The ‘inseparable bond between cure and research’: clinical case study as a method of psychoanalytic inquiry

Abstract

Since Freud's own time, there has been great deal of debate about the most appropriate research methodology for investigating psychoanalytic psychotherapy [Fonagy, Journal of Child Psychotherapy, 29 (2): 129 – 136, 2003 Fonagy, P. 2003. ‘The research agenda: the vital need for empirical research in child psychotherapy’. Journal of Child Psychotherapy, 29(2): 129–136. [Taylor &; Francis Online] , [Google Scholar]; Rustin, Journal of Child Psychotherapy, 29 (2): 137–145, 2003 Rustin, M. 2003. ‘Research in the consulting room’. Journal of Child Psychotherapy, 29(2): 137–145. [Taylor &; Francis Online] , [Google Scholar]]. The single case study, which has a long tradition both within child psychotherapy and the wider research field, has been widely criticised as an approach to research, even while its contribution to clinical practice, the development of new ideas and teaching have been acknowledged. After reviewing the history of case study as a research method, this paper argues that there are a broad range of approaches to the study of the single case, each of which may be appropriate depending on the particular research question. Each of these approaches, however, must respond to the three perceived weaknesses of the clinical case study as a research method: the ‘data problem’, the ‘data analysis problem’ and the ‘generalisability problem’. This paper outlines the nature of these criticisms and, using many examples of actual research projects, suggests various ways in which the criticisms can be addressed, in order for the single case study to re-gain its place at the heart of psychoanalytic research.     

Application of the Within- and Between-Series Estimators to Non-normal Multiple-Baseline Data: Maximum Likelihood and Bayesian Approaches

In single-case research, multiple-baseline (MB) design provides the opportunity to estimate the treatment effect based on not only within-series comparisons of treatment phase to baseline phase observations, but also time-specific between-series comparisons of observations from those that have started treatment to those that are still in the baseline. For analyzing MB studies, two types of linear mixed modeling methods have been proposed: the within- and between-series models. In principle, those models were developed based on normality assumptions, however, normality may not always be found in practical settings. Therefore, this study aimed to investigate the robustness of the within- and between-series models when data were non-normal. A Monte Carlo study was conducted with four statistical approaches. The approaches were defined by the crossing of two analytic decisions: (a) whether to use a within- or between-series estimate of effect and (b) whether to use restricted maximum likelihood or Markov chain Monte Carlo estimations. The results showed the treatment effect estimates of the four approaches had minimal bias, that within-series estimates were more precise than between-series estimates, and that confidence interval coverage was frequently acceptable, but varied across conditions and methods of estimation. Applications and implications were discussed based on the findings.     

慢性乙型肝炎抗病毒治疗的策略

抗病毒治疗是慢性乙型肝炎治疗的关键,有效的抗乙型肝炎病毒药物主要有干扰素和核苷（酸）类似物。单药抗病毒治疗可获得较好的疗效,便于监测、管理;联合抗病毒治疗增加抗病毒疗效尚难肯定,更无法避免耐药发生,并可导致多药耐药、增加药物副作用和治疗费用。因此,优选单药进行抗病毒治疗才是目前理想的方案。     

不同学习方式下归类不确定时的特征推理

采用学习-迁移模式, 探讨了同时学习和继时学习两种方式下归类不确定时的特征推理。共包括2个实验, 其中实验1探讨了固定学习轮次的情况, 实验2探讨了固定学习正确率的情况。实验结果表明：同时呈现类别要素的同时学习方式下, 被试习得序列式的单类别表征(原型表征), 在归类不确定时的特征推理中按照“单类的Bayesian规则”进行特征推理, 即P(j\F) =P(k\F)·P(j\k); 相继呈现类别要素的继时学习方式下, 被试习得并列式的多类别表征, 在归类不确定时的特征推理中按照“理性模型”进行推理, 即 P(j\F) =Σk P(k\F)·P(j\k)。     

心理疾病内隐污名：来自单类内隐联想测验的证据

以61名大学生为被试,采用三个独立的单类内隐联想测验（SC-IAT）考察心理疾病内隐污名的构成及其内隐效应。结果发现：（1）在认知评价、情感反应、行为倾向及其三者合并的4个SC-IATs中,被试在相容任务上的反应时均显著快于不相容任务;（2）总的SC-IAT和三个独立SC-IAT的内隐效应显著;（3）65.27%的被试的内隐效应值大于0,表现出对心理疾病患者负面的内隐态度;（4）研究采用的心理疾病内隐污名SC-IAT具有较好的信、效度指标。研究表明,被试倾向于将心理疾病与消极词联结在一起,心理疾病污名的内隐效应显著;心理疾病内隐污名包括自动化的负面认知、消极情感反应和歧视倾向。     

Single Motherhood Via Donor-Insemination (DI): Separation, Absence, and Family Creation

The formation of single motherhood by choice via donor-insemination became one of the alternative family structures in recent years. This paper presents the construction of pre-maternal processes, decision-making and the actual preparation for motherhood via a clinical case study. The therapeutic process is developed through mutual co-construction of patient-therapist relationships that implement analytic relational concepts. The absence of the paternal figure generates a unique creation of familial emotional space. The lack of a conceptual, as well as, a clinical body of knowledge leads both therapist and patient to find new boundaries and meaningful bonds for this family structure.     

Nonconcurrent Multiple Baseline Designs and the Evaluation of Educational Systems

Important findings are often a balance between the rigor of the experimental design and innovativeness of the experimental question. One broad topic area that has received a great deal of discussion, but little empirical study, is the evaluation of educational systems. Experimental designs that permit the analysis of practices used by state education agencies, local education agencies, and schools have the potential for yielding socially significant findings that could improve education. In this article we discuss the use of nonconcurrent multiple baseline designs as an option for studying the activities and effects of educational programs. Nonconcurrent multiple baseline designs stagger the timing of baseline-to-intervention changes across various entities, but the baselines and intervention phases are not contemporaneous across each of the tiers. Although considered less rigorous than concurrent multiple baseline designs, nonconcurrent designs have a degree of flexibility that may allow for their use in studying complex social contexts, such as educational settings, that might otherwise go unanalyzed.     

单一启动单一探测中基于相关低比例的负启动效应

启动和探测刺激相同试次低比例时可出现类似负启动的抑制现象。本研究采用不同于以往研究的单一探测范式,并操纵相关项（启动与探测词语义相关）的比例及刺激集的大小研究这一抑制机制的特点。实验一在低比例时发现了显著的负启动效应。实验二在低比例时,发现小的刺激集能诱发负启动,而大的则不能。表明在单一探测范式中启动与探测相关试次的低比例确实能诱发抑制控制,该抑制控制由忽视策略所致,并受刺激集大小的影响,支持了干扰项的凸显能够诱发强抑制的观点。