GEHART CHAPTER 11 - CASE CONCEPTUALIZATION

Question 1

VIEWING

Answer 1

KNOWING WHERE TO FOCUS YOUR ATTENTION WHILE LISTENING, CASE CONCEPTUALIZATION

Question 2

CASE CONCEPTUALIZATION

Answer 2

A THEORY-INFORMED ASSESSMENT

Question 3

CLINICAL ASSESSMENT

Answer 3

A DIAGNOSTIC ASSESSMENT

Question 4

CASE CONCEPTUALIZATION:

2. PRESENTING PROBLEM

Answer 4

DESCRIPTION OF HOW ALL PARTIES INVOLVE DESCRIBE THE PROBLEM. EACH PERSON INVOLVED HAS A DIFFERENT DEFINITION OF THE PROBLEM

Question 5

CASE CONCEPTUALIZATION:

3. BACKGROUND INFORMATION

Answer 5

HISTORY OF TRAUMA, P/E/S/ ABUSE, SUBSTANCE ABUSE, PRECIPITATING EVENTS, RELATED HISTORICAL BACKGROUND (HEALTH ISSUES, MEDICATIONS, PREVIOUS COUNSELING, ETC.)
-WRITE THIS INFORMATION WITH A POSITIVE IMPRESSION OF CL AND HOPE FOR CL’S RECOVERY

Question 6

CASE CONCEPTUALIZATION:

3. CLIENT /FAMILY STRENGTHS AND SOCIAL LOCATION

Answer 6

ASSESS FOR STRENGTHS AND RESOURCES FIRST. ENCOURAGES A MORE RESOURCEFUL MIND-SET. ABILITIES - ACCOMPLISHMENTS, SPECIAL TALENTS

PERSONAL/INDIVIDUAL STRENGTHS
-PERSONAL QUALITIES - OFTEN THE FLIP SIDE TO THE PRESENTING PROBLEM IS/ARE STRENGTHS

RELATIONAL/SOCIAL STRENGTHS AND SOCIAL LOCATION

• PHYSICAL SUPPORT - HELP WITH ERRANDS, PICKING UP CHILDREN, DOING TASKS AROUND HOUSE
• EMOTIONAL SUPPORT - LISTENERS, HELPING TO RESOLVE RELATIONAL ISSUES
• COMMUNITY SUPPORT - FRIENDSHIPS, ACCEPTANCE IN ANY COMMUNITY

SPIRITUAL RESOURCES - HOW A PERSON CONCEPTUALIZES HIS/HER RELATIONSHIP TO THE UNIVERSE, LIFE, GOD, ETC.
-ASSESS FOR SPIRITUALITY P. 504

SOCIAL LOCATION
COMMON RESOURCES
-STRONG SUPPORT NETWORK
-SENSE OF COMMUNITY/CONNECTION
-SENSE OF PURPOSE AND DIRECTION
-RESOURCES OF PROBLEM SOLVING
-BELIEFS THAT PROVIDE COMFORT
-ACCESS TO SOCIAL SERVICES

COMMON LIMITATIONS

• ISOLATION
• EXPERIENCE HARASSMENT, DISCRIMINATION
• DIFFICULTY FINDING OPPORTUNITIES
• DIFFICULTY COMMUNICATING WITH INSTITUTIONS
• DIFFICULTY ACCESSING SOCIAL SERVICES
• LACK OF SUFFICIENT FINANCIAL RESOURCES, HOUSING, LEGAL REPRESENTATION, ETC.

Question 7

CASE CONCEPTUALIZATION:

5. FAMILY STRUCTURE

Answer 7

1. FAMILY LIFE CYCLE STAGE
2. BOUNDARIES - CLEAR BOUNDARIES AND CULTURAL VARIANCE; DIFFUSE BOUNDARIES AND ENMESHED RELATIONSHIPS; RIGID BOUNDARIES AND DISENGAGED RELATIONSHIPS
3. TRIANGLES AND COALITIONS - TENSION BETWEEN TWO PEOPEL IS RESOLVED BY DRAWING IN A THIRD OR FOURTH PERSON TO STABILIZE THE ORIGINAL DYAD.
4. HIERARCHY BETWEEN CHILD AND PARENTS - IS PARENT-CHILD HIERARCHY DEVELOPMENTALLY AND CULTURALLY APPROPRIATE?
5. COMPLEMENTARY PATTERN - EACH CROSS-THEORETICAL CASE CONCEPTUALIZATION: PERSON TAKING ON OPPOSITE ROLES, RANGE FROM FUNCTIONAL TO PROBLEMATIC

Question 8

CASE CONCEPTUALIZATION:

6. INTERACTION PATTERNS

Answer 8

THREE PHASES OF PROBLEM INTERACTION PATTERN

1. START OF TENSION - SIGNAL BEHAVIORS THAT ARISE IN TENSION AND THE START OF A PROBLEM
2. CONFLICTS/SYMPTOM ESCALATION - FOCUS ON BEHAVIORAL ACTIONS AND RESPONSES OF EACH PARTY INVOLVED ONCE THE PROBLEM FULLY EMERGES
3. RETURN TO NORMAL/HOMEOSTASIS - WHAT DOES EACH PERSON DO TO GET BACK TO NORMAL/HOMEOSTASIS

Question 9

CASE CONCEPTUALIZATION:

7. INTERGENERATIONAL AND ATTACHMENT PATTERNS

Answer 9

USE A GENOGRAM SHOWING:
FAMILY STRENGTHS AND RESOURCES
SUBSTANCE AND ALCOHOL ABUSE/DEPENDENCE
P/E/S/ ABUSE
PERSONAL QUALITIES AND/OR FAMILY ROLES; COMPLIMENTARY ROLES
PHYSICAL AND MENTAL HEALTH ISSUES
HISTORICAL INCIDENTS

