Pub Date : 2022-01-26DOI: 10.55818/pcsp.v18i1.2106
Allison K. Ruork
Michael Marks (2022) describes the case of "Jane," a client presenting with multiple concerns and targets for treatment, who was treated over six months using Dialectical Behavior Therapy (DBT) at the DBT Clinic at Rutgers University (DBT-RU). Treatment of Jane was consistent with the principles of DBT and represented significant progress in treatment broadly and, more specifically, clear gains in addressing therapy interfering behaviors, increasing willingness to engage in accurate expression and needs assertion in her romantic relationships, and decreasing hopelessness, which subsequently decreased suicidal ideation. Despite this significant progress Marks reports ongoing struggles with noticing change as it was happening, polarization, and painful and frustrating interpersonal transactions. In this commentary, I propose that many of the transactional (and highly understandable) pitfalls experienced by Marks and Jane may have been addressed by a case conceptualization that more actively integrated the “secondary targets” in DBT, which are anchored in the dialectical dilemmas represented by three continua: Emotion Vulnerability versus Self-Invalidation; Unrelenting Crises versus Inhibited Grieving; and Active-Passivity versus Apparent Competence. Specifically, I suggest that consistent and thorough inclusion of secondary targets in treatment can decrease the potential for polarization and transactions that lead to stagnation and can make therapy more efficient. In addition, I address some of the challenges to such a conceptualization.
Michael Marks（2022）描述了“Jane”的案例，她是一位有多种担忧和治疗目标的客户，在罗格斯大学DBT诊所（DBT-RU）接受了六个多月的辩证行为疗法治疗。Jane的治疗符合DBT的原则，在广泛的治疗方面取得了重大进展，更具体地说，在解决干预治疗的行为方面取得了明显的进展，在她的浪漫关系中更愿意进行准确的表达和需求断言，并减少了绝望，从而降低了自杀意念。尽管取得了重大进展，但Marks报告称，在注意到正在发生的变化、两极分化以及痛苦和令人沮丧的人际交往方面仍存在着持续的困难。在这篇评论中，我提出，Marks和Jane经历的许多交易性（也是高度可理解的）陷阱可能已经通过案例概念化来解决，该概念化更积极地整合了DBT中的“次要目标”，这些目标锚定在由三个连续性代表的辩证困境中：情绪脆弱性与自我失效；持续的危机与抑制的悲伤；主动被动与表面能力。具体而言，我认为，在治疗中持续彻底地纳入次要靶点可以减少导致停滞的两极分化和交易的可能性，并使治疗更加有效。此外，我还谈到了对这种概念化的一些挑战。
{"title":"Secondary Targets Are Not So Secondary: Commentary on Michael Marks' Case Study of \"Jane\"","authors":"Allison K. Ruork","doi":"10.55818/pcsp.v18i1.2106","DOIUrl":"https://doi.org/10.55818/pcsp.v18i1.2106","url":null,"abstract":"Michael Marks (2022) describes the case of \"Jane,\" a client presenting with multiple concerns and targets for treatment, who was treated over six months using Dialectical Behavior Therapy (DBT) at the DBT Clinic at Rutgers University (DBT-RU). Treatment of Jane was consistent with the principles of DBT and represented significant progress in treatment broadly and, more specifically, clear gains in addressing therapy interfering behaviors, increasing willingness to engage in accurate expression and needs assertion in her romantic relationships, and decreasing hopelessness, which subsequently decreased suicidal ideation. Despite this significant progress Marks reports ongoing struggles with noticing change as it was happening, polarization, and painful and frustrating interpersonal transactions. In this commentary, I propose that many of the transactional (and highly understandable) pitfalls experienced by Marks and Jane may have been addressed by a case conceptualization that more actively integrated the “secondary targets” in DBT, which are anchored in the dialectical dilemmas represented by three continua: Emotion Vulnerability versus Self-Invalidation; Unrelenting Crises versus Inhibited Grieving; and Active-Passivity versus Apparent Competence. Specifically, I suggest that consistent and thorough inclusion of secondary targets in treatment can decrease the potential for polarization and transactions that lead to stagnation and can make therapy more efficient. In addition, I address some of the challenges to such a conceptualization.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43799008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-26DOI: 10.55818/pcsp.v18i1.2103
Gillian C. Galen, B. Aguirre, J. W. Tirpak
The case of "Jane" (Marks, 2022) provides a detailed examination of the evidenced-based treatment, Dialectical Behavior Therapy (DBT), in the treatment of a woman with complex and multifaceted psychiatric difficulties by Michael Marks, an advanced doctoral student clinician in a DBT training clinic. Marks’ presentation provides an excellent example of the challenges clinicians face when treating patients with borderline personality disorder (BPD) and many of the common and multiple co-morbidities that frequently accompany the BPD diagnosis. While DBT is sometimes dismissed as a treatment that just teaches skills, Marks demonstrates the technical demands and nuances that therapists must use to correctly and effectively treat suicidality, emotion dysregulation, mood dependent behaviors, and significant interpersonal deficits that often have destructive and painful consequences. The three authors bring a variety of perspectives in commenting on Marks’ case study. The first is a psychologist who is a senior DBT therapist and the Program Director and Director of Training at an established adolescent DBT Continuum of Care Program; the second is an internationally active psychiatrist who is the Medical Director of the same Continuum of Care Program and a Behavioral Tech DBT Trainer; and the third is a post-doctoral psychology fellow working with the first two authors. A major theme in our discussion will be the challenge, when delivering DBT, of how to balance between technical interventions, on the one hand, and emotional experiencing, on the other. In exploring this theme, we will answer the questions, what was left out and what does it feel like?
