also needs to be set aside for data analysis and interpretation of what are often highly complex datasets.

Case study research has sometimes been criticised for lacking scientific rigour and providing little basis for generalisation (i.e. producing findings that may be transferable to other settings)[ 1 ]. There are several ways to address these concerns, including: the use of theoretical sampling (i.e. drawing on a particular conceptual framework); respondent validation (i.e. participants checking emerging findings and the researcher's interpretation, and providing an opinion as to whether they feel these are accurate); and transparency throughout the research process (see Table ​ Table8 8 )[ 8 , 18 - 21 , 23 , 26 ]. Transparency can be achieved by describing in detail the steps involved in case selection, data collection, the reasons for the particular methods chosen, and the researcher's background and level of involvement (i.e. being explicit about how the researcher has influenced data collection and interpretation). Seeking potential, alternative explanations, and being explicit about how interpretations and conclusions were reached, help readers to judge the trustworthiness of the case study report. Stake provides a critique checklist for a case study report (Table ​ (Table9 9 )[ 8 ].

Potential pitfalls and mitigating actions when undertaking case study research

Stake's checklist for assessing the quality of a case study report[ 8 ]

Conclusions

The case study approach allows, amongst other things, critical events, interventions, policy developments and programme-based service reforms to be studied in detail in a real-life context. It should therefore be considered when an experimental design is either inappropriate to answer the research questions posed or impossible to undertake. Considering the frequency with which implementations of innovations are now taking place in healthcare settings and how well the case study approach lends itself to in-depth, complex health service research, we believe this approach should be more widely considered by researchers. Though inherently challenging, the research case study can, if carefully conceptualised and thoughtfully undertaken and reported, yield powerful insights into many important aspects of health and healthcare delivery.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

AS conceived this article. SC, KC and AR wrote this paper with GH, AA and AS all commenting on various drafts. SC and AS are guarantors.

Pre-publication history

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1471-2288/11/100/prepub

Acknowledgements

We are grateful to the participants and colleagues who contributed to the individual case studies that we have drawn on. This work received no direct funding, but it has been informed by projects funded by Asthma UK, the NHS Service Delivery Organisation, NHS Connecting for Health Evaluation Programme, and Patient Safety Research Portfolio. We would also like to thank the expert reviewers for their insightful and constructive feedback. Our thanks are also due to Dr. Allison Worth who commented on an earlier draft of this manuscript.

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Case Study Research Method in Psychology

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

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Case studies are in-depth investigations of a person, group, event, or community. Typically, data is gathered from various sources using several methods (e.g., observations & interviews).

The case study research method originated in clinical medicine (the case history, i.e., the patient’s personal history). 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 that are currently occurring in his or her everyday life.

The case study is not a research method, but researchers select methods of data collection and analysis that will generate material suitable for case studies.

Freud (1909a, 1909b) conducted very detailed investigations into the private lives of his patients in an attempt to both understand and help them overcome their illnesses.

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.

 Famous Case Studies

• Anna O – One of the most famous case studies, documenting psychoanalyst Josef Breuer’s treatment of “Anna O” (real name Bertha Pappenheim) for hysteria in the late 1800s using early psychoanalytic theory.
• Little Hans – A child psychoanalysis case study published by Sigmund Freud in 1909 analyzing his five-year-old patient Herbert Graf’s house phobia as related to the Oedipus complex.
• Bruce/Brenda – Gender identity case of the boy (Bruce) whose botched circumcision led psychologist John Money to advise gender reassignment and raise him as a girl (Brenda) in the 1960s.
• Genie Wiley – Linguistics/psychological development case of the victim of extreme isolation abuse who was studied in 1970s California for effects of early language deprivation on acquiring speech later in life.
• Phineas Gage – One of the most famous neuropsychology case studies analyzes personality changes in railroad worker Phineas Gage after an 1848 brain injury involving a tamping iron piercing his skull.

