Alliance rupture and repair processes in borderline personality disorder: A case study using dialogical sequence analysis

Objective: This study examined alliance rupture and repair processes in borderline personality disorder (BPD) and how the content of sessions interacts with the quality of the alliance.

Design: A mixed methods single case study design was employed incorporating quantitative and qualitative measures of process and outcome.

Methods: This case study examined a 22-year-old female with BPD who received 16 sessions of Cognitive Analytic Therapy. Measures of alliance, symptoms and global functioning were taken across multiple time-points. Selected sessions were analysed using dialogical sequence analysis (DSA), a theory-driven method of psychotherapy research that analyses utterances according to their author, addressee and referential object.

Results: Quantitative data indicated symptom reduction without functional improvement. DSA demonstrated that the first exchanges in therapy were reflective of key relational themes. The case suggests that, rather than simply negotiating tasks and goals, repairing ruptures involves systematically linking the manifest topic to the client’s core problems.

Conclusions: This case study points to the mediating role that the content of sessions has on alliance quality. Results underline the importance of the therapist stance, the need for a shared formulation to make sense of relational processes and the use of responsively timed interventions to decrease desperation and improve self-reflection.     

Resolution of an impasse at a network meeting: Dialogical sequence analysis of the use of a shared formulation

The study describes the resolution of an impasse at a network meeting during clinical child neurological assessment procedure, analysed by dialogical sequence analysis (DSA) a micro-analytic method for analysing utterances. The two earlier studies of the project describe how a DSA-based case conceptualisation can be used to assess change in the dyadic interaction between neuropsychologist and parent. This study applies the same formulation to analyse group level interaction at the network meeting. The case of a four-year-old girl was selected from a database of videotaped and transcribed child neurological team assessment processes. A repetitive problematic pattern was clearly manifested between parents and the child. At an early stage of the assessment, the neuropsychologist formulated and shared with the parents a clinical formulation of the pattern, summarised as the controlling/coercive parents to the rebellious child. In the earlier studies, microanalysis using DSA confirmed the accuracy of the neuropsychologist’s initial formulation, which she had used in the encounters with the parents. This study traces how she made use of it to address a re-enactment of the problematic pattern, now between the parents and professionals at the network meeting. The analysis of the phases of the conflict resolution by using DSA suggests that the impasse represented a re-enactment of the role positions of coercion and rebelliousness. The use of the original formulation at the meeting helped the conflicting parties to reach an observing stance to the pattern and a more empathic attitude to each other. The micro-analytic methodology by DSA used in this study allows to show the therapeutic potential of the network meeting and also how the development of an empathic stance is manifested in the discourse content.     

Understanding Pamina's recovery: An application of the hermeneutic single‐case efficacy design

This article reports an effectiveness case study of the individual systemic therapy of a 22‐year‐old Portuguese woman with a diagnosis of paranoid personality disorder, conducted in a university‐based clinic in Lisbon, Portugal. Data were analysed using the hermeneutic single‐case efficacy design, a non‐experimental interpretive approach that aims to determine whether change occurred, whether change was due to therapeutic strategies, and what in therapy caused the change. Results indicate that the treatment was effective and that de‐pathologising Pamina's condition and genogram‐based exploration techniques played a crucial role in her recovery.     

Pluralistic approaches to the study of process and outcome in psychoanalysis. The LAC depression study: a case in point

Approaching process and outcome in psychoanalysis is a topic that touches on ambitious and complex epistemological and methodological issues. As discussed in the first part of the paper, in keeping with challenging epistemic considerations, it would seem appropriate to describe the specificity of psychoanalysis as a specific scientific discipline of the unconscious (spezifische Wissenschaft des Unbewussten, see LIT). Psychoanalysis, over its more than 100-year history, evolved a range of highly advanced research methods for investigating the specific object of its research, namely unconscious conflicts and fantasies. Hence, like many other scientific disciplines, contemporary psychoanalysis comprises a plurality of theories, methods of clinical treatments as well as a plurality of research topics. This position is discussed with reference to a model illustrating different forms of clinical and extra-clinical research in psychoanalysis. A major, ongoing comparative study of outcomes of psychoanalytical and cognitive behavioural, long-term treatments of chronically depressed patients, the so-called LAC-study, serves to illustrate the richness of contemporary research in psychoanalysis.     

Randomization procedures in single‐case intervention research contexts: (Some of) “the rest of the story”

Following up on articles recently published in this journal, the present contribution tells (some of) “the rest of the story” about the value of randomization in single‐case intervention research investigations. Invoking principles of internal, statistical‐conclusion, and external validity, we begin by emphasizing the critical distinction between design randomization and analysis randomization, along with the necessary correspondence between the two. Four different types of single‐case design‐and‐analysis randomization are then discussed. The persistent negative influence of serially dependent single‐case outcome observations is highlighted, accompanied by examples of inappropriate applications of parametric and nonparametric tests that have appeared in the literature. We conclude by presenting valid applications of single‐case randomization procedures in various single‐case intervention contexts, with specific reference to a freely available Excel‐based software package that can be accessed to incorporate the present randomization schemes into a wide variety of single‐case intervention designs and analyses.     