{"title":"Finding a Dialectical Balance Between Process and Procedure","authors":"Gillian C. Galen, B. Aguirre, J. W. Tirpak","doi":"10.55818/pcsp.v18i1.2103","DOIUrl":"https://doi.org/10.55818/pcsp.v18i1.2103","url":null,"abstract":" \u0000The case of \"Jane\" (Marks, 2022) provides a detailed examination of the evidenced-based treatment, Dialectical Behavior Therapy (DBT), in the treatment of a woman with complex and multifaceted psychiatric difficulties by Michael Marks, an advanced doctoral student clinician in a DBT training clinic. Marks’ presentation provides an excellent example of the challenges clinicians face when treating patients with borderline personality disorder (BPD) and many of the common and multiple co-morbidities that frequently accompany the BPD diagnosis. While DBT is sometimes dismissed as a treatment that just teaches skills, Marks demonstrates the technical demands and nuances that therapists must use to correctly and effectively treat suicidality, emotion dysregulation, mood dependent behaviors, and significant interpersonal deficits that often have destructive and painful consequences. The three authors bring a variety of perspectives in commenting on Marks’ case study. The first is a psychologist who is a senior DBT therapist and the Program Director and Director of Training at an established adolescent DBT Continuum of Care Program; the second is an internationally active psychiatrist who is the Medical Director of the same Continuum of Care Program and a Behavioral Tech DBT Trainer; and the third is a post-doctoral psychology fellow working with the first two authors. A major theme in our discussion will be the challenge, when delivering DBT, of how to balance between technical interventions, on the one hand, and emotional experiencing, on the other. In exploring this theme, we will answer the questions, what was left out and what does it feel like? ","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43034649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-26DOI: 10.55818/pcsp.v18i1.2102
M. W. Marks
Dialectical Behavioral Therapy (DBT) is an evidence-based, long-term psychotherapy initially developed to treat Borderline Personality Disorder (BPD) patients and/or highly suicidal individuals. DBT involves four components: tailored individual therapy, phone coaching from the individual therapist, structured group skills training, and therapist supervision by participation in a "consultation team." While manualized, DBT is a multifaceted and flexibly applied treatment that balances interventions both for acceptance and maintenance (e.g., validating the patient in the present), and for change and progression (e.g., encouraging the patient to try on new, more healthy attitudes, emotions, and behaviors). The Dialectical Behavioral Therapy Clinic at Rutgers University (DBT-RU) is a research and training clinic that adapts the DBT Manual to provide short-term (6-months long), comprehensive DBT for community adults presenting with BPD and associated problems. The present project reports an example of the DBT-RU model in action, including the decision-making processes involved, by presenting the case of "Jane," for whom I was the therapist. At the beginning of therapy Jane was a 32-year-old, heterosexual, Caucasian, single mother of a 7-year-old son; and she worked as a medical technician. Her presenting problems met the full DSM-5 criteria for BPD. Her symptoms, following DSM-5 numbering, included: 1) frantic efforts to avoid abandonment; (2) recurrent unstable and intense relationships; (3) identity disturbance (in self and religious beliefs); (4) impulsivity; (6) affective instability; (7) chronic feelings of emptiness; and (8) inappropriate, intense anger. In addition, she reported past suicidal ideation that was "very strong." In line with Jane’s intense and challenging presenting problems, the process of therapy was complex with many starts and stops. However, over the course of therapy she showed important, substantial improvement, as reflected by both quantitative measures and qualitative indicators. To aid the reader in following the complex organization of this case study, an outline of it is presented in Appendix 1.
