Pub Date : 2021-04-19DOI: 10.14713/PCSP.V17I1.2090
S. Messer
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.
{"title":"How Do We Decide Which of Two Case Formulations Is Correct? Commentary on Westerman and Critchfield et al.","authors":"S. Messer","doi":"10.14713/PCSP.V17I1.2090","DOIUrl":"https://doi.org/10.14713/PCSP.V17I1.2090","url":null,"abstract":"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.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"17 1","pages":"104-108"},"PeriodicalIF":0.0,"publicationDate":"2021-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49648491","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.V17I1.2091
M. Westerman, K. Critchfield
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.
Stanley Messer（2021）在他的评论中提出了一个问题，即是否有可能评估不同案例制定方法对心理治疗的相对优点。他继续坚持，基于真理的语用理论，可以比较不同的案例表述方法，并指出他和他的合作者进行的一项研究计划是未来可能研究的一个例子（Collins&Messer，1991；霍兰德、罗伯茨和梅塞尔，1998年；梅塞尔、蒂什比和斯皮尔曼，1992年；蒂什比与梅塞尔，1995年）。在这一答复中，我们对梅塞尔的发言表示赞赏，我们在很大程度上同意他的发言，并试图强调和巩固他提出的一些观点。我们讨论了杜威（1896）对反射弧概念的经典批判，以指出实用主义的哲学观点支持不同治疗方法并非不可通约的观点的其他方式。我们还为未来的研究提供了一些建议，比较基于人际防御理论和IRT的心理治疗，或任何两种案例制定的治疗方法。在许多方面，我们的建议遵循梅塞尔的研究思路。我们还强调了基于病例配方的研究的价值，不仅在比较治疗方法的研究方面，而且在调查其他治疗问题方面。
{"title":"Philosophical Considerations and Research Ideas About Comparing the Two Approaches: Messer’s Comments Point the Way Forward","authors":"M. Westerman, K. Critchfield","doi":"10.14713/PCSP.V17I1.2091","DOIUrl":"https://doi.org/10.14713/PCSP.V17I1.2091","url":null,"abstract":"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.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"17 1","pages":"109-122"},"PeriodicalIF":0.0,"publicationDate":"2021-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43509688","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.V17I1.2088
M. Westerman
This paper compares the approaches to Sharon’s case presented in two articles that appear earlier in this module, my paper (Westerman, 2021a), which was based on Interpersonal Defense Theory, and the paper by Critchfield, Dobner-Pereira, and Stucker (2021a), which was based on Interpersonal Reconstructive Therapy (IRT). I begin by considering differences in general between the ways in which these two perspectives approach case formulation. I then turn to comparing the formulations of Sharon’s case based on the two perspectives. Among other things, this part of the paper contrasts IRT’s focus on copy processes and the Gift of Love with Interpersonal Defense Theory’s focus on functionalist processes that involve the temporal organization of the parts of noncoordinating defensive interpersonal patterns. The second half of the paper compares the treatment implications of the two approaches in general terms and as they relate to Sharon’s case in particular. Implications for treatment are discussed regarding both insight-oriented interventions and enacted interventions at the level of therapy relationship processes.
