The use of single-case methodology in psychotherapy research.

Discusses a new psychotherapy research strategy, the experimental analysis of single cases, which is being increasingly employed in behavior modification studies. The major single-case experimental designs used in these studies include the reversal design, withdrawal design, multiple schedule design, and multiple baseline design. Examples of these designs are presented, and the advantages and disadvantages of each design are critically discussed. Possible merits and limitations of applying controlled single-case methodology to the general area of psychotherapy research are also explored. It is concluded that in spite of limited purposes, single-case experimentation has proved to be a vital source of strength in the development and evaluation of behavior modification, and that it might be equally useful in the experimental study of other psychotherapy approaches. (26 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A paradigm for single-case research: The time series study of a long-term psychotherapy for depression.

Articulates a paradigm for single-case research in psychotherapy. A patient diagnosed as having major depressive disorder was seen in an intensive, twice-weekly psychodynamic psychotherapy for 2.5 years. Each session was videotaped, and assessments of patient change were obtained at regular intervals. A time-series analysis was used to model fluctuations in the therapy process to take into account time and the effect of previous events on subsequent changes, thereby preserving the context-determined meaning for therapist and patient actions. A bidirectional analysis of causal effects shows that the influence processes between therapist and patient are mutual and reciprocal and suggests that the effect of the patient on the therapist and on the process has not been made sufficiently explicit in previous models of process and change. The potential of intensive single-case designs for uncovering causal effects in psychotherapy is demonstrated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Single-case methodology in psychotherapy process and outcome research.

Delineates and explains the essential characteristics of single-case research methodology applied within the domain of psychotherapy research. Single-case research is presented as a subclass of intrasubject research in which aggregation across Ss is avoided and the generality of one's findings is addressed through replication on a case-by-case basis. The basic ways in which single-case designs vary are also discussed, and 3 basic types of single-case research are differentiated: (1) single-case experiments, (2) single-case quantitative analyses, and (3) case studies. Furthermore, some of the major weaknesses in current single-case psychotherapy research are identified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhancing the scientific credibility of single-case intervention research: Randomization to the rescue.

In recent years, single-case designs have increasingly been used to establish an empirical basis for evidence-based interventions and techniques in a variety of disciplines, including psychology and education. Although traditional single-case designs have typically not met the criteria for a randomized controlled trial relative to conventional multiple-participant experimental designs, there are procedures that can be adopted to create a randomized experiment in this class of experimental design. Our two major purposes in writing this article were (a) to review the various types of single-case design that have been and can be used in psychological and educational intervention research and (b) to incorporate randomized experimental schemes into these designs, thereby improving them so that investigators can draw more valid conclusions from their research. For each traditional single-case design type reviewed, we provide illustrations of how various forms of randomization can be introduced into the basic design structure. We conclude by recommending that traditional single-case intervention designs be transformed into more scientifically credible randomized single-case intervention designs whenever the research conditions under consideration permit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comment: Integrating methodologies in the scientific study of interpersonal psychotherapy: A reaction to "Therapist immediacy in brief psychotherapy: Case study I and case study II".

In this reaction article, the author concentrates on selected methodological components characterizing both Kasper, Hill, and Kivlighan's (see record 2008-13167-001) and Hill, Sim, Spangler, Stahl, Sullivan, and Teyber's (see record 2008-13167-002) respective case studies of therapist immediacy in brief psychotherapy. In tandem, the foci and methodology of these investigations break new ground in the scientific study of interpersonal psychotherapy, and more generally they serve as paradigmatic illustrations of the form that psychotherapy research can take if it is to be truly more meaningful and useful for practitioners. Emphasis is placed on the investigators' integration of single-case research, elements of change process research, and quantitative and qualitative methods in a way that enables highly intensive examination of this core intervention in interpersonal psychotherapy. Specific elements and implications of each of these methodological components are briefly discussed, which also creates a context for addressing the issue of discovery versus verification as this pertains to the present studies. Some underlying philosophical considerations are also briefly touched on along the way. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The attrition dilemma: Toward a new strategy for psychotherapy research.

Presents an analysis of the attrition dilemma in psychotherapy research and reviews the methods used to compensate for data loss. It is argued that attrition is not ultimately a problem of bias but a problem of lack of information. A reformulation is offered that integrates single-case studies with traditional group comparison methodology in an attempt to find optimal causal relations of treatments to outcomes. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Single-case design: A primer for play therapists.

