M. S. Halvorsen, J. McLeod, Kirsten Benum, H. Haavind
{"title":"Conceptualizing the Complexity of Change in Psychotherapy: The Case of \"Cora\"","authors":"M. S. Halvorsen, J. McLeod, Kirsten Benum, H. Haavind","doi":"10.14713/PCSP.V12I3.1979","DOIUrl":"https://doi.org/10.14713/PCSP.V12I3.1979","url":null,"abstract":"In this article we respond to the commentaries by Altman and Miller (2016), Bohart (2016), and Timulak and Keogh (2016) on our case of “Cora,” which involved over 121 psychotherapy sessions with a client with a history of severe relational trauma that had led to difficulty in forming close relationships, as well as a series of suicide attempts (Halvorsen, Benum, Haavind, & McLeod, 2016). The commentaries differ in their view of the value of Cora’s case, interpretations of the material, and methodological preferences. Together the commentaries illustrate the complexity of change in psychotherapy, how we need multifaceted approaches to understand change, and the challenges in writing up a case in this context. We call for further dialogue within the psychotherapy research community around the nature and implications of methodological choices arising from the conduct of case study research in this field.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"12 1","pages":"224-237"},"PeriodicalIF":0.0,"publicationDate":"2016-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67056666","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}
{"title":"Considering \"Cora\": A Critical Appreciation","authors":"A. Altman, R. Miller","doi":"10.14713/PCSP.V12I3.1978","DOIUrl":"https://doi.org/10.14713/PCSP.V12I3.1978","url":null,"abstract":"This discussion examines Halvorsen, Benum, Haavind, and McLeod’s (2016) case study of “Cora,” from a perspective both appreciative and at times critical of certain mixed-study methods it employs. While impressed with the clinical alliance it illustrates between therapist and challenging client, we find the study raises more theoretical questions than it answers in terms of our ability to enumerate the conceptual elements necessary to convey valuable clinical truths. The case study does indeed provide systematic data on the presence of dyadic courage, persistence, and symbolic expressions of trust during treatment from which there is much to be learned. As readers we were left marveling at an account of a therapist’s clinical acumen with a client who had faced unbearable childhood trauma, and at the same time wondering how much more we might have learned about how to actually do such work from a comprehensive narrative written in his own voice.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"12 1","pages":"215-223"},"PeriodicalIF":0.0,"publicationDate":"2016-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67057112","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}
{"title":"The Case of \"Cora\": Clinical and Methodological Perspectives","authors":"L. Timulak, Daragh Keogh","doi":"10.14713/PCSP.V12I3.1977","DOIUrl":"https://doi.org/10.14713/PCSP.V12I3.1977","url":null,"abstract":"In this commentary we explore the clinical aspects of Halvorsen, Benum, Haavind, and McLeod’s (2016) compelling case study of “Cora.” We were humbled by the courage and commitment of both the client and the therapist in the case. We begin by providing our perspective on how the therapist’s flexibility regarding certain boundaries helped to build trust between him and the client; and on how this trust in turn allowed the client find the courage to bring the most painful aspects of her experience to therapy. We then comment on certain methodological aspects of the case study. We discuss ways in which the steps describing the choices authors made could have been made more explicit. We question the necessity to present the case in the format of Interpretative Phenomenological Analysis (IPA; Smith, Flowers, & Larkin, 2009). We also question whether “theory building case study” is the best description for this particular study. In addition, we comment briefly on some of the themes reported by the study and share our own interpretative process, pointing out both the significant overlap and also those points where our interpretation may differ from the authors, including the role of transference interpretations and immediacy in the success of the case. Finally, we provide our perspective on the discrepancy between the quantitative versus qualitative outcomes obtained in the case.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"12 1","pages":"207-214"},"PeriodicalIF":0.0,"publicationDate":"2016-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67055754","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}
M. S. Halvorsen, Kirsten Benum, H. Haavind, J. McLeod
