bluuebunny/crossref_metadata_2025 huggingface dataset:
Rising to the Challenges of Identifying and Analyzing Clients' Narratives
Authors: Adler Jonathan M.
Published: April 2014

Psychotherapy researchers and clinicians alike are faced with two primary challenges in the service of most effectively understanding the therapeutic process: first, they must identify the most generative elements from the rich flow of therapeutic dialogue; and second, they must select the most appropriate and productive tools for analyzing them.  Singer and Bonalume (2010) have developed the Coding System for Autobiographical Memory Narratives in Psychotherapy (CS-AMNP), a trans-theoretical method for rising to these two challenges.  In this commentary, the CS-AMNP is evaluated: its noteworthy contributions are highlighted, its potential limitations are discussed, and fruitful expansions are proposed in terms of extending it from autobiographical narratives in therapy to autobiographical narratives about therapy.
Editor's Introduction to Issue on Case Formulation and Therapist Responsiveness
Authors: Fishman Daniel B.
Published: April 2014

This is the Editor's Introduction to this Issue on case formulation and therapist responsiveness.
Languages of Science and the Problem of Applied Clinical Knowledge: A Mixed Methods Appraisal of Eells' Case Formulation Research
Authors: Edwards David J.A.
Published: April 2014

This article is a methodological commentary on Eells’ (2010) summary of his research on case formulation.  It draws attention to an epistemological tension between a positivist and a qualitative/hermeneutic paradigm.  I argue that the kinds of questions researchers are most concerned with in the field of case formulation are ones with direct relevance for practice and that an exclusively positivist paradigm is problematically suited to answer these, an observation that emerges from a consideration of Eells account of his research.  While Eells’ account of his case-based strategy is initially positivist in intent, the introduction of a hermeneutic approach opens the field up considerably.  I conclude (a) that a "mixed methods" paradigm, which integratively and rigorously combines quantitative and qualitative methods and which has recently been called a "third research paradigm," offers a particularly attractive epistemological framework for planning research on case formulation that can directly guide and improve practice; and, following from this point, (b) that the meaning and direction of  Eells' research can be enhanced by explicitly conceptualizing it within such a mixed methods paradigm.
Pragmatic Clinical Research to Inform the Field of Men's Mental Health: A Commentary on and Extension of Papers by David Edwards and Tracy Eells
Authors: Reigeluth Christopher S. , Addis Michael E.
Published: April 2014

We consider the potential utility of the methods described by Eells (2010) and Edwards (2010) for guiding case conceptualization and treatment process in the area of men's mental health. As a relatively new field, men's mental health has been concerned with the clinical implications of understanding how masculine gender socialization influences the variety of ways different men experience, express, and respond to problems in their lives. Eells (2010) and Edwards (2010) have developed pragmatically driven research strategies that may help researchers and clinicians interested in working with men to (a) integrate gender in meaningful ways into case conceptualizations, and (b) develop effective ways of being therapeutically responsive to some of the specific challenges in working with more "traditional" men.
Evaluating Case Formulation Decision-Making and Therapist Responsiveness: A Perspective from the Area of Behavioral Assessment and Case Formulation
Authors: O'Brien William H.
Published: April 2014

In this paper two research studies by Eells (2010) and Edwards (2010) evaluating case formulation and therapist responsiveness are summarized and critically evaluated.  The central themes abstracted from these studies are subsequently articulated and integrated with existing research on the philosophical and theoretical competencies, clinical competencies, and quantitative competencies needed for effective case formulation. More specifically, I introduce  and evaluate the work of Edwards and Eells in terms of a behavioral model of case formulation that is based on four general principles: functionalism; empiricism, cognitive-behavioral learning theory; and a multivariate perspective that stresses the importance of collecting multimodal and multimethod assessment data as the basis of a case formulation.
Treating Posttraumatic Stress Disorder in South Africa: An Integrative Model Grounded in Case-Based Research
Authors: Edwards David J.A.
Published: April 2014

The article presents a model for formulating and planning treatment for post-traumatic stress disorder (PTSD) in South Africa derived from the existing literature and in conjunction with a review of a series of studies of cases treated using the guidelines of Ehlers and Clark’s cognitive therapy. It is argued that the construction of psychotherapies (or even components of psychotherapy) for PTSD in terms of traditional categories ("psychodynamic", "cognitive-behavioural", "narrative" etc.) is misleading and unhelpful. Instead, superordinate concepts derived from thinking about evidence-based practice provide a more grounded focus on the practical issues faced by therapists treating PTSD. These concepts, which include competences and metcacompetences, therapist responsiveness, stages of therapy and case formulation, provide a basis for a genuinely integrative approach. The proposed model suggests seven broad areas of clinical focus for work with PTSD which can be arranged at three levels of priority: level 1 crisis intervention and stabilization; level 2 promoting engagement with treatment, and level 3 selection, sequencing and timing of active treatment interventions. Material from the case series is used to illustrate the application of the model.
The Assessment and Treatment of Post-Abortion Syndrome: A Systematic Case Study From Southern Africa
Authors: Boulind Melissa , Edwards David J.A.
Published: April 2014

