Evidence-Based Case Study
Parallel in purpose to the Practice Review articles, I would like to issue an open invitation for authors to submit an Evidence-Based Case Study for possible publication in Psychotherapy. I believe developing such a series of Evidence-Based Case Studies will be extremely useful in several ways.
First, such investigation will provide much needed information to bridge the gap between research and practice.
Second, such studies will provide important templates of how to integrate basic research into applied work at the individual case level. In addition, I hope to open an avenue for publication to those in full time private practice who are interested in integrating research measures into their clinical work.
Finally, I wish to provide a readily identifiable aggregate of systematic case studies from various forms of treatment that meet the American Psychological Association's criteria for Evidence-Based Practice (APA, 2006) as well as the Clinical Utility dimension in the Criteria for Evaluating Treatment Guidelines (APA, 2002).
The goal of these Evidenced-Based Case Studies will be to integrate verbatim clinical case material with standardized measures of process and outcome evaluated at different times across treatment. That is, authors should describe clinical vignettes highlighting key interventions and mechanisms of change regarding their specific approach to treatment in the context of empirical scales.
With this goal in mind I offer the following guidelines for those who are interested in preparing an Evidence-Based Case Study:
1. At minimum the report should include the assessment (from patient or independent rater perspective, not therapist) of at least two standardized outcome measures, global functioning and target symptom (i.e. depression, anxiety, etc), as well as one process measure (i.e. therapeutic alliance, session depth, emotional experiencing, etc) evaluated on at least three separate occasions.
Optimally, such a report would include several outcome measures assessing a wide array of functioning such as global functioning, target symptoms (i.e. depression, anxiety, etc), subjective well-being, interpersonal functioning, social/occupational functioning and measures of personality, as well as relevant process measures evaluated at multiple times across treatment.
2. At minimum, specific outcome data should be presented using standardized mean difference (i.e. effect size) and clinical significance methodology (i.e. unchanged, reliable change, movement into functional distribution, clinically significant change, and deterioration; see Jacobson et al., 1999). Submission of both successful and unsuccessful treatment cases are encouraged. In addition, it might be quite instructive to compare and contrast the technical interventions that occurred during a positive change case with that of a clinically unchanged or deteriorated case from the same approach to treatment.
3. Verbatim clinical vignettes with several patient and therapist turns highlighting key interventions and mechanisms of change regarding the specific approach to treatment should be provided. Discussion of therapeutic interventions should not be presented from a global or abstract perspective.
4. Appropriate informed consent must be obtained.
A good template for this suggested Evidence-Based Case Study format can be found in Hill and colleagues (2008). Other case studies provide a good template for some aspects of this Evidence-Based Case Study format.
Related case studies that effectively address the first two outcome assessment criteria, but lack extensive verbatim clinical vignettes include Borckardt et al., 2008; Jones et al., 1993; and Porcerelli et al., 2007.
Similarly, Busch et al., 2009 report extensive process evaluations over multiple assessments, but do not provide extended verbatim clinical vignettes.
Conversely, Hilsenroth and Slavin, 2008 provide extensive verbatim clinical vignettes of proposed mechanisms of change in the context of summary information on clinically significant change, but do not report specific process or outcome scores.
Finally, Strupp et al., 1992 provide extensive verbatim clinical vignettes from a failed treatment that are quite instructive regarding possible indicators of treatment termination, with initial scores on several assessment measures.
In addition, I do not mean to suggest that this Evidence-Based Case Study section is for advanced statistical time series analyses of process or outcome data, although such articles would certainly be welcomed. Simple analyses of standardized outcome measures by way of clinical significance and effect size methods are sufficient, all of which can be readily tabulated by hand or with a calculator.
Any authors who have conducted an effectiveness or efficacy trial on a particular type of treatment that have collected standardized process and outcome measures across treatment in addition to the use of audio/videotape of sessions should consider submitting an Evidence-Based Case Study. Likewise, any clinician in private practice who would like to add these elements at the initiation of a new case should also consider submitting to this special series.
Anyone who may have an interest in submitting an Evidence-Based Case Study is invited to contact me if they have any questions about this process.
- American Psychological Association, (2002). Criteria for evaluating treatment guidelines. American Psychologist, 57, 1052–1059.
- American Psychological Association, (2006). Evidence-based practice in psychology. American Psychologist, 61, 271–285.
- Borckardt, J., Nash, M., Murphy, M., Moore, M., Shaw, D., & O'Neil, P. (2008). Clinical practice as a natural laboratory for psychotherapy research. American Psychologist, 63, 77–95.
- Busch, A., Kanter, J., Callaghan, G., Baruch, D., Weeks, C., & Berlin, K. (2009). A micro-process analysis of functional analytic psychotherapy's mechanism of change. Behavior Therapy, 40, 280–290.
- Hill, C., Sim, W., Spangler, P., Stahl, J., Sullivan, C., & Teyber, E. (2008). Therapist immediacy in brief psychotherapy: Case study II. Psychotherapy: Theory, Research, Practice, Training, 45, 298–315.
- Hilsenroth, M., & Slavin, J. (2008). Integrative dynamic treatment for co-morbid depression and borderline conditions. Journal of Psychotherapy Integration, 18, 377–409.
- Jacobson, N., Roberts, L., Berns, S., & McGlinchey, J. (1999). Methods for defining and determining the clinical significance of treatment effects: Description, application, and alternatives. Journal of Consulting and Clinical Psychology, 67, 300–307.
- Jones, E., Ghannam, J., Nigg, J & Dyer, J. (1993). A paradigm for single-case research: The time series study of a long-term therapy for depression. Journal of Consulting and Clinical Psychology, 61, 381–394.
- Porcerelli, J., Dauphin, V., Ablon, J., Leitman, S., & Bambery, M. (2007). Psychoanalysis with avoidant personality disorder: A systematic case study. Psychotherapy: Theory, Research, Practice, Training, 44, 1–13.
- Strupp, Schacht, Henry, & Binder (1992). Jack M.: A case of premature termination. Psychotherapy: Theory, Research, Practice, Training, 29, 191–205.