1/27
Looks like no tags are added yet.
Name | Mastery | Learn | Test | Matching | Spaced |
---|
No study sessions yet.
Case Conceptualization
The formulation is a hypothesis about the mechanisms causing and maintaining the patient’s problems.
The therapist uses the formulation (and other information) to develop a treatment plan and obtain the patient’s informed consent to it.
Context is important
Case Conceptualization
Comorbidity
Idiographic vs nomothetic
Functional analysis
Of behavior: Triggers, Consequence (can be a “reinforcer” or “punisher)
Idiographic
Individual traits and experiences
Nomothetic
General traits, laws, and principles
Purpose of Case Conceptualization
To better understand behavior
To increase empathy
To identify ways to engage clients
To identify targets for intervention
To create a shared understanding of a child or adolescent
Goals of Case Conceptualization
Patient story
Obtain understanding of patient’s presenting problems
Identify variables related to difficulties
Identify treatment targets, goals, and objectives
Case Conceptualization - Characteristics
A method and clinical strategy to obtain and organize information about the patient.
Incorporates areas such as learning history, maintaining factors, and presenting problem
Emphasis of factors may differ depending on theoretical orientation
Can work as a “map” or “blueprint” of treatment based on personalized factors
Should continually be updated throughout treatment
Collaborative empiricism
Diagnosis vs. formulation
Diagnosis
Categorical
Useful to quantify outcomes
May help cluster shared symptoms
Easy to use
More reliable than formulation
May ease clinical decision making
Increases familiarity between professionals
Formulation
Dimensional/personalized
May improve clinical decision making/outcomes
Can address shared mechanisms
Why Do We Need Conceptualization?
Why not just follow the manuals?
Even the most efficacious interventions have non-100% success rates
Limitations of clinical trials, RCTS
Why not just really on clinical wisdom?
Therapist judgement is highly fallible (internal and external biases)
Ethics: boundaries of competence
Why not just defer to the patient as the expert on themselves?
Patients don’t seek care if they know what to do and can do it alone
Case Conceptualization Terminology
Biopsychosocial assessment model
Case conceptualization: more broad
Functional analysis: more narrow, part of a case conceptualization
Statistical significance vs. clinical significance
Effect sizes: can lead to determine clinical significance
Meta analyses
Randomized controlled trials (RCT)
Efficacy vs. effectiveness
Efficacy vs. Effectiveness
Efficacy: internal validity
Does it work in a controlled environment?
Effectiveness: external validity
Does it work in the real world?
Most treatments/studies start in an efficacy trial and then move to effectiveness trials.
General Process of Case Conceptualization
Descriptive emphasis
Derived from assessment
Treatment recommendations
Flows directly from assessment, hypotheses, and proposes a treatment plan.
Review and update
Based on additional data, response to treatment.
Data to Help Inform Case Conceptualization
Observations
Clinical interview
Information from sources in client’s life
Psychological tools for assessment
Past records (medical, academic, etc.)
Self-report questionnaires
Self-monitoring
5 Ps
Idiographic framework
Presenting problem
Predisposing factors
Precipitating factors
Perpetuating factors
Protective factors
5 Ps - Presenting Problem
What the patient and clinician identify as difficulties.
5 Ps - Predisposing Factors
Biological, genetic, environmental, psychological, or personality risk factors
5 Ps - Precipitating Factors
Significant events preceding onset of disorder.
5 Ps - Perpetuating Factors
Repeating behavioral, cognitive, or biological patterns that maintain dysfunction.
Focus of CBT
5 Ps - Protective Factors
Strengths and supports.
Examples: friends and family, animals, religion
Case Formulation - SORC Model
Stimuli (e.g., triggers)
Organism factors
Response (e.g., problem behavior)
Consequence
5 Ps vs. SORC
Focus:
5 Ps: Broad bio psychosocial formulation of overall case
SORC Model: Functional analysis of a specific behavior/problem
Strength:
5 Ps: Big-picture understanding of the person’s history, context, and strengths
SORC: Vert practical for identifying and changing specific behaviors
Include Strengths?
5 Ps: Yes, protective factors
SORC: Not explicitly
Common in:
5 Ps: CBT, general clinical/psychiatric assessment, complex cases
SORC: Behavioral/CBT casework, worksheets, behavior plans
Cognitive Model
Cognitive tread: thoughts, feelings, and behaviors
Seek to make thoughts truthful
Challenges to Case Conceptualization
Complex cases
Connecting seemingly different problems
Prioritizing
Time management
Changes in what the patient/client wants to target
Client/patient insight
Client/patient willingness
Client/therapist expectations about therapy
Having hypotheses and refining them
Congruence between your goals and their
Results of Case Conceptualization
Treatment planning
Goal: use case formulation to select appropriate, matched interventions
Basic Structure of Treatment Plan
Treatment target
Objective 1
Goal 1
Goal 2
Objective 2
Goal 1
Goal 2
Example of CBT Treatment Plan Structure
Target: Prevent relapse of depression
Goal 1: Improve relationships with family
Objective 1: Identify clear values/goals relevant to relationships with each family members
Objective 2: Assertiveness skills
Goal 2: Regulate acute emotions well
Objective 1: Enhance emotional awareness and discrimination of emotions
Objective 2: Use cognitive reappraisal
Goal 3: Maintain social activities
Objective 1: Behavioral activation
Ways to Reassess Treatment Plan if it’s not Working
Return to the formulation
Modification in data used to create the formulation
Modification in formulation
Modification in treatment approach to change the targets