This article reports a clinical case study of "Grace", a black Zimbabwean woman with post-abortion syndrome (PAS), a form of post-traumatic stress disorder precipitated by aborting an unwanted pregnancy. She was treated by a middle class white South African trainee Clinical Psychologist. The case narrative documents the assessment and the course of treatment which was guided by ongoing case formulation based on current evidence-based models. Factors that made her vulnerable to developing PTSD included active suppression of the memory of the event and lack of social support. An understanding of these factors was used to guide an effective intervention. In spite of the differences in culture and background between client and therapist, there was considerable commonality in their experience as young women and students who each had to balance personal and occupational priorities. The narrative also highlights the commonalities of Grace’s experiences with those reported in the literature on post-abortion syndrome, which is mostly from the U. S. A. and Europe.
Trauma, Imagery and the Therapeutic Relationship: Langu's story
Authors: Karpelowsky Belinda , Edwards David J.A.
Published: April 2014

This paper, a phenomenological case study, describes the psychotherapy of Langu (pseudonym), a 21-year-old student, who presented with Acute Stress Disorder following a series of motor accidents that affected him and his family. Langu’s most distressing experience was having to identify his brother’s mutilated and severely burned body. Because of the intensity of the intrusive re-experiencing of traumatic imagery and the degree of dissociative numbing, Langu participated in four intensive guided imagery sessions, which involved reliving the incident, and imaginal dialogues with his dead brother. Session records and supervision notes from the therapy process that unfolded over 22 sessions served as the basis for a thematically selective case narrative. Additional material was obtained from several research interviews with Langu over the following months. The narrative highlights the impact of the imagery work as well as relational aspects of the therapy. The case narrative provides a source for examining many aspects of the psychological impact of trauma and the path to healing, as well as the dilemmas and challenges faced by therapists working with traumatised individuals.
Real Clinical Trials (RCT') -- Panels of Psychological Inquiry for Transforming Anecdotal Data into Clinical Facts and Validated Judgments: Introduction to a Pilot Test with the Case of "Anna"
Authors: Miller Ronald B.
Published: April 2014

This article reports another stage in the development of the Panel of Psychological Inquiry (the "Panel") model for evaluating case-study knowledge claims. Inspired by Bromley’s (1986) quasi-judicial model of clinical case studies, the methodology for evaluating clinical case-studies involves seven components: (1) standards of evidence for anecdotal data; (2) participants (judges, advocate, critic, witnesses); (3) pre-hearing review of the written case study and specific advocate claims and critic counterclaims; (4) collecting physical evidence and interviewing potential witnesses related to the case; (5) a sixteen step hearing procedure; (6) the judges’ opinion; and (7) appeal. This article begins with a rationale for and background on the Panel model, followed by an introduction to a specific pilot test of it. In the pilot text, a five-member Panel consisting of  senior practitioners and academics conducted a five-hour hearing on the treatment of  “Anna,” an 18-year-old, first year college student with a six year history of anxiety, panic, depression, and persistent self-cutting, who was seen in therapy by a clinical psychology graduate student. The judges evaluated five knowledge claims about the severity of psychopathology; relationship of the symptom to defenses; therapeutic orientation; outcome; and role of counter-transference in the case. This introduction orients readers to five other papers associated with the pilot test: (a) a systematic case study of Anna's treatment (Podetz, 2008, 2011a), which was part of the "physical evidence" of the case and which constituted the author's master's thesis; (2) and (3), the arguments that the advocate and critic (Altman, 2011 and DiGiorgianni, 2011, respectively), presented to the Panel of Inquiry, as well as some comments about their roles and experiences (not discussed at the Inquiry); (4) the experience of the therapist (Podetz, 2011b) in presenting to the Panel of Inquiry; and (5) the findings of the Panel of Inquiry (Miller et al., 2011).
"Anna" and the Panel of Psychological Inquiry: The Critic's Perspective
Authors: DiGiorgianni Jess
Published: April 2014

With an acknowledgment of the difficulty of evaluating the intricacies and implications of any intensely subjective interaction, the critic’s function was conceived as dialectical rather than adversarial.  Instead of a sustained attack directed against the therapist, this critical effort was formulated as a set of questions, reflections, perplexities, and suggestions designed to create opportunities for a deeper understanding of the intervention. Because the therapy under consideration so conscientiously depicted its work as an act of authentic concern, repeated attempts were made to understand the role that counter-transference played in the unfolding of the therapeutic relationship, an investigative orientation that led to the following overarching question: Is it possible that some of the clinician’s great therapeutic strengths, her reservoir of good will, her emotional attunement, her desire to be helpful, her capacity to be moved by the suffering of others, might also to some extent have undermined her therapeutic intent? Embedded in an understanding of psychotherapy as an activity of disappearance in which the therapist disappears by existing solely for the patient, the critical dialectic sought to access this paradoxical vitality in ways that might challenge the loving disappearance of the therapist without losing sight of her poignant contribution to the Freudian project of insightful, compassionate care protected against the unimaginative treatment of both physicians and priests.
The "Research Jury Method": The Application of the Jury Trial Model to Evaluating the Validity of Descriptive and Causal Statements about Psychotherapy Process and Outcome
Authors: Bohart Arthur C. , Tallman Karen L. , Byock Gayle C. , Mackrill Thomas
Published: April 2014

