Abstract
This study is the seventh of a series of seven and belongs to the second Italian systematic replication of findings from previous series that investigatedthe effectiveness of a manualized transactional analysistreatment for depressionthrough Hermeneutic Single-Case Efficacy Design. We address problems and difficulties emerged in previous case series, such as: spending time in training a group of people to conduct the hermeneutic analysis, organizing the involvement of external judges to give the final adjudication, and dealing with inconsistencies between quantitative and qualitative data. For these reasons, this study suggests a simplified method to conduct the hermeneutic analysis that require one person only, maintaining its validity. Therefore, we integrated hermeneutic design with the pragmatic case evaluation methodology in order to follow pre-defined criteria in analysing qualitative material. Furthermore, we present a way to use the Script System to detect changes in depressive symptomatology and depressive personality. We tested this approach to HSCED in the case of ‘Margherita’, a 56-years old white Italian woman who attended sixteen session of transactional analysis psychotherapy with a white Italian woman therapist with 5 years of clinical experience. The patient satisfied DSM-5 criteria for moderately severe major depressive disorder with anxious distress, and SWAP 200 criteria for traits of depressive, dependent, avoidant and hostile personality typeswith a high level of functioning.
Highlights
Quantitative Data Patient Health Questionnaire 9-item for depression (PHQ-9) and GAD-7 were administered in the pretreatment phase in order to obtain a four-point baseline, and during the three follow-ups, whereas constant reliable clinically significant improvement (RCSI) for global distress (CORE)-OM was administered only from session 0D
Affirmative Conclusion Margherita’s depression, anxiety, global distress and personal problems were related to difficulties in mood/emotions and relationships, and interpersonal patterns, such as being unable to understand and address her anger and use it in a constructive way, feeling always sad, sensitive and tearful, being unable to stand up for her rights, needs and wishes, being unable to say “no” to anyone’s request, and feeling inferior to others
Margherita had strong feelings of guilt when she thought of things on her own, and the therapist helped her get in contact with her needs and wishes and to express them
Summary
Since the publication of the first Hermeneutic Single-Case Efficacy Design (HSCED) applied to transactional analysis (TA) treatment of depression (Widdowson, 2012a) there have been one direct replication of three single cases (Widdowson, 2012b, 2012c, 2013) and three Italian systematic replications of three single cases each (Benelli, Revello, Piccirillo, Mazzetti, Calvo, Palmieri, Sambin & Widdowson, 2016a; Benelli, Scottà, Barreca, Palmieri, Calvo, De Renoche, Colussi, Sambin, & Widdowson, 2016b; Benelli, Boschetti, Piccirillo, Quagliotti, Calvo, Palmieri, Sambin, & Widdowson, 2016c; Benelli, Moretti, Cavallero, Greco, Calvo, Mannarini, Palmieri & Widdowson, 2017a; Benelli, Filanti, Musso, Calvo, Mannarini, Palmieri & Widdowson, 2017b; Benelli, Bergamaschi, Capoferri, Morena, Calvo, Mannarini, Palmieri, Zanchetta & Widdowson, 2017c; Benelli, Procacci, Fornaro, Calvo, Mannarini, Palmieri & Zanchetta, 2018a; Benelli, Gentilesca, Boschetti, Piccirillo, Calvo, Mannarini, Palmieri & Zanchetta, 2018b; Benelli, Vulpiani, Cavallero, Calvo, Mannarini, Palmieri & Zanchetta, 2018c) aiming to recognise TA psychotherapy for depression as an Empirically Supported Treatment. With the HSCED methodology Kerr (2013) evaluated TA treatment for emetophobia. Even if HSCED has demonstrated to be an important and valid way to demonstrate the efficacy of TA, its application remained secluded in these three groups of research. We identified two main difficulties in conducting a HSCED: (a) involving a group of people and training them to conduct the hermeneutic analysis, which is time-consuming and probably possible only in an academic environment; and (b) including judges who have to read a substantial amount of qualitative data, interpret it, along with quantitative data, and who International Journal of Transactional Analysis Research & Practice Vol 10 No 2, November 2019 www.ijtarp.org must emit a verdict on the outcome of the case (good-, mixed-, or poor-outcome case), which is extremely demanding. Less expensive methods are necessary to evaluate the efficacy of a single-case in clinical practice
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