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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.

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.

Psychotherapy case studies have the capacity to link directly to the work of practitioners because these studies are grounded in the same type of setting in which clinicians function, that of the single case. Not surprisingly, then, case studies have played a most important role in the development of a wide range of therapy models, like psychoanalysis, behavioral therapy, and client-centered therapy. However, until recently, case studies as a method of research have fallen into disuse because they have been viewed as subjective and journalistic. This situation has changed with the growth of the philosophical movement of postmodernism, which has encouraged pluralism in the social sciences, and in turn stimulated new approaches to the case study as a serious method for psychotherapy research. This paper reviews one such approach, the pragmatic case study method, which is grounded in the fast-growing "mixed methods" model in the social sciences that seeks new ways to integrate qualitative and quantitative research designs and data. This paper begins with an overview of the growing variety of types of psychotherapy research, indicating where case studies fit in and describing a new design that integrates the use of pragmatic case studies with randomized clinical trials. The paper then lays out the basic structure of the pragmatic case study, in the context of viewing therapy as a complex adaptive system and, in a related fashion, as an example of Peterson's (1991) "Disciplined Inquiry" model of professional practice. The paper next provides a more concrete idea of the pragmatic case study by summarizing guidelines for writing such a case study for this PCSP journal, and by describing the structure of a specific example of a pragmatic case study published in the journal, the case of Caroline by Ueli Kramer. Finally, the paper describes how the pragmatic case study can be integrated with other types of case study designs.

This case study deals with Sara, a 37-year-old social phobic woman who suffered from a primary fear of blushing as well as comorbid disorders, including obsessive-compulsive disorder, generalized anxiety disorder and spider phobia. The client was treated in an intensive, one-week group cognitive-behavioral therapy program in an educational university clinic in Aarhus, Denmark. She achieved a remarkable and durable change in her longstanding social phobia after two in-session behavioral experiments conducted during the third and fourth days of the program. After treatment, the client was interviewed about her sudden gain, and she read and commented on the case study report. The primary aim of the study was to investigate the micro-level mechanisms of change for this particular client, and thereby illustrate the prospects of pragmatic case studies in meticulous process research focusing on one of the most intricate problems in psychotherapy: how does treatment work.

The paper is a response to a commentary by Rogojanski and Rego (2013) on our case study of Sara (Jensen, Hougaard, & Fishman, 2013). Sara was a client who achieved a remarkable and durable change in her longstanding social phobia (SP) after short-term group cognitive-behavior therapy (CBT). Our response deals with the following topics: (1) safety behavior; (2) the idiographic arrangement of exposure as behavioral experiments; (3) acceptance as a mechanism of action in CBT; (4) the specific format of the Aarhus treatment program; and (5) recent advances in quantitative research on change mechanisms in CBT for anxiety disorders. We conclude that Rogojanski and Rego's commentary and our further reflections underline the original conclusion from our case study: that generally, change mechanisms in psychotherapy are highly complex, and that specifically, the data from Sara’s case could be consistent with several disparate theories of change mechanisms in CBT, revealing a high degree of overlap and intertwining among the theories.

While 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.

The target article in the current issue of PCSP by Fredrik Folke and associates (2012) documents and interprets six case studies of cognitive-behavioral therapy for Body Dysmorphic Disorder. This introduction places the article in a larger methodological context from my perspective as editor of the PCSP journal. I first review five types of case studies identified by McLeod (2010) in his seminal book on case study research. These include the main type of case study employed in PCSP, the Pragmatic Case Study, and four other kinds, including those that focus on theory-building, the adjudication of truth claims, the narrative experience of the participants, and single-case experimental designs. I then discuss the advantages of combining Pragmatic Case Study designs with these other types. The Folke et al. article is an example of a successful such combination, integrating parallel pragmatic case studies within a single-case experimental design structure.

This issue of PCSP explores a promising approach for bridging the gap in communication and mutual respect between therapy group researchers and therapy practitioners: the "Individual Case-Comparison" (ICC) method. This method consists of systematically comparing good-outcome and poor-outcome cases that have both been drawn from a successful randomized controlled trial (RCT) treatment condition. As such the ICC method adopts a "mixed methods" model that integrates group-based, quantitative results with the case-based results of systematic and contextualized, narrative case studies—viewing both types of knowledge as complementary. To illustrate the ICC method, two pairs of case comparisons between a good-outcome and a poor-outcome client are presented. One pair is drawn from the successful condition of an RCT on Dialectical Behavior Therapy (DBT) for borderline personality disorder; and one pair, from the successful condition of an RCT for Emotion-Focused Therapy (EFT) for depression. In each instance, the comparative analysis incorporates detailed qualitative data from the individual cases along with standardized, quantitative process and outcome measures drawn from the RCT studies—showing the "value added" of a mixed methods model. The issue is capped by a wide-ranging and incisive commentary by the Japanese clinical psychologist Shigeru Iwakabe, who discusses the history, logic, and cultural context of the comparative case study method, together with a critical analysis of the DBT and EFT case studies comparisons.

