PSYC 528: Case Conceptualizaiton & Treatment Plan Flashcards
ADDRESSING Model
Framework used to help therapist understand and address multidimensional factors that influence a clients experiences.
- Understanding this model helps therapist reduce bias and ensures that treatment plans are holistically tailored to the clients needs.
A: age
D: disability at birth
D: disability acquired
R: religion
E: ethnicity
S: Socioeconomic status
S: sexual orientation
I: indigenous heritage
N: nation of origin
G: gender identity/pronouns
Ex:
Adjunct Treatment
Additional theraputic interventions that are used alongside the primary treatment to enhance or suppor the overall theraputic process.
- Considerded a secondary intervention to enhance treatment effectiveness
- Important for improving client outcomes by providing a more holistic approch to treatment.
Ex: Client is being treated with CBT for depression and is also receiving adjuct treatment of mindfulness-based stress reduction. Together these treatments address both the cognitive and emotional components of the clients depression.
Case Conceptualization
A formulizing process that synthesizes all information gathers during the assessment and information gathering session to fully understand the clients presenting problem, symptoms and the origions that contribute to their distress.
- Involves identification of key issues and potential causes as well as how maintaining behaviors contribute to patterns of maladaptive behavior.
- Important bc it provides understanding of the clients challenges and helps clinicians prioritize treatment goals, select appropriate therapueutic techniques and track progress.
Ex: Use me as an example …. trama … control environment …. social situations …. trama focues therapy and CBT
Client Factors
Individual characteristic and personal attribute unique to each individual that can influence the therapeutic process and treatment outcomes.
- Using the ADDRESSING model (age, gender, ethnicity, sexual orientation, disabilities) and Spheres of Influence therapist is able to assess a client’s expectations of therapy, readiness to change, values and beliefs, temperament, assets, etc.
- Account for 40% of theraputic outcomes
Important bc it accounts for 40% of theraputic outcomes and enhances engagement, trust, goal setting and increases the likelyhood of acheiving positive outcomes. Alternativly, ignoring client factors can lead to misalignment with treatment.
Common Factors (in psychotherapy)
Elements shared across therapeutic approaches that contribute to successful treatment outcomes.
- Therapeutic alliance
- Clinet expectations
- WEG
- Sense of hope
- Belief change is possible
- In an Evidence Based Practice, the three legs of the stool are Client Factors, Clinician Skills and Emperically Supported Treatment Applied.
Ex: Your client is seeking therapy for anxiety. Your treatment for this is CBT but this is enhanced and supports by a strong therapeutic alliance where your client feel unconditional positive regard, understood and support. Your client trust that you have her best interest in mind and is willing to “get in the ring with you” and do the work collaborativly.
Efficacy vs Effectiveness Research
Efficacy research refers to studies that test whether a treatment works under ideal, controlled conditions such as in a clinical trial, and if it has potentile to be expanded.
Effectiveness research refers to how well the treatment works in “real world” settings, with a broader and diverse population without controlled variables.
- This is important to understand when determing how effective a treatment will be for your clients unique needs.
Ex: To test the efficacy of a new medication for depression, a clinical trial selects particants with no other health conditions to administer a controlled study. While the study showed that the medication did reduce symptoms of depression under these ideal conditions, the medication did not show effectiveness when administered to a diverse set of participants from a mental health clinic who had a multitude of other disorders and stressors.
Empirically Supported Treatments
One of the legs supporting an Evidence Based Practise.
- Gold standard theraputic interventions that have been put through rigorous scientific research.
- Based on clinical trails or studies that demonstration their ability to produce positive outcomes for specific conditions using peer reviewed research and randomized controlled trials.
Important bc ESTs ensure that they are providing the most effective care and improving the liklihood of positive outcomes.
Ex: A therapist wants to find an empirically supported treatment of anorexia-nervosa. Several peer-reviewed journal articles reports statistically significant results in favor of CBT as a treatment for anorexia. The therapist is able to confidently utilize CBT in her treatment plan due to its proven and empirically support research.
Evidence based practice
Remember stool metaphore.
Seat: EBP
Leg 1: Client Assest
Leg 2: Therapist Skills
Leg 3: Empirically Supported Treatments
- EBP is important because it allows clients to receive high quality care that is both scientifically supported and tailored to the clients needs.
Ex: For a client presenting with depression, and EBP would included a review of the clients assest ——- , psychoeducation re the therapist skills in this area, and implimentation of an ESTs that have been proven to work with depressive symptoms ensuring the highest opportunity for positive client outcomes.
