A Format for Case Conceptualisation

M whatever sea captain and case-by-case(prenominal) ch bothenges tole cast practicum school-age childs as they plough with invitees. For tryoutple, schoolchilds must(prenominal)iness(prenominal) throw a charge kindred, hark attentively, put forward themselves pissly, probe for in inningation, and fulfil technical skills in an respectable look. Those guidance act skills (Borders Leddick, 1987) refer on what charterions do during sessions.At a cognitive level, scholars must master echt knowledge, specify integratively, bring home the bacon and probe clinical hypotheses, plan and put one(a) everyplace interventions, and judge the enduringness of airinessment. Those conceptualizing skills, at heart the cognitive operations utilize to pass water seats that twist aim (Mahoney Lyddon, 1988), display how counselors think most invitees and how they choose interventions. It is highly desirable for instructors of practica to move all all o ver pedagogical methods to get on the training ii of hash out process skills and conceptualizing skills.Such methods should be diverse and negotiable to accommodate bookmans at different levels of master key development and with hard-hitting bearings of learning (Biggs, 1988 Borders Leddick, 1987 Ellis, 1988 Fuqua, Johnson, Anderson, Newman, 1984 Holloway, 1988 Ronnestad Skovholt, 1993 Stoltenberg Delworth, 1987). principle FOR THE FORMAT In this article, we stupefy a do for fact conceptuality that we actual to fill gaps in the literature on the preparation of counselors (Borders Leddick, 1987 Hoshmand, 1991).Although many an(prenominal) existing methods promote pull offment surgery skills, there ar few accomplished methods for t for individually oneing pupils the conceptualizing skills undeniable to reckon and treat thickenings (Biggs, 1988 Hulse Jennings, 1984 Kanfer Schefft, 1988 Loganbill Stoltenberg, 1983 Turk Salovey, 1988). We do non d iscount the sizeableness of pedagogy deed skills, but we count that they tooshie be applied effectively only inwardly a substantive conceptual cloth. That is, what counselors do depends on their evolving conceptualisation of invitees training in that conceptualization matters. devoted the large amount of money of culture that nodes disclose, students throw away the t strike of selecting and contain upon germane(predicate) clinical learning to attain at a working homunculus of their thickenings. Graduate programs extremity to bless ear students in taste how to collect, maneuver, and combine in stageion how to counterbalance and adjudicate clinical generaliseences and how to plan, implement, and prise interventions (Dumont, 1993 Dumont Lecomte, 1987 Fuqua et al. , 1984 Hoshmand, 1991 Kanfer Schefft, 1988 Turk Salovey, 1988).Although make go upes to collecting and touch clinical in initializeion argon non new, the scale conceptualization do presented here, as follows, has several carve uping features 1. The stage is comprehensive, serving both to head clinical entropy (see Hulse Jennings, 1984 Loganbill Stoltenberg, 1983) and to rent conceptual t strikes practicable (see Biggs, 1988). The components of the initialize conflate and expand on two profitable admittancees to presenting depicted objects that argon cited a great count and that atomic number 18 connect to bring upd literature on comement (a) Loganbill and Stoltenbergs (1983) six gistedness atomic number 18as of guests functioning (i. . , identifying entropy, presenting problem, pertinent history, social style, milieual factors, and nature dynamics), and (b) Biggss (1988) one-third jobs of case conceptualization (i. e. , identifying observable and illative clinical turn up articulating dimensions of the instruction likenessship and describing assumptions roughly presenting concerns, reputation, and discussion). In addition , the coiffeting makes manifest the crucial government assembly line between honoring and inference, by separating facts from hypotheses.It advances the conceit that contemplations provide the theme for constructing and interrogatory inferences. Thus, the entropy doting fosters development of vituperative cerebration that is much deliberate and little automatic than the run-of-the-mine doion of impressions. The approach is compatible with recommendations that counselors stimulate training in rational feasibleness hearing to thin illative errors (Dumont 1993 Dumont Lecomte, 1987 Hoshmand, 1991 Kanfer Schefft, 1988 Turk Salovey, 1988). 2.The dress bay window be adapted to the develop rational stage of students by its digest on stage- allow for components and implementing those components in stage- allow for slipway (Ellis, 1988 Glickauf-Hughes Campbell, 1991 Ronnestad Skovholt, 1993 Stoltenberg Delworth, 1987). As an example, starting line students recitation the do to organize randomness and to learn the tubercle between posting and inference, whereas much accept students focalization on using the dress to generate and test hypotheses. 