{"title":"Comparing Interpersonal Defense Theory and Interpersonal Reconstructive Therapy and Their Views of Sharon’s Case","authors":"M. Westerman","doi":"10.14713/PCSP.V17I1.2088","DOIUrl":"https://doi.org/10.14713/PCSP.V17I1.2088","url":null,"abstract":"This paper compares the approaches to Sharon’s case presented in two articles that appear earlier in this module, my paper (Westerman, 2021a), which was based on Interpersonal Defense Theory, and the paper by Critchfield, Dobner-Pereira, and Stucker (2021a), which was based on Interpersonal Reconstructive Therapy (IRT). I begin by considering differences in general between the ways in which these two perspectives approach case formulation. I then turn to comparing the formulations of Sharon’s case based on the two perspectives. Among other things, this part of the paper contrasts IRT’s focus on copy processes and the Gift of Love with Interpersonal Defense Theory’s focus on functionalist processes that involve the temporal organization of the parts of noncoordinating defensive interpersonal patterns. The second half of the paper compares the treatment implications of the two approaches in general terms and as they relate to Sharon’s case in particular. Implications for treatment are discussed regarding both insight-oriented interventions and enacted interventions at the level of therapy relationship processes.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"17 1","pages":"63-84"},"PeriodicalIF":0.0,"publicationDate":"2021-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42188027","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.V17I1.2086
M. Westerman
As part of this project comparing analyses of the case of Sharon based on Interpersonal Defense Theory (e.g., Westerman, 2018, 2019) and Interpersonal Reconstructive Therapy (e.g., Benjamin & Critchfield, 2010), this paper considers the case from the vantage point of Interpersonal Defense Theory. The first half of the paper presents the theory’s novel approach to case formulation. It begins by explaining the kind of case formulations the Interpersonal Defense Theory calls for in general and then presents a formulation of Sharon’s case based on the theory, illustrating that formulation with an examination of a transcript of a session excerpt from her therapy. The second half of the paper discusses the theory’s implications for treatment, beginning with a presentation of its treatment implications in general and then turning to its specific implications for Sharon’s case. Overall, the paper shows that the theory sheds new light on how to understand Sharon’s problems, provides a possible explanation for why the treatment, which was based on Brief Adaptive Psychotherapy (Pollack, Flegenheimer, Kaufman, & Sadow, 1992), resulted in a poor outcome, and suggests a different therapeutic approach that might have been more successful.
{"title":"The Case of Sharon Considered from the Vantage Point of Interpersonal Defense Theory","authors":"M. Westerman","doi":"10.14713/PCSP.V17I1.2086","DOIUrl":"https://doi.org/10.14713/PCSP.V17I1.2086","url":null,"abstract":"As part of this project comparing analyses of the case of Sharon based on Interpersonal Defense Theory (e.g., Westerman, 2018, 2019) and Interpersonal Reconstructive Therapy (e.g., Benjamin & Critchfield, 2010), this paper considers the case from the vantage point of Interpersonal Defense Theory. The first half of the paper presents the theory’s novel approach to case formulation. It begins by explaining the kind of case formulations the Interpersonal Defense Theory calls for in general and then presents a formulation of Sharon’s case based on the theory, illustrating that formulation with an examination of a transcript of a session excerpt from her therapy. The second half of the paper discusses the theory’s implications for treatment, beginning with a presentation of its treatment implications in general and then turning to its specific implications for Sharon’s case. Overall, the paper shows that the theory sheds new light on how to understand Sharon’s problems, provides a possible explanation for why the treatment, which was based on Brief Adaptive Psychotherapy (Pollack, Flegenheimer, Kaufman, & Sadow, 1992), resulted in a poor outcome, and suggests a different therapeutic approach that might have been more successful.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"17 1","pages":"19-41"},"PeriodicalIF":0.0,"publicationDate":"2021-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43504370","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 : 2021-01-01DOI: 10.14713/pcsp.v17i2.2096
A. Bohart, Lindsey Shenefiel, Marco Alejandro
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.
{"title":"What Can We Learn About Therapeutic Change From Case History Data? The Research Jury Method with the Couple Case of \"Carl\" and \"Sandra\"","authors":"A. Bohart, Lindsey Shenefiel, Marco Alejandro","doi":"10.14713/pcsp.v17i2.2096","DOIUrl":"https://doi.org/10.14713/pcsp.v17i2.2096","url":null,"abstract":"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.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67058213","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 : 2020-12-29DOI: 10.14713/pcsp.v16i3.2080
Ginelle Wolfe, R. Levant
Dr. Christopher Dewey (2020) wrote up the hybrid case study of "Tommy," a college student who presents with symptoms of masculine depression and alcohol use problems. The importance of this case study is heightened by the current national conversation about masculinity. Context is provided for the topic of men and depression. Consideration is given to the ways Dewey addresses and works as a clinician with traditional masculinity norms that Tommy endorses. Emphasis is given to the way men are socialized at a young age to conform to traditional masculinity norms, and how to work therapeutically with such men. Strengths and critiques of the case are discussed, organized into the following themes: masculine depression, normative male alexithymia, traditional masculinity ideology, discrepancy strain, questioning masculinity, positive masculinity, making masculinity less salient, dealing with problematic alcohol use, family history, trauma, relationships with women, social media consumption, performance as a college student, treatment goals and the course of treatment, and intersectionality.
