About PCSP

About PCSP

Pragmatic Case Studies in Psychotherapy (PCSP) is a peer-reviewed, open-access journal and database. It provides innovative, quantitative and qualitative knowledge about psychotherapy process and outcome, for both researchers and practitioners.

GOALS OF THE JOURNAL

1) To generate a growing database of systematic, rigorous, and peer-reviewed therapy case studies across a variety of theoretical approaches. These cases can serve:

A) as a source of guidance on individual cases for practicing clinicians.

B) as a research base for qualitative and quantitative cross-case analysis by researchers and theorists. This research base can be employed (a) to derive and test theory-based hypotheses about therapy process and change mechanisms; (b) to develop pragmatic, evidence-based, "best practice" guidelines for addressing particular types of cases; (c) to explore effective ways to combine qualitative and quantitative information; and (d) to compare, contrast, and/or integrate different theoretical approaches as applied to the same clinical facts in individual cases.

C) as a way to enhance the knowledge value of cases employed in quantitatively oriented therapy research involving either groups of therapy patients (e.g., efficacy research) or single-case research designs.

D) as a resource in therapist training, for both students, academic educators, and supervisors.

2) To pilot-test the special advantages of online, case study journals in applied psychology generally by exemplifying in detail their ability to make large amounts of qualitative and quantitative, peer-reviewed information particularly timely, accessible, searchable, and pragmatically and theoretically valuable.

3) To act as a vehicle for progress in therapy case-study method through the process of example, critical dialogue, and cross-case analysis.

BACKGROUND

In recent years, there has been a vigorous, renewed interest by applied psychology researchers and scholars in case studies of therapy -- and other psychosocial interventions -- whose process and outcome are systematically described with "thick" qualitative detail (see sample list of references below). These authors have been drawn to the case study from a variety of theoretical and applied perspectives, such as cognitive-behaviorism, psychoanalysis, phenomenology, hermeneutics, humanistic psychology, life-history, personology, and program evaluation. In spite of this diversity, these authors have offered converging rationales for restoring the case study to its former prominence as a vehicle for systematically reporting clinical observations, exploring theory, and documenting advances in professional effectiveness.

Furthermore, these authors have developed a variety of similar guidelines for improving the reliability and generalizablity of the case study's content. For example, Elliott, Fischer, and Rennie (1999) recently reported the following guidelines that emerged from a consensus-seeking process among psychotherapy researchers: "owning one's perspective," involving specification of factors like the author's theoretical orientation, personal anticipations, and values, and the role these play in the research design and conceptual analysis; "situationing the sample," by describing relevant contextual data about the subjects involved; "providing reliability checks," by the use of multiple qualitative analysts and/or a research "auditor"; and "grounding in examples." This latter guideline is analogous to reporting significance tests in quantitative research, in the sense that both types of research practices form the empirical basis of the logic for supporting conclusions about the phenomena being studied.

We believe that the scholarship, sophistication, vitality, and pragmatic import of this recent work in case study method, along with the power of electronic publishing and searchable databases, permits the field of professional psychology to take a ma jor leap forward towards the integration of theory, research and practice. Our aim is to maintain the clinical richness and creativity of the case study method while generating a database that permits cross-case comparisons and more generalized rules of psychotherapeutic practice.

Drawing on major themes in the new applied case research models, Fishman (1999, 2000, 2001) uses the term "pragmatic case study" to refer to systematic, qualitative case studies that capture the logic, process, and outcome of professional practice. Such case studies also include, where feasible and theoretically consistent, intake and outcome data on standardized quantitative measures to place an individual patient in normative context.

Fishman has illustrated the nature and theoretical and practical value of pragmatic case studies through article series in two journals: one involving 8 cases studies in forensic psychology (Fishman & Delahunty, 2003, 2004); and one involving 6 case studies in program planning & evaluation, and community psychology (Fishman & Neigher, 2003, 2004). In each of these series, there are complementary articles on case study method and cross-case comparisons. Broad-based, pragmatic case studies as applied to the arena of psychotherapy are the guiding model for the cases in PCSP. The location of pragmatic case studies within the larger psychotherapy research field is described below.

From Single Case to Database in Psychotherapy Research

There is a very well established tradition in psychotherapy research for evaluating the comparative efficacy and effectiveness of different types of clinical interventions across groups of similar kinds of patients. (For examples of efficacy research, which is experimentally based, see Nathan & Gorman [2002]; and for an example of effectiveness research, which is naturalistically-based, see Seligman [1996].) The late Kenneth Howard and his colleagues (e.g., Howard, Moras, Brill, Zoran, Martinovitch, & Lutz, 1996;) call this tradition "treatment-focused" research, because it views the intervention model and procedures as the basic unit of analysis.

