Table Of Contenti
Case Studies Within Psychotherapy Trials
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Case Studies Within
Psychotherapy Trials
Integrating Qualitative and Quantitative
Methods
EDITED BY
DANIEL B. FISHMAN
STANLEY B. MESSER
DAVID J.A. EDWARDS
FRANK M. DATTILIO
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1
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Library of Congress Cataloging-in-Publication Data
Names: Fishman, Daniel B., editor. | Messer, Stanley B., editor. |
Edwards, D. J. A., editor. | Dattilio, Frank M., editor.
Title: Case studies within psychotherapy trials : integrating
qualitative and quantitative methods / edited by Daniel B. Fishman,
Stanley B. Messer, David J.A. Edwards, and Frank M. Dattilio.
Description: Oxford ; New York : Oxford University Press, [2017] |
Includes bibliographical references and index.
Identifiers: LCCN 2016027783 (print) | LCCN 2016029927 (ebook) |
ISBN 9780199344635 | ISBN 9780199344642 (ebook)
Subjects: | MESH: Psychotherapy—methods | Research Design | Case Reports
Classification: LCC RC337 (print) | LCC RC337 (ebook) | NLM WM 40 |
DDC 616.89/140072—dc23
LC record available at https://lccn.loc.gov/2016027783
9 8 7 6 5 4 3 2 1
Printed by Edwards Brothers Malloy, United States of America
v
To Peter E. Nathan (1935–2 016),
valued colleague, good friend, and innovative thinker
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As a rule, when I have heard some slight indication of the course of events I am able to guide
myself by the thousands of other similar cases which occur to my memory.
— Arthur Conan Doyle, “The Red- Headed League,” 1891
What treatment, by whom, is most effective for this individual with that specific problem,
and under which set of circumstances?
— Gordon Paul, 1967, p. 111
A public policy proposal is forwarded that no form of health intervention— physical or men-
tal [including psychotherapy]—s hould be supported through third- party reimbursement
and publicly supported training programs unless it has been demonstrated to be safe and
effective. It is argued that randomized controlled clinical trials [RCTs] should be viewed as
the most valid, though not exclusive, source of evidence.
— Gerald Klerman, 1983, p. 929
EBPP [Evidence-B ased Practice in Psychology] promotes effective psychological practice
and enhances public health by applying empirically supported principles of psychological
assessment, case formulation, therapeutic relationship, and intervention.
— APA Task Force on Evidence- Based Practice, 2006, p. 271
Common to all experts, however, is that they operate on the basis of intimate knowledge of
several thousand concrete cases in their areas of expertise. Context-d ependent knowledge
and experience are at the very heart of expert activity. Such knowledge and expertise also lie
at the center of the case study as a research and teaching method or to put it more generally
still, as a method of learning.
— Bent Flyvbjerg, 2006, p. 222
A psychotherapy case formulation is a hypothesis about the causes, precipitants, and main-
taining influences of a person’s psychological, interpersonal, and behavioral problems.
A case formulation helps organize information about a person, particularly when that
information contains contradictions or inconsistencies in behavior, emotion, and thought
content. Ideally, it contains structures that permit the therapist to understand these contra-
dictions and to categorize important classes of information within a sufficiently encompass-
ing view of the patient. A case formulation also serves as a blueprint guiding treatment and
as a marker for change.
— Tracy Eells, 2007, p. 4
[In] statistical hypothesis testing, … the scientist deduces one statement (or a few state-
ments) from the theory and compares that statement with many observations [across dif-
ferent individuals]. If the observations tend to match the statement, … then the hypothesis
is considered as confirmed. In contrast, . . . the theory- building case study strategy … com-
pares many theoretically-b ased statements with correspondingly many observations [within
the same individual] … [asking] how well the theory describes details of the case. …
because many statements are examined … The gain in confidence in the theory from a
close match may be as large as from a statistical hypothesis- testing study.
— William B. Stiles, 2009, pp. 11– 12
Randomized clinical trials (RCTs) research has been touted for three decades as the gold
standard for determining effective and optimal treatments in the mental health arena.
Unfortunately, RCT designs have failed to advance the field of psychotherapy as much
as initially expected, largely because they have not proven able clearly to identify either
unique or specific treatments for different diagnostic conditions. … Aspects of treatment
and patients that do distinguish among treatment effects are seldom incorporated in RCT
designs because they lie outside of the realm of what are considered “interventions.”
