Using Single‐Case Research Designs to Demonstrate Evidence for Counseling Practices

The contemporary sociopolitical and economic climates have resulted in a necessity for counselors across settings to provide measurable outcomes that justify the type and amount of services rendered to clients (Lenz, 2013; Morgan & Morgan, 2009; Sanderson, 2003). When answering this call to accountability, some counselors have found themselves stymied by a set of assumptions wherein (a) such research is for people wearing lab coats, (b) predictive models are insufficient for making causal inferences, (c) between-groups treatment comparisons are not feasible, (d) the required sample size to complete outcome studies is often unrealistic, and (e) the practical preparation for completing research and program evaluation were insufficient during graduate preparation. Others may contest that formal research and appraisal practices are insufficient for capturing the humanistic nature of developments associated with treatment gains (Hansen, 2006, 2012). Despite these suppositions, the emphasis on implementing practices that support accountability between counselors, clients, funding sources, and stakeholders has remained. Therefore, a prudent task for counselors across settings is to use evaluative strategies that meet requirements for reporting outcomes, while also honoring the uniqueness of each counseling relationship and the holistic development of all clients. Single-case research designs (SCRDs) represent a practical strategy for making inferences about the efficacy of an intervention, establishing evidentiary support for counseling practices, and giving voice to counseling activities with small or understudied populations. At a basic level, SCRDs compose a category of experimental techniques for evaluating causal relationships between interventions and dependent variables in which individual participants function as the unit for analysis (Lundervold & Belwood, 2000; O'Neill, McDonnell, Billingsley, & Jenson, 2010; Sharpley, 2007). Several authors have suggested that the term single-case research design is a bit of a misnomer when considering that a single case can be represented by an individual client, family, or group (Morgan & Morgan, 2009; O'Neill et al., 2010). When implementing this approach, participants serve as their own comparison through contrasting scores associated with a dependent variable during and after an intervention with those collected prior to the introduction of an independent variable (Egel & Barthold, 2010; Rubin & Belamy, 2012). As a result, the analysis of SCRD data yields information related to outcomes of individuals that are associated with their experience during an intervention. A common practice is for counselors to inspect these data within individual participants (see Lenz, 2013); however, there is an emerging trend for aggregating results across all cases to promote the inspection of participant characteristics and study qualities that may moderate outcomes (see Bowman-Perrott et al., 2013; Cambell & Herzinger, 2010). In both scenarios, the data yielded from SCRDs can support counseling professionals as they attempt to monitor the progress of individual clients, complete program evaluations, support evidence-based practice, and report activities to stakeholders. Almost 2 decades ago, Chambless et al. (1996, 1998) presented benchmark criteria for evaluating the evidentiary support of therapeutic interventions. As a result, experimental between-groups research designs and SCRDs were galvanized within the social sciences as methods for contributing to the evidence-based treatment literature. Wampold, Lichtenberg, and Waehler (2002) expanded this framework by including deliberations related to the degree of specificity, utility of multiple type of comparison groups, treatment component analysis, broad assessment, methods for consolidating results across studies, and viability of interventions from one community to the next. Although these endorsements promoted two separate and unique methodologies for establishing evidentiary support for interventions, several authors have argued that between-groups designs, especially randomized controlled trials with an emphasis on null hypothesis testing, should be regarded as the gold standard of research methodologies (Balshem et al. …