Play therapy research is typically presented to practitioners as extensive and detailed studies that involve excessive controls of variables and large numbers of subjects in order to generalize findings. However, single-case design is one research design that involves concentration on data collection from few participants and involves clinical decision-making of the play therapist. This article defines single-case design and provides step-by-step suggestions for how to conduct a single-case design study. We also provide a specific example of single-case application to play therapy intervention and further discuss common problems in play therapy single-case design implementation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Regulated randomization: A potentially sharper analytical tool for the multiple-baseline design.

A dual-randomization procedure, regulated randomization, is proposed for behavioral and educational interventions that incorporate the logic of single-case multiple-baseline designs. The new approach is sharper conceptually and methodologically than previously developed approaches in that regulated randomization maintains the basic integrity of the multiple-baseline design (namely, the systematically staggered introduction of the intervention across the experimental units) while being statistically practicable with fewer units (N?     

Introduction to special section: Single-case research in psychotherapy.

As a method of inquiry, single-case research has been relegated conventionally to the role of discovery or hypothesis generation. New developments in the methodology of intensive single-case designs has extended its applicability to the testing of clinical theoretical constructs and even the identification of causal relations. A series of articles illustrates newer developments in single-case research and its use in addressing a wide range of clinical and research questions. It has often been noted that psychotherapy research has had little influence on clinical practice. Single-case designs are more closely linked to traditional means of clinical inquiry, teaching, and learning than are large-sample studies, and they are likely to have more immediate relevance for how intervention is conducted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Studies on the efficacy of child psychoanalysis.

This article summarizes 3 studies that evaluated the psychoanalytic psychotherapeutic treatment of diabetic children and adolescents with grossly abnormal blood glucose profiles necessitating repeated admissions to hospital. Study 1 used time series analysis to demonstrate that improvements in control were predicted by unconscious themes emerging in the analytic material. Study 2 compared the effect of psychotherapeutic treatment with that of minimal psychological intervention in 2 well-matched groups (n?=?11). Patients in the treatment group were offered psychoanalytic psychotherapy 3–4 times per week on the hospital ward. The intervention was highly effective in improving the diabetic control of the children, and this improvement was maintained at 1-yr follow-up. Study 3 used single-case experimental design to demonstrate the marked effect of psychotherapeutic help on growth in diabetic children with short stature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic assessment for preadolescent boys with oppositional defiant disorder: A replicated single-case time-series design.

The Therapeutic Assessment (TA) model is a relatively new treatment approach that fuses assessment and psychotherapy. The study examines the efficacy of this model with preadolescent boys with oppositional defiant disorder and their families. A replicated single-case time-series design with daily measures is used to assess the effects of TA and to track the process of change as it unfolds. All 3 families benefitted from participation in TA across multiple domains of functioning, but the way in which change unfolded was unique for each family. These findings are substantiated by the Behavior Assessment System for Children (Reynolds & Kamphaus, 2004). The TA model is shown to be an effective treatment for preadolescent boys with oppositional defiant disorder and their families. Further, the time-series design of this study illustrated how this empirically grounded case-based methodology reveals when and how change unfolds during treatment in a way that is usually not possible with other research designs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical practice and scientific psychology: Can this marriage be saved?

Discusses the relationship of scientific psychology to the practice of psychotherapy. The use of research to change psychotherapy techniques is examined in each of 3 major orientations of psychodynamic, experiential, and behavioral psychotherapy. Common factors that may be responsible for the success of all therapies are described, and the controversy between those who see psychotherapy as a cultural ritual and those who see it as a scientifically-based procedure is reviewed. The consequences of a split between researcher and clinician roles in clinical psychology are predicted. It is concluded that scientific psychology and psychotherapy can together contribute meaningfully to society and a divorce would not be in the best interest of either discipline. (41 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Modeling psychotherapy outcome as an event in time: An application of multistage analysis.

Standard survival analysis (SA) and multistate analysis (MSA) are methods for modeling categorical psychotherapy outcome events over time. The underlying principles, mathematical details, and indications for using each technique are discussed, and data from an anorexia nervosa psychotherapy outcome study comparing psychodynamic psychotherapy with psychodynamic psychotherapy plus cognitive–behavioral techniques are used to illustrate the use of SA and MSA techniques. MSA includes multiple competing outcome states in a single model. A single MSA model includes reaching target weight and treatment dropout before reaching target weight as competing events. It is concluded that MSA is an informative analytic technique in the domain of psychotherapy research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Critical issues in cognitive remediation.