This introduction is designed to orient the reader to the 11 articles that comprise this issue of PCSP. The theme of the articles is an exploration of the adjudicated case study method. The rationale for this approach is first outlined below. This is followed by a brief description of the three different types of adjudicated case study methods presented and illustrated by specific case studies in this issue. These include: Ronald B. Miller's "Panels of Psychological Inquiry" model; Arthur C. Bohart's "Research Jury Method"; and Robert Elliott's "Hermeneutic Single Case Design" model. This article series ends with a commentary by Susan Stephen and Robert Elliott on issues that cross cut the three models, with the implications of these issues for improving the overall adjudication method.

This issue’s target article by William Stiles (2009) presents a general paradigm that explains how the "logical operations" of deduction, induction, and abduction can be applied to case-study-level observations in order to build, test, and refine applied psychology theories in areas like psychotherapy. Stiles’ paradigm is exemplified in the development of his own "assimilation model" of psychological change across many types of successful therapy. The subsequent commentaries, written by nine well-known psychologists representing a wide diversity of perspectives and expertise, fall into three general categories. These include illustrations of the usefulness of Stiles paradigm, and critiques of the Stiles paradigm as either being "insufficiently grounded" in mainstream scientific method and philosophy of science, or being "too grounded" in traditional science and not open to new philosophical developments in the areas of moral theory, pragmatic approaches to truth, and methodical hermeneutics. Because of the richness of the issues raised here, publication of further dialogue between Stiles and the commentators is planned for 2010.

This is a response to the commentaries by Dr. Knight (2008) and Dr. Hyer (2008) on “The Case of Geoffrey” (Mohlman et al., 2008). The response focuses on three major themes: the notion of cultural competence in the psychotherapeutic setting; possible risks inherent in and alternatives to the medicalization of mental health treatment for older adults; and the growing use of cognitive remediation in the treatment of psychiatric disorders. We also address some of the other excellent issues raised by Drs. Knight and Hyer regarding cohort effects in the study of older therapy clients and missing elements in the case of Geoffrey.

Research in late life mental health has not kept pace with the rapidly aging population of the U.S. Older adults (over age 65), more specifically the “baby boomer” cohort, are likely to pose unique challenges to mental health care providers. This report describes the case of Geoffrey, a 66-year-old African American male who presented with a complex range of psychiatric conditions (e.g., major depressive disorder, social anxiety disorder, and a history of polysubstance dependence), and challenging life circumstances (e.g., limited financial and social resources, and poorly controlled medical illness). Because Geoffrey also evidenced impairment in several cognitive domains (attention, memory, executive functions), a combined intervention of executive skills training (Sohlberg, Johnson, Paule, Raskin, & Mateer, 2001) and cognitive behavior therapy (CBT) was selected. Furthermore, because time for conducting therapy was limited (fourteen, 90-minute sessions over a ten-week period), a “transdiagnostic” approach was taken to maximize efficiency. Results suggest the utility of augmented, transdiagnostic therapies to achieve optimal response with older clients. Although Geoffrey’s intervention progressed well, an event occurring late in treatment changed the course of therapy and led to an unexpected outcome. Several noteworthy aspects of the intervention, including the relevance of Geoffrey’s case to the current aging trend in the U.S., the use of a combined transdiagnostic intervention, and aspects of the therapy process are discussed throughout.

This is the Editor's Introduction to this Issue on case formulation and therapist responsiveness.

This is an introduction to a series of three articles that address the potentials and challenges of a systematic and naturalistic approach to the case study method as embodied in the design of this PCSP journal, a model that the late Kenneth Howard called "patient-focused research." These articles help to advance this model by addressing continuing barriers to case studies achieving an equal place at the therapy research table. These barriers can be found in politics and ideology (Edwards); in epistemology (Eells); in the logic of knowledge generation (Edwards and Eells); and in the relative lack of scientific rigor in a psychotherapy area that has traditionally embraced case studies, psychoanalysis (Messer). The three articles are followed by an integrating discussion (Caspar). As a group, these articles provide a persuasive rationale for the value of properly conducted case studies as a complement to group studies in improving the effectiveness of psychotherapy.

