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Stoyanova and Hope report their year-long, 29-session treatment experience with Andy, a 38-year-old European American client suffering from social anxiety disorder, complicated by the comorbid symptoms of panic disorder and poor anger management. The authors present a chronological account of their intervention and conclude that their treatment was successful, citing summary data from several measures in support of this claim. They attribute their successful outcome to their reliance on a creative combination of empirically established treatment procedures (described as CBT), principles from basic science (described only vaguely), and nonspecific factors (not well defined).
Reading this case, I kept wondering what, if anything, we might take away to help us treat similar cases more cost-effectively in the future. I believe that it is virtually impossible to draw meaningful strong inferences from such case studies because they simply involve too many twists and turns in the plot, so many choice points and potential decisions—typically governed mostly by inexplicable clinical intuitions—that we’ll never really know why the therapists did what they did, or what would have happened if the therapists had made different choices. Once the outcome is known, of course, we always can offer post hoc explanations, as though we actually know what caused what; in fact, however, there invariably are so many competing and conflicting forces at play (for example, this client’s failure to provide homework data, or his unstable romantic relationship, to name just two) that interpreting cause and effect is impossible in a single case.
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