Abstract
This study is inspired by previous case series replications of Hermeneutic Single-Case Efficacy Design which aim was to evaluate the effectiveness of a manualized transactional analysis treatment for depressive disorders and depressive personality. 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 ‘Giovanni, a 17-years old white Italian boy who attended sixteen session of transactional analysis psychotherapy with a white Italian woman specializing in psychotherapy with 2 years of clinical experience. The patient satisfied DSM-5 criteria for moderate major depressive disorder and generalized anxiety disorder.This is the second investigation which has evaluated the effectiveness of Transactional Analysis psychotherapy for depressed adolescents.
Highlights
We identified two main difficulties in conducting a Hermeneutic Single-Case Efficacy Design (HSCED): (a) involving a group of people and training them to conduct the hermeneutic analysis, which is timeconsuming 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 must emit a verdict on the outcome of the case, which is extremely demanding
Quantitative Data Patient Health Questionnaire 9-item for depression (PHQ-9), Generalised Anxiety Disorder 7-item for anxiety (GAD-7) and CORE were administered in the pretreatment phase in order to obtain a five-point baseline, and during the two follow-ups, whereas Personal Questionnaire (PQ) was generated during the assessment phase, are administered from session 0E
Affirmative Conclusion Giovanni’s depression, anxiety, personal and behavioural problems were related to difficulties in sustaining a self-nurturing internal dialogue, selfcriticism and difficulty in solving problems
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 being 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 timeconsuming 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 must emit a verdict on the outcome of the case (good-, mixed-, or pooroutcome 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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