Single-Case Efficacy Design Study Research Articles

The Effects of Sandplay Therapy on Behavioral Change of Domestic Violence Children based on Hermeneutic Single Case Efficacy Design Study (HSCEDS)

The Effects of Sandplay Therapy on Behavioral Change of Domestic Violence Children based on Hermeneutic Single Case Efficacy Design Study (HSCEDS)

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - 'Giorgio'

This study is the fourth of a series of seven and belongs to the second Italian systematic replication of findings from previous series that investigated the effectiveness of a manualized transactional analysis treatment for depression through Hermeneutic Single-Case Efficacy Design. The therapist was a white Italian man with 17 years of clinical experience and the patient, Giorgio, was a 23-year-old white Italian man who attended sixteen sessions of transactional analysis psychotherapy. Giorgio satisfied DSM-5 criteria for Major Depressive Disorder, Persistent Depressive Disorder,Panic Disorder, Agoraphobia and Dependent Personality Disorder. The treatment focused on both symptoms remission and conflicts at the core of dependent personality. The judges evaluated the case as a good outcome, mediated by the work on core conflicts of personality, that enhanced the treatment outcome and the remission of depressive symptoms. This case study suggests that the classical treatment for depression may be enhanced by considering the conflicts at the base of personality traits or disorders.
 Citation - APA format:
 Benelli, E., Procacci, M., Fornaro, A., Calvo, V., Mannarini, S., Palmieri, A. and Zanchetta, M. (2018). TA Treatment of Depression:A Hermeneutic Single-Case Efficacy Design Study - Giorgio. International Journal of Transactional Analysis Research & Practice, 9(2), 3-22 https://doi.org/10.29044/v9i2p3

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - 'Sergio'

This study is the fifth 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 depression through Hermeneutic Single-Case Efficacy Design.The therapist was a white Italian woman with 5years of clinical experience and the patient, Sergio, was a 39-year old white Italian man who attended sixteen sessions of transactional analysis psychotherapy. Sergio satisfied DSM 5 criteria for Persistent Depressive Disorder (Dysthymia) with melancholic features, Post-Traumatic Stress Disorder (PTSD) with Obsessive Personality traits. The treatment focused on the permission to enjoy and on self-protection. The focus on both depressive symptoms and obsessive traits allowed a remission of his dysthymia within the end of therapy. The judges evaluated the case as a good outcome: the depressive and anxious symptomatology clinically and reliably improved over the course of the therapy and these improvements weremaintained at the followups. Furthermore, the patient reported significant change in his post-treatment interview and these changes were directly attributed to the therapy.
 Citation - APA format:
 Benelli, E., Gentilesca, G., Boschetti, D., Piccirillo, C., Calvo, V., Mannarini, S., Palmieri, A. and Zanchetta, M. (2018). TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - Sergio. International Journal of Transactional Analysis Research & Practice, 9(2), 23-41 https://doi.org/10.29044/v9i2p23

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - 'Beatrice'

This study is the sixth 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.The therapist was a white Italian woman with 10 years of clinical experience and the patient, Beatrice, was a 45-year old white Italian woman who attended sixteen sessions of transactional analysis psychotherapy. Beatrice satisfied DSM 5 criteria for Major Depressive Disorder, Anxious Distress, with Dependent and Histrionic Personality Traits. The judges evaluated the case as a good outcome: the depressive and anxious symptomatology clinically and reliably improved over the course of the therapy and these improvements weremaintained throughoutthe duration of thefollowup intervals. Furthermore, the patient reported significant change in her post-treatment interview and these changes were directly attributed to the therapy.
 Citation - APA format:
 Benelli, E., Vulpiani, F., Cavallero, G., Calvo, V., Mannarini, S., Palmieri, A. and Zanchetta, M. (2018). TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - Beatrice. International Journal of Transactional Analysis Research & Practice, 9(2), 42-63 https://doi.org/10.29044/v9i2p42

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - ‘Deborah’

