Pragmatic Case Studies in Psychotherapy

What Can We Learn About Therapeutic Change From Case History Data? The Research Jury Method with the Couple Case of "Carl" and "Sandra"

2021-08-11T21:39:37-07:00

The purpose of this study was to explore the usefulness of using case history data to assess change in psychotherapy. This was a follow up to previous investigations utilizing a "research jury method" to evaluate psychotherapy outcome. Three judges studied the critical first five sessions of a ten session video of emotionally focused therapy with a couple, Carl and Sandra. They took intensive notes and then functioned as a "jury"” to evaluate the evidence. They concluded that the evidence from within the case history is strong that the couple changed for the better. The evidence also supported the conclusion that therapy contributed to the change, although, by their judgment, at the "preponderance of evidence" level. Finally, the evidence was used to evaluate how therapy contributed to change. It was concluded that the most likely factors contributed by the therapist were her helping the couple see that each other’s underlying intentions were positive, and by fostering their hope. Evidence also supported the contributions the clients themselves made through their taking responsibility for themselves, through their exploring their past experiences, and through their creativity. Limitations are discussed and conclusions for the evaluation of psychotherapy are drawn.

The Adjudicated Case Study Method, Part 2: Editor’s Introduction

2021-08-12T17:40:03-07:00

This article introduces readers to the present PCSP issue on the "adjudicated case study method." This method employs concepts from the law for evaluating qualitative information to determine the truth of statements about human psychology and behavior, including causal statements about psychotherapy outcome. Two models of the adjudicated case study method, which were originally presented in PCSP in 2011, are covered: Ronald Miller’s "Panels of Psychological Inquiry" (PPI), and Arthur Bohart’s "Research Jury Method." The issue concludes with a Commentary by Robert Elliott, Susan Stephen, and Anna Robinson.

Commentary—Extending the Boundaries of Systematic Case Study Research: Conceptual and Methodological Issues

2021-08-10T11:54:44-07:00

In this commentary we discuss the two examples of systematic case study research in this issue: Miller et al., (2021), who continue the development of the quasi-judicial Panels of Psychological Inquiry method by applying it to a child client with an autistic spectrum condition; and Bohart et al. (2021), who apply their research jury approach to a video recorded case of Emotionally-Focused Therapy for couples. We open by briefly summarizing the main issues addressed in our previous commentary (Stephen & Elliott, 2011), which involved the same authors; we also note some key developments in systematic case study research over the past ten years. The rest of our commentary is divided into three parts. First, we look at more general conceptual issues in systematic case study research, including situations in which systematic case studies are likely to be most useful; the problem of overly broad research questions; the definition and assessment of outcome; and the thorny issue of causality. In the second part, we turn our attention to methodological issues raised by the two articles, returning to the questions of what counts as evidence in systematic case study research (here the use of observational methods for assessing client change and change processes), but also to the processes by which research judges or jurors make decisions about knowledge claims and methods for generalizing from one case to other cases. In the final main section, we offer more substantive commentary on Miller et al. (2021), from the point of view of autism research. We start by putting the DIR/Floortime intervention in context before raising key diagnostic issues that we think circumscribe the case and spelling out uncertainties about the nature of the intervention used. We round off this section with a set of proposals for future systematic single case research on interventions for autism. We close our commentary with a brief set of recommendations.

Further Developments in the Panel of Psychological Inquiry Method of Case Study Research: The Case of "Ronan"

2021-08-12T17:52:36-07:00

In 2011 our research group published a pilot study—the Case of "Anna"—employing the Panel of Psychological Inquiry (PPI) Clinical Case Study Method. The present study—the Case of "Ronan"—is a second example of the PPI method in action. The Case of Ronan has a number of modifications in method compared to the Case of Anna. First, the Case of Ronan involves the evaluation of a more complex and controversial written case study of a 20-month old boy who was diagnosed with moderate to severe autism spectrum disorder (ASD), and who was treated in a comprehensive therapeutic daycare center program where the core approach was based upon Greenspan’s (2009) "Developmental, Individual-differences, Relationship-based" ("DIR"/ "Floortime") model. DIR/Floortime was originally developed for use by parents in their own homes, and the Case of Ronan demonstrates how a therapeutic pre-school environment can use DIR/Floortime as a model for most adult-child interactions in a pre-school therapeutic environment. In addition to the application of the PPI model to a radically different clinical diagnosis, there were modifications to the methodology itself including: (a) reduction in the number of judges from five to three; (b) having a key witness in the case testify remotely before the Panel; (c) the writing of a much more detailed judges’ opinion on the aspects of the case that most influenced their decisions; and (d) a further development of the logic of a quasi-judicial approach to clinical case studies in psychology. By examining how the civil law’s basic framework for proving causality in cases of personal injury (who did what harm to whom), the process by which knowledge claims that emerge out of clinical practice (who provided what benefit to whom) is further explicated.