A possible typology of case studies in the Feldenkrais Method*

A tension exists in neurology between those who believe that the most valuable lessons about the brain can be learned from statistical analyses involving large numbers of patients and those who believe that doing the right kind of experiments with the right kind of patients – even a single patient – can yield much more useful information. This is really a silly debate since its resolution is obvious: It's a good idea to begin with experiments on single cases and then to confirm the findings through studies of additional patients. (Ramachandran and Blakeslee, p. xiii)

Why case studies?

A case study is a study that can be described in terms of a single system, person, event, program, etc. They are used in a great variety of field and utilize a wide range of research methods, styles of reports, purposes, etc. For example, they may include qualitative, quantitative or a mix of data. Moshe Feldenkrais was familiar with and often referred to thinkers who make powerful use of case studies and histories (including A.R. Luria, Konrad Lorenz, Sigmund Freud, Charles Darwin, Jean Piaget, Milton Erikson, amongst others). He used ‘teaching stories’ extensively in his writing and in the training programs he conducted in San Francisco and Amherst. The wonderful and informative book The Case of Nora was just the first of a series of case studies he had planned.

Interestingly the early volumes of the FGNA’s Journal of the Feldenkrais Method featured many case studies. Likewise two issues of the IFF Journal featured case studie (including reproducing some from the Journal of the Feldenkrais Method). Perhaps this is reflective of the value of the case study as a form for exploration and clarification for those practitioners who were writing in the early days of the practice of the Method by practitioners other than Moshe Feldenkrais himself.

Recognition of the value of case studies, and the culture of writing case studies, is reflected in the fact that case studies are part of the requirements for advancement to become a teacher of Feldenkrais teachers – in the assessment requirements to become a Feldenkrais Assistant Trainer and Trainer Candidate.

Observation and documentation are fundamental to the development of any practice, including science. The natural sciences are based on hundreds – or thousands – of years of naturalistic observation before the development of the repeatable studies, sophisticated instrumentation and the formulation of the laws we associate with the ‘hard’ sciences. It is hardly surprising that the typical narrative case study, with its emphasis on observation and description, was a chosen form in the early days of reflection on the new kinds of knowledge and practice afforded by the Feldenkrais Method.

Intentions and Audiences

The intentions we have for our case study research and it’s intended audience will have a major influence on the kinds of case studies written.

Two of the most common questions of our Feldenkrais students and clients are ‘what is it like?’ and ‘how will I benefit?’. If we are thinking about informing the public, case studies using expression close to everyday language, and using a narrative form, can provide effective description of the process and outcomes of the Method.

For research into our own practice, case studies can afford both the writer and reader:

– a better understanding of the Feldenkrais Method itself, and our practice

– a chance to improve our own and our colleagues practice

– a way to clarify relationships between theory and practice.

For research into our own practice a mix of description of actual practice, with reflection on different aspects of the theory underlying the Method, may be the most effective form for a case study.

For research into the Method, case studies can provide information and ideas toward further and better research, including better research questions, methodologies, tools and measures, etc. Or to paraphrase Alan Fogel, if you don’t know what the intervention is you won’t be able to know what outcomes to measure. Researchers that want to collaborate with us, or we want to collaborate with, may get a better feel for the Method from the ‘thick description’ of a descriptive case study. They may get ideas for appropriate research strategies from a case study using a mix of documentation of the intervention, outcomes surveys and qualitative data such as interviews with students or clients, and the like.

Possibilities offered by case study research

Case study based research affords some unique possibilities not always offered by other approaches. Depending on which of these possibilities is emphasized, these emphases are likely to influence the kind of case study that ends up being written.

Case study research can be practical. As Alan Fogel has said, ‘Research is not so far away…’. When writing a narrative or a reflective case study, it is close to what we already do in practice: reflecting on practice, take notes, etc. Most such case studies will not need a lot of preparation, large team, lots of funding, etc.

Case study research suits the complexity of professional practice. Professional practice is always unique, case study research can capture things about the apractice of the Feldenkrais Method that other kinds of research cannot (Jarvis). For example it can capture our reflection on our ‘reflection-in-practice’ (Schön). A case study can allow for the study of complex relationships between the practitioner and student, the person and their environment, history, ‘variables’ in the ‘intervention’, etc. Here reflection is emphasised.

