Lecture 4: Personal Case Conceptualization

Question 1

What are 4 reasons why formulating is useful

Answer 1

1. Case formulation guides treatment by helping the therapist stay on track, monitor progress and be alert when a change of direction is indicated
2. Formulation increases treatment efficacy
3. Formulation tailors treatment to the specific circumstances a client is facing
4. Well-crafted formulation should enhance therapist empathy because it helps understand client better

Question 2

What are 5 tensions in case formulations

Answer 2

1. Immediacy vs comprehensiveness; deciding how much info is enough to formulate and determine when more info is needed and what type
2. Complexity and simplicity; complexity = extent to which multiple aspects of the clients problems are integrated into a meaningful representation
3. Bias and objectivity
4. Observation and inference;
   - observation = theory-free descriptive evidence gathered by careful watching/listening
   - inference = conclusion formed on the basis of observation, may logically follow from an observation or be guided by theory
5. Individual and general formulations; case formulation is by definition about a specific individual but prototype formulations provide useful hypotheses about causes and maintaining influences in psychological disorders

Question 3

Psychotherapy case formulation

Answer 3

Process for developing a hypothesis about, and a plan to address, the causes/precipitants/maintaining influences of a persons psychological/interpersonal/behavioral problems in context of that individual’s culture/environment

Question 4

Event formulation

Answer 4

Seeks to explain event/episode in treatment

Question 5

Prototype formulation

Answer 5

Theoretical conceptualization of a certain disorder

Question 6

What are 4 developments in psychology that have influenced case formulation

Answer 6

1. Nature and classification of psychopathology; decisions about normality and abnormality
2. Theories of psychopathology; theoretical orientation provides framework of explanation
   - psychoanalysis
   - cognitive
   - behavioral
   - phenomenological & humanistic
3. Psychometric tradition; psychological testing
4. Structured case formulation models; identify problems, infer maladaptive relationship transactions/concepts of self/others/world

Question 7

What are 3 reasons to approach case formulation integratively

Answer 7

1. It is widely prevalent among practicing therapists —> therapeutic mainstay
2. Allows therapist to tailor therapy to individual and to draw from multiple theoretical perspectives/intervention strategies
3. Most evidence shows that difference in effectiveness of therapy lies not in different kinds of theoretical approaches but in qualities shared in all forms of treatment

Question 8

What are 4 characteristics that Frank identifies as accounting for effectiveness of therapy

Answer 8

1. Emotionally charged and confiding relationship between client and clinician
2. Therapeutic relationship exists in restricted and culturally sanctioned context with specific roles
3. Reason for symptoms is accepted by both clinician and client
4. Active participation of both client and clinician

Question 9

What are the 4 main components of the integrative model of case formulation and therapy

Answer 9

• gather info
• formulate
• treat
• monitor progress

Question 10

what 4 components belong to “formulate” in the integrative model of case formulation and therapy

Answer 10

• create problem list
• diagnose
• develop explanatory hypothesis
• plan treatment

Question 11

Process info

Answer 11

How individual presents themselves

Question 12

Narrative info

Answer 12

Descriptions of specific stories/episodes

Question 13

What are 3 important points about the relationship between formulation and treatment

Answer 13

1. Treatment plan is only a plan and will inevitably change
2. Case formulation skills are distinct from those involved in conducting treatment
3. Psychotherapy always involves intermingling of theory and method and an interaction between the personness of client and that of the clinician

Question 14

What are the 5 most important aspects of case conceptualization

Answer 14

• predisposing factors; what made you vulnerable (distal)
• inducing factors; how did the problems start (proximal)
• problems; what are the current problems (present)
• maintaining factors; what mechanisms keep these problems in place (present)
• treatment considerations; what is needed to get better —> should include the personal factors of the client that might impact the therapeutic relationship and the treatment

Question 15

What are 4 factors of Current Personal Context

Answer 15

• what are your strengths
• vulnerabilities; what makes you currently vulnerable
• support; what resources can you use
• stressors; what is currently weighing on you

Question 16

Why is CC important (5)

Answer 16

• need to take personal context, development and goals into account
• personal narratives and recovery are not enough (need to input professional knowledge)
• general theories and scientific knowledge have to be applied to a specific situation
• a good working-theory and rational is supportive for the common factors that are crucial in promoting good treatment outcome
• great tool for learning clinical thinking and for supervision (feedback/learning from mistakes)

Question 17

What are 3 examples of sources for constructing hypotheses

Answer 17

• theories and research
• client experience and narrative
• clinical experience of therapist

Question 18

What do we know so far? (4)

Answer 18

1. Diathesis-stress model; heritable predisposition, early experiences, strengths and weaknesses and support and stress shape the context in which current complaints/symptoms take place
2. Evidence-based treatments; for many treatments there is evidence that they are relatively effective, no one treatment that seems to be better that the other —> should only inform prototype of treatment and then be tailored to specific individual (= intersubjective dialogue)
3. Common factors; there is strong evidence that certain common factors of therapy are important in leading to positive treatment outcome
4. Theories; there are many theories, not one that is better than the other, should still try to understand their mechanisms

Question 19

Intersubjective dialogue

Answer 19

Attunement to the first person perspective, interest in personal narratives and process of meaning-making

Question 20

What are 6 important common factors

Answer 20

1. Therapeutic alliance
2. Collaboration
3. Goal consensus
4. Adapting treatment to specific client characteristics (culture, gender, etc.)
5. Empathy
6. Promoting treatment credibility

Question 21

What are 4 categories of consideration when developing explanatory hypotheses

Answer 21

1. Precipitating stressors; events that trigger distress
2. Origins; key (learning) experiences that account for problems but also led to clients world view
3. resources; strengths of a client
4. Obstacles; factors that may interfere with treatment succes