This study is the third of a series of seven, and belongs to the second Italian systematic replication of findings from two previous series (Widdowson 2012a, 2012b, 2012c, 2013; Benelli, 2016a, 2016b, 2016c) that investigated the effectiveness of a manualised transactional analysis treatment for depression through Hermeneutic Single-Case Efficacy Design (HSCED). Major Depression and Subthreshold Depression are often in comorbidity with Anxiety disorders in childhood and adolescence and represent a risk factor for ongoing mental health problems in adulthood. The therapist was a white Italian woman with 15 years of clinical experience and the client, Deborah, was a 15-year old white Italian female adoloscent who attended sixteen sessions of transactional analysis psychotherapy. The conclusion of the judges was that this was a good-outcome case: the depressive and anxious symptomatology clinically and reliably improved over the course of the therapy and these improvements were maintained throughout the duration of the follow-up intervals. Furthermore, the client reported significant change in her post-treatment interview and these changes were directly attributed to the therapy. In this case study, the transactional analysis manualised treatment for depression in adulthood has demonstrated its effectiveness also in treating depressive and anxiety symptoms in adolescence.

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - ‘Caterina’

This study is the second of a series of seven, and belongs to the second Italian systematic replication of findings from two previous series (Widdowson 2012a, 2012b, 2012c, 2013; Benelli, 2016a, 2016b, 2016c) that investigated the effectiveness of a manualised transactional analysis treatment for depression through Hermeneutic Single-Case Efficacy Design. The therapist was a white Italian woman with 10 years of clinical experience and the client, Caterina, was a 28-year old white Italian woman who attended 16 sessions of transactional analysis psychotherapy. Caterina satisfied DSM-5 criteria for major depressive disorder with generalized anxiety disorder. The conclusion of the judges was that this was an outstanding good-outcome case: the depressive symptoms showed an early clinical and reliable improvement, maintained till the 6 months follow-up, accompanied by reductions in anxiety symptoms, global distress and severity of personal problems. Adherence to the manualised treatment for depression appears good to excellent. In this case study, transactional analysis treatment for depression has proven its efficacy in treating major depressive disorder in comorbidity with anxiety disorder.

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - ‘Anna’

This study is the first of a series of seven, and belongs to the second Italian systematic replication of findings from two previous series (Widdowson 2012a, 2012b, 2012c, 2013; Benelli, 2016a, 2016b, 2016c) that investigated the effectiveness of a manualised transactional analysis treatment for depression through Hermeneutic Single-Case Efficacy Design (HSCED). The therapist was a white Italian woman with 8 years of clinical experience and the client, Anna, was a 33-year old white Italian woman who attended 16 sessions of transactional analysis psychotherapy. Anna satisfied DSM-5 criteria for mild persistent depressive disorder (dysthymia) with anxious distress. The conclusion of the judges was that this was a good-outcome case: the dysthymic symptoms improved over the course of the therapy and were maintained in the ‘healthy’ range at the 6-month follow-up, the client reported a positive experience of the therapy and described important changes in intrapsychic and interpersonal patterns. In this case study, transactional analysis treatment for depression has proven its efficacy in treating persistent depressive disorder.

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - ‘Sara’

This study is the first of a series of three, and represents an Italian systematic replication of previous UK findings (Widdowson 2012a, 2012b, 2012c, 2013) that investigated the effectiveness of a recently manualised transactional analysis treatment for depression with British clients, using Hermeneutic Single-Case Efficacy Design (HSCED). The various stages of HSCED as a systematic case study research method are described, as a quasi-judicial method to sift case evidence in which researchers construct opposing arguments around quantitative and qualitative multiple source evidences and judges evaluate these for and against propositions to conclude whether the client changed substantially over the course of therapy and that the outcome was attributable to the therapy. The therapist in this case was a white Italian woman with 10 years clinical experience and the client, Sara, was a 62-year old white Italian woman with moderate depression and three recent bereavements, who attended sixteen sessions of transactional analysis therapy. The diagnosis is based on the new DSM-5 criteria that allow differentiation between Depression and Bereavement. The conclusion of the judges was that this was a good-outcome case: the client improved early over the course of the therapy, reported positive experience of therapy and maintained the improvement at the end of the follow-up.