Sometimes a single case can be as illuminating as a population study. In some areas of knowledge more understanding can be gained from studying unique cases than population studies, averages, etc. (Ramachandran, Sacks). Both the study of a single person’s situation or the study of a single ‘intervention’ could be very illuminating.

A researcher's experience can be included as part of the research process. Feldenkrais practice almost always involves the presence of a live teacher-practitioner.** Consistent with anthropological, qualitative and phenomenological approaches to research, a case study can include the practitioner’s own experience. (Meriam, Joly). Description and reflection are the order of the day in this approach.

The subject’s (client’s or student’s) experience may be included. Such a case study may include sections of a journal or interview material from a client. Or a project could be done collaboratively with clients or students using a ‘new paradigm research’ model (Reason and Rowan).

It can trace the progress of the person, etc. The Feldenkrais Method involves learning and development. Case study research can capture a variety of changes over time and explore their interrelationship. This could be done in a narrative form, or as a single case research design approach using, an A (before), B (during), A (after) could be used to administer a variety of appropriate measures (eg. quality of life questionnaires, range of motion tests, etc.). That is, a case study of a ‘single system research design’.

Possible sources of data

Finally, the types and sources of data chosen for any case study will have a major impact of the type of study written. And conversely the type of case study one intends to write critically affects the data collection processes used.

Data sources for Feldenkrais case studies could include:

1. Practitioner notes, diary, interview with a co-researcher, commentaries on documentation (Joly project), or dialogues with co-researchers (‘new paradigm research’ includes the possibly of including other practitioners, and the client or student. For example, a case study written by Barbara Pieper includes contributions both from her as the practitioner and the client.

2. Client or student diaries, evaluations, interviews, questionnaires (eg. standardized measures, eg. quality of life measures (such as the SF 36 and others)

3. Objective measure of client or student ‘action’ (eg. video/digital motion analysis)

4. Audio-visual documentation (eg. video of FI, eg. Joly project)

5. Relevant literature: Feldenkrais Method (eg. published ATMs that relate to described FI), other case studies, empirical studies, Feldenkrais ‘theory’, research and theory from other domains (eg. neuroscience, biomechanics, psychology, etc). In anthropology case notes are written into anthropological monographs in the context of the ongoing development of anthropological thought (Geertz). The case studies become ‘the literature’.

One example of the use of mixed measures can be found in the single case research design developed by Stephens, et al (poster presentation 2004 FGNA Conference). That study involved a literature review, brief descriptions (case histories, biographies and demographics) of participants, qualitative (subjective) feedback from participants (self-reports), video motional analysis of two movement activities, documentation of ATM class themes and content – excerpts from transcripts of audio recordings, standardized measures of incapacity, indexes of well being, and questionnaires with open ended questions. It also used a pre-program (base line) and end of program re-testing, questionnaires, etc. The methodology used was a simple ‘ABA’ (pre-test, intervention, re-test) design.

A possible Typology of Feldenkrais Method Case Studies

In this possible typology four kinds of existing or putative Feldenkrais case studies have been identified:

  • Narrative/Naturalistic;
  • Reflective
  • Mixed Measures (qualitative & quantitative) Single (or multiple) Case Study;
  • Single System Research Design (experimental model),

and mapped against a set of criteria or descriptors:

  • Selection of subject(s)
  • Number of subjects
  • Researcher
  • Research questions
  • Data Collection
  • Practitioner experience
  • Relationship to theory & other sources
  • Reflection on language
  • Style of ‘argument’ in report
  • Style of published report
  • Main uses
  • Examples in the Feldenkrais literature

to map out the characteristics and possible uses and benefits of each type.

