Table 14 Using Case Study Evaluation-tool (CaSE): Lunn et al. (2016)’s case ‘Psychoanalytic psychotherapy with a client with bulimia nervosa’

Critical

The studied phenomenon is identified as the treatment of bulimia nervosa. The case tests the need of adapting therapeutic approaches to individual patients on the basis of their specific therapeutic needs and goals rather than providing manualised therapy across the entire clinical population.

A patient was selected from an RCT trial where cognitive behavioural therapy (CBT) was found, on average, more effective than psychoanalytic psychotherapy (PP). However, this patient’s symptoms and context indicated that she may benefit from techniques and principles common to PP, which is why she was chosen for this case study. The case involves a lengthy patient description, including previous diagnosis of anorexia nervosa, binge and purge episodes, early object relations, and childhood-rooted trauma. The case provides substantial information on patient’s psychological context and demographics but does not contain cultural information (this may have been deemed not relevant).

The case contains a detailed description of therapeutic interventions, such as therapeutic containment, reflection, and acknowledgement of unconscious, split-off, or disavowed aspects of patient’s experiences. Therapist observations and clinical decision-making are informed by the theoretical PP principles, particularly in terms of affirming and interpreting patient’s experiences. The effectiveness of therapeutic interventions is described as highly positive: patient has stopped binging and purging and was able to develop a closer relationship with her family.

Several theoretical and research perspectives are explored in order to tailor the most suitable approach for the patient, including attachment styles, mentalization and integrative approaches. One of the authors acted as a therapist, while the two other authors were involved in data analysis; this improved the data triangulation process. Several hypothetical assumptions were made about therapeutic setting and relationship and their suitability for this patient; they are shown to be highly effective and helpful later in the case (e.g. nondirective PP therapy was experienced as more helpful by the patient than directive CBT therapy).

The case demonstrates that insight-oriented, nondirective PP can yield significant successes for patients with bulimia nervosa who also display low reflective functioning and insecure attachments. This case is an important critical follow-up to larger RCT study, which by and large favoured CBT to PP for patients with eating disorders.