{"title":"A Life-Saving Therapy: The Theory-Building Case of \"Cora\"","authors":"M. S. Halvorsen, Kirsten Benum, H. Haavind, J. McLeod","doi":"10.14713/PCSP.V12I3.1975","DOIUrl":"https://doi.org/10.14713/PCSP.V12I3.1975","url":null,"abstract":"The present paper presents a case study of long-term (121 sessions over three years), integrative therapy with \"Cora,\" a client with a history of severe relational trauma that had led to difficulty in forming close relationships, and a history of hospitalization resulting from a series of suicide attempts. Despite these challenges, Cora reported a highly satisfactory outcome at the end of therapy. Using the format of a theory-building case study (McLeod, 2010; Stiles, 2007), qualitative analysis of session evaluations, session transcripts, and post therapy interviews were used to investigate how both the client and therapist understood the process of therapy and why it had been successful. Data from quantitative process and outcome measures were analyzed to provide contextual information. In spite of repeated challenges and difficult therapeutic situations, Cora and the therapist were able to establish a recurring pattern of interaction that they found relevant and productive and that was characterized by persistence . Other helpful aspects of the therapy process included acting with courage , and the use of symbolic representations of their accomplishments. The results contribute to our understanding of the process of therapy with clients who have been exposed to severe relational trauma. The discussion includes reflection on methodological issues associated with mixed-methods case study research in psychotherapy.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"12 1","pages":"158-193"},"PeriodicalIF":0.0,"publicationDate":"2016-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67055914","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}
{"title":"The Life-Saving Case of \"Cora\": A Rogerian Perspective","authors":"A. Bohart","doi":"10.14713/PCSP.V12I3.1976","DOIUrl":"https://doi.org/10.14713/PCSP.V12I3.1976","url":null,"abstract":"Halvorsen, Benum, Haavind, and McLeod’s (2016) A Life-Saving Therapy: The Theory-Building Case of \"Cora\" is rich in ideas and findings. My reflections fall into four categories. First, I comment on the finding that therapist and client reports of change in the case of Cora differ from results on objective measures. I argue that an extensive qualitative examination could better resolve this issue. Second, I raise questions concerning the idea that clients’ problems necessarily stem from early childhood abuse. Third, I argue that the authors’ finding of the importance of persistence in therapy may better explain how therapy works than a primary focus on significant events or significant moments. Finally, I agree with the authors’ finding of client courage, but give an alternative interpretation of that.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"12 1","pages":"194-206"},"PeriodicalIF":0.0,"publicationDate":"2016-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67056133","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}
{"title":"Further Consideration of Systems, Stigma, Trauma, and Access to Care","authors":"K. Rogers, Michelle Bobich, P. Heppell","doi":"10.14713/PCSP.V12I2.1970","DOIUrl":"https://doi.org/10.14713/PCSP.V12I2.1970","url":null,"abstract":"The commentaries by Williams (2016) and Gartenberg and Lang (2016) on the case of Cathy and her mother Ms. Z (Rogers, Bobich, & Heppell, 2016) explore the similarities between children who have been homeless and those in the foster system, and highlight the importance of trauma-focused treatment to address their mental health needs. A further consideration of the challenges to obtaining such treatment due to system barriers, stigma, and the intergenerational transmission of trauma is applied to the case of Cathy. This illustrates the importance of an array of mental health treatment options and the ability to transition from one treatment (an Incredible Years [IY] group) to another (Child-Parent Psychotherapy [CPP]) as opportunities to increase access to needed care for marginalized families.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"12 1","pages":"139-157"},"PeriodicalIF":0.0,"publicationDate":"2016-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67055810","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}
{"title":"The Impact of Implementing an \"Incredible Years\" Group Within a Family Living Unit in a Transitional Living Shelter: The Case of \"Cathy\"","authors":"K. Rogers, Michelle Bobich, P. Heppell","doi":"10.14713/PCSP.V12I2.1967","DOIUrl":"https://doi.org/10.14713/PCSP.V12I2.1967","url":null,"abstract":"Young children who experience homelessness have a markedly increased risk of behavior disorders. This case study illustrates the impact of the \"Incredible Years\" (IY) program, an evidence-supported group psychotherapy intervention, on \"Cathy,\" a 4-year-old Latina girl with externalizing behaviors who was living in a transitional program for homeless women and children. Adaptations of the model to address the child and family’s trauma history and to allow for its implementation in a residential program are delineated. Qualitative and quantitative data support that the IY group had a positive impact on Cathy and her family and led to significant symptom decreases in externalizing behaviors and PTSD symptoms, as well as an improvement in the quality of child and parent interactions. Additionally, recommendations for future studies and treatment considerations and adaptations for this underserved population are addressed.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"12 1","pages":"65-112"},"PeriodicalIF":0.0,"publicationDate":"2016-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67055566","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}