Failure to Respond
When a client does not respond to treatment or does not show the expected improvement from a certain treatment
- Important bc it is a sign that the current approach is not appropriate or effective for the client highlighting a need for reassessment, treatment modification, considering comorbitiy or alternative diagnosis as well as a consideration of other external factors that could hinder progres..
- Also need to consider if there is an ethical obligation to refer the client to another therapist.
Ex: Client is being treated for depression using CBT and ACT. Client has not been responding to treatment and is now requesting antidepressent medication. While reviewing the goals of treatment, you discover that you client has not stopped consuming alcohol, even after you discusssed the risk factors associated with depression and drinking. Addtionally, your client has started smoking marijuana daily to “take their mind off things”. You determine that their failure to respond to treatment is due to clieint’s lack of engagement and that a reevaluation of their depressive symptoms is necessary.
Informed Consent for Treatment
Legal and ethical process in which a therapist provides clients with clear information about the nature of therapy, including risks, benefits, and alternatives, enabling clients to make informed decisions about their treatment.
- Crucial for respecting client autonomy and ensuring they
understand what to expect from therapy making them aware of
their rights and any potential risks involved. - Legal necessity to obtain informed consent/assent to protect therapists from liability if issues arise.
Before starting therapy, a therapist explains to a client the therapeutic approach, potential risks (like emotional discomfort) and benefits (reductions in symptoms),
confidentiality policies (also where it must break), right to withdraw from treatment at any time, and details regarding how to schedule and pay for services, making sure to leave time for questions the client may have.
3 requirements must be met for a client:
capacity, comprehension, and voluntarily.
Agreement must with verbal and written with the cilents understanding that they may revoke consent at any time.
Practice Guidelines
Practice Guidelines are recommendations designed to inform and standardize the delvery of care known as “the standard of care”.
- Provides clinicians with guidance on best practices, intervenntions, procedures for diagnosing and treating mental health conditions.
- Put out by organizations such as APA, NICE to ensure ethical practice of mental health professionals
Ex: Clinician with a particularly complex case consults with APA guildliness on how to ethically proceed with treatment for a client presenting with PTSD who also admitted to abusing his romantic partner.
Precipitants of the Problem
Immediate triggers or events that cause or intensifys a clients presenting mental health problem.
- Often external or situations factors that are combined with internal vulnerabilities which promt or escalate symptoms.
Important bc by recognizing precipitants (trigger) therapists can address not only the presenting and underlying issues but also provide guideance on navegate these specific triggering events.
Ex: A client presents with hightened anxiety after a recent breakup which has sent them spirling into feelings of abandonment and insecurity. During session it is reveild that your clients mother took her own life at a young age …… etc…
Problem List
Comprehensive and systematic record of the clients presenting problems, symptoms and converns that were identified during the assessment phase.
- Often contain 5-8 items so as to keep the list manageable for both client and clinician to serve as a roadmap for developing treatment. Problems may be added or removed during treatment.
- Items should be recored in a way as to be measurable
Mechanisms of Action
Mechanisms of action are reasons “why” a treatment works. Each therapy has specific MOAs that explain why and how they are effective for different mental health conditions.
CBT – Works by identifying and modifying negative thought patterns (cognitive restructuring) and encouraging behavioral changes (behavioral activation).
ACT – Promotes psychological flexibility by encouraging acceptance, mindfulness, and values-based actions rather than avoidance of distress.
Exposure Therapy – Reduces fear by repeated exposure to anxiety-provoking stimuli, leading to desensitization and decreased avoidance behaviors.
Dialectical Behavior Therapy (DBT) – Improves emotional regulation through mindfulness, distress tolerance, and interpersonal effectiveness.
Psychodynamic Therapy – Works through insight and emotional processing by exploring unconscious conflicts and past experiences.
Nonadherence
Situation where a client does not follow through with the prescribe treatment plan by any number of actions : not attending session, not following through on activies or exercises, not taking medication as perscribed.
- Could be lack of motivation, misunderstanding of treatment, side effects,
Important to recognize bc nonadherence can significantly derail treatment progress and requires and adjusted to the treatment plan.
Ex: Client is being treated for depression using CBT and ACT. Client has not been responding to treatment and is now requesting antidepressent medication. While reviewing the goals of treatment, you discover that you client has not stopped consuming alcohol, even after you discusssed the risk factors associated with depression and drinking. You determine that their failure to respond to treatment is due to clieint’s lnonadherence of the treatment plan and goals.
