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PSY343 > PSY343 - 6. Case Formulation > Flashcards

PSY343 - 6. Case Formulation Flashcards

1
Q

Case Formulation

A

Process for developing hypothesis about causes, precipitants + maintaining influences of person’s psychological, interpersonal + behavioural problems in context of that individual’s culture + environment

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2
Q

Case Formulation

A

pulling together ideas + hypothesis about problems + causes based on context
theoretical, but grounded on specific experience of client
individualized
explanatory: inferences based on history, biology, sociocultural influences

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3
Q

Case Formulation

A

currently operating: contingencies + reinforcements in environment
person’s psychology: how they process information
pieces of puzzle: guides diagnosis + approach

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4
Q

Case Formulation

A

psychodynamic: unconscious
cognitive: beliefs, disruptive thinking
behavioural: learning history + contingencies
depends on approach
heavy emphasis on cause, sometimes narrative
diff depending on orientation + theory

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5
Q

Case Formulation

A

Subject to revision as new information emerges, new problems develop, new insights gained
tentative - can never be sure why they have problem

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6
Q

Case Formulation

A

Involves aspects of process and content:
Process: clinician’s activities aimed at eliciting info required to develop formulation content (clinical interview)
ask questions - how i get the data

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7
Q

Case Formulation

A

Content: problems identified, diagnosis, explanation of problem - data
content will vary widely depending on which theory of psychotherapy + psychopathology clinician uses

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8
Q

Case Formulation

A

blueprint guiding treatment; tool to facilitate treatment planning
use it to determine how to treat
treatment is also tentative: changes based on preference + how well it’s working, case formulation

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9
Q

Tensions Inherent in Case Formulation

A

Immediacy vs Comprehensiveness
Balance betw goals of efficiently identifying what is needed to help client + getting all necessary information to help understand client’s situation
pragmatic: need to process lots of info naturally

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10
Q

Tensions Inherent in Case Formulation

A

more we make sense of it, better we can intervene
comprehensive: also need to take time to see what’s missing
ppl change over time, thinking + relationships change
get more info over time, but we need to start case formulation quickly

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11
Q

Tensions Inherent in Case Formulation

A

Complexity vs Simplicity: ppl are very complex
we can’t capture complexity
too complex - don’t know what to do with it
simplicity: too reductive - don’t grasp richness of person it’s gonna be useless

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12
Q

Tensions Inherent in Case Formulation

A

Balance betw goals of integrating multiple aspects of problem into meaningful presentation + keeping formulation clear + reliable

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13
Q

Tensions Inherent in Case Formulation

A

Therapist Bias vs Objectivity
Balance between managing therapist bias + relying on one’s personal experience to empathize with client
we all have bias

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14
Q

Tensions Inherent in Case Formulation

A

some can overpathologize based on degree of difference
some underpathologize - same as their experience
use my humanity to relate, but need to see other as seperate

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15
Q

Tensions Inherent in Case Formulation

A

Observation vs Inference
Balance between gathering descriptive evidence + forming conclusions based on this evidence
too much inferences can be bad

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16
Q

Tensions Inherent in Case Formulation

A

Individual vs General Formulations
rely on theoretical understanding of how ppl work
relying too much might mean we don’t see individual
if we look at individual too much, we miss years of research

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17
Q

Tensions Inherent in Case Formulation

A

Balance betw generating unique understanding of an individual with general knowledge about psychopathology + psychotherapy

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18
Q

Case Formulation in Psychotherapy Research

A

Value of case formulation is relative to its reliability + validity
reliability: extent clinicians agree on approximation of same case formulation

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19
Q

Case Formulation in Psychotherapy Research

A

validity: how likely is to accurately guide me to successful outcome or the course of treatment

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20
Q

Case Formulation in Psychotherapy Research

A

Persons (1991): “conceptual incompatibility” betw design of psychotherapy studies + models of psychotherapy evaluated in studies
seitz: consensus problem: looked at same case

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21
Q

Case Formulation in Psychotherapy Research

A

essay on precipitants, focal conflict, defence mechanisms, reasoning on interpretations
difficult to achieve any consensus
problem since it’s a research, scientific field

22
Q

Case Formulation in Psychotherapy Research

A

more important that it guides me a therapist rather than objective therapy process
Revised approach to case formulation
big push toward identifying specific steps in formulation

23
Q

Case Formulation in Psychotherapy Research

A

when we study therapy decontextualize, we talk about an artificial design
assessment + treatment are separate
process is what predicts outcome more than content of case formulation

24
Q

Steps for Developing a Case Formulation

A

Step 1. Create Problem List – Describe full range of client’s problems
what they wanna focus on, doesn’t mean we disregard what they don’t wanna talk about, but it influences our formulation

25
Q

Steps for Developing a Case Formulation

A

Signs + Symptoms: types of behaviours exhibited by client, complaints of distress, signs of disturbances observable to therapist + others, but not client

