Pragmatic Case Studies in Psychotherapy

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September 12, 2015 -- From the Editor 


Sudden Gains and Sudden Losses in the Clients of a "Supershrink": 10 Case Studies  

Brian Hansen & Michael Lambert, Brigham Young University, and Erigoni Vlass, Private Practice in Australia  


*** Kevin Laska & Edward Federman, Bedford VA Medical Center

*** Jo-Ann Pereira & Michael Barkham, University of Sheffield, England 

Response to Commentaries

Brian Hansen & Michael Lambert, Brigham Young University, and Erigoni Vlass, Private Practice in Australia  

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Eri Vlass, a clinical psychologist and private psychotherapy practitioner in Sydney Australia, is a "supershrink" (Ricks, 1974; Okiishi, Lambert, Nielsen,  & Ogles, 2003). She has earned this title by creating a percentage of successful outcomes with her clients (based on the widely used OQ-45 measure) that is more than 5 times greater than those of the average therapist. Moreover, she has achieved these results in a very short time: the average length of therapy for her most successful clients is 3.9 sessions, and for all her clients, 3.8 sessions. In addition, Eri has a rate of over 5 times the norm for "sudden gains" in her clients, defined as a sizable, statistically rare positive gain in a client's functioning between individual sessions.  

Eri employs an holistic theoretical approach that looks at both psychological and medical problems. Her model integrates the following components: (a) psychoeducation about proper sleep hygiene, diet, and use of alcohol, coffee, and other drugs; (b) psychoeducation about the brain's role in creating and managing stress and emotion; (c) cognitive-behavior therapy; (d) "compassionate mind training" (Gilbert & Proctor, 2006), designed to reduce high levels of shame and self-criticism; (e) individualized case formulation; and (f) completion of the OQ-45 before each session, for ongoing feedback.  

The target article in the present issue—by Brian Hansen, Michael Lambert, and Eri Vlass herself—focuses on studying the experiences of Eri's clients and the nature and process of her therapy, to learn more about how she achieves her outstanding results. Specifically, a random sample of 5 of her clients with a "sudden gain" session (her "Blue" clients) and 5 of her very few clients with a "sudden loss" session (her "Red" clients) were followed up and compared, with both quantitative and qualitative measures, two years after the end of therapy to yield relevant information.    

Following the target article, two pairs of authors—Kevin Laska & Edward Federman from the Bedford VA Medical Center in the U.S., and Jo-Ann Pereira & Michael Barkham from the University of Sheffield in the U.K.—provide expert reflections on the research about Eri's therapy. As can be seen from the target article, from the two commentaries, and from Hansen et al.'s response to the commentaries, the study of Eri Vlass's therapy draws from two increasingly important areas of psychotherapy research. These include (a) exploring the differential impact of the person of the individual therapist per se in affecting outcome; and (b) the nonlinearity of therapeutic trajectories, especially the clinical phenomenon of clients making sudden gains or sudden losses between individual therapy sessions, and its relationship to overall outcome.     

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1. Case Context and Method
2. The Client
3. Guiding Conception with Research and Clinical Experience Support
4. Assessment of the Client's Problems, Goals, Strengths, and History.
5. Formulation and Treatment Plan
6. Course of Therapy
7. Therapy Monitoring and Use of Feedback Information
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Vol 11, No 3 (2015)

Table of Contents

Case Study

Sudden Gains and Sudden Losses in the Clients of a "Supershrink": 10 Case Studies Abstract PDF
Brian P. Hansen, Michael J Lambert, Erigoni N. Vlass 154-201
Rapid Recovery with an Effective Therapist: A Comment on Hansen, Lambert, and Vlass Abstract PDF
Kevin M. Laska, Edward J Federman 202-215
An Exceptional, Efficient, and Resilient Therapist: A Case Study in Practice-Based Evidence Abstract PDF
Jo-Ann Pereira, Michael Barkham 216-223
Calling for More Case Studies of Exceptional and Efficient Psychotherapists Abstract PDF
Brian P. Hansen, Michael J Lambert, Erigoni N. Vlass 224-229