Pragmatic Case Studies in Psychotherapy

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January 9, 2020 -- From the Editor 



Affect Phobia Therapy for Mild to Moderate Alcohol Use Disorder: The Cases of "Carey," "Michelle," and "Mary"

*** My Frankl, Linkoping University, Sweden; and Stockholm Center for Dependency Disorders, Sweden 

*** Peter Wennberg, Stockholm University, Sweden; and Karolinska Institutet, Stockholm, Sweden

*** Lene Berggraf, Mod Bad Psychiatric Center, Vikersund, Norway

*** Bjorn Philips, Linkoping University, Sweden; Stockholm Center for Dependency Disorders, Sweden; and Karolinska Institutet, Stockholm, Sweden  


*** Kristen Osborn, Harvard Medical School, Boston, MA; Strategic Psychotherapeutics, Glastonbury, CT; and Kaizen Brain Center, LaJolla, CA 

*** Bjorn Philips, Linkoping University, Sweden; Stockholm Center for Dependency Disorders, Sweden; and Karolinska Institutet, Stockholm, Sweden


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        The late clinical psychologist Leigh McCullough developed the concept of "affect phobia," a fear of feelings—some positive, like joy and closeness, and some negative, like grief and anger/self-assertion. This affect phobia leads an individual to engage in maladaptive, defensive maneuvers to avoid or otherwise mis-control feelings, maneuvers that are manifested as psychological symptoms.

        The present series of case studies by therapist and researcher My Frankl and her colleagues is based on the hypothesis that mild to moderate Alcohol Use Disorder (AUD) is one of these defensive ways, and thus that Affect Phobias Therapy (APT)—designed to address the fear of feelings—can be successful in reducing AUD.

        Specifically, in the role of therapist, Frankl employed the APT manual to individually treat three women with mild to moderate AUD, whom she names "Carey," "Michelle," and "Mary." These women were representatively drawn from a large public-sector addiction clinic in Stockholm, Sweden.

        Carey’s therapy was very successful, and the other two patients, while expressing commitment to the therapy and showing some gains, were generally not successful. The three women all had mild to moderate AUD, were somewhat similar demographically, and had the same therapist who employed the same APT manual. Thus, a comparison of the three cases yields important information about the interaction between the APT treatment, on the one hand, and the patients’ different personality dynamics and the different therapist-patient relationships that were developed, on the other. 

        Two commentaries follow Frankl et al.’s cases. In the first, Kristin Osborn applies her extensive clinical experience in conducting and teaching APT to further apply APT concepts to the therapy process in Frankl’s three cases. In addition, Osborn describes the use of two systematic process measures, not used in Frankl’s case studies: the “Ten-Session Summary Form,” and the micro-process coding approach of the “Achievement of Therapeutic Objectives Scales” (ATOS). 

        Since these two measures help to operationally define the core APT concepts into specific behaviors, statements, and emotional responses, Osborn discusses how these measures could have enhanced our understanding of what was happening in Frankl’s therapies. (In her response to the commentaries, Frankl enthusiastically agrees but points out that since her research design focused on efficiency in creating a short, first-line treatment, she did not have the extensive resources needed to complete these measures.)

        The second commentary is by Bjorn Philips, who is Frankl’s main research supervisor and is also a co-author of the Frankl et al. case studies article. Phillips focuses on Frankl’s use of systematic, qualitatively thick case study methodology and compares such research to other approaches Philips has employed in his career: randomized controlled trials, experimental N=1 case designs, and process research. Philips explores the ways in which these different methodologies can complement one another in terms of providing alternative perspectives on therapy process and outcome.  


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Vol 15, No 3 (2019)

Table of Contents

Case Study

My Frankl, Peter Wennberg, Lene Berggraf, Bjorn Philips
Kristen A.R. Osborn
Bjorn Philips
My Frankl