Commentary—Extending the Boundaries of Systematic Case Study Research: Conceptual and Methodological Issues

In this commentary we discuss the two examples of systematic case study research in this issue: Miller et al., (2021), who continue the development of the quasi-judicial Panels of Psychological Inquiry method by applying it to a child client with an autistic spectrum condition; and Bohart et al. (2021), who apply their research jury approach to a video recorded case of Emotionally-Focused Therapy for couples. We open by briefly summarizing the main issues addressed in our previous commentary (Stephen Elliott, 2011), which involved the same authors; we also note some key developments in systematic case study research over the past ten years. The rest of our commentary is divided into three parts. First, we look at more general conceptual issues in systematic case study research, including situations in which systematic case studies are likely to be most useful; the problem of overly broad research questions; the definition and assessment of outcome; and the thorny issue of causality. In the second part, we turn our attention to methodological issues raised by the two articles, returning to the questions of what counts as evidence in systematic case study research (here the use of observational methods for assessing client change and change processes), but also to the processes by which research judges or jurors make decisions about knowledge claims and methods for generalizing from one case to other cases. In the final main section, we offer more substantive commentary on Miller et al. (2021), from the point of view of autism research. We start by putting the DIR/Floortime intervention in context before raising key diagnostic issues that we think circumscribe the case and spelling out uncertainties about the nature of the intervention used. We round off this section with a set of proposals for future systematic single case research on interventions for autism. We close our commentary with a brief set of recommendations.

The Ability to Authentic Presence of the Therapist as a Method of Quality Follow Up the Effectiveness of Psychotherapy

There are disputes and a large number of methods that claim to measure efficacy in psychotherapy. Most studies focus on the personality and skills of the therapist, fewer which examine the process of psychotherapy and how interconnections between the therapist and the client change this process. In this study we present a method of assessing the authenticity and the level of communication inspired by the theory of Budgatal (Budgendhal), examining the authenticity of the client’s contact after each session, together with two therapist-related factors: expression and openness ( Reflectiveness according to Peseschkian). In the semantics of positive psychotherapy, these are the abilities of the therapist, the ability of openness, emotional expression, and so on. The results are determined through the correlation analysis of the authentic presence and communication scale (Alpha of Cronbach Alfa 0.6) which presents the correlation relationship between abilities of Expression and accessibility of the therapist and the level of authenticity in the therapeutic sharing of the client. The results show that there is a statistically significant positive correlation (Spearman’s Correlation .748 and .511, p=0,01) between the ability of openness and high levels of authenticity in therapeutic communication and a negative correlation with the emotional expression of the therapist. In conclusion, we can say that the level of authenticity in therapeutic communication depends on the ability of openness (frankness according to Peseschkian) and needs the opposite of expressiveness, namely the introverted function of the emotion capable of “the contents of the other’s experiences, without taking space with excessive expression of their emotions.

Evaluating Programs to Counter Violent Extremism: The Example of Case-Managed Interventions

In recent years, there has been a proliferation of programs aimed at preventing radicalization and disengaging known violent extremists. Some programs have targeted individuals through the use of case management approaches and the development of individual intervention plans (e.g., the Desistance and Disengagement Program and the Channel program in the UK; the Australian New South Wales Corrections Proactive Integrated Support Model—PRISM—and state-based division initiatives in Australia). There is a broad consensus in the literature that the evaluation of such initiatives has been neglected. However, the evaluation of case-managed interventions to counter violent extremism (CVE) is challenging. They can have small caseloads which makes it difficult to have any comparison or control group. Client participation can vary over time, with no single intervention plan being alike. This can make it hard to untangle the relative influence of different components of the intervention on indicators of radicalization and disengagement. In this presentation, results from primary research that set out to evaluate case-managed CVE interventions in Australia and develop evaluation metrics are presented. This research involves the examination of interventions implemented by New South Wales corrections and state police. The effectiveness of these interventions was assessed against a five-point metric of client change. Client change overtime was analyzed using case note information collected by the various interventions on client participation. Results show that client change is not a linear process and that the longer an individual is engaged in a case-managed intervention, the more likely they are to demonstrate change relating to disengagement. Specific case studies are used to illustrate trajectories and turning points related to radicalization and to highlight the role of case-managed interventions in facilitating disengagement. Key elements of effective interventions include the provision of ongoing informal support. Investment in capturing case note information should be a priority of intervention providers. Different challenges confronted by case-managed CVE interventions are highlighted.

