Lecture 4: Case conceptualisation Flashcards
psychotherapy case formulation is=
- a process
- for developing a hypothesis about,
- and a plan to address,
- the causes, precipitants, and maintaining influences of
- a person’s psychological, interpersonal and behavioral problems
- in the context of that individual’s culture and environment
wat zijn de onderdelen van case conceptualisation model
problem
maintaining factors
inducing factors
predispositional factors
treatment considerations
welke onderdelen beinvloeden de problemen & maintaining factors
strengths (skills, coping, personality)
Vulnerabilities
Stressors
Support
vulnerabilities
pitfalls
beliefs
habits
emotionality
support
what resources can you use?
social
help
activities
medication
stressors
what is currently weighing on you
events
social, family
occupation
living conditions
finances
welke dialogue gaat dit over (uit lecture 2)
the intersubjective dialogue, attunement to the first person perspective. interest in personal narratives and processes of meaning making.
hoe meot je de DSM eigenlijk gebruiken
DSM 5 -> prototype conceptualisation, kijken of het specifieke individu daarbij fit. anders aanpassen naar de case conceptualisation
wat is de rationale tijdens het uitwerken van de case conceptualisation en wat zijn 3 vragen die je jezelf hierbij moet stellen
Working hypotheses developed in collaboration between therapist and client
- Credible enough?
- Acceptable for the client?
- Useful for treatment?
multiple sources for constructing hypotheses
theories and research, client experience and narrative, clinical experience of therapist
individual case formulations, individualised treatment, evaluation of outcomes
what knowledge do we have for creating valid conceptualisations?
- Diathesis-stress model
- Evidence-based treatments
- ‘Common factors’
- Theories and proposed mechanisms
diathesis-stress model
heritable predispositions -> genotype, temperament
early experiences -> nurture, care, trauma, deprivation
strengths and vulnerabilities -> fenotype, schemas/cognitions/attributions, neuro-endocrine, attachment style, personality)
support and stress -> social, medication, psychotherapy, daily stress, trauma, life events)
links is diathesis, rechts is stress.
boven is distal-past, onder is proximal-present
kijken naar diathesis stress model
oke
hoe gebruik je evidence based treatments
EBT -> prototype CC + intersubjective dialogue -> personal CC
obv research kunnen we EBTs opstellen waardoor we weten dat ‘mensen met X usually benefit from treatment Y’, en daarna bespreken met de client zelf en op hen aanpassen
common factors
- Therapeutic alliance
- Collaboration
- Goal consensus
- Adapting treatment to specific client characteristics
- Empathy
- Promoting treatment credibility
etc
common factors and CC
- Adaptation to specific client needs and characteristics
- A person-specific rationale why a certain therapy fits and will work
- Validation and empathy
- Indications for alliance ruptures to take care of
- A shared ground for setting goals
- A starting point for adequate collaboration
waar gebruik je therapeutic knowledge vooral bij in CC
maintaining factors
waar ben je bij inducing factors in geinteresseerd
wat er is gebeurd, maar ook wat dat betekende voor die persoon!!! (bv naast scheiding ook angst om alleen met het leven om te moeten gaan, andere sociale rollen, etc)
theories die we hebben
behaviourism
cognitivism
schemata
psychoanalysis
mentalization
emotion-focused
attachment
body oriented
system-based
problems =
- initially indicated by the client
- uncovered during the interview
- indicated by other sources
behaviours, emotions, cognitions, experiences, consequences, interpersonal issues, symptoms, etc
maintaining factors=
vicious cycles
interactions between problems
effects of…
- core beliefs
- coping
- emotion regulation
inducing factors
how did the problems start?
- events
- personal context at the time (how does the client interpret this event?)
predisposing factors
- temperament
- learning history
- skill deficit
treatment considerations
what is needed to get better?
- request for help
- motivation
- intervention options
- obstacles
current personal context=
strengths (skills, coping, persoonlijkheid)
kwetsbaarheid (valkuilen, overtuigingen, gewoontes, emoties)
support (sociaal, hulp, activiteiten, medicatie)
stressors (events, sociaal, familie, werk, leefcondities, financieën)
waarom is CC belangrijk
omdat we moeten nadenken over persoonlijke context, omstandigheden en ontwikkeling en doelen
a good-working theory and rationale is supportive for the common factors that are crucial in promotoing a good treatment outcome
oke
bv bij helplessness gevoelens: geen behavioural activation want deze personen hebben al negatieve cognities over hulp
oke
case conceptualisation is intersubjective dialogue, interest in personal narratives and processes of meaning making
oke
meestal zouden verschillende psychologen verschillende case conceptualisations hebben
oke
