Comparing helpful and hindering processes in good and poor outcome cases: A qualitative metasynthesis of eight Hermeneutic Single Case Efficacy Design studies

Stephen, Susan; Bell, Laura; Khan, Maha; Love, Ruth B.; Macintosh, Hannah; Martin, Melanie; Moran, Rebecca; Price, Emily; Whitehead, Brigid; Elliott, Robert

doi:10.1080/10503307.2021.1934746

Cited by 6 publications

(7 citation statements)

References 34 publications

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“…We did, however, note (Stephen et al, 2021, online supplemental material) that the adjudication panels for good outcome cases were more clearly convinced by the evidence produced by the affirmative case (that improvement had occurred by the end of therapy, and that this change was due to the therapy), than the adjudication panels for poor outcome cases were convinced that deterioration had occurred. It may be that the panels were influenced by their prior focus on a particular type of outcome (good v poor): for example, the members of adjudication panels who developed HSCEDs on good outcome cases may have been more inclined to recognize contrasting evidence suggesting improvement in the cases of clients who, according to quantitative outcome data, seemed to have deteriorated by the end of therapy.…”

Section: Making Decisionsmentioning

confidence: 81%

“…However, in a recent study (Stephen et al, 2021), a different approach was followed: adjudication panels received the HSCED material in advance, then met to discuss their views in order to reach a decision by consensus. The researcher who prepared the HSCED (both affirmative and skeptic views) was available to answer questions from panel members, if required.…”

Section: Making Decisionsmentioning

confidence: 99%

“…On the other hand, the official position in HSCED is that the best basis for establishing the generalizability of systematic case studies is through specifying relevant mediator and moderator variables (Elliott et al, 2009). Thus, Stephen et al (2021) used their qualitative metasynthesis of moderator and mediator variables across a series of eight HSCED studies as a means to develop generalizable conclusions analogous to case law. First, the eight case studies (two groups of cases: four good outcome, four poor outcome) were conducted using the HSCED method.…”

Section: Generalizability Again: Developing "Case Law"mentioning

confidence: 99%

“…First, Benelli et al (2015) reported an extensive, detailed systematic review of thirteen HSCED studies, resulting in a checklist of 28 evaluative criteria. Second, Wall et al (2017) and Stephen et al (2021) have extended HSCED to include multiple case designs in which collections of 3 or more cases are presented together in the same report, including comparing good and poor outcome cases. For example, in Stephen et al, for the poor outcome cases, the affirmative case sought to prove that the change experienced by the client at the end of therapy was deterioration, rather than improvement.…”

Section: Introduction: the Story So Farmentioning

confidence: 99%

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Commentary—Extending the Boundaries of Systematic Case Study Research: Conceptual and Methodological Issues

Elliott¹,

Stephen²,

Robinson³

2021

PCSP

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In this commentary we discuss the two examples of systematic case study research in this issue: Miller et al., (2021), who continue the development of the quasi-judicial Panels of Psychological Inquiry method by applying it to a child client with an autistic spectrum condition; and Bohart et al. (2021), who apply their research jury approach to a video recorded case of Emotionally-Focused Therapy for couples. We open by briefly summarizing the main issues addressed in our previous commentary (Stephen Elliott, 2011), which involved the same authors; we also note some key developments in systematic case study research over the past ten years. The rest of our commentary is divided into three parts. First, we look at more general conceptual issues in systematic case study research, including situations in which systematic case studies are likely to be most useful; the problem of overly broad research questions; the definition and assessment of outcome; and the thorny issue of causality. In the second part, we turn our attention to methodological issues raised by the two articles, returning to the questions of what counts as evidence in systematic case study research (here the use of observational methods for assessing client change and change processes), but also to the processes by which research judges or jurors make decisions about knowledge claims and methods for generalizing from one case to other cases. In the final main section, we offer more substantive commentary on Miller et al. (2021), from the point of view of autism research. We start by putting the DIR/Floortime intervention in context before raising key diagnostic issues that we think circumscribe the case and spelling out uncertainties about the nature of the intervention used. We round off this section with a set of proposals for future systematic single case research on interventions for autism. We close our commentary with a brief set of recommendations.

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Section: Making Decisionsmentioning

confidence: 81%

Section: Making Decisionsmentioning

confidence: 99%

Section: Generalizability Again: Developing "Case Law"mentioning

confidence: 99%

Section: Introduction: the Story So Farmentioning

confidence: 99%

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Commentary—Extending the Boundaries of Systematic Case Study Research: Conceptual and Methodological Issues

Elliott¹,

Stephen²,

Robinson³

2021

PCSP

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“…In addition, implementation of ROM can be difficult for both patients and clinicians (e.g., Mellor‐Clark et al, 2016; Solstad et al, 2021). Finally, some researchers raise questions about the “procedural objectivity” of pre to posttreatment measurement when compared to other sources of data and argue for a broader assessment of change (e.g., Elliott, 2002; Stephen et al, 2021; Truijens, 2017). These scholars argue that the client's narrative may highlight problems with relying solely on the numbers when describing the outcome of therapy (Stephen et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Treatment success or failure? Using a narrative interview to supplement ROM

2022

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Although routine outcome monitoring (ROM) has been demonstrated to improve therapy efficiency and effectiveness, categorizations of improvement or deterioration using ROM measures (typically global symptoms) may not always be consistent with the lived experience of the client. A recent line of investigation examines these discrepancies and recommends supplementing ROM with additional measures or narrative interviews. In this case study, we use qualitative analysis of a posttreatment interview to specifically examine the client's perspective of discordant outcome when ROM indicated that the client deteriorated during treatment and the client reported retrospective improvement. We find that the interview provides a unique and helpful narrative perspective that supplements ROM.Findings suggest it may be useful to supplement ROM with approaches that extend beyond global symptom measurement and that outcomes from aggregated patient-focused research may be more complex than anticipated.

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Contrasting two improved and two unimproved cases of patients with medically unexplained physical symptoms after multicomponent treatment

Polakovská

Roubal

Čevelíček

et al. 2023

Counselling Psychology Quarterly

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Comparing helpful and hindering processes in good and poor outcome cases: A qualitative metasynthesis of eight Hermeneutic Single Case Efficacy Design studies

Cited by 6 publications

References 34 publications

Commentary—Extending the Boundaries of Systematic Case Study Research: Conceptual and Methodological Issues

Commentary—Extending the Boundaries of Systematic Case Study Research: Conceptual and Methodological Issues

Treatment success or failure? Using a narrative interview to supplement ROM

Contrasting two improved and two unimproved cases of patients with medically unexplained physical symptoms after multicomponent treatment

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