{"title":"Treating Masculinity: A Commentary on The Hybrid Case Study of \"Tommy\"","authors":"Ginelle Wolfe, R. Levant","doi":"10.14713/pcsp.v16i3.2080","DOIUrl":"https://doi.org/10.14713/pcsp.v16i3.2080","url":null,"abstract":"Dr. Christopher Dewey (2020) wrote up the hybrid case study of \"Tommy,\" a college student who presents with symptoms of masculine depression and alcohol use problems. The importance of this case study is heightened by the current national conversation about masculinity. Context is provided for the topic of men and depression. Consideration is given to the ways Dewey addresses and works as a clinician with traditional masculinity norms that Tommy endorses. Emphasis is given to the way men are socialized at a young age to conform to traditional masculinity norms, and how to work therapeutically with such men. Strengths and critiques of the case are discussed, organized into the following themes: masculine depression, normative male alexithymia, traditional masculinity ideology, discrepancy strain, questioning masculinity, positive masculinity, making masculinity less salient, dealing with problematic alcohol use, family history, trauma, relationships with women, social media consumption, performance as a college student, treatment goals and the course of treatment, and intersectionality.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43441616","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 : 2020-12-29DOI: 10.14713/pcsp.v16i3.2079
Ethan Hoffman, M. Addis
Men’s psychological well-being has in recent decades garnered increasing attention in research, clinical practice, and larger society. Dewey’s insightful case study provides an occasion for reflecting on the multiple conceptual lenses that can be used to understand and work with masculinity in psychotherapy. In this commentary, we discuss how these conceptualizations of masculinity facilitate different approaches to psychotherapy at the levels of treatment planning and intervention. We offer our own approach to masculine identity work, noting specific points of contrast with the approach illustrated by Dewey. Finally, we critically explore the clinical and societal implications of concepts like "toxic masculinity" and "healthy masculinity" in light of social justice pursuits for gender equality. Throughout, we emphasize the importance for clinicians to make deliberate choices about how masculinity is conceptualized and to consider the pragmatic consequences of these conceptual choices.
{"title":"Reconstructing and/or Deconstructing Masculinity: A Commentary on the Case of \"Tommy\"","authors":"Ethan Hoffman, M. Addis","doi":"10.14713/pcsp.v16i3.2079","DOIUrl":"https://doi.org/10.14713/pcsp.v16i3.2079","url":null,"abstract":"Men’s psychological well-being has in recent decades garnered increasing attention in research, clinical practice, and larger society. Dewey’s insightful case study provides an occasion for reflecting on the multiple conceptual lenses that can be used to understand and work with masculinity in psychotherapy. In this commentary, we discuss how these conceptualizations of masculinity facilitate different approaches to psychotherapy at the levels of treatment planning and intervention. We offer our own approach to masculine identity work, noting specific points of contrast with the approach illustrated by Dewey. Finally, we critically explore the clinical and societal implications of concepts like \"toxic masculinity\" and \"healthy masculinity\" in light of social justice pursuits for gender equality. Throughout, we emphasize the importance for clinicians to make deliberate choices about how masculinity is conceptualized and to consider the pragmatic consequences of these conceptual choices.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42338580","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 : 2020-12-29DOI: 10.14713/PCSP.V16I3.2077
C. Dewey
The purpose of this study is to explore and discuss the effects of inflexibly enacted traditional masculinity norms (IE-TMNs) on adolescent and young adult males with depression and how to address such issues in therapy. This study provides a literature review of the subject of IE-TMNs and how such a worldview holds a potentially negative influence and impact on the physical and mental health of boys and young men. Specifically, the study aims to highlight how these beliefs, attributes, and values influence the extent to which these individuals seek help, express emotion, and utilize healthy coping skills when experiencing depressive symptoms and how such behaviors can be addressed in therapy. Treatment considerations are explored through the hybrid case example of "Tommy," a depiction of a depressed college freshman following IE-TMNs while going through a difficult life transition. A fictional case, Tommy serves as a composite character informed by real life psychotherapy cases and clinical examples found in relevant literature. Tommy’s course of treatment depicts potential clinical issues that could come up when working with a depressed male client with strong internalized masculinity norms and how some of these themes can be adequately addressed to