title: Clinical errors as a lack of context responsiveness.
abstract: Although standardized treatments have the potential to decrease clinical errors, within-session responsiveness is complicated and complementary frameworks may be needed to foster enhanced responsiveness in the context of evidence-based treatments. Recent efforts have targeted the enhancement of flexibility and responsiveness in the delivery of manualized treatments, including the development of transdiagnostic treatments (i.e., protocols that are designed to be used across different diagnoses) intended to tailor intervention principles to the needs of individual patients. Context-Responsive Psychotherapy Integration (Constantino, Boswell, Bernecker, & Castonguay, 2013) offers anif-thenframework that supports the utilization of evidence-based clinical strategies in response to the identification of specific process markers. Failure to identify or appropriately respond to such markers may result in negative therapeutic process as well as outcomes. This case study uses the context-response psychotherapy integration framework to understand critical moments of clinical decision-making through examining an individual treatment case that unilaterally terminated after seven sessions of transdiagnostic treatment. This illustrative empirical case analysis focuses on three potential clinical errors, as indicated by a lack of responsiveness to three candidate process markers: (a) low outcome expectations, (b) self-strivings, and (c) outcome monitoring. For each clinical error, alternative clinical strategies are discussed.
authors.affiliation: Department of Psychology, University at Albany, State University of New York.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bugatti
authors.affiliation: Department of Psychology, University at Albany, State University of New York.
authors.forename: James F
authors.initials: JF
authors.lastname: Boswell
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology / Q000628:therapy; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy; D003156:Community Mental Health Services; D003661:Decision Support Techniques; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy; D055317:Evidence-Based Practice; D030141:Feedback, Psychological; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D019300:Medical Errors / Q000523:psychology*; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D008611:Mentors; D009034:Mother-Child Relations; D009042:Motivation; D010043:Outcome and Process Assessment, Health Care; D010352:Patient Dropouts / Q000523:psychology; D011369:Professional-Patient Relations; D013811:Psychotherapeutic Processes; D011613:Psychotherapy / Q000193:education; D012649:Self Concept; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology; D017211:Treatment Failure