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Journal of Nervous & Mental Disease:
doi: 10.1097/NMD.0b013e31825bfaf4
Original Articles

Treating Patients Who Strain the Research Psychotherapy Paradigm

Markowitz, John C. MD*†; Kaplowitz, Matthew PhD; Suh, Eun-Jung PhD*†; Meehan, Kevin B. PhD; Neria, Yuval PhD*†; Jonker, Hanske BSc; Rafaeli, Alexandra PsyD*; Lovell, Karina PhD

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Abstract

Abstract: Clinical trials of psychotherapy require diagnostic homogeneity, which implies a convergence of clinical presentations. Yet research study patients present diversely, and patients who do not fit a treatment paradigm may greatly complicate delivery of the study psychotherapy. The research literature has not addressed this issue. The authors use case illustrations of three psychotherapies – Prolonged Exposure, Relaxation Therapy, and Interpersonal Psychotherapy – from an ongoing psychotherapy outcome trial of posttraumatic stress disorder to describe psychotherapeutic responses to complex, “atypical” patients who strain standard treatment paradigms. Therapists required flexibility, and occasionally deviations from strict protocol, in treating heterodox patients. Such heterogeneity of presentation may have implications for psychotherapy outcome in research trials. Despite lack of discussion in the literature, many trials may face such issues.

© 2012 Lippincott Williams & Wilkins, Inc.

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