 

Narrative

/Naturalistic

Reflective

Mixed Measures (qualitative & quantitative) Single (or multiple) Case Study

Single System Research Design

(experimental model)

Selection of subject(s)

Subject selected by researcher-practitioner

Subject(s) selected by researcher-practitioner

Probably selected against criteria

Probably selected against criteria

Number of subjects

Usually one

One or more

Single (N=1) or multiple

Single (N=1) or multiple

Researcher

Single practitioner; peer reviewed for publication

Single practitioner; peer reviewed for publication; Possibly include client-student explicitly (eg. Pieper, unpublished)

Multiple researchers (practitioners & others); Reviewed by peers & people in other fields for publication

Multiple researchers (practitioners & others); Reviewed by peers & people in other fields for publication

Research questions

Likely to be no theory-testing intent

May be explicit or generated by the study

Research issues discussed & explored; May include a formal literature review

Hypothesis explicit & stated; Formal literature review

Data Collection

Practitioner observation & note taking; Client reports of situation as reported by the practitioner; Data treated as non-problematic

Practitioner observation & note taking; Readings of relevant literature (eg. Feldenkrais, Rywerant, Ginsberg, Lambert), Possibly documentation, eg. photos

Quantitative or qualitative, or a mix; May include pre-test & post test data, as well as collection throughout or at end of intervention, Documentation of process

Base line data established before intervention, plus data collection through or at end of intervention, eg: ABABA, etc.

May include multiple interventions, eg. ABACAD, etc.

Practitioner experience

Essential

Included, may be explicitly reflected on

May be included, but likely to be more formal documentation

More likely to be more formal documentation

Relationship to theory & other sources

Implicitly (& sometimes explicitly) refers to theory or the Feldenkrais Method

Explicit reference to theory from FK & outside (eg. neuroscience, medical or arts literature)

Reflection on theory, generation of research questions from documentation, measurement & discussion

Testing of theory or predictions from base line

Reflection on language

Language & terms treated as non-problematic

Language & terms may be reflected upon

Terms defined

Terms defined

Style of ‘argument’ in report

‘Arguments’ about process, outcomes, efficacy, variables mostly made through narrative structure & description; Use of literary tools.

Switching between descriptive & reflection/ interpretation; Assumptions
made explicit (‘bracketed’), may include researcher reflection on process; Use of documents (Joly)

Blends reflection on documentation of the intervention, outcomes of qualitative & quantitative measures

Statistical (eg. over time, baseline, before & after interventions) & interpretation

Style of published report

Richly descriptive

Switches from description to reflection on theory/theory generation

Combines literature review, presentation of results documentation & measurements, discussion of results

Combines literature review, presentation of results of measurements, discussion of results

Main uses

Basic research/ research into practice, Promoting Method

Reflection on practice & relationship to theory

Documenting outcomes; Identifying further research themes
& tools

Documenting outcomes; Identifying further research themes & tools

Examples in the Feldenkrais literature

Many case studies in Feldenkrais journals, poster presentations at this Conference

Feldenkrais (Case of Nora), Beringer (in Groundworks and Self-Imaging), Ginsberg (Roots of Functional Integration)

Stephens, et al, (MS study), poster presentations at this Conference

(none)

Some final reflections

The above is only a very preliminary schema, but I hope it provides a rough guide to where we have been and where we might go in terms of case study based research. Like all travel guides it can only be of value of if it is used and updated with input from the users. Please send me any feedback on this typology and its possible uses.

I am a believer in the value of writing case studies for the development of ourselves as practitioners. I also believe case studies has ongoing value for the development of our understanding of the Feldenkrais Method and the development of our research agenda. I would love to see the further publication of already written and new case studies as part of this Journal or as a separate project of the international Feldenkrais professional community. Perhaps there are a number of practitioners interested in working on such a project?

In the mean time: reflect, take some notes on a client or a session or a class, talk with a colleague, rough out some ideas about a research project…

Notes

*This article is based on a presentation at the Research Forum at the FGNA Conference in Seattle, Washington in 2004. Thanks for Pat Buchanan and Jim Stephens for their assistance with editing the original presentation.

**Which is why some controlled studies of the effects of as aspect of the Feldenkrais Method have chosen to use a recorded Awareness Through Movement lesson as the ‘intervention’ for the purposes of the study.

