Social Factors in the Case Study

Some years ago, I heard a colleague who was giving a paper make a joking aside about the unforeseen consequences of preserving confidentiality in case presentations. I'm not sure whether this is an old shrink's tale or it really happened, but the story he told was about someone who had published a paper about a client with asthma problems and a host of other psychological issues. Some enterprising behavioral medicine psychologist/researcher read the paper and thought he recognized important correlations between the psychic issues the patient had and the condition of asthma. So he began a research project that attempted to replicate these correlations, but the research project ended with no significant results. The researcher wrote to the person who had published the paper and found out, to his dismay, that the therapist had been trying to disguise his patient to preserve confidentiality, and one way he did so was to substitute asthma for what was really a gastrointestinal problem. At the time, I, and the rest of the audience, thought this was hilariously funny. But now, several years later, and two or three published case studies later, I don't find it funny at all. Indeed, I am rather paralyzed at the moment with regard to the ethics and conventions of both publishing case studies and of using them for instruction.

The case study is both one of the discipline's primary research tools and one of its primary teaching tools. It presents enormous learning possibilities but also raises a lot of ethical concerns. One of the things that makes therapy work is the assumption between patient and therapist of strict confidentiality. Thus, when writing a case study, particularly one in which treatment is ongoing, we must take great care to disguise our patients' identities. But as we know from the cases of Anna O., Dora, the Wolf man, etc., the disguises have never been good enough to keep the subject from being unmasked. In my own experience, it has been clear that any relativ