A rationale for using a qualitative "Research Jury Method" for assessing psychotherapy outcome as an alternative to randomized controlled trials is given. It is argued that the jury research method is compatible with scientific practice and that science itself relies on the method. Methods and results from two preliminary studies are briefly summarized. In the current study three jurors evaluated a rich case history to decide (a) whether the client changed, and (b) to what degree, and how, psychotherapy contributed. Results suggest the method can be a useful way of assessing psychotherapy outcome and can produce differentiated insights into case-specific changes and change processes. A conclusion is that we can draw inferences and make plausible cases that people change in psychotherapy and that therapy contributes to it from individual cases using rich data, qualitative analysis, and a jury method. In addition, we can learn things from this method that one cannot learn as easily from randomized controlled trials.
Developing a Systematic Framework for Utilizing Discrete Types of Qualitative Data as Therapy Research Evidence
Authors: Bohart Arthur C. , Berry Makenna C. , Wicks Carrie L.
Published: April 2014

In a follow-up study on a "Research Jury Method" for qualitatively adjudicating statements about psychotherapy process and outcome (Bohart, Tallman, Byock, & Mackrill, 2011), the utility of 56 criteria for aiding jurors in analyzing a case history was examined. It was found that these criteria were useful in helping jurors identify aspects of the case that led to their conclusions. Utilizing the criteria also helped jurors adjudicate differences between them.
A Diary-Based, Cross-Contextual Case Study Methodology: Background for the Case of "Jane and Joe"
Authors: Mackrill Thomas
Published: April 2014

This paper describes the epistemological, theoretical, and methodological background and context of the therapy case study, “The Case of 'Jane and Joe': A Diary-Based, Cross-Contextual Case Study" (Mackrill, 2011). The “Jane and Joe” case study served as the “raw data” of a “jury trial model” analysis, also published in this journal by Bohart, Tallman, Byock, and Mackrill (2011). The Joe and Jane case study is one of eight researched as a series with a method inspired by postmodern-oriented movements in phenomenology, post-positivism, hermeneutics, social constructionism, and action research. Specifically, the method used in analyzing the Jane and Joe case study involved the client (Jane) and therapist (Joe) following a set of diary writing guidelines for a series of 10 therapy sessions, which were audio-recorded. The therapist wrote about his experience of the sessions, and the client wrote both about her experience of the sessions, and about her new and different experiences between sessions. After the 10 sessions were competed, Joe and Jane exchanged diaries at the end of the eleventh session, and the twelfth session was dedicated to responding to the experience of reading each other’s diaries. The diaries and recordings were then passed on to me as the researcher for analysis. My draft analysis of the Jane and Joe case study was next sent to Jane and Joe for comment so misinterpretations could be corrected. Jane and Joe’s amendments were then incorporated into the final case study, which is published in this journal (Mackrill, 2011).  The analysis of the audio recordings and the diaries followed a systematic series of procedures within a particular theoretical framework. The framework has three major dimensions: (a) a postmodern emphasis on the patient and therapist's experiences and phenomenology as they dynamically interact with one another (McLeod, 2010); (b) a postmodern emphasis on the development of the client's sense of agency during the therapeutic process; and (c) in line with Dreier's (2008) theory of cross-contextual influences, an emphasis on the importance of cross-contextual transactions between the client's experience inside and outside of therapy during the time of the therapy.
The Case of "Jane and Joe": A Diary-Based, Cross-Contextual Case Study
Authors: Mackrill Thomas
Published: April 2014

This case study of the client "Jane" seen by the therapist "Joe" is an unpublished part of my dissertation (Mackrill, 2008). Jane's presenting problems included: (1) memories that bother her on a daily basis, and Jane’s sense of vulnerability in relation to these; (2) Jane’s experience of being very sensitive; (3) Jane’s low self-esteem; and (4) Jane’s insecurity with regard to close relationships with men. Joe's theoretical orientation in treating Jane was humanistic and existential. The case study is based on (a) diaries that the client and therapist wrote after each session, (b) recordings of the 12 therapy sessions, and (c) feedback from Jane and Joe on initial drafts of the case study. In the first few pages of the case study Mackrill identifies the concepts he utilized in organizing the data. These are based on a contextual view of behavior. In order to understand change in therapy one must look at the client’s behavior and experiences across life contexts (Dreier, 2008). Specific organizing concepts utilized in writing up the case included focusing on the client’s point of view in different contexts; the difference among points of view of the participants; and identifying shifts in perspective when they occurred. The write-up steered clear of an analysis in terms of theoretical mechanisms of change based on any particular theory of psychotherapy, such as cognitive-behavioral, existential, or psychodynamic. The methodology behind this case is presented in Mackrill (2011). .
Extending Systematic Case Study Method: Generating and Testing Hypotheses About Therapeutic Factors Through Comparisons of Successful and Unsuccessful Cases
Authors: Iwakabe Shigeru
Published: April 2014