Exploratory factor analysis in transportation research: Current practices and recommendations

Exploratory factor analysis (EFA) is a widely used statistical method in traffic and transportation research, particularly for the development and validation of measurement instruments. This article critically examines current practices in conducting and reporting EFA in published transportation studies. One hundred and eighty papers published between 2016 and 2018 were examined, of which eighty-two were included in the present study after applying eligibility criteria. The review suggests that the quality of EFA reported in the field is routinely poor: (a) researchers fail to provide sufficient information to be able to adequately assess the appropriateness and quality of both the input data and the reported output; and (b) the decisions underlying the choices of EFA methods are not justified and rely mostly on procedures advised against, particularly the Little-Jiffy approach. In summary, a significant gap between current practice and experts' recommendations exists. We provide some guidelines that may help in conducting, reporting and reviewing EFA in transportation research.     

Translational research in behavior analysis: historical traditions and imperative for the future

"Pure basic" science can become detached from the natural world that it is supposed to explain. "Pure applied" work can become detached from fundamental processes that shape the world it is supposed to improve. Neither demands the intellectual support of a broad scholarly community or the material support of society. Translational research can do better by seeking innovation in theory or practice through the synthesis of basic and applied questions, literatures, and methods. Although translational thinking has always occurred in behavior analysis, progress often has been constrained by a functional separation of basic and applied communities. A review of translational traditions in behavior analysis suggests that innovation is most likely when individuals with basic and applied expertise collaborate. Such innovation may have to accelerate for behavior analysis to be taken seriously as a general-purpose science of behavior. We discuss the need for better coordination between the basic and applied sectors, and argue that such coordination compromises neither while benefiting both.     

Change mechanisms in cognitive therapy of a simple phobia: Logical analysis and empirical hypothesis testing

The effectiveness of two hypothesized change mechanisms in cognitive therapy was investigated: logical analysis and empirical hypothesis testing. Thirty-eight spider phobics, as determined by performance on a behavioral avoidance test, were randomly assigned to either one of these two conditions or to a no-treatment control condition. Subjects participated in three group sessions. Outcome phobia questionnaire data suggested that both mechanisms produced desirable changes in a short period of time, with stronger evidence that logical analysis was superior to the control. Outcome from the behavior avoidance test and self-efficacy ratings failed to reach statistical significance but the trends were in the direction of positive change. Results are discussed in terms of the tripartite response dessynchrony hypothesis. Suggestions for future process research in cognitive therapy are provided.William O'Donohue, Ph.D., is an assistant professor of psychology at Northern Illinois University.Jeff Szymanski is a graduate student in clinical psychology at Northern Illinois University.The authors would like to thank Christine Casselles, Melissa McKelvie, Thomas M. Brown, Jill C. Rudman, Bonnie Schrieber, Amy Ray, Anne Valle, Lisa Herold, Jacqueline Ryan, Heather Barta, and Angela Leek for their assistance in this project. Moreover, the authors are grateful to Sol Feldman and Jane Fisher for their comments on an earlier version of this paper.     

Using time‐lagged panel data analysis to study mechanisms of change in psychotherapy research: Methodological recommendations

The introduction of novel methodologies in the past decade has advanced research on mechanisms of change in observational studies. Time‐lagged panel models allow us to track session‐by‐session changes and focus on within‐patient associations between predictors and outcomes. This shift is crucial as change in mechanisms inherently takes place at a within‐patient level. These models also enable preliminary casual inferences, which can guide the development of effective personalised interventions that target mechanisms of change, used at specific treatment phases for optimal effect. Given their complexity, panel models need to be implemented with caution, as different modelling choices can significantly affect results and reduce replicability. We outline three central methodological recommendations for use of time‐lagged panel analysis to study mechanisms of change: (a) taking patient‐specific effects into account, separating out stable between‐person differences from within‐person fluctuations over time; (b) properly controlling for autoregressive effects; and (c) considering long‐term time trends. We demonstrate these recommendations in an applied example examining the session‐by‐session alliance–outcome association in a naturalistic psychotherapy study. We present limitations of time‐lagged panel analysis and future directions.     

Application of focusing‐oriented psychotherapy in dealing with issues of Asian immigrants: A single‐case study of a Korean immigrant in Japan

A single case study is presented of the successful application of focusing‐oriented therapy in the case of a Korean woman who migrated to Japan. The client had a host of problems related to the discrimination she faced from her own family and from Korean society for being female, as well as relationship and cultural difficulties in trying to adjust to married life in Japan. Through 10 sessions of focusing‐oriented therapy, the client was able to re‐examine her situation from a positive perspective and began to accept herself as a person, not necessarily as a woman or a Korean in Japan. Issues related to Korean women immigrants in Japan are explored and the related effectiveness of focusing‐oriented therapy for the particular population is discussed.     

A holistic perspective on career development in UK female soccer players: A negative case analysis

ObjectivesThe purpose of this study was to examine career experiences of UK-based female youth soccer players from a holistic perspective with a view to producing a grounded theory of factors contributing to career/talent development and transitions in UK youth female soccer.MethodologyA Grounded Theory methodology (Corbin & Strauss, 2008) was used. Negative case (Denzin, 1989) former female soccer players (N = 13), their best friend (N = 13), soccer coaches (N = 4), and teachers (N = 8) took part in semi-structured interviews about factors associated with talent development and career transitions in female youth soccer.ResultsMultiple social agents (players, team-mates, peers, teachers, parents and siblings) need to optimally interact to ensure that an optimal talent development and learning environment is created. This will provide a supportive holistic talent development environment, lead to adaptive player-level changes, and a greater chance of successful athletic and dual career development.ConclusionsThis study presents a rich understanding of the dual careers of players who did not make it in female soccer. By considering their perspectives alongside of a range of important social agents, we have been able to construct a substantive grounded theory of factors contributing to career/talent development and transitions in UK youth female soccer. As a result, these findings may contribute to policy and practice development in UK female youth soccer.