therapist’s emotional presence and its interactional functions in promoting client change in relationship-focused integrative psychotherapy

Therapeutic alliance is often posed as an explanation for why therapy works, and there seems to be a consistent finding that the stronger the alliance, the greater the therapeutic change. Although extensively documented in the professional literature as an essential aspect of therapeutic alliance, the concept of emotional presence and its actualization in moment-by-moment interaction have not been adequately described. This paper applies integrative qualitative methodology, including tools and insights from discourse analysis and conversation analysis, to five extracts of Relationship-focused Integrative Psychotherapy sessions with three different clients. It examines the concept of emotional presence operationalized in terms of the therapist’s invoking the client’s immediate experience. The analytical focus falls on an interactive sequence involving the therapist’s topicalization of the client’s (proffered) non-verbal cues aiming at eliciting emotion talk in the interactional here-and-now and the latter’s orientation to it. The psychotherapist’s strategy of emotional presence is proposed to play a salient role in promoting the client’s (gradual) change by focusing the talk on the client’s here-and-now experience. Thus clients are prompted to project their emotions and/or engage in overt self-reflexive examination of emotional and relational patterns in the immediate context of their concrete trouble-telling. By being regularly exposed to such practices in therapy, clients are instilled with a sense of being in touch with how they feel about a particular situation or person.

Temporal Therapeutic Letters: Utilizing Time as a Structural Guide

Therapeutic letters have been incorporated into psychotherapy for over half a century, being used for a variety of purposes, including recruiting non-attending members to therapy, implementing therapeutic interventions, summarizing client change, and termination. Therapeutic letters have been used by therapists from a variety of models, such as narrative, solution-focused, and strategic therapies. This article presents a format for writing therapeutic letters that focuses on temporality. These temporal therapeutic letters are structured to highlight the flow of a client's story: past, present, and future. By focusing on temporality, the temporal therapeutic letter acknowledges the client's initial limited identity, highlights their co-constructed resourceful identities, and reflects on the future implementation of those resourceful identities. Two temporal therapeutic letters are presented to demonstrate how therapists can compose this three-part format of letters.

Facilitating Narrative Change in Career Construction Counseling

Career Construction Counseling fosters client change by evoking and elaborating innovative moments in client narratives. In this article, we describe four types of dialogues that counselors may use to prompt narrative novelty and foster client change: (a) identify and evaluate the effects of innovative moments, (b) highlight contrasting self-positions, (c) ask about changes achieved, (d) promote a meta-perspective on change. Vignettes from a case are used to illustrate how to use IM markers as a heuristic guide for when to engage in these four types of dialogues.

Anticipating and Planning for the Duration of Counseling

One parameter of the treatment planning process that needs more attention is the expected duration of counseling. Mental health counselors should be prepared to discuss with new clients both the typical duration of counseling and the rate of change that commonly occurs throughout counseling. Mental health counselors should be aware that most of their clients will attend only a few sessions before discontinuing, and they should plan counseling services accordingly. Furthermore, researchers have found that most client improvement occurs within the first few sessions, with diminishing returns as counseling continues, and discontinuation tends to occur when clients reach a level of improvement that they, but perhaps not their counselors, consider to be satisfactory. The purpose of this article is to describe how research on the base rate of counseling and the trajectory of client change can enhance the treatment planning process for both clients and counselors.