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - ‘Penelope’

This study is the second of a series of three, and represents an Italian replication of a previous UK -based case series (Widdowson 2012a, 2012b, 2012c, 2013) that investigated the effectiveness of a recently manualised transactional analysis treatment for depression with British clients, using Hermeneutic Single-Case Efficacy Design (HSCED). The various stages of HSCED as a systematic case study research method are described, as a quasi-judicial method to sift case evidence in which researchers construct opposing arguments around multiple sources of quantitative and qualitative evidence and judges evaluate these to conclude whether the client changed substantially over the course of therapy, and whether the outcome was attributable to the therapy. The therapist in this case was a white Italian man in the third year of training to become a psychotherapist, and the client, Penelope, was a 45-year old white Italian woman with mild depression and anxiety. The conclusion of the judges was that this was a mixed-outcome case: the client improved some aspects of her problems, without obtaining a complete and stable remission. Interestingly, this case presents a minimal correlation between empirical and proxy-rated indexes of depression and anxiety and answers to self reported questionnaires, raising the question of validity of self report measures with specific typology of client.

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - ‘Luisa’

This study is the third of a series of three, and represents an Italian systematic replication of previous UK findings (Widdowson 2012a, 2012b, 2012c, 2013) that investigated the effectiveness of a recently manualised transactional analysis treatment for depression with British clients, using Hermeneutic Single-Case Efficacy Design (HSCED). The various stages of HSCED as a systematic case study research method are described, as a quasi-judicial method to sift case evidence in which researchers construct opposing arguments around quantitative and qualitative multiple source evidences and judges evaluate these for and against propositions to conclude whether the client changed substantially over the course of therapy and that the outcome was attributable to the therapy. The therapist in this case was a white Italian woman with 10 years clinical experience and the client, Luisa, was a 65-year old white Italian woman who attended sixteen sessions of TA therapy. Luisa satisfied DSM-5 criteria for severe adjustment disorder, with moderate depression and mixed deflected humour and anxiety, for which she had been taking medications and homeopathic treatments for over a year. The conclusion of the judges was that this was a good-outcome case: the client improved over the course of the therapy, reported a positive experience of therapy and maintained this improvement at the end of the follow-up.

Nondirective Person-centered therapy for social anxiety: a hermeneutic single-case efficacy design study of a good outcome case

Hermeneutic Single-case Efficacy Design (HSCED) was applied to a good-outcome case in which an individual presenting with social anxiety (SA) received 13 sessions of nondirective Person-centered therapy. A Rich Case Record of qualitative and quantitative data gathered over the course of therapy was constructed, and provided the basis for affirmative and skeptic arguments. A panel of three judges returned verdicts on the client’s therapeutic process and its outcome. Judges concluded unanimously that the client changed substantially over the course of therapy and that therapy contributed substantially to client change (80% probability). The judges emphasized the contribution of the therapeutic relationship, especially unconditional positive regard. Judges identified the therapist’s non-directive stance, openness and empathy, and reflection and summarizing in session as additional qualitative mediators of change. Judges identified the client’s own readiness for change, understanding of the therapeutic process and ability to use the research processes to reflect on therapy as moderators of change. We discuss the implications for Person-Centered-Experiential therapies as a credible treatment for SA, and for the further development of HSCED as an approach to evaluating psychotherapy.

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - ‘Linda’ - a mixed outcome case

Hermeneutic Single-Case EfficacyDesign (HSCED) is a systematic case study research method involving the cross-examination of mixed method data to generate both plausible arguments that the client changed due to therapy and alternative explanations. The present study is the fourth article of a case series which has investigated the process and outcome of transactional analysis psychotherapy using Hermeneutic Single-Case Efficacy Design (Elliott 2002). The client, Linda, was a 45 yearold white British woman with mild depression who attended nine sessions of therapy. The conclusion of the judges was that this was a mixed-outcome case:whilst the client improved over the course of therapy and was positive about her experience of therapy, her changes did not last when she experienced considerable stressful events during follow-up. Linda provided a detailed and idiosyncratic description of the aspects of the therapy which were most helpful for her. A cross-case comparison with other cases in this series suggests several interesting features which are worthy of further investigation. Specifically, the use of a shared theoretical framework and an egalitarian therapeutic relationship were helpful. As with other cases in this series, the client experienced positive changes in her interpersonal relationships suggesting that this outcome of TA therapy warrants further investigation