In previous writings, I have set forth a rationale for the foundational knowledge value in psychology and psychotherapy of (a) the individual, systematic case study, and (b) inductive generalizations derived from databases of large numbers of such case studies. This rationale is build upon the epistemology and ontology of contemporary philosophical pragmatism and social constructionism as applied to psychology âA‚€A‚“ what I have termed âA‚€A‚A“pragmatic psychology.âA‚€A‚? Held (2006) challenges this rationale, claiming first, that a justification of case study methodology can be made within conventional, natural-science-oriented psychological science, i.e., independent of pragmatism and constructionism; and second, that in fact, by my adopting a social constructionist epistemology, I undermine two characteristics âA‚€A‚“ objectivity and causality âA‚€A‚“ that are only available in the conventional psychological science paradigm and that are crucial to the meaningful, inductive psychological generalizations from individual case studies that I am seeking. In responding to HeldâA‚€A‚â„¢s challenges, I point out their value in helping me to more explicitly articulate components of pragmatic psychology that have not been fully discussed in my previous publications. These components include: (a) pragmatic psychologyâA‚€A‚â„¢s capacity, in certain important contexts, to generate statements that are âA‚€A‚A“objectively trueâA‚€A‚? in HeldâA‚€A‚â„¢s definition of this term; and (b) pragmatic psychologyâA‚€A‚â„¢s embrace of causal mechanisms and principles when these are framed as âA‚€A‚A“conceptual toolsâA‚€A‚? for problem solving, not as ontological mirrors (or approximations of such mirrors) of external reality, as proposed by conventional, natural-science-oriented psychological science. The article ends with a call for accepting pluralism in psychology.

This is the fourth round in my interchange with Barbara Held about the nature and role of objectivity and causality as they relate to the rationale for scientific and scholarly legitimacy of case study knowledge. Throughout, I have found HeldâA‚€A‚â„¢s critical responses to my views collegially delivered and very helpful in stimulating me to clarify and expand upon my own thinking. In this fourth and final round to our discussion, as context, I include a narrative summary of the back and forth in our discussion during the first three rounds. I then point out that HeldâA‚€A‚â„¢s definition of objective knowledge in Round 3 does not separate out a crucial distinction between (a) truth within a knowledge system that is a function of the internal logic of the system, and (b) the attitudes, values, and beliefs of particular individuals and groups. I argue that this distinction plays a very important pragmatic role in our society (e.g., in the functioning of the criminal justice system) in creating knowledge with important characteristics of objectivity âA‚€A‚“ i.e., characteristics associated with the coherence and pragmatic criteria of truth. I also argue that this line of reasoning allows us to distinguish causal mechanisms that are more or less objective in their roles as conceptual tools. I conclude by proposing that broadening the concept of objectivity to include the coherence and pragmatic criteria of truth helps to facilitate acceptance of William JamesâA‚€A‚â„¢ attractive idea of psychology as a âA‚€A‚A“pluralistic societyâA‚€A‚? rather than as a monolithic knowledge structure.

With renewed interest in and support of the scholarly, theoretical, practical, and clinical value of case study knowledge (as illustrated in a wealth of recent writings reflecting a wide diversity of conceptual perspectives), questions have arisen as to the proper epistemology for philosophically grounding such knowledge. For example, how scientifically objective is case-based knowledge, how generalizable is it, and can it validly uncover causal mechanisms? And what are the implications for these questions when a psychological intervention project like psychotherapy is viewed as an intrinsically moral enterprise focusing on human agency, moral choice, and the alleviation of suffering? The present series of articles by Barbara Held, Ronald B. Miller, and myself offers different perspectives on these issues in the form of a trialogue. This introduction briefly outlines the structure of the arguments of Held, Miller, and myself as these sequentially emerged over the four rounds of our discussion.

This article sets forth a new model for knowledge generation in applied and professional psychology -- the pragmatic case study (PCS) method. Drawing from both psychology's traditional/quantitative and alternative/qualitative approaches, the PCS method involves the creation of systematic, peer-reviewed case studies in psychotherapy (and in all other areas of applied psychology) that follow D. Peterson's "disciplined inquiry" epistemological model. The studies are designed to be organized into "journal-databases," like Pragmatic Case Studies in Psychotherapy (PCSP), which combine (a) individual studies; (b) articles that address epistemological, theoretical, methodological, logistical, economic, political and ethical issues in the PCS method; and (c) substantive cross-case analyses of groups of individual cases already published in the database. To lay out the model's arguments, the article is divided into four major sections that consider, respectively: (1) a discussion of the relevant historical and philosophical context from which the PCS model emerges; (2) a proposal for an initial set of methodological guidelines for ensuring rigorous quality in each case study; (3) an illustrative application of the model to cognitive-behavioral efficacy research; and (4) an exploration of the implications of the model. Throughout, the emphasis is upon creating an integrative, pragmatic alternative for gaining new useful knowledge in our discipline.