New Jersey History (NJH - E-Journal)
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Treatment Refusal and Family Accommodation
No full textThis commentary discusses a case study by James Marinchak (2013), who treated a mother’s accommodation of her adult son’s obsessive-compulsive disorder (OCD). A variety of issues raised by the case are considered. These include: the relationship between dependency and OCD, the presence of rituals without apparent obsessions, the pros and cons of treating one primary relative versus the family, ways of handling treatment refusal, methodological issues, and the relationship between stress, high emotionality and severity of OCD. The main topic of helping families cope with OCD when the person manifesting it refuses treatment is an overlooked and important area of research
"Cool Kids" in Denmark: Commentary on a Cognitive-Behavioral Therapy Group for Anxious Youth
No full textTwo case studies by Lundkvist-Houndoumadi and Thastum (2013a, 2013b) describe the use of the Cool Kids cognitive behavioral therapy program for anxious children and their parents, which was conducted at their Clinic at the University of Aarhus in Denmark. In providing our reactions to these two fascinating and illuminating articles, we first familiarize readers with the Cool Kids program, including both its nature, range, and evidence base. This is followed by a discussion of some relevant issues and complications in doing therapy with anxious children that are illustrated by these case studies, including the motivation of both anxious children and their parents; the therapeutic role of exposure to anxious situations; a modular approach to accommodate individual variation; group versus individual format; directly addressing parental anxiety problems; and the cost-effectiveness of treatment
Treating a Mother's Accommodation Behaviors of Her Adult Son's OCD: The Case of "Brianne" and "Charlie"
No full textObsessive-compulsive disorder (OCD) is an anxiety disturbance in which distress and impairment extend beyond the patient to their immediate family members. Many family members become involved in their loved one’s compulsions by engaging in accommodation behaviors, which ultimately make it easier to perform compulsions or avoid obsession-invoking triggers, frequently exacerbating the severity of the OCD symptoms and decreasing motivation for treatment. Also, accommodation behaviors can indirectly result in negative consequences for the family member engaging in them and for other non-OCD members of the family, reducing their quality-of-life. The current case study documents and discusses a 3-month, 10-session, cognitive-behavioral treatment designed to help "Brianne," a married Caucasian mother of two in her 40s, reduce her accommodation behaviors with her 19-year-old son, "Charlie," who was unmotivated to accept treatment for his diagnosed OCD and who was living at home. In line with the above, the treatment was premised on the hypothesis that reducing Brianne's accommodation behaviors would have a positive impact not only on Charlie and Brianne, but also on the other two members of Brianne's nuclear family: her husband "Jack," and her older son "Shane." The therapy focused on (a) providing Brianne with psychoeducation regarding the nature of OCD and the negative impact of accommodation behaviors, (b) developing Brianne's alternative coping behaviors in response to Charlie's rituals, (c) offering Brianne communication training, and (d) promoting Brianne's self-care behaviors. Results indicate that the treatment was effective in reducing Brianne's accommodation and improving her quality of life as well as her husband's and other son's within the household, but that more treatment was likely necessary in order to consolidate therapeutic gains. The treatment did not appear to impact Charlie's OCD treatment-seeking motivation nor his levels of anxiety or aggressive outbursts by the end of therapy. Factors contributing to the results of the treatment are discussed. Overall, the case results suggest that family members living with OCD-diagnosed adults not currently seeking treatment can derive benefit from a brief intervention designed to reduce accommodation behaviors, improve family communication, and promote self-care
The Case Formulation Approach to Psychotherapy Research Revisited
No full textThis article revisits the case formulation approach to psychotherapy outcome research, first proposed by Persons (1991). Persons asserted that randomized clinical trials (RCTs) of psychotherapy do not test the theoretical underpinnings of psychotherapy models since these trials standardize rather than individualize patient problems, ignore the link between individualized assessment and treatment as described in these models, and employ standardized rather than individualized treatment. This article assesses the current status of these claims, concluding that they remain valid today. A reformulated case formulation approach is described and research strategies proposed. Investigating the reformulated case formulation approach will require increased resources for case formulation training, the addition of treatment arms in effectiveness trials that include case-formulation-based interventions, and expanded RCTs that include systematic case studies
The Anxiety Disorders Clinic for Children and Adolescents (TADCCA) at Aarhus University in Denmark
No full textThis article serves as an introduction to the two case studies in this issue of PCSP. The first is the single case of "Erik," a 12-year-old boy with cognitive difficulties and multiple anxiety disorders who was seen with his family in a cognitive behavioral therapy group program designed for children with anxiety problems. The second case study is one of the total group of six families in which Erik was participating; as such it includes a summary of Erik's case in the context of the other five who participated. The group was conducted by a combination of a senior doctoral clinical psychologist and eight students. They were part of a training clinic, called The Anxiety Disorder Clinic for Children and Adolescents (TADCCA), in the Educational and Research Clinic of the Department of Psychology at Aarhus University in Aarhus, Denmark. This article describes the background and context of the TADCAA in which the two case studies took place.
