Further Developments in the Panel of Psychological Inquiry Method of Case Study Research: The Case of "Ronan"

In 2011 our research group published a pilot study—the Case of "Anna"—employing the Panel of Psychological Inquiry (PPI) Clinical Case Study Method. The present study—the Case of "Ronan"—is a second example of the PPI method in action. The Case of Ronan has a number of modifications in method compared to the Case of Anna. First, the Case of Ronan involves the evaluation of a more complex and controversial written case study of a 20-month old boy who was diagnosed with moderate to severe autism spectrum disorder (ASD), and who was treated in a comprehensive therapeutic daycare center program where the core approach was based upon Greenspan’s (2009) "Developmental, Individual-differences, Relationship-based" ("DIR"/ "Floortime") model. DIR/Floortime was originally developed for use by parents in their own homes, and the Case of Ronan demonstrates how a therapeutic pre-school environment can use DIR/Floortime as a model for most adult-child interactions in a pre-school therapeutic environment. In addition to the application of the PPI model to a radically different clinical diagnosis, there were modifications to the methodology itself including: (a) reduction in the number of judges from five to three; (b) having a key witness in the case testify remotely before the Panel; (c) the writing of a much more detailed judges’ opinion on the aspects of the case that most influenced their decisions; and (d) a further development of the logic of a quasi-judicial approach to clinical case studies in psychology. By examining how the civil law’s basic framework for proving causality in cases of personal injury (who did what harm to whom), the process by which knowledge claims that emerge out of clinical practice (who provided what benefit to whom) is further explicated.

The Adjudicated Case Study Method, Part 2: Editor’s Introduction

This article introduces readers to the present PCSP issue on the "adjudicated case study method." This method employs concepts from the law for evaluating qualitative information to determine the truth of statements about human psychology and behavior, including causal statements about psychotherapy outcome. Two models of the adjudicated case study method, which were originally presented in PCSP in 2011, are covered: Ronald Miller’s "Panels of Psychological Inquiry" (PPI), and Arthur Bohart’s "Research Jury Method." The issue concludes with a Commentary by Robert Elliott, Susan Stephen, and Anna Robinson.

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.

What Can We Learn About Therapeutic Change From Case History Data? The Research Jury Method with the Couple Case of "Carl" and "Sandra"

The purpose of this study was to explore the usefulness of using case history data to assess change in psychotherapy. This was a follow up to previous investigations utilizing a "research jury method" to evaluate psychotherapy outcome. Three judges studied the critical first five sessions of a ten session video of emotionally focused therapy with a couple, Carl and Sandra. They took intensive notes and then functioned as a "jury"” to evaluate the evidence. They concluded that the evidence from within the case history is strong that the couple changed for the better. The evidence also supported the conclusion that therapy contributed to the change, although, by their judgment, at the "preponderance of evidence" level. Finally, the evidence was used to evaluate how therapy contributed to change. It was concluded that the most likely factors contributed by the therapist were her helping the couple see that each other’s underlying intentions were positive, and by fostering their hope. Evidence also supported the contributions the clients themselves made through their taking responsibility for themselves, through their exploring their past experiences, and through their creativity. Limitations are discussed and conclusions for the evaluation of psychotherapy are drawn.

Interpersonal Wishes and Fears with Regard to Internalized Attachment Figures: Differing Focus of Two Case Formulation Methods that use SASB

This commentary is organized in parallel with Westerman’s (2021b) comparison to include focus on (1) the formulation methods used by IRT and Interpersonal Defense Theory, and then (2) their treatment implications. In each major section, comments center first on comparison of the approaches in general, and then turn to a focus on the details of Sharon’s case. In sum, we wish to underscore the need for continued empirical work in both IRT and Interpersonal Defense Theory traditions as ways to advance our field. We see each method as offering a different scope and focal areas of concern. With a mind toward the advancement of research and application along both lines of thought, our commentary provides an overview of how we see areas of alignment, divergence, and their potential meaning for theory and practice. The two methods share a great deal in terms of assumptive worldviews, prioritization of relational material, and even specific measurement methodology (SASB). Where the methods diverge, we believe it is primarily because they seek answers to different kinds of questions.