References

These are come of the materials I used in preparation of the original August 2004 presentation. New editions of the books may be available. The URLs still work as of November 2008. And one new reference:

Alan Fogel, Documenting Cases as a Participant Observer: A Manual for Somatic Awareness Practitioners, IFF Research Journal, Vol. 3, 2006-2007

General: Case Studies and Research

Peter Jarvis, The Practitioner-Researcher: Developing Theory from Practice, Jossey-Bass, San Francisco, 1999

Sharan B. Merriam, Qualitative Research and Case Study Applications in Education (revised and expanded from Case Study Research in Education), Jossey-Bass, San Francisco, 1998

V.S. Ramachandran and Sandra Blackslee, Phantoms in the Brain, William Morrow and Co, NY, 1998 (See: Preface, pp. xi-xvii).

Oliver Sacks, An Anthropologist on Mars, Vintage/Random House, NY, 1995 (See: Preface, pp. xv-xx)

Robert K Yin, Case Study Research: Design and Methods, Sage Publications, Thousand Oaks, California, 1994

Narrative/Thick Description/Phenomenological & Anthropological Research Methods/New Paradigm/Collaborative Research

Robert M. Emerson, Rachel I. Fretz, and Linda L Shaw, Writing Ethnographic Field Notes, University of Chicago Press, Chicago and London , 1995

Julia Epstein, Altered Conditions: Disease, Medicine and Storytelling, Routledge, NY and London, 1995

Clifford Geertz, The Interpretation of Cultures: Selected Essays, Basic Books, NY, 1973 (See: Part 1: Thick Description: Toward an Interpretive Theory of Culture)

Yvan Joly, The Experience of Being Embodied: Qualitiative Research and Somatic Education: A perspective based on the Feldenkrais Method, IFF Research Journal, No.1, 2004, IFF Academy, International Feldenkrais Federation

Don Hanlon Johnson (ed), Body Making, pp. 1-13, Groundworks: Narratives of Embodiment, North Atlantic Books, Berkeley, California/California Institute of Integral Studies, San Francisco, California, 1997

Don Hanlon Johnson, Body Practices and Human Inquiry: Disciplined Experiencing, Fresh Thinking, Vigorous Language, Chapter in: Vincent Berdayes (ed), The Body in Human Inquiry Interdisciplinary Explorations of Embodiment, in publication. (Available at: www.donhanlonjohnson.com)

Peter Reason and John Rowan (eds), Human Inquiry: A Sourcebook of New Paradigm Research, John Wiley and Sons, Chichester & New York, 1981

Peter Reason (ed), Human Inquiry in Action: Developments in New Paradigm Research, Sage Publications, London, 1998

Single Case Research Designs

David Aldridge Single Case Research Design for the Clinician, Complementary Medical Research, 1988; 3 (1), pp.37-46. (Available at: www.musictherapyworld.net/modules/archive/papers/list_all.php?orderby=title)

Neville M. Blampied, Arreed Barabasz and Marianne Barabasz, Single Case Research Design for the Science and Practice of Neurotherapy, Journal of Neurotherapy, (1-2) 2. (Available at: http://209.85.173.132/search?q=cache:zIgIIll4EUUJ:www.isnr.org/uploads/(1-4)1.pdf+,+Single+Case+Research+Design+for+
the+Science+and+Practice+of+Neurotherapy
&hl=en&ct=clnk&cd=1&gl=us
)

Alan E. Kazdin, Single Case Research Designs: Methods for clinical and applied settings, Oxford University Press, New York, 1982.

Douglas W Smith, Annotated Bibliography of Single-Subject Design. (Available at: http://silcom.com/~dwsmith/Critical_Assessment/annobib.html).

Donna M. Zucker, Using Case Study Methodology in Nursing Research, The Qualitative Report, Volume 6, Number 2, June 2001. (Available at: www.nova.edu/sss/QR/QR6-2/zucker.html)

Feldenkrais Case Studies

All the published case studies from all editions of the Journal of the Feldenkrais Method and the IFF Journal.

Elizabeth Beringer, Feldenkrais: Introduction, Heather, pp. 81-99 in Groundworks: Narratives of Embodiment, North Atlantic Books, Berkeley, California/California Institute of Integral Studies, San Francisco, California, 1997.

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