{"title":"A Short-Term Training Clinic Model for Dialectical Behavior Therapy (DBT) in Treating Borderline Personality Disorder (BPD): The Case of \"Jane\"","authors":"M. W. Marks","doi":"10.55818/pcsp.v18i1.2102","DOIUrl":"https://doi.org/10.55818/pcsp.v18i1.2102","url":null,"abstract":"Dialectical Behavioral Therapy (DBT) is an evidence-based, long-term psychotherapy initially developed to treat Borderline Personality Disorder (BPD) patients and/or highly suicidal individuals. DBT involves four components: tailored individual therapy, phone coaching from the individual therapist, structured group skills training, and therapist supervision by participation in a \"consultation team.\" While manualized, DBT is a multifaceted and flexibly applied treatment that balances interventions both for acceptance and maintenance (e.g., validating the patient in the present), and for change and progression (e.g., encouraging the patient to try on new, more healthy attitudes, emotions, and behaviors). The Dialectical Behavioral Therapy Clinic at Rutgers University (DBT-RU) is a research and training clinic that adapts the DBT Manual to provide short-term (6-months long), comprehensive DBT for community adults presenting with BPD and associated problems. The present project reports an example of the DBT-RU model in action, including the decision-making processes involved, by presenting the case of \"Jane,\" for whom I was the therapist. At the beginning of therapy Jane was a 32-year-old, heterosexual, Caucasian, single mother of a 7-year-old son; and she worked as a medical technician. Her presenting problems met the full DSM-5 criteria for BPD. Her symptoms, following DSM-5 numbering, included: 1) frantic efforts to avoid abandonment; (2) recurrent unstable and intense relationships; (3) identity disturbance (in self and religious beliefs); (4) impulsivity; (6) affective instability; (7) chronic feelings of emptiness; and (8) inappropriate, intense anger. In addition, she reported past suicidal ideation that was \"very strong.\" In line with Jane’s intense and challenging presenting problems, the process of therapy was complex with many starts and stops. However, over the course of therapy she showed important, substantial improvement, as reflected by both quantitative measures and qualitative indicators. To aid the reader in following the complex organization of this case study, an outline of it is presented in Appendix 1. ","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43971892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-05DOI: 10.14713/pcsp.v17i2.2093
D. Fishman
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.
{"title":"The Adjudicated Case Study Method, Part 2: Editor’s Introduction","authors":"D. Fishman","doi":"10.14713/pcsp.v17i2.2093","DOIUrl":"https://doi.org/10.14713/pcsp.v17i2.2093","url":null,"abstract":"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. ","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44184088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-05DOI: 10.14713/pcsp.v17i2.2095
R. Miller, B. Ashley, Kristin S. Mount, Samantha Tuepker, Thomas Powell, David O'Leary, Michele Fouts, K. Allshouse, Jacob R. Rusczek, Kelsy Hennebarrows, Amanda Dombroski
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.
{"title":"Further Developments in the Panel of Psychological Inquiry Method of Case Study Research: The Case of \"Ronan\"","authors":"R. Miller, B. Ashley, Kristin S. Mount, Samantha Tuepker, Thomas Powell, David O'Leary, Michele Fouts, K. Allshouse, Jacob R. Rusczek, Kelsy Hennebarrows, Amanda Dombroski","doi":"10.14713/pcsp.v17i2.2095","DOIUrl":"https://doi.org/10.14713/pcsp.v17i2.2095","url":null,"abstract":"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.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47494271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-05DOI: 10.14713/pcsp.v17i2.2097
R. Elliott, Susan Stephen, A. Robinson
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.
{"title":"Commentary—Extending the Boundaries of Systematic Case Study Research: Conceptual and Methodological Issues","authors":"R. Elliott, Susan Stephen, A. Robinson","doi":"10.14713/pcsp.v17i2.2097","DOIUrl":"https://doi.org/10.14713/pcsp.v17i2.2097","url":null,"abstract":"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.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41440202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-19DOI: 10.14713/PCSP.V17I1.2087
K. Critchfield, Julia Dobner-Pereira, Eliza Stucker
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.
{"title":"The Case of Sharon Considered from the Vantage Point of Interpersonal Reconstructive Therapy","authors":"K. Critchfield, Julia Dobner-Pereira, Eliza Stucker","doi":"10.14713/PCSP.V17I1.2087","DOIUrl":"https://doi.org/10.14713/PCSP.V17I1.2087","url":null,"abstract":"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.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"17 1","pages":"42-62"},"PeriodicalIF":0.0,"publicationDate":"2021-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45342402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-19DOI: 10.14713/PCSP.V17I1.2089
K. Critchfield, Julia Dobner-Pereira, Eliza Stucker
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.
{"title":"Interpersonal Wishes and Fears with Regard to Internalized Attachment Figures: Differing Focus of Two Case Formulation Methods that use SASB","authors":"K. Critchfield, Julia Dobner-Pereira, Eliza Stucker","doi":"10.14713/PCSP.V17I1.2089","DOIUrl":"https://doi.org/10.14713/PCSP.V17I1.2089","url":null,"abstract":"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.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"17 1","pages":"85-103"},"PeriodicalIF":0.0,"publicationDate":"2021-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48645084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-19DOI: 10.14713/PCSP.V17I1.2084
M. Westerman, K. Critchfield
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.
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Pub Date : 2021-04-19DOI: 10.14713/PCSP.V17I1.2083
D. Fishman
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.
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