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I am pleased to comment on this paper because a single-case report has special value when (1) it is part of a larger body of quantitative results from a treatment trial (Milrod et al. 2014) and (2) provides a sufficiently complex qualitative description of how the treatment process has led to a good outcome. The single case presented by Busch and Milrod is that of a twenty-three-year-old man who was part of a group assembled because the subjects were all refractory to previous treatment. Mr. S. received a psychoanalytically informed psychotherapy, twice a week for twenty-one sessions, conducted by a clinician who followed the treatment manual for Panic-Focused Psychodynamic Psychotherapy-eXtended Range for separation anxiety syndromes (PFPP-XR; Milrod et al. 1997, 2001, 2007; Busch et al. 2012). The PFPP-XR treatment was successful, and the report includes an explanation of why it worked.
The patient presented with mixed anxiety and depressive symptoms. These included panic attacks occasioned by any threat of separation. He had not responded to previous treatments: three different regimens of antidepressant medication and three courses of psychotherapy, including cognitive behavioral therapy. The authors selected him for this case report because he was one of the patients who successfully responded to the treatment. Their aim in this single-case report was to illustrate how the theory behind the manual works in practice.
In this commentary, I discuss the change process using the methodology of explanatory understanding. This method employs configurational analysis (Horowitz 2005; Horowitz in press). It starts with individualized