This commentary focuses on two case comparison studies, one by Burckell and McMain (2011) on Dialectical Behavior Therapy for borderline personality disorder, and one by Watson et al. (2011) and Goldman et al. (2011) on Emotion-Focused Therapy for depression. The associated case comparison method, which evaluates and contrasts one successful case against one unsuccessful case that are both conducted in similar conditions, provides a unique opportunity for deepening our understanding of therapeutic change. Both therapies are integrative approaches that are clinically state-of-the art and empirically supported, and that have been drawing considerable attention from practitioners and researchers. In this commentary, I first discuss the case comparison method by reviewing previous such approaches, I then examine each pair of case studies with a focus on (a) findings on factors influencing success and limited success, and (b) methodological issues associated with the application of this unique method. Finally, I end my commentary with a suggestion for conducting case comparison studies.
Developmental Perspectives on the Treatment of Childhood Conduct Problems
Authors: Hawes David J.
Published: April 2014

Clement's (2011) case Rafael was a 12-year-old boy referred for reactive aggression in the school setting, whose developmental history was characterized by a serious birth defect and significant disruption early in life. He received individual cognitive-behavioral therapy, the aim of which was to enhance his capacity to self-regulate his behavior and emotions in social contexts using skills-training components that capitalized on his existing strengths. This case demonstrates the potential for older children and adolescents with conduct problems to actively participate in the change process. It also raises a number of important issues related to the planning and delivery of conduct problem interventions, which are explored in this commentary. Particular attention is given to the assessment and conceptualization of developmental trajectories of antisocial behavior, and the role of the family in the treatment of childhood conduct problems.
A Key Role for Case Studies: Theory Building
Authors: Fishman Daniel B. , Westerman Michael A.
Published: April 2014

This article provides an integrative introduction to a PCSP journal issue on using case studies to develop theory. The case studies explore a variety of conceptual models, including two-person relational theory in psychoanalysis (Messer, 2011); interpersonal defense theory (Westerman, 2011); and assimilation theory (Schlieke, Stiles, et al. [2011]; and Gray & Stiles [2011]). In addition, the case studies include a variety of types of clinical psychopathology and therapy orientations.  We note that the articles represent two different ways in which therapy transcript material can be employed in theory building: by focusing in on a small amount of clinical material to study detailed process in a single session (Messer; Westerman); or by analyzing an extensive amount of transcript material across many sessions to study positive change over the course of therapy (Schielke, Stiles, et al.; Gray & Stiles). Overall, we believe that this journal issue illustrates the impressive potential of case studies in advancing theory building.
Psychotherapy as a Human Science: Clinical Case Studies Exploring the Abyss of Madness
Authors: Atwood George E.
Published: April 2014

This paper presents examples of my clinical work that illustrate a phenomenologically, humanistically, existentially, and psychodynamically informed approach to severe psychological disturbances, including both so-called schizophrenia and so-called bipolar disorder.  I illustrate how "symptoms" that appear in this realm can be seen not as outward signs of an inward illness, but as reactions to such ongoing experiences as devastating abandonment, felt misunderstanding, and re-traumatization. Following this, I imagine a world of psychiatry and psychology as a human science, one that has escaped the hegemony of the medical model and grounds itself in the study of human lives as they are lived and experienced.  In this world, the therapist has a radical engagement with the client, with the therapist’s subjectivity being everywhere present in the psychotherapeutic process. Here, there is no such thing as detached observation; and if  a psychotherapeutic dialogue is in any measure successful, it always illuminates and transforms the worlds of both of the people involved.
The Humanity of the Psychotic Patient and the Human Approach by the Therapist: A Relational and Intersubjective Meeting
Authors: Josselson Ruthellen , Mattila Heidi
Published: April 2014

Atwood describes a relational, humanistic, existential, and psychodynamic approach to treating seriously mentally ill clients and calls for a restoration of psychology as a human science.  In our response, we echo Atwood’s values and explore the phenomena of serious mental illness from the point of view of the patient’s subjectivity and lived experience, contrasting it with reductionist and efficiency-oriented models of mental illness and treatment.  In our commentary, we extend his thoughts on treatment of psychotic patients through the lens of contemporary relational and intersubjective theories. We also discuss the place of this work in the current context.
The Abyss of Madness and Human Understanding
Authors: Atwood George E.
Published: April 2014

