Use of dialectical psychotherapy in treating bulimarexic disorders: A case study

A variety of therapeutic approaches have been used in the treatment of anorexia nervosa and bulimia with varying degrees of success. This paper describes the treatment of a bulimarexic patient by co-therapists, using a dialectical approach.Appreciation is extended to Betty Hoffman for her editorial assistance.     

Evaluation of changes in mother-infant brief psychotherapy: A single case study

Representation-oriented brief psychotherapy with mother-infant dyads is used to examine correspondences between maternal behaviors and maternal representations of her infant. A single case study is presented to illustrate how one can objectify interactional variables that may correspond behaviorally to underlying maternal mental representations. This paper presents the results of a collaboration that focuses on the process of enacting fantasy via the domain of behavior. Attention is drawn to interacted themes that are enacted versions of representational themes. Enacted themes are pathogenic in behavioral terms for the infant. Five themes are identified in the case material. Changes in the mother's representations affect both the mother-infant relationship and the infant's functioning.     

Using strategic psychotherapy: A case study of chronic PTSD after a terrorist attack

This article describes a case of chronic post traumatic stress disorder (PTSD). The patient came to psychotherapy three years after he was injured in a terrorist attack. He was in a state of dysfunction. The article elaborates on theoretical issues, the choice of strategic model of psychotherapy, the various phases of the therapeutic process and the specific difficulties that such a case presents.     

Multi-component behavioral treatment of trichotillomania: a case study.

A 21-year-old female with a 13-year history of compulsive hair pulling was treated via a multi-component behavioral intervention strategy. Dependent variables included both quasi-direct behavioral frequency counts (i.e., number of hairs pulled) and physical trace, natural erosion measures (i.e. size of bald areas). Results indicated dramatic decrease in number of hairs pulled from treatment through 40 weeks post-initiation of baseline. These findings were discussed with regard to situational-specificity of trichotillomania and reliance upon experimenter-derived rather than subject-controlled data collection sources.     

Topic-focused analysis in a case of integrative psychotherapy with a father fearing his own anger

Even though evidence-based knowledge is considered the foundation of clinical practice, many clinicians question the clinical relevance of published research. Clinicians increasingly define themselves as having an integrative stance, in contrast to the tendency for most research to be based on clearly defined psychotherapies. Qualitative single case studies make it possible to generate knowledge about what actually occurs in integrative therapy. Topic change process analysis (TCPA) is used in the analysis of brief integrative therapy conducted by a very experienced psychotherapist drawing on a complex variety of therapeutic approaches. The client was a man in his late thirties, worrying about his strong anger, particularly related to one of his children. Analysis of topic areas, topic shifts, response patterns within topics and changes in perspective made it possible to identify key processes and key patterns of the therapy which resulted in a very positive outcome for the client. Implications of these findings for practice, and future research, are discussed.     

A case study of behavioral assessment and treatment of insect phobia

We assessed the academic performance of a 14-year-old boy with insect phobia in the context of feared stimuli. The dependent measure was math calculation rate across three conditions that varied therapist statements about the presence of crickets and the actual presence of live crickets. Subsequent treatment consisted of graduated exposure and contingent rewards for math problem completion. Assessment results indicated that the boy's performance was consistently low in the presence of live crickets but not when he was spuriously informed that crickets were present (the primary referral concern). Treatment results indicated no effect from exposure alone and a dramatic effect when exposure was combined with contingent rewards.     

Assessing personality change in psychotherapy with the SWAP-200: a case study

Many studies document the efficacy of psychotherapy for acute syndromes such as depression, but less is known about personality change in patients treated for personality pathology. The Shedler-Westen Assessment Procedure (SWAP-200; Westen & Shedler, 1999a, 1999b) is an assessment tool that measures a broad spectrum of personality constructs and is designed to bridge the gap between the clinical and empirical traditions in personality assessment. In this article, we demonstrate the use of the SWAP-200 as a measure of change in a case study of a patient diagnosed with borderline personality disorder. We collected assessment data at the start of treatment and after 2 years of psychotherapy. The findings illustrate the personality processes targeted in intensive psychotherapy for borderline personality.     

Making a case for case studies in psychotherapy training: A small step towards establishing an empirical basis for psychotherapy training

The evidence debate in psychotherapy pays little attention to developing an evidence base for training practices. Understanding effective training requires an examination of what makes training work. This article examines the role of case studies in psychotherapy training. This has not been articulated explicitly or researched systematically in spite of its cardinal importance. An analysis of the role of case studies in psychotherapy training is presented. Reading, watching, or hearing about cases can offer novice psychotherapists access to a closed world; access to psychological theory in action; access to whole courses of therapy; access to different approaches; access to significant moments; access to the therapeutic relationship; access to a wide range of client types; access to working in different contexts; and the opportunity of identifying with therapists and clients. Writing or presenting cases offer students the opportunity of: learning to integrate information into a relevant whole; being in the ‘hot seat’; learning to give appropriate feedback; assessing the validity of interpretations, inferences, and interventions; adapting methods to suit the client; and learning to collaborate with other professionals. The paper presents directions for future research into psychotherapy training, specifically proposing an international survey of training practices at psychotherapy training institutions.     

Supportive psychotherapy of a psychodynamic orientation as an adjunctive treatment for drug-induced depression: A case study

Abstract

Treatment for drug-induced depression usually consists of cessation or reduction of the causative agent and psychopharmacologic management. In addition, psychotherapy can be useful as an adjunctive treatment. The author presents case material related to a young woman with an inborn physical illness, who became depressed during the course of interferon treatment for a medical complication, hepatitis virus infection. In addition to the cessation of interferon and pharmacologic management, supportive psychotherapy of a psychodynamic orientation was started in order to address the patient’s low self-esteem and anxiety about her future. During the course of psychotherapy, it was understood that the premature cessation of interferon was, to her, a narcissistic injury. It was also important to explore the meanings of her inborn illness and her guilty feelings. After reviewing various formulations of depression, the author discusses the case material from an integrative perspective, which describes vicious cycles of depression.