Philosophical Considerations and Research Ideas About Comparing the Two Approaches: Messer’s Comments Point the Way Forward

In his commentary, Stanley Messer (2021) posed the question of whether it is possible to evaluate the relative merits of different case formulation approaches to psychotherapy. He went on to maintain, based on the pragmatic theory of truth, that it is possible to compare different case formulation approaches, and pointed to a program of research that he and his collaborators conducted as an example for possible future research (Collins Messer, 1991; Holland, Roberts, Messer, 1998; Messer, Tishby, Spillman, 1992; Tishby Messer, 1995). In this reply, we express our appreciation for Messer’s remarks, with which we agree in large measure, and attempt to highlight and build upon some of the points he made. We discuss Dewey’s (1896) classic critique of the reflex arc concept to point out other ways the philosophical perspective of pragmatism supports the view that different approaches to therapy are not incommensurate. We also offer a number of suggestions for future research comparing psychotherapy based on Interpersonal Defense Theory and IRT, or any two case formulation approaches to therapy. At many points, our suggestions follow along the lines of Messer’s research. We also emphasize the value of case formulation-based studies, not only with regard to research comparing approaches to treatment, but for investigating other issues about therapy as well.

Editor's Introduction: The Psychotherapy Case of "Sharon" -- A Comparative Analysis Using Contrasting Interpersonal Theories

This article is a brief orientation to the current PCSP issue, which presents and compares two contrasting, interpersonal theories—Interpersonal Defense Theory and Interpersonal Reconstructive Therapy—for developing a case formulation and treatment plan for the case of "Sharon," a 28-year, unmarried social worker with no children. At the beginning of Sharon’s therapy, which was part of a randomized clinical trial (RCT), Sharon presented with comorbid anxiety and personality disorders. A major focus of her problems was being stuck between being simultaneously drawn to and repelled by "Jeff," her former finance. In reading this article series, a number of important themes to keep in mind are mentioned, including (a) comparing theoretical similarities and differences between the two theories; (b) the differences in the information selected by each theory from the large database of quantitative and qualitative clinical information in the database generated by the RCT; and (c) the enrichment of theory that occurs when it is applied to an individual case.

Goals and Design of the Project and Basic Information About Sharon’s Case

This paper sets the stage for subsequent papers in this set of articles, which collectively offer a comparative examination of two approaches to case formulation and treatment by examining the same case from the two theoretical perspectives. One approach is based on Interpersonal Defense Theory (e.g., Westerman, 2018, 2019), the other is Interpersonal Reconstructive Therapy (IRT, Benjamin, 2006, 2018). In this paper, we present the goals of the project and its design, which was novel in some respects. We also introduce the case by presenting basic clinical information about the patient, Sharon (pseudonym), and describing the short-term therapy approach that was employed. The concluding section introduces the subsequent papers in this set, which includes a commentary by Stanley Messer that raises fundamental methodological/philosophy of science issues about comparing the relative merits of different therapy approaches and a reply to that commentary that addresses the important questions it poses.

The Case of Sharon Considered from the Vantage Point of Interpersonal Reconstructive Therapy

In Interpersonal Reconstructive Therapy (IRT: Benjamin, 2003/2006; 2018) a case formulation is used to tailor interventions to each patient’s unique patterns. Using the IRT lens, psychopathology is understood as reflecting attempts to adapt to current environments using maladaptive rules and values that were learned and internalized in the context of close attachment relationships. IRT identifies precise ways in which early learning shapes present experience. Additionally, the "gift of love" (GOL) hypothesis posits that motivation to repeat maladaptive ways is linked to the wish to receive love and acceptance from specific internalized attachment figures by repeating their ways and values for the patient. The IRT case formulation has been shown to be reliable and valid (Critchfield, Benjamin, Levenick, 2015). The therapy adherence measure is also reliable (Critchfield, Davis, Gunn, Benjamin, 2008) and correlates well with retention as well as reduced symptoms and rehospitalization rates (Karpiak, Critchfield, Benjamin, 2011) among "difficult to treat" patients characterized as having high levels of personality disorder, chronic and severe problems, and prior failed treatment attempts. To illustrate the case formulation process, an IRT formulation is applied to the case of a 28-year-old female patient for whom a poor outcome was documented.

How Do We Decide Which of Two Case Formulations Is Correct? Commentary on Westerman and Critchfield et al.

This commentary takes a meta-view of the articles in this module by Westerman (2021a), and by Critchfield, Dobner-Pereira and Stucker (2021a), which offer two overlapping but also different formulations of the same case. It raises the question of whether there is only one true formulation of a clinical case (correspondence theory), or whether any one of several would qualify as accurate (coherence theory). A third alternative is that the truth-value of a formulation is a function of its ability to predict which therapist interventions will most help the client (pragmatic theory). A study is described in which the relative accuracy of two different formulations of the same case was put to the test in predicting which therapist interventions led to client progress. I propose that the current authors compare the pragmatic value of their formulations in a similar manner.