Two pairs of authors—Pienkos and Sass (2012) and Josselson and Mattila (2012)—have commented upon my article, "Psychotherapy as a Human Science: Clinical Case Studies Exploring the Abyss of Madness." In the article I present a number of case studies that illustrate a phenomenologically, humanistically, and existentially and psychodynamically informed approach to severe psychological disturbances, including both so-called schizophrenia and so-called bipolar disorder. I appreciate the common sympathy that both sets of commentators have with the concept of psychotherapy as a human science. The commentaries also help to raise a number of issues around the concepts of "phenomenological contextualism," "radical otherness" in so-called schizophrenia, the conflict between phenomenological and medical disorder language in describing severe disturbance, and challenges to a psychotherapist working with severely disturbed individuals.
Assimilative and Theoretical Integration in the Treatment of a Trauma Survivor
Authors: Messer Stanley B.
Published: April 2014

This commentary discusses the therapy of a trauma survivor from the perspective of psychotherapy integration. The case of Grace (Pass, 2012) illustrates the concept of assimilative integration in so far as it incorporates an expressive writing technique into Accelerated Experiential Dynamic Psychotherapy, which is itself a theoretical integration of psychodynamic and experiential approaches.
The Management of Narcissistic Vulnerability: Three Case Studies Guided by Stephen Mitchell's Integrated Treatment Model
Authors: Riordan Robert W.
Published: April 2014

The psychological literature pertaining to the treatment of the patient with a narcissistic personality disturbance is dominated by the divergent theories of Otto Kernberg and Heinz Kohut.  In this context, Stephen Mitchell’s theory of narcissistic illusion, which integrates Kernberg’s view of narcissism as a defensive phenomenon and Kohut’s view of narcissism as a growth-enhancing opportunity, is first reviewed. The current study then seeks to assess, through the application of Mitchell’s integrated treatment model to three long-term psychotherapy cases, the efficacy of Mitchell’s model. Efficacy is assessed through (a) a comparison of pre-treatment and post-treatment scores on two standardized, self-report measures, Raskin and Terry's Narcissistic Personality Inventory and the Millon Clinical Multiaxial Inventory-III; (b) DSM diagnostic appraisals before and after therapy; and (c) behavioral comparisons indicating initial psychopathology versus improvement over the course of therapy. In interpreting the findings of the case studies, I argue that the goal of treatment of patients with a narcissistic personality disturbance is to help them (a) acknowledge their narcissistic orientation, and (b) ultimately understand the function of their narcissistic illusion. I conclude that Mitchell’s theory successfully guides the clinician to such an outcome. The strengths and limitations of Mitchell’s model are critically reviewed.  Finally, adjunctive interventions to aid the clinician in the management of the patient’s ongoing narcissistic vulnerability are proposed.
"Selling" Exposure Therapy
Authors: Muller Katherine , Schultz Luke
Published: April 2014

Exposure therapy, or Exposure and Response Prevention (ERP), is a well-established treatment intervention for anxiety and related disorders. In their comprehensive case study series, Folke, Von Bahr, Assadi-Talaremi, and Ramnerö (2012) offer not only an excellent review of their treatment for Body Dysmorphic Disorder, but also a thoughtful discussion of the importance and impact of ERP in these cases. Our commentary addresses the concerns the authors raise in their discussion of patient reactions to the exposure component of the therapy intervention. Using examples from the authors’ case studies, along with relevant research and clinical anecdotes, we offer suggestions on overcoming some of the factors that may prevent the optimal implementation and application of exposure therapy.
"Functional," Sub-Clinical Obsessive-Compulsive Symptoms and Their Challenges: The Case of "Angela"
Authors: Pontes Livia M.M. , Pereira Rodrigo F.
Published: April 2014

Complex behavior patterns may underlie symptoms of obsessive-compulsive disorder (OCD), which, in turn, seem to contribute to the maintenance of symptoms, hinder its management, and interfere with the client’s compliance with treatment. Although the evidence-based choice for treating OCD is cognitive-behavior therapy (CBT), such treatment might prove ineffective if it is not accompanied by a careful and thorough investigation of the contingencies involved in the onset and maintenance of symptoms; and this  might take longer than predicted by treatment manuals. We present a case study of the treatment of "Angela," a client with OCD who suffered from sub-clinical symptoms for 20 years and did not obtain relief with antidepressant medication. Angela underwent cognitive-behavioral therapy for three and a half years and was treated by the first author in weekly sessions. The difficult management of symptoms, the contingencies involved in them, and the development of the therapeutic relationship are discussed. Treatment results indicated a significant decrease in symptoms, anxiety, and discomfort. We believe this case illustrates limitations associated with a strict, manual-driven treatment with a pre-determined number of sessions.
Synergy Among Research, Practice, and Training in Psychotherapy: An Introduction to the Work of Mikael Thastum and His Students at Aarhus University, Denmark
Authors: Fishman Daniel B.
Published: April 2014