create a more flexible masculine identity. Through use of a qualitative, disciplined inquiry approach, I explore therapeutic interventions that could be utilized to meet the unique needs of such a client within the context of historical, contextual, and cultural factors. Tommy’s case material is analyzed qualitatively and quantitatively in accordance with the pragmatic case study research format (Fishman, 2013). The hybrid case of Tommy explores how client-centered therapy, motivational interviewing, harm reduction interventions, and cognitive-behavioral interventions can be integrated to assist adolescent boys and young men with strongly internalized and rigid beliefs about masculinity, while also utilizing Bronfenbrenner’s ecological systems theory to explore the proximal and distal factors in one’s environment that contribute to such a worldview. The hybrid case study of Tommy is designed to serve as a resource for therapists working with clients with IE-TMNs and provides guidance about how to alter unhelpful coping strategies; increase emotional expression and help-seeking behaviors; and explore personal beliefs, goals, and values. This case study concludes with a critical discussion of future directions for research on this topic, as well as the advantages and limitations of the hybrid case study design.
{"title":"Inflexibly Enacted Traditional Masculinity Norms (IE-TMNs) and Their Impact on Adolescent and Young Adult Depression: The Hybrid Case Study of \"Tommy\"","authors":"C. Dewey","doi":"10.14713/PCSP.V16I3.2077","DOIUrl":"https://doi.org/10.14713/PCSP.V16I3.2077","url":null,"abstract":"The purpose of this study is to explore and discuss the effects of inflexibly enacted traditional masculinity norms (IE-TMNs) on adolescent and young adult males with depression and how to address such issues in therapy. This study provides a literature review of the subject of IE-TMNs and how such a worldview holds a potentially negative influence and impact on the physical and mental health of boys and young men. Specifically, the study aims to highlight how these beliefs, attributes, and values influence the extent to which these individuals seek help, express emotion, and utilize healthy coping skills when experiencing depressive symptoms and how such behaviors can be addressed in therapy. Treatment considerations are explored through the hybrid case example of \"Tommy,\" a depiction of a depressed college freshman following IE-TMNs while going through a difficult life transition. A fictional case, Tommy serves as a composite character informed by real life psychotherapy cases and clinical examples found in relevant literature. Tommy’s course of treatment depicts potential clinical issues that could come up when working with a depressed male client with strong internalized masculinity norms and how some of these themes can be adequately addressed to create a more flexible masculine identity. Through use of a qualitative, disciplined inquiry approach, I explore therapeutic interventions that could be utilized to meet the unique needs of such a client within the context of historical, contextual, and cultural factors. Tommy’s case material is analyzed qualitatively and quantitatively in accordance with the pragmatic case study research format (Fishman, 2013). The hybrid case of Tommy explores how client-centered therapy, motivational interviewing, harm reduction interventions, and cognitive-behavioral interventions can be integrated to assist adolescent boys and young men with strongly internalized and rigid beliefs about masculinity, while also utilizing Bronfenbrenner’s ecological systems theory to explore the proximal and distal factors in one’s environment that contribute to such a worldview. The hybrid case study of Tommy is designed to serve as a resource for therapists working with clients with IE-TMNs and provides guidance about how to alter unhelpful coping strategies; increase emotional expression and help-seeking behaviors; and explore personal beliefs, goals, and values. This case study concludes with a critical discussion of future directions for research on this topic, as well as the advantages and limitations of the hybrid case study design.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49168962","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 : 2020-12-29DOI: 10.14713/pcsp.v16i3.2078
J. Mahalik
The case of "Tommy" highlights both an underutilized methodology for increasing the field’s understanding of the therapeutic process in working with men, and the importance of addressing inflexibly enacted masculinity norms. My commentary focuses on detailing how the methodology helps those of us interested in understanding how masculine norms contribute to men’s presenting concerns, help-seeking, and experiences in treatment focusing on the multi-directionality of relational experiences, masculine identity development, and presenting issues. Then I discuss how the concepts of inflexibility has its roots within an Interpersonal Therapy framework (e.g., Kiesler, 1983) and how this inflexibility develops consistently with explanations contained in Precarious Manhood Theory (i.e., Vandello Bosson, 2013).