Clinical Case Studies

• Studying the effectiveness of psychotherapy approaches with an individual patient
• Assessing and treating mental illnesses like depression, anxiety disorders, PTSD
• Neuropsychological cases investigating brain injuries or disorders

Child Psychology Case Studies

• Studying psychological development from birth through adolescence
• Cases of learning disabilities, autism spectrum disorders, ADHD
• Effects of trauma, abuse, deprivation on development

Types of Case Studies

• Explanatory case studies : Used to explore causation in order to find underlying principles. Helpful for doing qualitative analysis to explain presumed causal links.
• Exploratory case studies : Used to explore situations where an intervention being evaluated has no clear set of outcomes. It helps define questions and hypotheses for future research.
• Descriptive case studies : Describe an intervention or phenomenon and the real-life context in which it occurred. It is helpful for illustrating certain topics within an evaluation.
• Multiple-case studies : Used to explore differences between cases and replicate findings across cases. Helpful for comparing and contrasting specific cases.
• Intrinsic : Used to gain a better understanding of a particular case. Helpful for capturing the complexity of a single case.
• Collective : Used to explore a general phenomenon using multiple case studies. Helpful for jointly studying a group of cases in order to inquire into the phenomenon.

Where Do You Find Data for a Case Study?

There are several places to find data for a case study. The key is to gather data from multiple sources to get a complete picture of the case and corroborate facts or findings through triangulation of evidence. Most of this information is likely qualitative (i.e., verbal description rather than measurement), but the psychologist might also collect numerical data.

1. Primary sources

• Interviews – Interviewing key people related to the case to get their perspectives and insights. The interview is 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, workmates, and others who have a good knowledge of the person, as well as to obtain facts from the person him or herself.
• Observations – Observing behaviors, interactions, processes, etc., related to the case as they unfold in real-time.
• Documents & Records – Reviewing private documents, diaries, public records, correspondence, meeting minutes, etc., relevant to the case.

2. Secondary sources

• News/Media – News coverage of events related to the case study.
• Academic articles – Journal articles, dissertations etc. that discuss the case.
• Government reports – Official data and records related to the case context.
• Books/films – Books, documentaries or films discussing the case.

3. Archival records

Searching historical archives, museum collections and databases to find relevant documents, visual/audio records related to the case history and context.

Public archives like newspapers, organizational records, photographic collections could all include potentially relevant pieces of information to shed light on attitudes, cultural perspectives, common practices and historical contexts related to psychology.

4. Organizational records

Organizational records offer the advantage of often having large datasets collected over time that can reveal or confirm psychological insights.

Of course, privacy and ethical concerns regarding confidential data must be navigated carefully.

However, with proper protocols, organizational records can provide invaluable context and empirical depth to qualitative case studies exploring the intersection of psychology and organizations.

• Organizational/industrial psychology research : Organizational records like employee surveys, turnover/retention data, policies, incident reports etc. may provide insight into topics like job satisfaction, workplace culture and dynamics, leadership issues, employee behaviors etc.
• Clinical psychology : Therapists/hospitals may grant access to anonymized medical records to study aspects like assessments, diagnoses, treatment plans etc. This could shed light on clinical practices.
• School psychology : Studies could utilize anonymized student records like test scores, grades, disciplinary issues, and counseling referrals to study child development, learning barriers, effectiveness of support programs, and more.

How do I Write a Case Study in Psychology?

Follow specified case study guidelines provided by a journal or your psychology tutor. General components of clinical case studies include: background, symptoms, assessments, diagnosis, treatment, and outcomes. Interpreting the information means the researcher decides what to include or leave out. A good case study should always clarify which information is the factual description and which is an inference or the researcher’s opinion.

1. Introduction

• Provide background on the case context and why it is of interest, presenting background information like demographics, relevant history, and presenting problem.
• Compare briefly to similar published cases if applicable. Clearly state the focus/importance of the case.

2. Case Presentation

• Describe the presenting problem in detail, including symptoms, duration,and impact on daily life.
• Include client demographics like age and gender, information about social relationships, and mental health history.
• Describe all physical, emotional, and/or sensory symptoms reported by the client.
• Use patient quotes to describe the initial complaint verbatim. Follow with full-sentence summaries of relevant history details gathered, including key components that led to a working diagnosis.
• Summarize clinical exam results, namely orthopedic/neurological tests, imaging, lab tests, etc. Note actual results rather than subjective conclusions. Provide images if clearly reproducible/anonymized.
• Clearly state the working diagnosis or clinical impression before transitioning to management.