Describes cognitive remediation (CGR) as a rehabilitation intervention that gained momentum in the early 1970s when a group of investigators at New York University Medical Center began a series of systematic studies to examine the learning styles of brain-damaged patients and to determine if their cognitive deficits were amenable to treatment. Although CGR is widely applied to individuals with brain injury, insufficient large-scale research has been conducted supporting its efficacy. Several principles that underlie successful CGR are discussed. These include (1) the existence of a logical basis for the ordering of treatment, (2) generalization as the goal and outcome of CGR, (3) psychotherapy as a mediator of successful CGR, and (4) the need to modify existing methodologies to assess treatment efficacy. The use of single-case experimental designs is suggested as a means of expanding the literature on the utility of CGR. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Placebo controls in psychotherapy research: A sine qua non or a placebo for research problems?

Contends that efforts to transpose to psychotherapy research the definition and the pejorative meanings associated with the medical concept of placebo are inappropriate. Problems in implementing placebo controls in psychotherapy are described, including the difficulty of ensuring that under nonblind design conditions, therapists and their patients will view both the experimental and placebo treatments as comparably credible. Six research issues are reviewed that stem from the definitional requirement that the placebo control for the critical and specific components characteristic of the experimental treatment. These issues are (1) lack of standardization of placebos, (2) lack of standardization of psychotherapies, (3) the problem of viewing psychotherapy as a set of techniques, (4) the difficulty in differentiating placebos from alternative forms of treatment, (5) insensitivity of measures, and (6) limits of generalization. A research strategy is proposed that is more likely than the placebo control model to facilitate the accumulation of knowledge regarding effective elements of psychotherapy. (55 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Single-case investigative research and its relevance for the nonoperant clinician.

Asserts that a new research approach is needed to intra-S investigations that deals as seriously with actual clinical goals as it does with experimental design criteria. It is contended that the work of M. B. Shapiro published from 1951 to 1979 offers the nonoperant clinician a patient-oriented approach to evaluate the efficacy of clinical treatment. Four of his methodological principles of single-case research are presented. A new therapy process structure, the stage process model, which is compatible with Shapiro's patient-oriented approach, is presented. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of verbal reinforcement with information feedback in analogue psychotherapy

Thirty Ss were assigned randomly to one of the two experimental analogue psychotherapy groups and a control group. In the experimental psychotherapy groups two different psychotherapy techniques were used for eight sessions. The two psychotherapy techniques employed were one-word verbal reinforcement (VR) and lengthy verbal information feedback (IF). Three therapists each demonstrated significant differences (P less than .001) in their verbal interactions with the Ss when they used the two different psychotherapy techniques. The results indicated that both treatment techniques were significantly effective (p less than .05) in improving self-ratings of self-concept. However, the two psychotherapy techniques were differentially effective in improving social skills as measured by behavioral ratings.     

Dimensions of psychotherapists' activity.

2 samples of psychotherapists (N = 59 and N = 248) responded to a 17-item scale sampling the usual practices of psychotherapists. Factor analysis, performed separately for each sample, yielded 6 factors, only 4 of which were sufficiently clear to lend themselves to interpretation. Factor I, concerned with the maintenance of personal distance, was by far the strongest factor. The remaining factors referred respectively to preference for intensive psychotherapy, preference for keeping verbal communications to a minimum, and viewing psychotherapy as an artistic activity that should be flexibly applied. The need for further work to arrive at better delineations of the several factors was stressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comments on "a case study of the process and outcome of time-limited counseling."

The single-case outcome study reported by C. E. Hill et al (see record 1983-10833-001) has several strengths, including the use of sequential analysis and careful recording and investigation of sessions. However, several limitations are identified, such as the small variety of outcome measures, the lack of behavioral change measures, the failure to impose a theoretical structure on the therapy and its evaluation, and the suitability of this client for case analysis. Recommendations are made for case studies in outcome research. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intensive experimental research in counseling.

Considers that experimental research in counseling has been dominated by pretest-posttest designs. However, intensive designs that examine treatment processes and effects with individuals over time offer several advantages, such as immediate data on how treatment influences clients. K. R. Mitchell's (see record 1970-04151-001) article on using an intensive design is analyzed. Several design and analysis problems are discussed, such as inadequate experimental control and nonindependence of data. Alternative designs and analysis methods are presented. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)