{"title":"Considerations for the Dissemination of Incredible Years in Welfare Systems: Implications of the Case of \"Cathy\" for Intervention in the Foster Care System","authors":"Arielle S. Gartenberg, Robin Lang","doi":"10.14713/PCSP.V12I2.1969","DOIUrl":"https://doi.org/10.14713/PCSP.V12I2.1969","url":null,"abstract":"The Incredible Years (IY) Parent and Child Series are evidence-based interventions that increase knowledge and mastery of parenting, mood regulation, and interpersonal problem solving strategies for caregivers while developing similar social and emotional skills in their children. Rogers, Bobich, and Heppell (2016) use a case study approach to examine the effectiveness of adaptations of the IY program for delivery in a transitional housing shelter. They describe strategies for modifying IY to meet the needs of a vulnerable population within the context of the shelter and the broader welfare system. In this commentary, the difficulties commonly experienced by youth like \"Cathy\" as a function of homelessness and trauma are discussed. Aspects of IY and its adaptation are examined as they highlight (1) essential elements of psychological interventions with clients exposed to trauma, and (2) barriers and facilitators in the delivery of evidence-based treatments within complex natural settings and systems of care. These considerations are salient for practitioners treating youth and families involved in the child welfare system and foster care. The most vital adaptations presented in the Case of Cathy and the IY literature are reviewed to address anticipated pragmatic barriers and therapeutic issues in the implementation of IY for youth in these systems.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"12 1","pages":"124-138"},"PeriodicalIF":0.0,"publicationDate":"2016-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67055694","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}
{"title":"Integrating Early Childhood Mental Health and Trauma-Informed Care for Homeless Families With Young Children","authors":"Marian E. Williams","doi":"10.14713/PCSP.V12I2.1968","DOIUrl":"https://doi.org/10.14713/PCSP.V12I2.1968","url":null,"abstract":"Rogers, Bobich, and Heppell’s (2016) case study illustrating the successful application of an \"Incredible Years\" intervention with a 4-year-old girl and her family in the context of a homeless shelter provides an opportunity to consider the intersecting perspectives of infant and early childhood mental health and trauma-informed care. Cathy’s exposure to intimate partner violence, her mother’s chronic depression, and her homelessness occurred during the critical developmental stages of prenatal development and the first four years of life, impacting her developing understanding of relationships and her emotion regulation. A trauma-informed perspective provides an understanding of the links between Cathy’s history of trauma and her presenting symptoms of tantrums, aggression, and \"moodiness,\" leading to recommended parenting strategies that support co-regulation and eventually self-regulation of emotions. Although the Incredible Years intervention was successful in reducing Cathy’s symptoms, the addition of trauma-focused interventions may have the added benefit of helping Cathy to directly play and talk about her experience, together with her mother, so that both can understand and integrate their traumatic experiences and her mother can restore her role as a \"protective shield\" for her family. Finally, the opening provided by implementation of a successful parenting intervention could lead to a broader consultation aimed at creating a trauma-informed organization within the transitional living shelter.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"12 1","pages":"113-123"},"PeriodicalIF":0.0,"publicationDate":"2016-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67056034","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}
{"title":"Expanding My Perspective on the Case of Daniel","authors":"R. Cohen","doi":"10.14713/PCSP.V12I1.1947","DOIUrl":"https://doi.org/10.14713/PCSP.V12I1.1947","url":null,"abstract":"I appreciate the reflections on the case of Daniel from Dr. Jill Bresler (2016) and from Dr. Stephen Holland (2016) —two experienced clinicians well versed in moving between psychodynamic and cognitive-behavioral orientations to more comprehensively meet the needs of their patients. Dr. Bresler’s response led me to think more about my development as a therapist and the process through which a psychoanalyst struggles to become more integrative. Dr. Holland’s response provided a helpful overview of additional cognitive techniques I might have used, but it also suggested that there may be limits to integrating certain aspects of different theories because of fundamental discrepancies.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"12 1","pages":"56-64"},"PeriodicalIF":0.0,"publicationDate":"2016-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67055556","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}