3. Management and Outcome

• Indicate the total duration of care and number of treatments given over what timeframe. Use specific names/descriptions for any therapies/interventions applied.
• Present the results of the intervention,including any quantitative or qualitative data collected.
• For outcomes, utilize visual analog scales for pain, medication usage logs, etc., if possible. Include patient self-reports of improvement/worsening of symptoms. Note the reason for discharge/end of care.

4. Discussion

• Analyze the case, exploring contributing factors, limitations of the study, and connections to existing research.
• Analyze the effectiveness of the intervention,considering factors like participant adherence, limitations of the study, and potential alternative explanations for the results.
• Identify any questions raised in the case analysis and relate insights to established theories and current research if applicable. Avoid definitive claims about physiological explanations.
• Offer clinical implications, and suggest future research directions.

5. Additional Items

• Thank specific assistants for writing support only. No patient acknowledgments.
• References should directly support any key claims or quotes included.
• Use tables/figures/images only if substantially informative. Include permissions and legends/explanatory notes.
• Provides detailed (rich qualitative) information.
• Provides insight for further research.
• Permitting investigation of otherwise impractical (or unethical) situations.

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’.

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 that only looks into the measurable aspects of human behavior is not likely to give us insights into the subjective dimension of experience, which is 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

• Lacking scientific rigor and providing little basis for generalization of results to the wider population.
• Researchers’ own subjective feelings may influence the case study (researcher bias).
• Difficult to replicate.
• Time-consuming and expensive.
• The volume of data, together with the time restrictions in place, impacted the depth of analysis that was possible within the available resources.

Because a case study deals with only one person/event/group, we can never be sure if the case study investigated is representative of the wider body of “similar” instances. This means the conclusions drawn from a particular case may not be transferable to other settings.

Because case studies are based on the analysis of qualitative (i.e., descriptive) data , a lot depends on the psychologist’s interpretation of the information she has acquired.

This means that there is a lot of scope for Anna O , 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 particular behavioral theories (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.

Breuer, J., & Freud, S. (1895).  Studies on hysteria . Standard Edition 2: London.

Curtiss, S. (1981). Genie: The case of a modern wild child .

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.

Harlow J. M. (1848). Passage of an iron rod through the head.  Boston Medical and Surgical Journal, 39 , 389–393.

Harlow, J. M. (1868).  Recovery from the Passage of an Iron Bar through the Head .  Publications of the Massachusetts Medical Society. 2  (3), 327-347.

Money, J., & Ehrhardt, A. A. (1972).  Man & Woman, Boy & Girl : The Differentiation and Dimorphism of Gender Identity from Conception to Maturity. Baltimore, Maryland: Johns Hopkins University Press.

Money, J., & Tucker, P. (1975). Sexual signatures: On being a man or a woman.

Further Information

• Case Study Approach
• Case Study Method
• Enhancing the Quality of Case Studies in Health Services Research
• “We do things together” A case study of “couplehood” in dementia
• Using mixed methods for evaluating an integrative approach to cancer care: a case study

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Criterion Validity: Definition & Examples

What happened when Israel attacked Rafah?

Israel has attacked twice since Sunday, killing tens of people in horrific circumstances.

Thirteen out of 21 people killed by Israel in an air strike on the so-called “safe area” of al-Mawasi were civilian women and girls, Al Jazeera’s Hind Khoudary reported on Tuesday.

This was the second attack since Sunday, with a horrifying strike on Sunday night setting displaced people’s shelters ablaze not too far from Tuesday’s strike.

Keep reading

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The world had watched, aghast, on Monday as displaced Palestinians were forced to dig through smouldering remains with their bare hands – looking for bodies, or injured people, or in some cases, a few scraps of food they could salvage to keep their families going a bit longer.

As reports further clarify what happened on Tuesday, here are the details of Sunday’s attack:

When and where was this attack?

The attack happened at night on May 26.

It was inflicted on an encampment of makeshift shelters just north of Rafah city, in an area called Tal as-Sultan

It came after United States President Joe Biden said a “major offensive” by Israel on Rafah would be a red line.

What happened in the attack?

Many shelters burst into flames with their occupants still inside.

The Gaza Government Media Office said Israel dropped seven 900kg (2,000-pound) bombs as well as missiles on the displacement camp.

The Israeli army said it targeted Rafah with “precision munitions”, and that a nearby fuel tank led to the subsequent fire.