TA Treatment of Emetophobia: A Hermeneutic Single-Case Efficacy Design Study – ‘Peter’

This study reports on theapplication of Hermeneutic Single Case Efficacy Design (HSCED) (Elliott 2002) to a 39 session TA-based psychotherapy intervention with a 19 year old white male student in the UK who was suffering from emetophobia. The author, who was also the researcher, provides literature reviews on emetophobia clinical characteristics,contrasts it with other phobias, and reviews prior research including TA-based approaches to phobias generally. HSCED Methodology is briefly described; quantitative outcome measures are obtained and analysed using GAD-7 (Spritzer et al 2006)and SPQ (Elliott et al 1999), and qualitative measures via a rich case record, session recordings/transcripts, and a 4-month follow-up interview. Bohart at al’s (2011) 56 criteria for evidence adjudication were used alongside HSCED criteria. There was strong evidence of significant client changes, and that these changes were the result of the therapy.

Counselling for sight loss: Using systematic case study research to build a client informed practice model

There is compelling evidence to suggest that acquired sight loss negatively impacts on emotional well-being. Despite increasing recognition of the need to provide emotional support for people with sight loss, we still do not fully understand what counselling interventions help and why they help. The aim of this study was to examine the process and outcome of counselling for a 70-year-old client who had experienced complete, irreversible, post-operative sight loss in order to gain a deeper understanding of client-defined helpful aspects of therapy. A Hermeneutic Single-Case Efficacy Design study was undertaken having received ethical approval from the University’s Research Ethics Committee. The client received six sessions of counselling from a vision-impaired counsellor working within a pluralistic framework. Measures were completed by the client at every session, as well as at pre- and post-counselling. All sessions were recorded and transcribed. The client also participated in pre- and post-counselling interviews. Data formed a rich case record that was analysed by a quasi-judicial enquiry team. Results suggested that this was a successful outcome case. Client-defined helpful aspects of therapy were (1) feeling understood; (2) being able to express emotions around the loss of sight; (3) finding a new identity; (4) finding ways to cope with fear, loss, dependency, and other people’s perceptions; (5) exploring the possibility of a positive future without sight; (6) making sense of things; and (7) finding ways to become more socially connected. Relevant therapeutic tasks are proposed, and four key aspects of therapy are identified, which may have implications for the development of a practice model.

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - ‘Tom’

Hermeneutic Single-Case Efficacy Design (HSCED) is a systematic case study research method involving the cross-examination of mixed method data to generate both plausible arguments that the client changed due to therapy and alternative explanations. The present study uses HSCED to investigate the outcome of short-term TA psychotherapy with a man with moderate depression and comorbid social anxiety The objective of the research was to investigate the effectiveness of short-term TA therapy for the treatment of depression and to explore and identify key aspects of the TA therapy process and associated factors promoting change amongst effective cases. To enhance rigour and address potential for researcher allegiance, indep-endent psychotherapy researchers have adjudicated the case and offer a verdict on outcome. The majority verdict of two judges in this case was that this was a positive outcome case and that the client had changed substantially and that these changes were substantially due to the effects of therapy. The third judge’s conclusion was that this was a mixed outcome case, and that the client had changed considerably and that this had been considerably due to therapy.
 This is the 3rd case reported on and additional rigour was introduced into the HSCED approach in the same way as reported in the accompanying paper about the 2nd case. (IJTAR 3:2, 3-14)

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - ‘Denise’

Hermeneutic Single-Case Efficacy Design (HSCED) is a systematic case study research method involving the cross-examination of mixed method data to generate both plausible arguments that the client changed due to therapy and alternative explanations. The present study uses HSCED to investigate the outcome of short-term TA psychotherapy with a woman with severe depression. The objective of the research was to investigate the effectiveness of short-term TA therapy for the treatment of depression and to explore and identify key aspects of the TA therapy process and associated factors promoting change amongst effective cases. To enhance rigour and to address potential for researcher allegiance, independent psychotherapy researchers have adjudicated the case and offer a verdict on outcome. The conclusion of the adjudicators is that the client changed substantially, and that these changes were substantially due to the effects of therapy.
 Additional rigour was introduced into the HSCED approach for this 2nd case through the use of a more stringent classification of change, an increased reliable change index score, a higher standard of proof, the use of two teams to develop the affirmative and sceptic cases, and the addition of a third judge.