ATTACHMENT PATTERNS

• SECURE: WHEN ATTACHMENT NEEDS ARE NOT MET, THE PERSON IS STILL GENERALLY ABLE TO MAINTAIN A SUFFICIENT LEVEL OF COPING AND IS ABLE TO PURSUE RECONNECTION IN CONSTRUCTIVE WAYS.
• ANXIOUS AND HYPERACTIVE: WHEN ATTACHMENT NEEDS NOT MET, PERSON BECOMES ANXIOUS AND CLINGY, RELENTLESSLY PURSUES CONNECTION, AND MAY BECOME AGGRESSIVE, BLAMING, AND CRITICAL
• AVOIDANCE: WHEN ATTACHMENT NEEDS ARE NOT MET, PERSON SUPPRESSES ATTACHMENT NEEDS AND INSTEAD FOCUSES ON TASKS AND OTHER DISTRACTIONS
• COMBINATION ANXIOUS AND AVOIDANT: WHEN ATTACHMENT NEEDS NOT MET, PERSON PURSUES CLOSENESS AND THEN AVOIDS IT ONCE OFFERED, OFTEN ASSOCIATED WITH TRAUMA HISTORY.

Question 10

ATTACHMENT PATTERNS

Answer 10

• SECURE: WHEN ATTACHMENT NEEDS ARE NOT MET, THE PERSON IS STILL GENERALLY ABLE TO MAINTAIN A SUFFICIENT LEVEL OF COPING AND IS ABLE TO PURSUE RECONNECTION IN CONSTRUCTIVE WAYS.
• ANXIOUS AND HYPERACTIVE: WHEN ATTACHMENT NEEDS NOT MET, PERSON BECOMES ANXIOUS AND CLINGY, RELENTLESSLY PURSUES CONNECTION, AND MAY BECOME AGGRESSIVE, BLAMING, AND CRITICAL
• AVOIDANCE: WHEN ATTACHMENT NEEDS ARE NOT MET, PERSON SUPPRESSES ATTACHMENT NEEDS AND INSTEAD FOCUSES ON TASKS AND OTHER DISTRACTIONS
• COMBINATION ANXIOUS AND AVOIDANT: WHEN ATTACHMENT NEEDS NOT MET, PERSON PURSUES CLOSENESS AND THEN AVOIDS IT ONCE OFFERED, OFTEN ASSOCIATED WITH TRAUMA HISTORY.

Question 11

CASE CONCEPTUALIZATION:

8. SOLUTION-BASED ASSESSMENT

Answer 11

WHAT SOLUTIONS WORKED BEFORE?

WHAT SOLUTIONS DID NOT WORK BEFORE?

QUESTIONS TO ASSESS SOLUTIONS AND UNIQUE OUTCOMES:
-WHAT KEEPS THIS PROBLEM FROM BEING WORSE THAN IT IS RIGHT NOW?
-IS THERE ANY SOLUTION YOU HAVE TRIED THAT WORKED FOR A WHILE OR MADE THING SLIGHTLY BETTER?
-ARE THERE TIMES AND PLACES WHEN THE PROBLEM IS LESS OF A PROBLEM OR NOT A PROBLEM?
- MIRACLE QUESTION: “IMAGINE THAT…
“WHAT ARE SOME OF THE FIRST THINGS YOU WOULD NOTICE THAT WOULD BE DIFFERENT?”
“WHAT ARE SOME OF THE FIRST CLUES THAT A MIRACLE OCCURED?”

Question 12

CASE CONCEPTUALIZATION:

9. POSTMODERN: SOCIAL LOCATION AND DOMINANT DISCOURSES

Answer 12

*OUTLINE THE BROADER CONTEXTS IN WHICH THE CL’S PROBLEM OCCURS

Question 13

DOMINANT SOCIAL DISCOURSES

Answer 13

COMMON DOMINANT DISCOURSES OR BROADER NARRATIVES THAT INFORM CL’S LIVES:

• CULTURE, RACE, ETHNICITY, CLASS, IMMIGRATION, RELIGION
• GENDER IDENTITY AND SEXUAL ORIENTATION
• COMMUNITY, SCHOOL, AND PROFESSIONAL CULTURES
• WEALTH, POVERTY, POWER, FAME
• SMALL TOWN, URBAN, REGIONAL DISCOURSES
• HEALTH, ILLNESS, BODY IMAGE, ETC.

Question 14

CASE CONCEPTUALIZATION:

10. CLIENT PERSPECTIVES

Answer 14

REFLECT ON AREAS OF CLIENT AGREEMENT AND DISAGREEMENT.
-CONSIDERING CLIENT PERSPECTIVE IS IMPORTANT PARTICULARLY WHEN CL DIFFERS FROM CO IN AGE, CULTURAL BACKGROUND, GENDER, SEXUAL ORIENTATION, OR SES

Question 15

DIVERSITY AND SAMENESS

Answer 15

THERE IS NO OBJECTIVE STANDARD BY WHICH A PERSON/FAMILY/SYSTEM CAN BE MEASURED AS HEALTHY AND EMOTIONALLY ENGAGED.

• CO MUST CONSIDER BROADER CULTURAL NORMS
• DO NO DISCOUNT ACCEPTING DIVERSITY WITHIN MY SAME CULTURE

*WHETHER WORKING WITH SOMEONE VERY SIMILAR TO OR VERY DIFFERENT FROM YOURSELF, YOU NEED TO slowly ASSESS AND EVALUATE, ALWAYS CONSIDERING CL’S BROADER SOCIOCULTURAL CONTEXT AND NORMS.