title: Treating patients who strain the research psychotherapy paradigm.
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.
authors: Department of Psychiatry, Columbia University. jcm42@columbia.edu
authors: John C
authors: JC
authors: Markowitz
authors: Matthew
authors: M
authors: Kaplowitz
authors: Eun-Jung
authors: EJ
authors: Suh
authors: Kevin B
authors: KB
authors: Meehan
authors: Yuval
authors: Y
authors: Neria
authors: Hanske
authors: H
authors: Jonker
authors: Alexandra
authors: A
authors: Rafaeli
authors: Karina
authors: K
authors: Lovell
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007171:Implosive Therapy; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011613:Psychotherapy / Q000379:methods*; D012064:Relaxation Therapy; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology / Q000628:therapy