bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
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). .
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 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.
"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.
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.
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.
Unmet Needs of Siblings of Pediatric Stem Cell Transplant Recipients
Authors: Pentz Rebecca D. , Alderfer Melissa A. , Pelletier Wendy , Stegenga Kristin , Haight Ann E. , Hendershot Kristopher A. , Dixon Margie , Fairclough Diane , Hinds Pamela 
Published: April 2014

BACKGROUND AND OBJECTIVES:In 2010, the Bioethics Committee of the American Academy of Pediatrics issued recommendations that pediatric hematopoietic stem cell donors should have an independent advocate. Formulating appropriate guidelines is hindered by the lack of prospective empirical evidence from families about the experience of siblings during typing and donation. Our aim was to provide these data.METHODS:Families with a child scheduled to undergo hematopoietic stem cell transplant were recruited. All family members, including children aged 9 to 22 years, were eligible. Qualitative interviews were conducted within 3 time periods: pretransplant, 6 to 8, and 9 to 11 months posttransplant. Quantitative scales assessing decision satisfaction and regret were administered at time 2.RESULTS:Thirty-three families were interviewed. Of the 119 family members, 76% perceived there was no choice in the decision to HLA-type siblings; 77% perceived no choice in sibling donation; 86% had no concerns about typing other than needle sticks; and 64% had no concerns about donation. Common concerns raised were dislike of needle sticks (19%), stress before typing results (14%), and fear of donation (15%). Posttransplantation, 33% of donors wished they had been given more information; 56% of donors stated they benefited from donation. Only 1 donor expressed regret posttransplant.CONCLUSIONS:Most family members did not view sibling typing and donation as a choice, were positive about the experience, and did not express regrets. We recommend education for all siblings before typing, comprehensive education for the donor by a health care provider pretransplant, and systematic donor follow-up after transplantation.
United States Birth Weight Reference Corrected For Implausible Gestational Age Estimates
Authors: Talge Nicole M. , Mudd Lanay M. , Sikorskii Alla , Basso Olga 
Published: April 2014

OBJECTIVES:
To provide an updated US birth weight for gestational age reference corrected for likely errors in last menstrual period (LMP)-based gestational age dating, as well as means and SDs, to enable calculation of continuous and categorical measures of birth weight for gestational age.

METHODS:
From the 2009–2010 US live birth files, we abstracted singleton births between 22 and 44 weeks of gestation with at least 1 nonmissing estimate of gestational age (ie, LMP or obstetric/clinical) and birth weight. Using an algorithm based on birth weight and the concordance between these gestational age estimates, implausible LMP-based gestational age estimates were either excluded or corrected by using the obstetric/clinical estimate. Gestational age– and sex-specific birth weight means, SDs, and smoothed percentiles (3rd, 5th, 10th, 90th, 95th, 97th) were calculated, and the 10th and 90th percentiles were compared with published population-based references.

RESULTS:
A total of 7 818 201 (99% of eligible) births were included. The LMP-based estimate of gestational age comprised 85% of the dataset, and the obstetric/clinical estimate comprised the remaining 15%. Cut points derived from the current reference identified ∼10% of births as ≤10th and ≥90th percentiles at all gestational weeks, whereas cut points derived from previous US-based references captured variable proportions of infants at these thresholds within the preterm and postterm gestational age ranges.

CONCLUSIONS:
This updated US-based birth weight for gestational age reference corrects for likely errors in gestational age dating and allows for the calculation of categorical and continuous measures of birth size.