Who Needs a Case Formulation and Why: Clinicians Use the Case Formulation to Guide Decision-Making
No full textProtocols for empirically-supported treatments (ESTs) typically do not require the therapist to develop an individualized formulation of the patient, nor do they describe procedures for doing this. I offer some hypotheses about why the idiographic case formulation receives short shrift in most EST protocols, I describe an exception to this general rule, and I conclude with a discussion of implications of these ideas for psychotherapy research
"Functional," Sub-Clinical Obsessive-Compulsive Symptoms and Their Challenges: The Case of "Angela"
No full textComplex behavior patterns may underlie symptoms of obsessive-compulsive disorder (OCD), which, in turn, seem to contribute to the maintenance of symptoms, hinder its management, and interfere with the client’s compliance with treatment. Although the evidence-based choice for treating OCD is cognitive-behavior therapy (CBT), such treatment might prove ineffective if it is not accompanied by a careful and thorough investigation of the contingencies involved in the onset and maintenance of symptoms; and this might take longer than predicted by treatment manuals. We present a case study of the treatment of "Angela," a client with OCD who suffered from sub-clinical symptoms for 20 years and did not obtain relief with antidepressant medication. Angela underwent cognitive-behavioral therapy for three and a half years and was treated by the first author in weekly sessions. The difficult management of symptoms, the contingencies involved in them, and the development of the therapeutic relationship are discussed. Treatment results indicated a significant decrease in symptoms, anxiety, and discomfort. We believe this case illustrates limitations associated with a strict, manual-driven treatment with a pre-determined number of sessions.
In Support of Evidence-Based Case Formulation in Psychotherapy (From the Perspective of a Clinician)
No full textPersons (2013) has commented on my article (Eells, 2013) about revisiting the case formulation approach to psychotherapy research. I elaborate on her ideas by advocating for an evidence-based case formulation (EBCF) model of psychotherapy practice. The latter encourages clinician freedom of choice to select a case conceptualization and treatment plan, as long as those choices are empirically defensible. While the EBCF approach is intellectually challenging for clinicians, it has the advantage of being flexible in accommodating evidence, including but not limited to that derived from randomized clinical trials. The EBCF approach is preferable to the untenable position of relying primarily on one’s personal experience as a therapist or primarily on intuition. The EBCF approach is an empirically defensible alternative to the empirically supported treatment (EST) movement. Clinical judgment is emphasized more in the EBCF approach than in ESTs. Conditions are described under which intuition in context can be trusted as one of a number of components of evidence-based practice. Finally, since therapists practicing ESTs tailor treatment to meet patient needs as they arise, a false dichotomy may exist between the EST and EBCF approaches when considering psychotherapy as it is actually practiced. A mixed-methods research agenda that examines the case formulation hypothesis can help determine whether such a false dichotomy exists, while advancing knowledge of psychotherapy as it unfolds in practice
Synergy Among Research, Practice, and Training in Psychotherapy: An Introduction to the Work of Mikael Thastum and His Students at Aarhus University, Denmark
No full textWhile the nature of research, practice, and training in psychotherapy makes it possible for them to be synergistic in advancing best practice and continuous improvement in the field, this potential is just beginning to be mined. In this process, the systematic case study has important roles to play since it captures and analyzes the contextually complex, qualitative and quantitative data that constitute the basic phenomena of the field. This article briefly reviews the dynamics of the research-practice-training synergy and illustrates how they are embodied in the work of Dr. Mikael Thastum at The Anxiety Disorder Clinic for Children and Adolescents (TADCCA) of Aarhus University. As a second example of this synergy and as a comparison to Thastum's Clinic, the parallel work of Brian Chu at the Youth and Depression Clinic (YAD-C) at Rutgers University is reviewed.
Increasing the Rigor of Case Study Evidence in Therapy Research
No full textOver recent years, an increasing number of systematic case-based investigations of the process and outcomes of counseling and psychotherapy has been published. Nevertheless, case study knowledge continues to have a limited impact on therapy training, practice and policy. It is argued that improvement in the status of case study evidence requires further attention to ways of enhancing the rigor of case study reports. Strategies for strengthening the credibility of case study evidence are explored in relation to a range of methodological issues: the design and goals of case study research, quality criteria for evaluating the validity of case study findings, approaches to aggregating the conclusions of sets of cases, and the interpretation of case data. The paper concludes with a call for case study investigators to be active in asserting the value and relevance of this form of inquiry.