Horrific videos emerged of the aftermath – the most notable was of a man holding up the corpse of a young child without a head.

Al Jazeera’s Sanad Verification Agency was able to obtain images of fragments believed to be of the weaponry used in this attack. The photos the agency obtained show the tail of a GBU-39/B small-diameter bomb, which is made by Boeing. The GBU-39/B includes a jet engine taken from the M26 unguided missile.

Who were the people killed?

Thousands of civilians had been sheltering in the Tal as-Sultan area, seeking some minimal protection from the continuous Israeli attacks across Gaza.

The Israeli government had not issued any orders to evacuate the area before it attacked.

How many people died?

Israel killed at least 45 people in the offensive.

The total number of injured people is hard to determine, as the hospital where casualties were taken has closed after a subsequent Israeli drone attack on its entrance that killed two members of staff.

How did they die?

Some people died from the impact of the bomb.

Some people “reportedly burned to death”, according to Philippe Lazzarini, commissioner-general of the United Nations Relief and Works Agency for Palestine Refugees (UNRWA).

What were they doing when they died?

Accounts from Rafah say that many of the dead were preparing to go to sleep when the attack occurred.

Why is Israel doing this?

Initially, the Israeli army claimed it had struck “a Hamas compound in Rafah in which significant Hamas terrorists were operating”.

It added it was “aware of reports indicating that as a result of the strike and fire that was ignited several civilians in the area were harmed”.

Israeli Prime Minister Benjamin Netanyahu has since said the attack was “a tragic mistake.”

“Despite our best effort not to harm those not involved, unfortunately a tragic error happened last night. We are investigating the case,” Netanyahu said.

The attack came two days after the ICJ ordered Israel to halt its offensive on Rafah.

Is the international community going to do anything?

The United Nations Security Council (UNSC) is set to convene an emergency meeting over the attack on Rafah.

To date, the United States has vetoed every UNSC proposal aimed at holding Israel accountable.

Donald Trump found guilty on all counts in New York hush money trial

Trump, who is seeking another term in the White House, becomes the first former U.S. president convicted of a crime.

NEW YORK — A Manhattan jury on Thursday found Donald Trump guilty on 34 counts of falsifying business records to conceal a hush money payment to an adult-film actress, delivering a historic verdict that could shape the November election and that makes Trump the first former U.S. president convicted of a crime.

The verdict is an extraordinary loss for the presumptive GOP nominee, who delivered near-daily tirades outside the courtroom throughout the trial — excoriating the justice system and declaring his innocence.

Twelve jurors, whose names were shielded by the judge from public view, spent a little more than a day weighing the felony counts against Trump before returning their judgment unanimously saying otherwise.

Trump guilty verdict

Trump, 77, faces a maximum sentence of 1⅓ to four years in prison after being deemed a felon in the city where he first rose to prominence . Given his age and lack of a prior criminal record, he could serve a shorter sentence or no term of incarceration at all.

New York Supreme Court Justice Juan Merchan scheduled the former president’s sentencing for July 11 — just days before the start of the Republican National Convention, where Trump is set to be formally nominated by his party.

The verdict propels the country into unprecedented territory, and its impact will reverberate across U.S. politics in the coming months. While awaiting his sentence, Trump will continue to campaign to reclaim the White House. Trump, who has been charged in three other criminal cases , is expected to appeal the New York verdict; neither the conviction nor any sentence he may receive prevents him from serving as president.

Podcast episode

After the verdict was read, Trump was told he could go free without bail. He turned to his son, Eric, and the two shared a stern handshake before Trump left the courtroom with a grimace, his face flushed. While Eric and his brother, Donald Trump Jr., attended multiple days of their father’s trial, former first lady Melania Trump and the former president’s daughter Ivanka stayed away.

Outside the courtroom, Trump again declared himself innocent, calling the trial “a disgrace” and falsely insisting that the case was driven by President Biden , his opponent in the Nov. 5 election.

“This was a rigged trial by a conflicted judge who was corrupt,” Trump said. “The real verdict is going to be November 5, by the people, and they know what happened here.”

The conviction is a major victory for Manhattan prosecutors, who brought a local case with immense national implications even after their federal counterparts declined to seek an indictment against Trump in the matter years earlier.