26
Q

Steps for Developing a Case Formulation

A

signs: stressed, struggling in relationship
sign: observable to others, but client not related
symptom

27
Q

Steps for Developing a Case Formulation

A

Problems in living: issues in self-functioning, social/interpersonal functioning, societal functioning
self-functioning: mood, identity, existential concern
interpersonal: relationships
societal: relates to larger society - war, poverty

28
Q

Steps for Developing a Case Formulation

A

Step 2. Diagnose: Provide diagnosis for both practical requirements (i.e., billing) + future treatment planning
formal diagnoses
some base interventions on diagnoses

29
Q

Steps for Developing a Case Formulation

A

Step 3. Develop explanatory hypothesis – therapist’s account of what is causing, maintaining, + precipitating client’s problems
Identify precipitants – triggers of symptoms + problems
anything that precedes episode when they seek treatment

30
Q

Steps for Developing a Case Formulation

A

Identify origins – predisposing events, traumas, stressors, + risk factors inferred as causally related to development of client’s current problems
often emerges gradually

31
Q

Steps for Developing a Case Formulation

A

development inferred to be causally related to development of issues
distal precipitant
direct: divorce, failing, death
contributing; established conditions that increase vulnerability to issues

32
Q

Steps for Developing a Case Formulation

A

Identify resources – strengths client brings to therapy to facilitate recovery (internal + external)
internal - qualities, skills (hobbies)
external - strong social network, money
contributes to process

33
Q

Steps for Developing a Case Formulation

A

Identify obstacles – aspects of client’s life that may interfere with treatment success
start planning on how to address them

34
Q

Steps for Developing a Case Formulation

A

State core hypothesis – brief summary statement of central mechanism generating problems, based on specific theoretical approach
how it fits together
ideological understanding of person

35
Q

Steps for Developing a Case Formulation

A

Step 4. Plan Treatment – explicit statement of how selected problems will be addressed in treatment
Identify treatment goals (process + outcome goals)
short term + long term goals

36
Q

Steps for Developing a Case Formulation

A

goals: decrease anxiety, resolve conflict in relationships
plan: how do we do this? change contingencies/look at disruptive thoughts - depends on specific therapy

37
Q

Steps for Developing a Case Formulation

A

outcome goals: reduce anxiety/avoidance
process goals: expose client to emotion
Plan interventions to address goals
explanatory hypothesis + creating process goals around it

38
Q

Cultural Competence in Case Formulation

A

Culture: collection of ideas + values in individual + group behavior + that over time have acquired stabilizing power in personality + in society
• distinguishes groups along multiple dimensions
can include age, sexuality, gender, SES

39
Q

Cultural Competence in Case Formulation

A

Cultural influences vary among people from similarcultural backgrounds
common mistake that ppl from similar cultural background are the same

40
Q

Cultural Competence in Case Formulation

A

on paper looks the same, but how it effects 1 person is diff from another
it’s about the thought of considering culture

41
Q

Cultural Competence in Case Formulation

A

Meta-analysis demonstrated that culturally adapted psychotherapy more effective than therapy not culturally adapted

42
Q

Cultural Competence in Case Formulation

A

client at centre of case formulation; conceptualizes person
through sensitive understanding of his/her identity
begins with client at the centre, not the diagnosis, the protocols or treatment plan
understand person based on how they identify, not how i identify them

43
Q

Cultural Competence in Case Formulation

A

ppl don’t fit well in specific categories

doesn’t privilege one cultural influence, but how intersections influence person’s formulation

44
Q

Cultural Competence in Case Formulation

A

Hays’ (2007) ADDRESSING model of human diversity:
• Age
• Disability
• Religion

45
Q

Cultural Competence in Case Formulation

A
  • Ethnicity
  • Social Class
  • Sexual Orientation
46
Q

Cultural Competence in Case Formulation

A
  • Indigenous Origins
  • National Origin
  • Gender
47
Q

Cultural Competence in Case Formulation

A

• Other dimensions: history of colonization, relationship status, size, attractiveness, trauma history, combat experience, etc.
all inform person’s identity

48
Q

Cultural Competence in Case Formulation

A

Cultural factors intersect in multiplicity of ways: they are not additive, but dynamically related in ways unique to individual
sensitive to the fact that ppl’s identities are formed in multiple ways

49
Q

Cultural Competence in Case Formulation

A

children of interracial couple
in sibling pairs - multiplicity of ways they can understand trajectory of developing identities
important to understand intersectionality + asking what aspects is important to them

50
Q

Cultural Competence in Case Formulation

A

Therapists must understand their own biases, rather than operate from an assumption of “neutrality”
recognize/understand own biases + how they influence interpretions

51
Q

Cultural Competence in Case Formulation

A

if one claims to be unbiased, shut down part that says i need to explore biases - it’s impossible to be completely unbiased

52
Q

Cultural Competence in Case Formulation

A

Amending to common factors + relationship variables is a solution for culturally competent psychotherapy practice
when we get very narrow, we are more prone to miss individual differences

PSY343 (11 decks)

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