Transcending the efficacy versus effectiveness research debate: Proposal for a new, electronic "Journal of pragmatic case studies."

Abstract

The power struggle between the efficacy and effectiveness models in psychotherapy research has reached an impasse, and the time is ripe for fundamentally new ideas. This article contends that one way of transcending the impasse is to adopt a new, case-based "pragmatic psychology" paradigm that, while deeply and inherently different, (a) draws elements from both the efficacy and effectiveness approaches in an integrative manner and (b) can be viewed as complementing rather than competing with these approaches. Centered within philosophical pragmatism and following K. I. Howard's "patient-focused" research approach, the new pragmatic psychology paradigm calls for the development of databases of systematic, rigorous, solution-focused case studies of human service programs of all types, including psychotherapy. This article proposes that an ideal way of pilot-testing the pragmatic psychology paradigm is for the American Psychological Association to sponsor a new, electronic "Journal of Pragmatic Case Studies" that would begin by focusing on psychotherapy. The nature, structure, and scholarly and practical uses of such a journal are set forth.

What kind of research can we realistically expect from the practitioner?

“…Participants in this discussion have attempted to move toward these objectives by identifying those research areas and methodologies most appropriate for naturalistic research by practitioners. Representative research models of this kind include, but are not limited to, (a) innovative qualitative or quantitative (pre-experimental, quasi-experimental, or experimental) case studies, where the focus is to describe and pretest or test new interventions, new hypotheses, and unusual clinical phenomena (Davison & Lazarus, 1994;Fishman, 2000;Hayes, Barlow, & Nelson-Gray, 1999;Messer, 2000; including new integrative approaches, e.g., Lampropoulos & Nicholas, 2001); (b) small N quasi-experimental or experimental designs, where the practicing clinician can pre-test or test specific hypotheses of interest (e.g., a 2 ϫ 2 aptitude-treatment interaction design with four participants; Heiby, 1986); (c) medium N effectiveness research, where a clinician can evaluate his or her own practice over a period of time (e.g., Lambert et al, 1998;Persons, Bostrom, & Bertagnolli, 1999); large N clinical utility programmatic research through local practitioner networks, where a group of clinicians in one or more naturalistic settings can evaluate their clinical practices (i.e., effectiveness of same or different models of therapy, manualized or not manualized), as well as test specific hypotheses in quasi-experimental designs (Arnkoff, Glass, Opazo, Caspar, & Lampropoulos, 2000;Borkovec et al, 2001;Pekarik & Mangione, 1999).…”

A Novel Group Therapeutic Format in Cognitive Behavioral Treatment for Clients with Social Phobia in a Training Setting: A Case Study of One Treatment Group with Nine Clients

“…The integration of the pragmatic case study strategy (Fishman, 2000;2005) within an educational setting aimed at teaching students psychotherapeutic skills has had value from a variety of perspectives. This case-based evaluation provides support for the clinical value and feasibility of the new treatment program for social phobia clients at the Anxiety Clinic of the Behavioral experiments in the large group (9 clients, 8 studenttherapists, psychologists may not be present) with video-feedback Relationship between self-concept, dysfunctional attitudes and negative automatic thoughts Telling of life events that might have contributed to problems in a small group (4 or 5 clients, 4 student-therapists) Extensive group treatment in small groups with student-therapists (4 or 5 clients, 4 students) (2 hours a week for 6 weeks) Table 3A -3J a Pre = at the beginning of therapy.…”

“…On the individual level, cases are studied by means of qualitative and quantitative information (4). Since space does not permit a full presentation of all 9 cases according to the guidelines for pragmatic case studies (Fishman, 2000;2005), the individual "case vignettes" should, primarily, be considered illustrations of the treatment procedures, the clients, their course of treatment and responses to this specific therapy program. Most of the vignettes are summaries of the students' more elaborated case reports.…”

Understanding the diversity and dynamics of living with diabetes: a feasibility study focusing on the case

“…In the field of psychotherapy, a data base of 'pragmatic case studies' was proposed, which once large enough, could allow comparison of cases and so a development of typologies of patient characteristics in relation to outcome. 40 A major issue for such studies is deciding what data should be recorded. There is no doubt that if we were to include enough attributes about individuals, then we would find that all individuals were different from all other individuals.…”