Insights from Qualitative Single Case Study Research in Counselling

When a client walks into a counsellor’s room, they bring with them a story that is entirely their own – shaped by their history, relationships, fears, and moments of courage. Understanding that story in its full depth is something standardised questionnaires and large-scale studies often struggle to do. This is where qualitative single case study research steps in. By focusing intensely on one individual’s therapeutic journey, this approach captures what numbers and averages simply cannot: the lived, subjective reality of therapy. For counselling practice, the insights it generates are not just academic – they are directly applicable, deeply human, and often revelatory.

What is qualitative single case study research? 🔗

At its core, a single case study is a concentrated, in-depth investigation of one individual, examined within the context of their therapy and personal circumstances. According to Stake (1995), case study research is an investigation intended to capture the complexity of the object of study – and a single case study does this by treating one person’s experience as a complete, holistic unit of inquiry. Unlike quantitative methods that look for patterns across populations, this approach asks: what is happening with this person, in this context, right now?

Qualitative single case studies offer insights into developmental processes within specific contexts, making it possible to examine in detail how therapeutic processes, relationship dynamics, and change trajectories unfold over time. From the earliest days of psychotherapy – when Freud’s case studies formed the foundation of psychoanalytic theory – case-based research has been central to how practitioners develop clinical understanding and refine their practice.

How it differs from quantitative approaches 🔗

The distinction between qualitative and quantitative research in counselling is fundamental. Quantitative research prioritises measurable variables, statistical significance, and generalisability across large groups. Qualitative single case research, by contrast, is rooted in a constructivist paradigm – it recognises that meaning is personal and context-dependent, and that a client’s psychological experience cannot be adequately reduced to numbers.

McLeod and Elliott (2011) argue that while randomised controlled trials are well-suited to assessing the causal impact of therapy, they overlook the complexity and uncertainty of everyday clinical reality. Qualitative case studies, by contrast, allow the detailed views and lived experience of clients to be documented, tracked over time, and interpreted in context – something large-scale studies are not built to do.

This does not make single case research less rigorous. More and more therapists are now willing to record therapy sessions, creating material that is open to analysis by researchers beyond the treating therapist – a significant shift from the older model of purely retrospective, therapist-authored accounts. The result is a methodology that is both systematic and deeply sensitive to individual experience.

Key methods of data collection 🔗

One of the distinguishing features of qualitative single case research is the range of data sources it draws on. Rather than relying on a single measure or observation, researchers typically combine multiple methods to build a rich, multidimensional picture of the client’s experience.

Therapy session recordings 🔗

Audio or video recordings of therapy sessions are among the most direct sources of data available to case study researchers. Recordings allow researchers to focus on interactions rather than taking extensive notes, capturing the full texture of a therapeutic exchange – including tone, pacing, and emotional register. Transcribed verbatim, these recordings become rich textual data for thematic analysis, identifying how a client describes their experiences, how they respond to interventions, and how their language shifts over time.

In-depth interviews 🔗

In-depth interviews are widely used in qualitative counselling research to capture clients’ first-person accounts of their experiences. Interviews can be conducted at multiple points – before, during, and after therapy – allowing researchers to trace how a client’s understanding of themselves and their difficulties evolves. They are particularly well-suited to exploring sensitive and complex experiences, since the conversational format allows clients to articulate meaning in their own words, with the researcher able to follow threads and probe for deeper understanding.

Diaries and personal journals 🔗

Qualitative diary designs have been used in counselling research to explore what happens between sessions – the connection between what occurs in therapy and a client’s day-to-day life. Unlike interviews, diaries capture experience close to the moment it occurs, rather than relying on retrospective recall. Multiple diary entries documented across a study can track changes in perspectives and experiences over time, revealing patterns that a single interview would miss entirely. They also offer a private, reflective space that encourages candour – clients may disclose thoughts in a diary that they would not readily articulate in a session.

The narrative and subjective emphasis 🔗

What sets qualitative single case research apart is its commitment to the narrative dimension of therapy. Rather than reducing therapeutic progress to scores on a symptom checklist, it attends to how clients construct and make sense of their experiences – the stories they tell, the meanings they assign, and the turning points they identify in their own healing.

Narrative case study analysis attempts to capture the experience of the client and use themes that emerge from that story to extend and enrich professional understanding. This is fundamentally different from an approach that treats a client as a data point. It positions the client as the primary authority on their own inner world – and the researcher’s task as listening carefully enough to understand it.

