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.     

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.     

Emergence of amae crying in early infancy as a possible social communication tool between infants and mothers

Amae is defined as “wishing to be loved (Scheidlinger (1999). The Journal of the American Academy of Psychoanalysis, 27(1), p. 91)”. Amae crying is known as crying of infants when seeking intimate emotional communication with caregivers. The objective of this study was to delineate when and how amae crying emerges in early infancy. Crying episodes of four infants were observed bimonthly, in the natural context of their homes, from birth to 6 months of age, for approximately 60 min per session. Crying episodes (total = 275) as determined by two coders were analyzed with respect to several behavioral measures. Results indicated that amae crying emerged at the age of 2 months, and consistently accounted for 30–40% of the total crying episodes after the ages of 3 months. Amae crying could be accurately identified when infants were not in acute discomfort and had already got the attention of their mothers. At such times, infants did not shed tears, cried with a fussy voice, and frequently looked at their mothers. Mothers responded to amae crying more promptly than they did to other types of crying behaviors. It is concluded that 3 months of age, when infants probably begin to use crying as a social communication tool is a major turning point for crying behavior from the perspective of its biological and social roles. It is suggested that amae crying might play an important role in strengthening and encouraging mother–infant interactions.     

Examining patterns suggestive of acquisition during functional analyses: A consecutive controlled series of 116 cases

The functional analysis approach described by Iwata et al. (1982/1994) has been used widely to determine the variables evoking and maintaining challenging behavior. However, one potential concern with conducting functional analyses is that repeated exposure to contingencies may induce a novel functional relation. To examine the likelihood of these potential iatrogenic effects, we evaluated social test conditions of the functional analysis for 116 participants and searched for patterns of responding indicative of acquisition. Patterns suggestive of acquisition occurred in 13.70% of tangible reinforcement conditions; however, the prevalence was only slightly lower in the attention condition (8.75%). Much lower prevalence was observed for the escape condition (2.13%). When grouped by quotient score, a pattern of acquisition was just as likely to be observed in the attention condition as in the tangible condition. Additionally, patterns indicative of acquisition were no more likely to be observed with participants who emitted automatically reinforced challenging behavior.     

Applying Cases to Solve Ethical Problems: The Significance of Positive and Process-Oriented Reflection

This study examined the role of reflection on personal cases for making ethical decisions with regard to new ethical problems. Participants assumed the position of a business manager in a hypothetical organization and solved ethical problems that might be encountered. Prior to making a decision for the business problems, participants reflected on a relevant ethical experience. The findings revealed that application of material garnered from reflection on a personal experience was associated with decisions of higher ethicality. However, whether the case was viewed as positive or negative, and whether the outcomes, processes, or outcomes and processes embedded in the experience were examined, influenced the application of case material to the new problem. As expected, examining positive experiences and the processes involved in those positive experiences resulted in greater application of case material to new problems. Future directions and implications for understanding ethical decision making are discussed.     

Predictor Variables of PTSD Symptoms in School Victimization: A Retrospective Study with College Students

The literature has indicated that school victimization might favor the development of posttraumatic stress disorder (PTSD) symptoms. However, few studies have shown which variables are important in this process. This study aimed to investigate the relationship between explanatory variables (individual characteristics and aversive school experiences), and the development of PTSD symptoms, using an ordinal logistic regression model. To this end, 691 students of a public university situated in the state of São Paulo, Brazil, with a mean age of 21.1 years responded to a Brazilian version of the retrospective instrument Student Alienation and Trauma Survey–R (SATS–R). Significant variables for the regression model were age, duration of the worst school experience and subsequent discomfort, and relational and verbal violence victimization. In general, the greater the discomfort experienced by the student, the longer the duration of the worst school experience, the older the student and the more verbal and relational victimization episodes experienced, the greater the possibility of displaying clinically significant symptoms of PTSD.     

Where the Whole Thing Fell Apart

Abstract

This article examines the intersection of societal prejudice and psychological trauma. In an instrumental case study created through a layered narrative analysis, the author highlights the potentially traumatic effects of racism and discrimination, while also exploring the phenomenon of resilience in a complex ecological system. The findings suggest that the enduring and continual strain of racial prejudice may cause significant psychological distress, particularly when those experiences reinforce early negative experiences within a family; and that assessments of resilience need to consider the contribution of ecological context to psychological outcomes as well as to an individual's ability to mobilize personal resources when such a context finally shifts.     

Ethics in Publication

Summary

This article highlights ethical issues in publication. It addresses the provenance of ideas, problems with joint authorship, plagiarism, and the practice of duplicate submission of material for publication. Confidentiality and privacy matters, and the protection of human subjects in publication of research and clinical case studies are also discussed. The article further examines biases in literature reviews, and in the biased selection of one's best results for publication, intentional misinterpretation of data and the slanting of discussion, summary, and conclusions. Finally, the article deals with ethical problems that can arise in the publication of sponsored research, and the ethical responsibilities of editors and readers.     

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.