Tag: depressione

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study


This study is the sixth of a series of seven and belongs to the second Italian systematic replication of findings from previous series that investigated the effectiveness of a manualized transactional analysis treatment for depression through Hermeneutic Single-Case Efficacy Design. The therapist was a white Italian woman with 10 years of clinical experience and the client, Beatrice, was a 45-year old white Italian woman who attended sixteen sessions of transactional analysis psychotherapy. Beatrice satisfied DSM 5 criteria for Major Depressive Disorder, Anxious Distress, with Dependent and Histrionic Personality Traits. The judges evaluated the case as a good outcome: the depressive and anxious symptomatology clinically and reliably improved over the course of the therapy and these improvements were maintained throughout the duration of the follow up intervals. Furthermore, the client reported significant change in her post-treatment interview and these changes were directly attributed to the therapy.

Key words

Systematic Case Study Research; Hermeneutic Single-Case Efficacy Design; Transactional Analysis Psychotherapy; Major Depressive Disorder; Anxious Distress; Dependent Personality Traits; Histrionic Personality Traits.


This Hermeneutic Single-Case Efficacy Design (HSCED) is the sixth of a series of seven, and belongs to an Italian systematic replication of findings from previous case series (Widdowson 2012a, 2012b, 2012c, 2013, 2014; Benelli, 2016a, 2016b, 2016c, 2017a, 2017b, 2017c) and is conducted under the auspices of the project ‘Transactional Analysis meets Academic Research in order to become an Empirically Supported Treatment: an Italian two-year plan for publishing evidence of Transactional Analysis efficacy and effectiveness into worldwide recognized scientific journals’, funded by the European Association for Transactional Analysis (EATA). Previous publications have widely described the rationale for supporting by HSCED the accumulation of evidences of efficacy and effectiveness for those models of psychotherapy that are emerging or marginalized (Benelli, De Carlo, Biffi & McLeod, 2015) and specifically how this is important for recognition of TA and inclusion within the acknowledged treatments for common mental disorders (i.e., depression, anxiety and personality disorders) (Widdowson 2012a, 2012b, 2012c, 2013, 2014; Benelli, 2016a, 2016b, 2016c, 2017a, 2017b, 2017c).
The aim of this study was to investigate the effectiveness of the manualised TA treatment of depression (Widdowson, 2016) applied to a major depressive disorder in comorbidity with anxious distress. The quantitative primary outcomes investigated were depressive and anxious symptomatology, the secondary outcomes were global distress and client-generated personal problems, which were analysed both quantitatively and qualitatively.
The present study analyses the treatment of ‘Beatrice’, a 45-year-old Italian woman with diagnosis of major depressive disorder in comorbidity with anxious distress, dependent and histrionic personality disorder.

Ethical Considerations

The research protocol follows the requirements of the ethical code for Research in Psychotherapy of the Italian Association of Psychology, and the American Psychological Association guidelines on the rights and confidentiality of research participants. The research protocol has been approved by the Ethical Committee 9 (1), 42-63 https://doi.org/10.29044/v9i2p42
International Journal of Transactional Analysis Research & Practice Vol 9 No 2, December 2018 www.ijtarp.org Page 43
of the University of Padua. Before entering the treatment, clients received an information pack, including a detailed description of the research protocol, and they gave a signed informed consent and written permission to include segments of disguised transcripts of sessions or interviews within scientific articles or conference presentations. Patients were informed that they would have received therapy even if they decided not to participate in the research and that they were able to withdraw from the study at any point, without any negative impact on their therapy. All aspects of the case material were disguised, so that neither the client nor third parties are identifiable. All changes are made in such a way that does not lead the reader to draw false conclusions related to the described clinical phenomena. Finally, as a member checking procedure (Lincoln & Guba 1985), that is a qualitative research technique wherein the researcher compares her understanding of what an interview participant said or meant with the participant to ensure that the researcher’s interpretation is accurate, the final article in English language was presented to the client, who read the manuscript, amended it, and confirmed that it was a true and accurate record of the therapy and gave her final written consent for its publication. […]


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Trattamento della depressione

TA Treatment of Depression: three
case study research – Liliana, MD, Bia

G. C. Cavallero, E. Berdini, E. Moretti, F. Vulpiani

Scuola di Analisi Transazionale – SIFP Roma


These studies are part of an Italian series of systematic
replication of Hermeneutic Single Case Efficacy Design (HSCED) aiming to
support the efficacy of Transactional Analysis treatment for depression.

A rich case record with quantitative and qualitative data
was collected for each case and analysed by two teams of researchers in order
to develop arguments either for or against 1) the claim that a change occurred,
2) the role of therapy in change, 3) mediator and moderator factors of change.
Finally, a panel of independent judges came to a verdict about the quality of
the outcome and the factors of change.

Qualitative data includes Change Interview at the end of
the therapy (CI) and Helpful and hindering Aspect of Therapy (HAT).
Quantitative data include instruments for: depression (PHQ9), distress (CORE),
anxiety (GAD7) and Personal problems (PQ).

All patients fulfilled DSM criteria for Major Depression
and received 16 sessions of a manualized transactional analysis treatment
(Widdowson, 2013), tailored in accordance with their personality traits as
diagnosed with SWAP and Psychodynamic Diagnostic Manual.

The first case presents Liliana, a 67 years old Italian
female with severe Major Depression (severe) and histrionic and narcisistic
personality traits. Her PQ described emotional problems due to divorce from her
husband after 33 years of marriage, feeling of lloneliness, helplessness,
inability to handle daily life, lack of interest anddifficulty in managing

The second case presents MD, a 37 years old Italian female
with mild Major Depression (mild) and dependent and histrionic (SWAP)
personality traits. Her PQ described longstanding problems about relationship,
loneliness, feeling of inadequacy and guilt.

The third case presents Bia, a 44 years old Italian female
with mild Major Depression (mild) in comorbidity with anxiety disorder and
dependent and histrionic personality traits. He PQ described desperation for
being unable to have chidren, difficulties in relationship with the partner,
feeling of guilt for the choices made in the past, fear for the future, job

The three cases showed a mixed to good outcome as for RCI
index and clinical cut off in quantitative measures (PHQ9, CORE, GAD7, PQ), and
a good outcome in qualitative patients’ accounting of therapy (HAT, CI),
supporting the claim that TA Therapy for depression may be effective.

The patients’ personality characteristics (SWAP), theirs
experiences of the therapists and theirs perception of their own change (CI)
and theirs perceptions of helpful and hindering aspects of the therapies (HAT)
are presented and discussed in respect of developing and refining the
theoretical model of TA treatment for depression.



– Widdowson, M. (2013) Transactional Analysis for Depression Stage One Treatment Manual. Unpublished Manuscript, University of Salford.

– Novellino, M. (2003) L’organizzazione depressiva, in L’approccio clinico in analisi transazionale. Francoangeli, Milano


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