{"title":"Understanding the Role of Inflexibly Enacted Masculinity Norms in Therapy: A Commentary on the Case of \"Tommy\"","authors":"J. Mahalik","doi":"10.14713/pcsp.v16i3.2078","DOIUrl":"https://doi.org/10.14713/pcsp.v16i3.2078","url":null,"abstract":"The case of \"Tommy\" highlights both an underutilized methodology for increasing the field’s understanding of the therapeutic process in working with men, and the importance of addressing inflexibly enacted masculinity norms. My commentary focuses on detailing how the methodology helps those of us interested in understanding how masculine norms contribute to men’s presenting concerns, help-seeking, and experiences in treatment focusing on the multi-directionality of relational experiences, masculine identity development, and presenting issues. Then I discuss how the concepts of inflexibility has its roots within an Interpersonal Therapy framework (e.g., Kiesler, 1983) and how this inflexibility develops consistently with explanations contained in Precarious Manhood Theory (i.e., Vandello Bosson, 2013).","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47640036","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 : 2020-10-12DOI: 10.14713/PCSP.V16I2.2073
L. Sass, J. Walkup
In our contribution, we note the remarkable nature of Dr. Michael Garrett’s (2020) case study of "Sean" and of the rich therapeutic relationship he so eloquently describes with his client. We then discuss several overlapping topics: the question of diagnosis and functional considerations, the patient’s attitude toward his delusions, and certain issues pertaining to the therapeutic relationship. Regarding diagnosis: we ask about the extent to which the patient "Sean" might or might not qualify as a case of schizophrenia. It is not clear from the report that Sean demonstrates the widespread disturbances of perception, cognition, and affect that would be expected in prototypical cases of schizophrenia. His psychopathology seems largely bound up with his delusions or delusional system, and these latter do not seem distinctively "bizarre." We suggest that "Sean" might better be viewed as a case of delusional disorder (while recognizing the vagueness of the boundaries between these and other conditions). We examine Sean’s attitude toward his delusions in some detail, asking whether this seems in keeping with what is assumed by the standard poor-reality-testing formula that is adopted in mainstream psychiatry, psychoanalysis, and the CBT approach to psychosis. The standard view assumes that a patient’s delusions, though false, are believed by him or her, and that the delusional objects or events are experienced as having the ontological status of something truly real (existing in the objective and intersubjective world). In our view, evidence suggests that Sean did not in fact experience his own delusions in this literalist way, but implicitly recognized their purely subjective or "virtual" nature. In light of this, we question the appropriateness of adopting the standard CBTp approach to this aspect of his psychopathology. The success of the treatment may be more intimately bound up with the relationship-building aspect (e.g., with Dr. Garrett’s skillful use of humor and perspective-taking) than with the empirical or logical refutation of his delusional preoccupations that CBTp theories would seem to emphasize. There are interesting parallels between the treatment of delusions in psychotic patients and the progression of theories in science described by such philosophers as Kuhn and Lakatos. Finally, we consider an additional aspect of the therapeutic encounter: namely, the avoidance of issues (well-advised, in our view) that could provoke or revive a sense of inferiority or humiliation in the patient (that is, of shame concerns). This is one of many demonstrations of this therapist’s remarkable skill, discernment, and capacity for empathy.
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