Outcome Measures
Assessments used to evaluate the effectiveness of a treatment or intervention taken before, during and after the intervention
- Captures changes in client’s functioning , symptoms, and treatment experiences throughout the course of treatment helping therapist to know if the client is making progress toward their goals.
Important in guiding treatment decisions and help clients recognize their own improvement or where a treatment might benefit from being adjusted.
Ex: A therapist treating a client with GAD will use the GAD-7 scale as an outcome measure to gather date on their anxiety at the begining of treatment and then retest again after 6 weeks of CBT and ACT therapy. IF the GAD-7 score has decrease showing a reducting in anixty symptons the therapist and client can determine that the treatment is effective and to continue on with the current plan.
Origins of Mechanisms
The underlying factors that lead to the development of specific mechanisms.
- Origins are the root of the root cause of clients problems
- Is helpful to determine how and why a particular EST might be effective based on the dysfunction thoughts leading to emotional distress
- Allows the clinician to better understand “why” problems beginning in the first place and to challange those maladaptive thoughts and feelings about oneself
Therapy Interfering Behavior
Actions, attitudes or patterns of behavior that disrupt or prevent a successful theraputice process.
- Either come form client or therapist and get in the way of treatment shutting down the productivity of a session
- Include being late to sessions, continually cancelling, refusal to engage, refusal to acknowledge problem, being non-communicative, therapist being bias, trans/counter-transferance, being unprepaired, not maintaining boundaries.
Important to address this behavior and determine if repairing the relationship or referring out is in the best interst of the client and therapist.
Ex: Dave lies in therapy - still drinks - still cheats - and lies even to his therapist.
Treatment Goals
Specific
Measurable
Acheievable
Relevant
Time Bound
Goals guide the course of therapy.
- Collaboratively developed between the therapist and client as a roadmap for what the client hopes to acheive
Important bc they provide direction and focus for therapy to stay on track, monitor progress and make adjustments as needed. Goals can also inspire and provide hope to the client.
Ex: Client will reduce anxiety symptoms from a 7 to a 4 as evident by the GAD-7 scale score within a 6 week period of time.
Treatment Monitoring
Regular - ongoing assessmenting a client’s progress throughtout the course of therapy by tracking symptoms, behaviors and well-being to ensure that treatment is effective and that goals are being met.
Feedback can be gathered through self-reports, therapist observations, formal assessments and outcome measures.
Important to maintain therapeutic progress to identify necessary adjustments and to ensure that interventions are effective.
Ex: Therapist asked client to complete the PHQ-9 Patient Health Questionnaire during each session to monitor changes in depressive symptoms. Even though the client reports they believe they are feeling better, they still are not engaging in social activies outside of their home indication that ongoing monitoring of symptoms is necessary.
Treatment Plan
A detailed, written document that outlines the goals,
interventions, and strategies for a client’s therapy which serves as a roadmap for treatment.
- Developed collaboratively between the therapist and client and are regularly reviewed and updated as therapy progresses.
- Provides structure and clarity and ensures that the therapeutic process is goal-oriented and tailored to the client’s unique needs.
Important bc it eensures that treatment remains focused and organized, making it easier to track the client’s progress and make data-driven decisions about the next steps.
Key Components:
1. Presenting Problem: A brief description of the client’s issues or symptoms.
2. Treatment Goals: Clear, specific, and measurable objectives to be achieved through
therapy
3. Interventions/Strategies: The specific therapeutic techniques, modalities, and approaches that will be used to address the client’s goals (e.g., CBT, DBT, mindfulness).
4. Timeline: A time frame for achieving goals and the frequency of therapy sessions.
5. Expected Outcomes: Hypothesis / Sescription of the expected results or improvements by the end of treatment.
6. **Client Strengths and Resources: **Identifying
Cinical Example:
A treatment plan for a client with social anxiety might include:
● Presenting Problem: Client experiences excessive fear and avoidance of social situations, impacting work and relationships.
● Treatment Goals:
1. Reduce social anxiety from an 8/10 to a 4/10 on the social anxiety scale in 3 months.
2. Increase participation in social events from 0 to 2 per week within 6 weeks.
● Interventions:
1. Cognitive Behavioral Therapy (CBT) focusing on challenging negative beliefs and cognitive distortions.
2. Gradual exposure to feared social situations.
● Timeline: Weekly sessions for 12 weeks.
● Expected Outcomes: Decreased avoidance behavior, improved self-confidence in social settings.
● Client Strengths: Motivated to work on anxiety, strong support system in family and friends.