While the nature of research, practice, and training in psychotherapy makes it possible for them to be synergistic in advancing best practice and continuous improvement in the field, this potential is just beginning to be mined. In this process, the systematic case study has important roles to play since it captures and analyzes the contextually complex, qualitative and quantitative data that constitute the basic phenomena of the field. This article briefly reviews the dynamics of the research-practice-training synergy and illustrates how they are embodied in the work of Dr. Mikael Thastum at The Anxiety Disorder Clinic for Children and Adolescents (TADCCA) of Aarhus University. As a second example of this synergy and as a comparison to Thastum's Clinic, the parallel work of Brian Chu at the Youth and Depression Clinic (YAD-C) at Rutgers University is reviewed.
A "Cool Kids" Cognitive-Behavioral Therapy Group for Youth with Anxiety Disorders: Part 1, The Case of Erik
Authors: Lundkvist-Houndoumadi Irene , Thastum Mikael
Published: April 2014

This case study involves a 12-year-old boy, Erik, with cognitive difficulties, who also suffered from multiple anxiety disorders (specifically, he met the diagnostic criteria of Generalized Anxiety, Specific Phobias, Social Phobia, and Separation Anxiety). Erik and his family were treated for 10 sessions over three months with the "Cool Kids " cognitive-behavioral therapy (CBT) program developed by Ronald Rapee and his colleagues (Rapee et al., 2006). The treatment took place in a university training clinic in Aarhus, Denmark. CBT was conducted in a group format, with both children and their families taking an active part, and included cognitive restructuring, gradual exposure, child management training, and skills training in areas such as assertiveness. Results show that therapy effectively reduced the child’s anxiety symptoms, as measured by the Anxiety Disorder Interview Schedule for Children and Parents (ADIS-IV P/C) and by the Spence Children's Anxiety Scale (SCAS). Additional quantitative and qualitative data indicate an overall positive therapeutic outcome, which was maintained at 3 months and 15 months after the conclusion of treatment. A primary aim of the case study was to investigate the mechanisms of change leading to success in Erik's case, focusing on the role of parental inclusion in the therapy and the necessary accommodations made to the child’s cognitive developmental level. For example, through parents’ engagement in therapy, it was possible to alter their expectations and behaviors, with Erik’s mother learning how to be less overprotective and control her own anxiety, functioning as a positive role model for her child. Furthermore, the present study stresses the significance of accommodating the treatment to the child’s cognitive developmental level, such that Erik’s cognitions were initially challenged successfully through gradual exposures and only later addressed with cognitive restructuring, aided by the treatment given to his parents and Erik’s advancing cognitive maturation.
A "Cool Kids" Cognitive-Behavioral Therapy Group for Youth with Anxiety Disorders: Part 2, Analysis of the Process and Outcome of Responders Versus Nonresponders
Authors: Lundkvist-Houndoumadi Irene , Thastum Mikael
Published: April 2014

This case study involves a therapy group of four boys and two girls aged 8-12 who suffered from multiple anxiety disorders. The children and their families were treated for 10 sessions over three months with the "Cool Kids" cognitive-behavioral therapy (CBT) program developed by Rapee and his colleagues (2006). The treatment, which took place in a university training clinic in Aarhus, Denmark, was conducted in a group format, with both children and their families taking an active part, and included cognitive restructuring, gradual exposure, child management training, and skills training in areas such as assertiveness. Outcome was measured by change over time on standardized self-report measures, on diagnosis, and on an overall judgment based on all the data on a "Clinical Global Impression-Improvement of Anxiety Scale" ("CGI-I"). Four of the cases, the "responders," showed successful outcomes on standardized measures, while two, the "nonresponders," did not. This case study looks both qualitatively and quantitatively at the process and outcome of each child and family, exploring the differences between the responders and nonresponders.
Advances and Controversies in the Application of a Modified Version of Cognitive Behavior Therapy for Social Anxiety Disorder
Authors: Rogojanski Jenny , Rego Simon A.
Published: April 2014

In their comprehensive case study, Jensen, Hougaard, and Fishman (2013) examined the micro-level mechanisms of change for a socially anxious client who underwent one-week of intensive group-based cognitive behavioral therapy (CBT) and experienced rapid symptom improvement. Our commentary focuses on two key components in the cognitive model of social anxiety, which this study highlights - the role of safety behaviors and interrogating the social environment, as well two topics that are applicable to anxiety treatments in general - integrating acceptance-based strategies into CBT and novel approaches in treatment delivery. We highlight what can be learned from Jensen and colleagues’ case study by incorporating both empirical research and our own clinical anecdotes.
Further Reflections on the Complexities of Therapeutic Change Mechanisms in a Case Study of Social Phobia
Authors: Hougaard Esben , Jensen Vicki L. , Fishman Daniel B.
Published: April 2014