An interpretive or social constructivist approach to qualitative case study research supports a transactional method of inquiry, where the researcher engages personally with the case rather than observing from a detached distance. This is especially important in counselling, where the therapeutic relationship itself is a key mechanism of change – and therefore a key subject of study.

Etherington’s study of male survivors of sexual abuse 🔗

One of the most significant examples of qualitative single case research in counselling is the work of Kim Etherington at the University of Bristol. Etherington conducted in-depth interviews with adult males who had been sexually abused during childhood, producing first-person accounts of their experiences – their abuse, its impact on their psychosocial development, and their journeys through therapy. Her research was published in full in Adult Male Survivors of Childhood Sexual Abuse (1995), and built on through her later work on narrative approaches to working with this population.

Etherington’s research was groundbreaking for several reasons. First, it addressed a population that had been significantly underrepresented in the counselling literature – male survivors of abuse, for whom social norms around masculinity created additional barriers to disclosure and help-seeking. Second, it foregrounded the client’s own voice and narrative, rather than filtering experience through diagnostic categories or treatment protocols. Third, it raised important ethical questions about boundary issues and the dual role of counsellor-researcher – particularly around the tension between a therapist’s instinct to respond therapeutically and a researcher’s obligation to maintain the integrity of the research process.

Her work also highlighted the diversity of experiences within what might appear to be a single category of trauma. The men she interviewed had not followed a uniform path of suffering and recovery. Each had a distinct relationship to shame, self-understanding, and healing. This is precisely what qualitative single case methodology is built to reveal: not the average, but the particular.

What single case studies contribute to counselling practice 🔗

Case studies can be beneficial for investigating exceptions to general trends and giving voice to underrepresented experiences in psychotherapy research. This is one of their most important practical contributions. When a client does not respond in the way most clients do, or when an intervention works in an unexpected way, a single case study can help practitioners understand why – generating hypotheses that can then inform broader practice.

In the field of counsellor education, the natural boundedness of the fifty-minute therapy session or a protocol with distinct time limits is a good fit for case study methodology. This makes single case research particularly accessible to practising counsellors, who already work within clear structures and hold detailed knowledge of their clients’ histories.

There is also a cumulative function. Systematic case study research contributes to an evidence base for therapy policy and practice, especially when individual studies are published and made available for comparison across cases. A practitioner reading a well-documented case may recognise patterns from their own clinical work – and gain new insight into how to respond.

Limitations to consider 🔗

Qualitative single case studies are not without their challenges. Because findings focus on a specific individual and context, they are not easily generalised to broader populations – a significant limitation from an evidence-based practice standpoint. Methodological triangulation and multi-case approaches can help address this, but single case research is always primarily about depth over breadth.

There are also ethical complexities. In single case studies, the life-story of the client is likely to have unique features that may make the case identifiable to people close to them – a challenge that does not arise in the same way in large-N studies. Researchers must take particular care to protect anonymity and obtain meaningful informed consent, especially when working with survivors of trauma.

Researcher subjectivity is also a factor. Because the researcher is personally engaged with the material – conducting interviews, interpreting narratives, and drawing conclusions – their own assumptions and experiences can shape the analysis. This is not necessarily a flaw; reflexivity and transparency about the researcher’s positionality are considered marks of quality in qualitative work. But it requires ongoing self-awareness and honest accounting throughout the research process.

The value of the single story 🔗

In a research landscape often dominated by large datasets and standardised outcomes, qualitative single case study research insists on the value of the individual story. It holds that one person’s therapeutic journey – examined carefully, documented fully, and interpreted thoughtfully – can illuminate something important about the human experience of change, suffering, and healing. It is a methodology built not on the power of numbers, but on the power of attentive, rigorous listening.

For counsellors, this is not simply an academic concern. Every client who sits across from a therapist is, in a sense, a single case – a unique configuration of history, meaning, and need. Qualitative single case research formalises and extends the kind of attentive, contextually sensitive inquiry that good therapy already demands. It turns clinical observation into shareable knowledge, and in doing so, helps the whole profession learn.

What do you think? Can a single client’s story ever tell us something genuinely universal about the experience of therapy – or does the specificity of a case study always limit what we can learn from it? And how should counsellors navigate the ethical tension between their duty to a client and the demands of research when they occupy both roles simultaneously?

References

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