A Life-Saving Therapy: The Theory-Building Case of "Cora"

The present paper presents a case study of long-term (121 sessions over three years), integrative therapy with "Cora," a client with a history of severe relational trauma that had led to difficulty in forming close relationships, and a history of hospitalization resulting from a series of suicide attempts. Despite these challenges, Cora reported a highly satisfactory outcome at the end of therapy. Using the format of a theory-building case study (McLeod, 2010; Stiles, 2007), qualitative analysis of session evaluations, session transcripts, and post therapy interviews were used to investigate how both the client and therapist understood the process of therapy and why it had been successful. Data from quantitative process and outcome measures were analyzed to provide contextual information. In spite of repeated challenges and difficult therapeutic situations, Cora and the therapist were able to establish a recurring pattern of interaction that they found relevant and productive and that was characterized by persistence. Other helpful aspects of the therapy process included acting with courage, and the use of symbolic representations of their accomplishments. The results contribute to our understanding of the process of therapy with clients who have been exposed to severe relational trauma. The discussion includes reflection on methodological issues associated with mixed-methods case study research in psychotherapy