Emotion-focused therapy for social anxiety: A hermeneutic single case efficacy design study of a low-outcome case

BackgroundHermeneutic single case efficacy design (HSCED) has emerged and developed as a rigorous psychotherapy research method for examining the effects of therapy in single cases (Stephen & Elliott, 2011). The effectiveness of Person-centred experiential (PCE) psychotherapies for treating Social Anxiety (SA) has been the specific focus of recent HSCED research, and initial findings have indicated that various strands of PCE therapy have potential to be effective treatments for SA (Stephen, Elliott & MacLeod, 2011; MacLeod, Elliott & Rodgers, 2012).MethodologyHSCED was applied to a low-outcome case in which an individual presenting with SA received 20 sessions of Emotion-focused therapy (EFT). A rich case record, and set of affirmative and sceptic arguments – arguing for and against client change – were developed, based on a body of qualitative and quantitative data gathered over the course of the client’s therapy.FindingsThe client showed evidence of a slight to moderate degree of change. In addition, his therapy was judged to have had a clear but modest effect on outcome.DiscussionFindings, and wider implications for the application of HSCED, are highlighted and discussed.

Emotion-focused therapy for social anxiety: A hermeneutic single case efficacy design study of a low-outcome case

BackgroundHermeneutic single case efficacy design (HSCED) has emerged and developed as a rigorous psychotherapy research method for examining the effects of therapy in single cases (Stephen & Elliott, 2011). The effectiveness of Person-centred experiential (PCE) psychotherapies for treating Social Anxiety (SA) has been the specific focus of recent HSCED research, and initial findings have indicated that various strands of PCE therapy have potential to be effective treatments for SA (Stephen, Elliott & MacLeod, 2011; MacLeod, Elliott & Rodgers, 2012).MethodologyHSCED was applied to a low-outcome case in which an individual presenting with SA received 20 sessions of Emotion-focused therapy (EFT). A rich case record, and set of affirmative and sceptic arguments – arguing for and against client change – were developed, based on a body of qualitative and quantitative data gathered over the course of the client’s therapy.FindingsThe client showed evidence of a slight to moderate degree of change. In addition, his therapy was judged to have had a clear but modest effect on outcome.DiscussionFindings, and wider implications for the application of HSCED, are highlighted and discussed.

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - 'Peter'


 Hermeneutic Single-Case Efficacy Design (HSCED) is a systematic case study research method involving the cross-examination of mixed method data to generate both plausible arguments that the client changed due to therapy and alternative explanations. The present study uses HSCED to investigate the outcome of short-term TA psychotherapy with a young man with severe depression. The objective of the research was to investigate the effectiveness of short-term TA therapy for the treatment of depression and to explore and identify key aspects of the TA therapy process and associated factors promoting change amongst effective cases. To enhance rigour and to address potential for researcher allegiance, independent psychotherapy researchers have adjudicated the case and offer a verdict on outcome. The conclusion of the adjudicators is that the client changed considerably-substantially, and that these changes were substantially due to the effect of therapy.

Process-experiential/emotion-focused therapy for social anxiety: A hermeneutic single-case efficacy design study

Social Anxiety (SA) is a common and debilitating problem. Although a range of therapies have been applied to treat SA, only a narrow range of these has been researched to date. In this study, Hermeneutic Single Case Efficacy Design (HSCED) was used to investigate Process-Experiential/Emotion-Focused Therapy (PE-EFT) with a socially isolated client with Social Anxiety. Using a combination of qualitative and quantitative data, we constructed a rich case record and a set of documents arguing for and against client change; these were judged by three graduate student peer judges. The judges found the client to have changed substantially over the first 16 sessions of therapy, and PE-EFT was found to have contributed substantially to this change.