The paper is a response to a commentary by Rogojanski and Rego (2013) on our case study of Sara (Jensen, Hougaard, & Fishman, 2013). Sara was a client who achieved a remarkable and durable change in her longstanding social phobia (SP) after short-term group cognitive-behavior therapy (CBT). Our response deals with the following topics: (1) safety behavior; (2) the idiographic arrangement of exposure as behavioral experiments; (3) acceptance as a mechanism of action in CBT; (4) the specific format of the Aarhus treatment program; and (5) recent advances in quantitative research on change mechanisms in CBT for anxiety disorders. We conclude that Rogojanski and Rego's commentary and our further reflections underline the original conclusion from our case study: that generally, change mechanisms in psychotherapy are highly complex, and that specifically, the data from Sara’s case could be consistent with several disparate theories of change mechanisms in CBT, revealing a high degree of overlap and  intertwining among the theories.
"Cool Kids" in Denmark: Continuing Reflections on a Cognitive-Behavioral Therapy Group for Anxious Youth
Authors: Thastum Mikael , Lundkvist-Houndoumadi Irene
Published: April 2014

This paper responds to a commentary by Perini, Wuthrich, and Rapee (2013) on two case studies on cognitive behavioral therapy for anxious children and their parents using the "Cool Kids" treatment program (Lundkvist-Houndoumadi & Thastum, 2013a; Lundkvist-Houndoumadi & Thastum, 2013b). In our response we address the following topics: including fathers in the therapy; a stepped-care approach to treatment; treatment of non-responders; parental anxiety as a predictor of treatment response; combining group and individual formats; and inclusion of students in the treatment.
The Pragmatic Case Study Method for Creating Rigorous and Systematic, Practitioner-Friendly Research
Authors: Fishman Daniel B.
Published: April 2014

Psychotherapy case studies have the capacity to link directly to the work of practitioners because these studies are grounded in the same type of setting in which clinicians function, that of the single case. Not surprisingly, then, case studies have played a most important role in the development of a wide range of therapy models, like psychoanalysis, behavioral therapy, and client-centered therapy. However, until recently, case studies as a method of research have fallen into disuse because they have been viewed as subjective and journalistic. This situation has changed with the growth of the philosophical movement of postmodernism, which has encouraged pluralism in the social sciences, and in turn stimulated new approaches to the case study as a serious method for psychotherapy research. This paper reviews one such approach, the pragmatic case study method, which is grounded in the fast-growing "mixed methods" model in the social sciences that seeks new ways to integrate qualitative and quantitative research designs and data. This paper begins with an overview of the growing variety of types of psychotherapy research, indicating where case studies fit in and describing a new design that integrates the use of pragmatic case studies with randomized clinical trials. The paper then lays out the basic structure of the pragmatic case study, in the context of viewing therapy as a complex adaptive system and, in a related fashion, as an example of Peterson's (1991) "Disciplined Inquiry" model of professional practice. The paper next provides a more concrete idea of the pragmatic case study by summarizing guidelines for writing such a case study for this PCSP journal, and by describing the structure of a specific example of a pragmatic case study published in the journal, the case of Caroline by Ueli Kramer. Finally, the paper describes how the pragmatic case study can be integrated with other types of case study designs.
The Case Formulation Approach to Psychotherapy Research Revisited
Authors: Eells Tracy D.
Published: April 2014

This article revisits the case formulation approach to psychotherapy outcome research, first proposed by Persons (1991).  Persons asserted that randomized clinical trials (RCTs) of psychotherapy do not test the theoretical underpinnings of psychotherapy models since these trials standardize rather than individualize patient problems, ignore the link between individualized assessment and treatment as described in these models, and employ standardized rather than individualized treatment.  This article assesses the current status of these claims, concluding that they remain valid today.  A reformulated case formulation approach is described and research strategies proposed.  Investigating the reformulated case formulation approach will require increased resources for case formulation training, the addition of treatment arms in effectiveness trials that include case-formulation-based interventions, and expanded RCTs that include systematic case studies.
Curricular Aspects of the Fogarty Bioethics International Training Programs
Authors: Matar Amal , Garner Sam , Millum Joseph , Sina Barbara , Silverman Henry
Published: April 2014

The curriculum design, faculty characteristics, and experience of implementing masters' level international research ethics training programs supported by the Fogarty International Center was investigated. Multiple pedagogical approaches were employed to adapt to the learning needs of the trainees. While no generally agreed set of core competencies exists for advanced research ethics training, more than 75% of the curricula examined included international issues in research ethics, responsible conduct of research, human rights, philosophical foundations of research ethics, and research regulation and ethical review process. Common skills taught included critical thinking, research methodology and statistics, writing, and presentation proficiency. Curricula also addressed the cultural, social, and religious context of the trainees related to research ethics. Programs surveyed noted trainee interest in Western concepts of research ethics and the value of the transnational exchange of ideas. Similar faculty expertise profiles existed in all programs. Approximately 40% of faculty were female. Collaboration between faculty from low- and ***middle-income countries (LMICs) and high-income countries (HICs) occurred in most programs and at least 50% of HIC faculty had previous LMIC experience. This paper is part of a collection of papers analyzing the Fogarty International Research Ethics Education and Curriculum Development program.
Research Ethics Capacity Building in Sub-Saharan Africa: A Review of NIH Fogarty-Funded Programs 2000–2012
Authors: Ndebele Paul , Wassenaar Douglas , Benatar Solomon , Fleischer Theodore , Kruger Mariana , Adebamowo Clement , Kass Nancy , Hyder Adnan A. , Meslin Eric M.
Published: April 2014