“While this defendant may be unlike any other in American history, we arrived at this trial, and ultimately today at this verdict, in the same manner as every other case that comes through the courtroom doors,” Manhattan District Attorney Alvin Bragg (D), the elected prosecutor whose office brought the case, said after the verdict, “by following the facts and the law, and by doing so without fear or favor.”

Asked about legal commentators and analysts who questioned the indictment — with some calling it the weakest of four criminal prosecutions facing Trump — Bragg said there was only one group whose view of the case ultimately mattered.

“Today, we have the most important voice of all,” Bragg said at a news conference, delivering his first extended public remarks about the trial since it began. “And that’s the voice of the jurors.”

The trial, which began in mid-April, hinged on a $130,000 payment made to Stormy Daniels, an adult-film actress who alleged a sexual encounter with Trump in a Lake Tahoe hotel room in 2006. Trump denies they had sex.

Michael Cohen, Trump’s onetime attorney and fixer, paid Daniels on the eve of the 2016 presidential election to keep her from publicly sharing her claims of a tryst. Cohen was then given monthly reimbursement payments from Trump that were recorded as legal fees in documents maintained by Trump’s company. Prosecutors say classifying the payments as legal fees was criminal.

Prosecutors accused Trump of overseeing “a long-running conspiracy to influence the 2016 election.” The government’s complex theory of the case was built on interlocking alleged criminal violations, and jurors were given a convoluted set of instructions as a result.

Defense attorneys argued that monthly $35,000 payments made to Cohen in 2017 were in fact compensation for legal services and that the classification of the business records was correct. The defense team also took blistering aim at Cohen, the prosecution’s key witness who has pleaded guilty to multiple crimes , including lying to Congress.

“You cannot convict President Trump of any crime beyond a reasonable doubt on the words of Michael Cohen,” defense lawyer Todd Blanche had told jurors.

Cohen told jurors that he was acting at Trump’s direction in arranging the Daniels payment. He was the only witness to testify that his former boss was directly involved. Defense attorneys subjected Cohen to brutal cross-examination, accusing him of lying on the stand and painting him as singularly focused on seeing Trump punished.

Blanche said after the verdict that it appeared jurors accepted Cohen’s testimony despite his attempts to convince them otherwise.

“At the end of the day, it remains true that if the word of Michael Cohen was not accepted at all, then you could not have convicted President Trump,” Blanche said on CNN a few hours after the verdict was reached. “And the jury convicted. So at the end of the day, they looked past what we thought were fatal flaws in Mr. Cohen’s story and his past, and they reached a guilty verdict.”

He also said he did not believe New York was “a fair place” to put Trump on trial.

Concerns about Cohen’s credibility were part of the reason federal prosecutors declined to pursue charges against Trump in connection with the hush money payment years earlier , according to people familiar with the decision who spoke to The Washington Post on the condition of anonymity to reveal internal discussions.

But Bragg’s office continued scrutinizing the issue. The hush money allegations had been known around his office as the “zombie” case because for years, it seemed lifeless without truly dying. Last year, a Manhattan grand jury took the historic step of voting to indict Trump, the first of four times he was charged in a span of about five months.

The verdict Thursday was Trump’s latest legal defeat in a New York court since last year. He lost two civil cases to the writer E. Jean Carroll, who accused him of battery and defamation, and was ordered to pay her nearly $90 million ; he is appealing. He was also hit with nearly half a billion dollars in penalties following a civil fraud lawsuit brought by New York Attorney General Letitia James (D), though he was allowed to post a lower bond while appealing that decision.

And Trump faces criminal cases in Florida, Georgia and D.C. — though due to appeals and pretrial motions, it is quite possible none of them will go to trial before Election Day.

The jury in Manhattan was tasked with deciding whether Trump was guilty on each specific count of falsifying business records and whether he did so in an effort to unlawfully impact an election. Prosecutors offered three types of underlying crimes that could raise the unlawful election-meddling allegation; jurors did not have to be unanimous about which of those they felt was at play.

A jury of seven men and five women — seated during a week-long selection process in April — began deliberations Wednesday and, within hours, said they wanted to hear part of the trial testimony and some of Merchan’s instructions repeated to them. After that happened Thursday morning, the jurors retreated to the jury room to continue deliberations.

