Assessing clinical progress: A case study of Daryl

In this single case study, the authors conceptually framed their understanding of dissociation and splitting as defensive/adaptive coping mechanisms through which children respond to abusive/neglectful environments and the developmental deficits of abused/neglected children as related to failure in separation/individuation. Case study methodology with a nested experimental research design employed content analysis of process recordings to identify targeted defenses and developmental themes and then to assess therapeutic effectiveness during the first six months of psychodynamic play therapy with Daryl. In-session cliniial progress was assessed through charting changes in defenses and developmental themes, identifying degree of goal achievement, and clinically observing treatment stage progression. Visual analysis of the frequency charts identified a slight cyclical decline in use of splitting and guarding against dissociation and a somewhat uneven increase in the developmental theme of coexistence/integration. While these changes in targeted outcome variables were not statistically significant, the amount of change did exceed the predetermined outcome goals for decreased splitting and increased coexistence but not the goal of decreased guarding against dissociation. Review of the process recordings also identified clear markers of treatment progression through two therapeutic stages in the first six months of long term psychodynamic play therapy and further supported the clinical meaningfulness of the observed changes.