Story of "Hope": Successful Treatment of Obsessive Compulsive Disorder
Keywords:pragmatic psychotherapy, obsessive compulsive disorder, flying phobia, separation anxiety disorder, treatment effect size, cognitive behavioral therapy, client-centered therapy, common factors in therapy
AbstractThe client Hope provides a good example of a very positive outcome from sustained, multifaceted psychotherapy with a 30-year-old woman presenting with obsessive compulsive disorder (OCD), fear of flying, panic disorder without agoraphobia, nightmare disorder, and a childhood history of separation anxiety disorder. Based on ratings at the beginning of therapy and end of therapy on a structured, self-report instrument, and relative to other, similar clients in my practice and as reported in research studies, Hope achieved a very successful result after 103 sessions of psychotherapy during a period of about two and a half years, and she maintained her gains during one-year follow-up. Specifically, Hope achieved a treatment effect size (ES) of 3.95 at termination and of 3.81 at one-year follow-up, compared with a mean ES of 1.65 at termination for OCD clients in my practice, and compared with mean ESs ranging from 1.12 to 1.56 as reported in meta-analyses of OCD clients in randomized clinical trials. This case study report presents both a systematic, qualitative description of the case together with an illustration of how an individual case in a private practice can be quantitatively compared with other, similar cases seen by the same therapist and with similar, research cases reported in the literature. The case study is intended to illustrate an integration of two sets of recommendations about therapy practice that I endorse from the American Psychological Association's Clinical Psychology and Psychotherapy Divisions, namely, recommendations for the use of empirically supported treatments and for the use of empirically supported therapy relationships, respectively.
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