Abstract

Objective: We tested qualitative metasynthesis of a series of Hermeneutic Single Case Efficacy Design (HSCED) studies as a method for comparing within-session processes that may explain good and poor therapeutic outcome. Method: We selected eight HSCED studies according to change in clients’ scores on the Strathclyde Inventory (SI), a brief self-report instrument used to measure outcome in person-centered psychotherapy. Four of the case studies investigated the experience of clients whose pre–post change in SI scores showed improvement by the end of therapy, and the other four focused on clients whose change in SI scores indicated deterioration. We conducted a qualitative metasynthesis, adopting a generic descriptive-interpretive approach to analyze and compare the data generated by the HSCED studies. Results: In contrast to improvers, deteriorators appeared to be less ready to engage in therapeutic work at the beginning of therapy, and found the process more difficult; their therapists were less able to respond to these difficulties in a responsive, empathic manner; deteriorators were less able to cope successfully with changes of therapist and, eventually, gave up on therapy. Conclusion: We found that our qualitative metasynthesis of a series of HSCED studies produced a plausible explanation for the contrasting outcomes that occurred.

摘要

目的：我们测试了一系列解释学单例疗效设计 (HSCED) 研究的定性综合，作为比较可能解释良好和不良治疗结果的会话内过程的方法。方法：我们根据客户在斯特拉斯克莱德量表 (SI) 上得分的变化选择了八项 HSCED 研究，这是一种用于衡量以人为中心的心理治疗结果的简短自我报告工具。其中四个案例研究调查了在治疗结束时 SI 评分的前后变化显示有所改善的客户的经历，另外四个关注的是 SI 评分的变化表明恶化的客户。我们进行了定性综合综合，采用通用的描述性解释方法来分析和比较 HSCED 研究产生的数据。结果：与改善者相比，恶化者在治疗开始时似乎不太愿意从事治疗工作，并且发现过程更加困难；他们的治疗师不太能够以反应灵敏、同理心的方式应对这些困难；恶化者无法成功应对治疗师的变化，最终放弃了治疗。结论：我们发现，我们对一系列 HSCED 研究的定性综合分析为所发生的对比结果提供了合理的解释。