Empirically supported emerging and marginalized psychotherapies: Integration of non-concurrent multiple baseline design and hermeneutic single case efficacy design

According to APA division 12, at least two Randomized Clinical Trials (RCT) or alternatively nine Single Case Experimental Design (SCED) are required to be recognized as Empirically Supported Treatments (EST). Multiple baseline is the most suitable SCED in psychotherapy research because the treatment effects do not reverse after conclusion and do not require withdrawal in ABAB phases. Treatment's introduction is staggered sequentially across multiple participants, which allows the researcher to demonstrate that changes occur when treatment is introduced, simulating a waiting list. Hermeneutic Single Case Efficacy Design (HSCED) ensures time series analysis as the SCED, adding also qualitative and hermeneutic analysis that allow the recognition of bidirectional linkage between outcome and process variables. Furthermore, external judges assess the quality of the studies providing a verdict of good, mixed or poor outcome. To present systematic replication of multiple non-concurrent baseline HSCED as a way to empirically support both emerging and marginalized models of psychotherapy. After a phase of assessment and the collection of a stable three-point baseline, change in a convenience sample of five patients was tracked with quantitative (PHQ9, STAI, CORE-OM, PQ) and qualitative (HAT, CI) measures. Hermeneutic analysis and judge evaluation were conducted according HSCED protocol. Quantitative data show Clinical Significant and Global Reliable Change in all patients, supported by qualitative data. Hermeneutic analysis suggests specific outcome-to-process linkage and therapeutic interventions followed by shift in weekly outcome measures, supporting and refining the theoretical predictions of the manualized Intensive Transactional Analysis Psychotherapy. Combining multiple baseline design and HSCED, it is possible to support recognition as EST of emerging and marginalized treatments, involving less resources than RCT.