Howard and his colleagues have pioneered and developed an alternative, complementary approach, which they call "patient-focused research," because it views the individual case as the basic unit of analysis. More specifically, working in this paradigm, Howard et al. began by developing a common, omnibus, psychometrically established database of quantitative indicators normed on large numbers of patients and the general population, including a summary mental health index (MHI) score. For the patient sample, these measures were collected at intake, during therapy, and at follow-up. Then, by administering the same quantitative measures to a new client, a patient's psychometric intake profile could be matched to a group of similar patients in the database, and that group could be used to generate the expected course of therapy over time on the MHI score for that patient. The resultant feedback of how the patient is doing over time is of important practical use to the practitioner, supervisor, and case manager. At follow-up, patients' information goes into the database, adding to the power of the database, which can be employed for research trends across groups of patients. Howard's group has successfully pilot-tested their paradigm and continue to develop it (Grissom, Lyons, & Lutz, 2002).

One major goal of Pragmatic Case Studies in Psychotherapy (PCSP) is to expand the Howard model into the qualitative sphere, adding the capacity to look in process detail at cases that are normatively contextualized with quantitative measures like Howard's. In addition, PCSP is interested in other case study paradigms that focus on qualitative data per se. Specifically, while we expect many of the cases to be quantitatively contextualized, we anticipate other cases where quantitative measures are not feasible or where the author argues that quantitative data are not compatible w ith the theoretical model employed in the case. We believe that having such cases side by side with those that are quantitatively contextualized will stimulate constructive discussion and exploration of the potentials and limits of quantification in researching therapy.

In order to facilitate comparison among cases, it is important to strive for a common framework and structure embodied in common headings -- within each case. The editors of PCSP have chosen to begin their project with a framework developed by Donald Peterson (1997) titled "Disciplined Inquiry." This model has been chosen because it can accommodate (a) a wide array of different theoretical approaches, such as cognitive behavior therapy, psychodynamic therapy, humanistic therapy, and family systems; (b) the whole continuum defined by highly manualized treatment models at one end, highly individualized therapy at the other end, and some type of synthesis in the middle (e.g., Davison, 1998; Kendall, Chu, Gifford, Hayes, & Nauta, 1998; Persons, 2003); (c) and a variety of models of how the most effective practitioners in many fields actually function (e.g., the models of Schön's [1987] "reflective practitioner" and Stricker & Trierweiler's [1995] "local clinical scientist").

Briefly, Disciplined Inquiry requires the practitioner to lay out his or her "guiding conception" of therapy," as informed by published research and the practitioner's clinical experience. This guiding conception is then employed to create an individualized assessment, formulation, and treatment plan for the client. Interventions are next carried out -- with appropriate monitoring and feedback -- until termination, follow-up, and a concluding evaluation. (For a more detailed description of this Disciplined Inquiry, see Instructions for Authors.)

Clearly, the results of a single case study lack the ability for deductive generalization to other similar situations that is found in a group study. However, in line with the Howard et al. model, collections of case studies develop the capacity for inductive generalization to other, similar settings. This capacity can come about by organizing case studies of patients with similar target goals and similar intervention approaches into databases. For example, consider the application of cognitive behavior therapy to a phobia in a middle-class, professional Latina woman who has associated depressive symptoms, marital difficulties, and alcohol problems. Or consider family therapy with a poor, White teenager who is also a single mother of a child with attention deficit disorder. A write-up of either case is limited in terms of the number of case situations in the future to which it will apply. This limitation is due to large contextual differences that can occur between any one case and any other case that is randomly drawn out of a heterogeneous case pool.

However, as cases in the database grow, they begin to sample a wide variety of contextually different situations in which the target problem can occur and a wide variety of intervention approaches for that problem. Therefore, as the number of cases in the database rises substantially, the probability increases: (a) that there exist specific cases in the database that are pragmatically relevant to a new target case in terms of both the nature of the target problem and the intervention approach employed; and (b) that there are groups of cases that are contextually similar enough to inductively create general guidelines for working with and theoretically understanding such cases. (Note that this "case-based reasoning" [e.g., Fishman, 1999, 2003] is similar to the use of the Westlaw and Lexis databases in the legal profession.) To accomplish (a) and (b) involves a capacity for appropriate case-finding and for performing cross-case analyses where the units of study are in a large database with detailed qualitative data. These tasks seem only feasible with the online capacities of a journal like PCSP.

In sum, we have three broad goals for PCSP. First, the journal should be a vehicle for progress in therapy case study method through the process of example and critical dialogue. Second, the journal should be a vehicle for creating a growing database of systematic, rigorous, and peer-reviewed therapy case studies, which can serve as a systematic knowledge resource for practicing clinicians, for researchers and theorists, and for therapy educators and students. Finally, we view PCSP as an opportunity within the field of applied psychology generally to prove the special advantages of online journals in their ability to make large amounts of qualitative, peer-reviewed information particularly timely, accessible, searchable, and pragmatically and theoretically valuable.

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(* references specifically cited in the text)

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