Pragmatic Case Studies in Psychotherapy

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July 25, 2020 -- From the Editor 


A Telephone-Based, Clinician-Guided Self-Help Cognitive Behavioral Therapy for Depression in Parkinson’s Disease (dPD): The Responder Cases of “Alice” and “Carl,” and the Nonresponder Cases of “Ethan” and “Gary”  

*** Logan Durland, Springfield Psychological, Springfield, Pennsylvania  


*** Sarah L. Mann, Rachael Miller, & Lauren St. Hill of VA New Jersey Health Care System, Lyons, NJ; and Roseanne Dobkin of Rutgers—Robert Wood Johnson Medical School, Piscataway, NJ   

*** Liza Pincus, Graduate School of Applied & Professional Psychology, Rutgers-New Brunswick, NJ  

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        Parkinson's disease (PD) is a common and highly debilitating, degenerative, longterm neurological disorder of the central nervous system that mainly affects motor functions, with symptoms like tremors, shaking, rigidity, slowness of movement, and difficulty walking. In addition to motor symptoms, many PD patients suffer from cognitive symptoms, including the deterioration of executive function and memory, and sleep disorders.

        With such losses, it is not surprising that PD patients react to their symptoms with depression and anxiety, which in turn exacerbate the original physical and cognitive symptoms.

        Roseanne Dobkin, of Rutgers—Robert Woods Johnson Medical School, together with her research team have adapted standard cognitive-behavioral therapy (CBT) techniques for depression in non-PD patients to the therapeutic needs of PD patients. This adaptation includes modules for patients on exercise, behavioral activation, thought monitoring and restructuring, relaxation training, worry control, and sleep hygiene; together with psychoeducation and skill building for caregivers intended to provide them with the skills needed to facilitate patients’ home-based practice of CBT techniques.

        Dobkin et al. package their CBT techniques in a "guided self-help" approach to treatment. This involves providing modules of educational materials on the intervention techniques in hard copy or digital form to the patients and their caregivers. In addition, there is regular telephone-based contact with a therapist to help the patient and caregiver team best utilize the module materials.

        In the Dobkin et al. program, participants and their caregivers receive 10 weekly individual sessions (60–75 minutes) of manualized CBT, supplemented by four separate individual caregiver educational sessions (30–45 minutes).

        Dobkin et al.’s program has empirically been shown to be strongly effective, in both group pilot studies and in a recently published randomized clinical trial (RCT).

        This issue of PCSP describes four systematic case studies conducted by therapist Logan Durland of patients who were drawn from Dobkin et al.’s group research, including the RCT. These case studies include two “responders” who had positive outcomes (“Alice” and “Carl”), and two “nonresponders,” who had poor outcomes (“Ethan” and “Gary”).

         As mentioned, overall the Dobkin et al. treatment approach is effective. However, the rich process detail in the four case studies -- together with intensive, critical analysis of that process by therapist Durland -- brings out the complex interplay of a variety of impactful factors that contribute to positive versus negative outcomes. These factors are independent of the substance of the CBT procedures and include patient variables, caregiver variables, patient-caregiver dynamics, and the therapist-patient-caregiver relationship.  

        A Commentary by members of Dobkins’ research team, including Sarah Mann, Rachael Miller, Lauren St. Hill, and Dobkins herself, further explores the variety of factors going into tailoring treatment to the individualized needs of each patient.

        A second Commentary by Liza Pincus focuses on the implications of Durland’s case studies for the general practice of teletherapy in today's world of Covid-19.

        The issue ends with a Response to the Commentaries by Durland.   


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PCSP is a peer-reviewed, open-access journal and database. It is intended to provide innovative, quantitative and qualitative knowledge about psychotherapy process and outcome, for both researchers and practitioners.

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** Manuscripts. Two types of manuscripts are desired: those consisting of one or more case studies, and those consisting of case method articles.

** Suggested Author Guidelines. These can be found by clicking on the link Instructions for Authors, as described above. Note that we suggest 11 common headings for case study manuscripts:
1. Case Context and Method
2. The Client
3. Guiding Conception with Research and Clinical Experience Support
4. Assessment of the Client's Problems, Goals, Strengths, and History.
5. Formulation and Treatment Plan
6. Course of Therapy
7. Therapy Monitoring and Use of Feedback Information
8. Concluding Evaluation of the Therapy's Process and Outcome
9. References
10. Tables (optional)
11. Figures (optional)
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Vol 16, No 1 (2020)

Table of Contents

Case Study

Logan Durland
Sarah L Mann, Rachael Miller, Lauren St. Hill, Roseanne D. Dobkin
Liza E. Pincus
Logan Durland