The last fifteen years have witnessed a significant increase in investment in research ethics capacity development throughout the world. We examine nine research ethics training programs that are focused on Sub-Saharan Africa and supported by the US National Institutes of Health. We collected data from grants awards' documents and annual reports supplemented by questionnaires completed by the training program directors. Together, these programs provided long-term training in research ethics to 275 African professionals, strengthened research ethics committees in 19 countries in Sub-Saharan Africa, and created research ethics curricula at many institutions and bioethics centers within Africa. Trainees' leadership resulted in new national systems and policies on research ethics, human tissue storage and export, and methods of monitoring compliance with research ethics guidelines. Training programs adapted to challenges that arose due to varied trainees' background knowledge in ethics, duration of time available for training, spoken and written English language skills, administrative obstacles, and the need to sustain post-training research ethics activities. Our report showcases the development of awareness of research ethics and building/strengthening of basic research ethics infrastructure in Sub-Saharan Africa. Nevertheless, the increasing amount and complexity of health research being conducted in Sub-Saharan Africa suggests the need for continued investment in research ethics capacity development in this region. This paper is part of a collection of papers analyzing the Fogarty International Center's International Research Ethics Education and Curriculum Development program.
Research Ethics Review: Identifying Public Policy and Program Gaps
Authors: Strosberg Martin A. , Gefenas Eugenijus , Famenka Andrei
Published: April 2014

We present an analytical frame-work for use by fellows of the Fogarty International Center–sponsored Advanced Certificate Program in Research Ethics for Central and Eastern Europe to identify gaps in the public policies establishing research ethics review systems that impede them from doing their job of protecting human research subjects. The framework, illustrated by examples from post-Communist countries, employs a logic model based on the public policy and public management literature. This paper is part of a collection of papers analyzing the Fogarty International Center's International Research Ethics Education and Curriculum program.
Evolutionary conservation and modulation of a juvenile growth-regulating genetic program
Authors: Delaney Angela , Padmanabhan Vasantha , Rezvani Geoffrey , Chen Weiping , Forcinito Patricia , Cheung Crystal S F , Baron Jeffrey , Lui Julian C K
Published: April 2014

Body size varies enormously among mammalian species. In small mammals, body growth is typically suppressed rapidly, within weeks, whereas in large mammals, growth is suppressed slowly, over years, allowing for a greater adult size. We recently reported evidence that body growth suppression in rodents is caused in part by a juvenile genetic program that occurs in multiple tissues simultaneously and involves the downregulation of a large set of growth-promoting genes. We hypothesized that this genetic program is conserved in large mammals but that its time course is evolutionarily modulated such that it plays out more slowly, allowing for more prolonged growth. Consistent with this hypothesis, using expression microarray analysis, we identified a set of genes that are downregulated with age in both juvenile sheep kidney and lung. This overlapping gene set was enriched for genes involved in cell proliferation and growth and showed striking similarity to a set of genes downregulated with age in multiple organs of the juvenile mouse and rat, indicating that the multiorgan juvenile genetic program previously described in rodents has been conserved in the 80 million years since sheep and rodents diverged in evolution. Using microarray and real-time PCR, we found that the pace of this program was most rapid in mice, more gradual in rats, and most gradual in sheep. These findings support the hypothesis that a growth-regulating genetic program is conserved among mammalian species but that its pace is modulated to allow more prolonged growth and therefore greater adult body size in larger mammals.
Use of Antihistamines After Serious Allergic Reaction to Methimazole in Pediatric Graves’ Disease
Authors: Toderian Amy B. , Lawson Margaret L.
Published: April 2014

Antithyroid drugs are usually considered first-line therapy for management of pediatric Graves’ disease because they avoid permanent hypothyroidism, provide a chance for remission, and are less invasive than the alternatives of thyroidectomy or radioactive iodine. Methimazole (MMI) is the only antithyroid drug recommended in pediatrics due to the risk of propylthiouracil-induced liver toxicity. Allergic reactions with MMI occur in up to 10% of patients and, when mild, can be managed with concurrent antihistamine therapy. Guidelines recommend discontinuation of MMI with serious allergic reactions. We present the case of an adolescent girl with Graves’ disease and a serious allergic reaction after starting MMI whose family refused radioactive iodine and was reluctant to proceed to surgery. Antihistamine therapy was successfully used to allow continued treatment with MMI. This case demonstrates extension of management guidelines for minor cutaneous allergic reactions to MMI, through the use of antihistamines for a serious allergic reaction, allowing us to continue MMI and provide treatment consistent with the family’s preferences and values.