Attorneys were preparing to leave court for the day at 4:30 p.m. without a verdict and return Friday morning. Then a note from the jury room arrived.

“We the jury have a verdict,” the note said.

Trump and his legal team then spent an agonizing half-hour waiting while the panel filled out the lengthy jury form.

Jurors looked solemn as they filed into the jury box to reveal their verdict. All eyes in the courtroom were on the jury foreman as he rose from his seat to deliver their findings count by count. After he repeated “guilty” 34 times, once for each count, the jurors were individually polled by the clerk to confirm they were unanimous.

Trump watched them, frowning, his hands resting on his lap.

Merchan then thanked the jurors for their work, saying they had “a very stressful and difficult task.” He also told them that they were now free to discuss the case but did not have to.

They filed out of court a short while later, walking one final time in front of Trump. As usual, they looked forward but not directly at him.

Bragg left the courtroom. His trial team, all smiles, remained for several minutes, holding their transcripts and other materials.

The jury had deliberated for about 11 hours across two days, including the time spent hearing testimony and instructions repeated Thursday.

“The speed with which this verdict was returned is shocking,” particularly given the legal complexity of the case, said Robert Mintz, a former federal prosecutor now in private practice.

“It signals that despite the doubts raised by the defense about the credibility of Michael Cohen, the jury viewed this as an overwhelming case for prosecutors and there was little dissent among jurors about this outcome,” he said.

During the trial, witness testimony frequently veered into sordid territory , offering an expansive education about tabloid practices as well as how famous, powerful people work to keep scandalous stories and allegations hidden.

Daniels testified in graphic detail about what she said happened between her and Trump in 2006, when they met at a celebrity golf tournament. She described what sounded at times like a nonconsensual sexual encounter with him, leading his attorneys to unsuccessfully call for a mistrial .

Trump ultimately did not take the stand — an unlikely scenario , but one he publicly insisted was on the table throughout the proceedings.

Instead, he frequently pilloried the case on his way in and out of court, often castigating Merchan and Bragg.

Merchan had issued a gag order prohibiting Trump from commenting on witnesses or jurors in the case. He ruled that Trump violated the gag order 10 different times and twice found him in contempt of court, warning that jail time could follow if that continued.

Inside the courtroom, Trump could be a passive figure and closed his eyes while witnesses testified, leading to speculation that he had dozed off — something that he denies. Other times, he glowered or appeared angry, including when Daniels testified, leading Merchan to tell Trump’s lawyer the former president was “ cursing audibly ” and needed to stop.

In the trial’s final stretch, Trump was accompanied to the Manhattan courthouse by a rotating entourage of political allies and supporters , who sat behind him in the courtroom and appeared before cameras in a nearby park to denounce and question the trial.

Some of those allies pilloried the outcome Thursday. House Speaker Mike Johnson (R-La.) called it “a shameful day in American history,” while House Majority Leader Steve Scalise (R-La.) decried what he called “radical partisan Democrats behind this abuse of power.”

Biden’s campaign said in a statement that the verdict showed “no one is above the law,” while noting that Trump would still be on the ballot in November.

If Trump wins that election, he would regain the presidency’s broad power to grant pardons. He could not , however, pardon himself, because he was convicted Thursday in state court. Presidents can only grant clemency on federal charges.

Berman reported from Washington. Isaac Arnsdorf in New York and Marianne LeVine in Washington contributed to this report.

Trump New York hush money case

Donald Trump is the first former president convicted of a crime .

Can Trump still run for president? Yes. He is eligible to campaign and serve as president if elected, but he won’t be able to pardon himself . Here’s everything to know about next steps , what this means for his candidacy and the other outstanding trials he faces .

What happens next? Trump’s sentencing is scheduled for July 11. He faces up to four years in prison, but legal experts say incarceration appears unlikely. Trump has 30 days to file notice of an appeal of the verdict and six months to file the full appeal.

Reaction to the verdict: Trump continued to maintain his innocence , railing against what he called a “rigged, disgraceful trial” and emphasizing voters would deliver the real verdict on Election Day.

The charges: Trump was found guilty on 34 felony counts of falsifying business records . Falsifying business records is a felony in New York when there is an “intent to defraud” that includes an intent to “commit another crime or to aid or conceal” another crime.