— Larry Beutler and Bryan Forrester, 2014, p. 168
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CONTENTS
Preface and Acknowledgments ix
About the Editors xi
Contributors xiii
PART I Introduction
1. The Terrain 3
Daniel B. Fishman and David J.A. Edwards
2. Navigating the Projects 26
Daniel B. Fishman
PART II The Projects
3. “Cool Kids/C hilled Adolescents”: Cognitive- Behavioral Therapy for Youth
With Anxiety Disorders in Denmark 39
Mikael Thastum, Irene Lundkvist-H oundoumadi, Kristian Bech Arendt,
Silke Stjerneklar, and Daniel B. Fishman
Commentary: International Implementation of CBT: Universal
Principles Meet Local Needs 108
Lauren J. Hoffman, Elaina A. Zendegui, and Brian C. Chu
4. The Efficacy of Interpersonal Psychotherapy – Adolescent Skills Training
(IPT- AST) in Preventing Depression 119
Sarah S. Kerner and Jami F. Young
Commentary: Identifying Moderators of Change From Both RCTs
and Case Studies 181
Laura J. Dietz
5. Transference- Focused Psychotherapy for Adult Borderline
Personality Disorder 190
Kenneth N. Levy, Kevin B. Meehan, Tracy L. Clouthier, Frank E. Yeomans,
Mark F. Lenzenweger, John F. Clarkin, and Otto F. Kernberg
Commentary: Complementarity and Clinical Implications in Using
a Mixed- Methods Approach 246
William E. Piper and Carlos A. Sierra Hernandez
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viii CONTENTS
6. Motivational Enhancement Therapy for Increasing Antidepressant
Medication Adherence and Decreasing Clinical Depression
Among Adult Latinos 256
Alejandro Interian, Ariana Prawda, Daniel B. Fishman,
and William M. Buerger
Commentary: The Best of Both Worlds 316
John C. Norcross
PART III Reflections and Next Steps
7. An Outside Perspective 327
Harold Chui, Sarah Bloch- Elkouby, and Jacques P. Barber
8. Themes and Lessons Learned 337
Daniel B. Fishman, Stanley B. Messer, David J.A. Edwards, and
Frank M. Dattilio
Index 363
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PREFACE AND ACKNOWLEDGMENTS
In psychotherapy research, the world of randomized clinical trials (RCTs) is one
of elaborate logical designs to achieve experimental control; a focus on specific
variables and discrete, normative, quantitative measures of them; a search for
general laws; fidelity to therapy manuals; and extensive statistical analyses of the
therapy results of groups of clients. In contrast, the world of case studies of indi-
vidual psychotherapy sessions and courses of therapy is one of qualitatively rich
patterns of human transactions; the narrative development of an emotionally
important relationship between therapist and client; the complex interaction of a
client’s personality, life history, presenting symptoms and distress, and present life
situation, leading the therapist to develop a guiding case formulation and treat-
ment plan; and the personality, training, and expertise of the therapist. In short,
one world focuses on numbers about variables within groups, and the other world
focuses on words about patterns within specific persons. Up to this point, these
worlds— sometimes seeming to be more associated with the physical sciences and
the humanities, respectively, than with “social science” per se—h ave not unsur-
prisingly been separated, despite the fact that the methods associated with these
worlds actually analyze the exact same data, consisting of psychotherapy inter-
actions, and despite the fact that some mental health professionals like clinical
psychologists are intensively trained in both of them.
This book is based on the premise that both of these worlds are of great value
in psychotherapy research. Specifically, in Chapters 3– 6 we present four psycho-
therapy research projects. In each there is a combination of a formal, quantitative
RCT study of randomly assigned groups; two or three systematic, in-d epth quali-
tative case studies of individual clients drawn from the experimental group of
the RCT; and a discussion of how the two types of knowledge emerging from the
RCT study and the case studies can be integrated and synthesized, with the sum
of the two types of knowledge being greater than their parts. We believe one of the
strengths of this book is that we systematically bring together these two different
perspectives on the same psychotherapy interactions, and that readers thus have
the opportunity to immerse themselves in each, side by side, and then to join the
process of exploring how these two perspectives can complement one another.
