Themes and Lessons Learned

Case Studies Within Psychotherapy Trials: Integrating Qualitative and Quantitative Methods presents a specific, mixed-methods approach, called the “Cases Within Trials” (CWT) model, to psychotherapy research, combining the results from a randomized clinical trial (RCT) with systematic case studies involving contrasting outcomes drawn from the experimental condition of the RCT; and a synthesis of the two types of knowledge. Chapters 3–6 of the book present four specific and diverse projects that concretely illustrate the CWT method. In Chapter 8 the editors analyze the four chapters and explore emergent themes in the knowledge gained from them. In the process, the editors systematically compare the positive-outcome and negative-outcome cases across the four projects, highlighting, for example, (a) the importance of contextual variables in creating the conditions for change mechanisms to be activated; (b) the multidimensional, reciprocally interactional nature of the therapy process; and (c) the particular role of therapist responsiveness.

The Efficacy of Interpersonal Psychotherapy – Adolescent Skills Training (IPT-AST) in Preventing Depression

Case Studies Within Psychotherapy Trials: Integrating Qualitative and Quantitative Methods presents a specific, mixed-methods approach, called the “Cases Within Trials” (CWT) model, to psychotherapy research combining the results from a randomized clinical trial (RCT); the results of richly and qualitatively detailed systematic case studies involving contrasting outcomes drawn from the experimental condition of the RCT; and a synthesis of the two types of knowledge. Chapter 4 of the book applies this model to a study of the application of a group-based, interpersonal therapy treatment—called “Interpersonal Psychotherapy—Adolescent Skills Training” (IPT-AST)—in preventing depression in adolescents. Finding a substantial statistical advantage of the interpersonal treatment over a “school counseling as usual” condition, the authors then analyze and compare the positive-outcome case of Menorka with the negative-outcome case of Shelly, both drawn from the IPT-AST condition.

Motivational Enhancement Therapy for Increasing Antidepressant Medication Adherence and Decreasing Clinical Depression Among Adult Latinos

Case Studies Within Psychotherapy Trials: Integrating Qualitative and Quantitative Methods presents a specific, mixed-methods approach, called the “Cases Within Trials” (CWT) model, to psychotherapy research, combining the results from a randomized clinical trial (RCT), from case studies drawn from the RCT, and a synthesis of the two types of knowledge. Chapter 6 of the book applies this model to a study of the application of a three-session, individual, “motivational interviewing” therapy—specifically labeled “motivational enhancement therapy for antidepressants” (META). META was employed for treating disadvantaged, predominantly Spanish-speaking Latinos with depression. Finding META plus routine individual psychiatric therapy based in a community mental health center (CMHC) to be statistically and substantially superior to the CMHC-therapy-only condition, the authors then analyze and compare the positive-outcome case of Lupe, the mixed-outcome case of Ana, and the negative-outcome case of Maria, all drawn from the META condition.

Commentary

When I (the first author, W. E. P.) read the chapter by Levy, Meehan, Clouthier, Yeomans, Lenzenweger, Clarkin, and Kernberg (2016), my immediate reaction was a flashback to the initial RCT that I conducted in the mid-1970s. This included a comparison of psychodynamic group therapy by psychiatric residents in their first year of training with a treatment-as-usual condition for young adults suffering from neurotic or mild characterological problems, using a battery of 10 sociometric measures taken prior to and after 3 months of treatment (...

Commentary

As a clinical researcher and practitioner with a specialty interest in preadolescent and adolescent depression and structured treatments for it, I was particularly interested in Kerner and Young’s excellent and engaging chapter (this volume) that focuses on and adds importantly to the research knowledge base on this topic. As these authors point out, depression, like other mental disorders, often begins early in life and has a recurrent course. Early-onset depression (i.e., depression occurring before the age of 18) has a more debilitating and severe course of disorder as compared to that of adult-onset depression marked by greater functional impairment, increased likelihood of depression recurrence, and higher risk of suicidality (...

The Terrain

Although much has been written about the basic incompatibility of the dominant quantitative research model in psychotherapy and the qualitative preferences of the practitioner community, the recent developments detailed in this chapter have resulted in a growing rapprochement on both sides in the service of pragmatically improving the effectiveness of psychotherapy. Examples of these developments include (a) the growing mixed-methods movement; (b) the creation of the American Psychological Association’s evidence-based practice in psychology and evidence-based relationships models, to complement traditional empirically supported treatments; (c) the growth of the “practice-based evidence” model to complement evidence-based practice; (d) the organization of the case study field into a coherent whole with a variety of types of complementary approaches; (e) the emergence of “theory-building” case studies; (f) the development of case-study-based thinking within the cognitive-behavioral therapy movement; and (g) government support of initiatives that link traditional randomized controlled trial research to approaches that emphasize both qualitative and quantitative methods.

Commentary

The work of Thastum and his colleagues (this volume) presents exciting new directions for improving the robustness and accessibility of evidence-based services. Their chapter describes efforts to replicate evidence-based cognitive-behavioral therapy (CBT) treatment programs from one country, Australia, to another, Denmark, which contributes to the ever-expanding evidence base for global applicability of CBT for youth anxiety. We comment on the contributions of this replication trial and its implications for further dissemination of evidence-based practice across the globe, in addition to the unique role that mixed methods can play in this effort....

“Cool Kids/Chilled Adolescents”

Case Studies Within Psychotherapy Trials: Integrating Qualitative and Quantitative Methods presents a specific, mixed-methods approach, called the “Cases Within Trials” (CWT) model, to psychotherapy research, combining the results from a randomized clinical trial (RCT); the results of richly and qualitatively detailed systematic case studies involving contrasting outcomes drawn from the experimental condition of the RCT; and a synthesis of the two types of knowledge. Chapter 3 of the book applies this model to an RCT study of a group-based, cognitive-behavioral treatment (CBT)—called “Cool Kids/Chilled Adolescents”—for youth anxiety in Denmark. Finding a substantial statistical advantage of the CBT treatment to a waiting-list control condition, the authors then analyze and compare the positive-outcome case of Lisa with the negative-outcome case of Marius, both drawn from the CBT condition.

An Outside Perspective

Case Studies Within Psychotherapy Trials: Integrating Qualitative and Quantitative Methods presents a specific, mixed-methods approach, called the “Cases Within Trials” (CWT) model, to psychotherapy research, combining the results from a randomized clinical trial (RCT) with systematic case studies involving contrasting outcomes drawn from the experimental condition of the RCT; and a synthesis of the two types of knowledge. Chapters 3–6 of the book present four specific and diverse projects that concretely illustrate the CWT method. Chapter 7 presents an outside perspective on the four projects from a research team expert in conducting traditional RCTs. The authors explore the benefits of the CWT approach, such as confirming certain findings and challenging other findings in the quantitative group literature, and coming up with new hypotheses emerging from individual differences within group findings. In addition, the authors document some of the challenges of the CWT approach, such as confirmatory bias and case selection.

Commentary

The extraordinary contribution by Interian, Prawda, Fishman, and Buerger (this volume) presents and celebrates many of my favorite methods: motivational interviewing (MI), real-world research, cultural adaptations, therapeutic relationships, systematic case studies, and randomized clinical trials (RCTs). The reader may excuse me, then, for my unabashed enthusiasm for the chapter and for its clinical and research underpinnings. As a commentator, however, I will endeavor to highlight an occasional quibble and to offer an alternative hypothesis or two. All that within the context of my rousing burst of “Well done, colleagues! This is precisely what the future of clinical practice and psychotherapy research requires.”...