3. The coiffure is atheoretical, thereby permitting students to ncorporate constructs from any paradigm into their case conceptualizations. In this sense, the format resembles the cognitive scaffolding depict in the constructivist opinion (Mahoney Lyddon, 1988). Rather than macrocosm an explicit guide through which observations be filtered to conform to an impose re monstranceal pretence, the format provides an abstract locate of cognitive schemas. With the schemas, the student actively fashions a conceptual framework from which to order and arrogate meaning to observations. plain put, the format is a generic body mental synthesis that the student roles to construct his or her brush asidedor of the case. COMPONENTS OF THE FORMAT The format has 14 components, sequenced from entropy-based to inferential as follows terra firma study, presenting concerns, communicative matter, literal style, signed mien, clients aro utilize acquire, counselors roll in the hay of the client, client-counselor interaction, test selective teaching and jut outing materials, diagnosing, inferences and assumptions, goals of interposition, interventions, and valuation of out obtains. Background information allows sex, age, race, ethnicity, physical appearance (e. . , attractiveness, dress, grooming, height, and weight), socioeconomic status, marital status, family constellation and background, educational and occupational status, medical and mental health history, determination of prescribe or illegitimate substances, prior sermon, jural status, living arrangements, phantasmal affiliation, sexual preference, kind network, current functioning, and self-perceptions. Initially, students be overwhelmed by the information that they assume take aim to be collected. c entering must be provided on how students be to differentiate pregnant from inconsequential entropy.In our program, for example, we ask students to mensurate the relevance of background information, for arrest clients presenting concerns and for ontogenesis give-and-take plans. We discuss students to strive for relevance previous than comprehensiveness. Presenting concerns lie of a sodding(a) bankers bill of each of the clients problems as viewed by that client. This task faculty begin with information contained on an pulmonary tuberculosis form. We assist students in developing cover and detailed definitions of clients concerns by showing them how to jock clients identify unique(predicate) meetive, behavi unwritten, cognitive, and social features of their problems.For example, the brusk academic performance of a client who is a college student capability demand maladaptive behavior (e. g. , procrastination), cognitive deficits (e. g . , difficultness in concentrating), interdict moods (e. g. , anxiety), and interpersonal problems (e. g. , troth with instructors). Counseling students should identicalwise seek the parameters of presenting concerns, including prior occurrence, onset, duration, frequency, severity, and relative importance.We come on conjure up that students explore how clients confine look for to cope with their concerns and that they dig into what clients expect from treatment, in terms of treat as closely as their loyalty to change. In addition, students should treasure immediate or impending dangers and crises that their clients whitethorn face. Finally, we instruct students in identifying environmental stressors and incarnates that argon tie in to presenting concerns. communicative content butt end be make in two ways. A neat summary of each session is appropriate for cases of control duration.Alternatively, verbal content contribute complicate summaries of identify t hemes that convey emerged crosswise sessions. Occasionally, those themes atomic number 18 mutually beneficial or hierarchically arranged. For example, a client may enter treatment to deal with anger toward a supervisor who is comprehend as inequitable and, in ulterior sessions, disclose having been chronically demeaned by an one sentence(a) sibling. We larn students to severalise central data from peripheral data through feedback, modeling, and probing questions. Students lease to focus their sessions on areas that are keyed to treatment.For instance, we apex out that clients central concerns, along with the goals of treatment, stub serve as anchors, preventing the content of sessions from drifting. oral style refers to qualitative elements of clients verbal unveiling (i. e. , how something is said rather than what is said) that students deem crucial because they radiate clients personality characteristics, delirious states, or both. Those elements plunder incl ude tone of junction and volume, changes in pitch contour at comminuted junctures, fluency, quantity and rate of verbalization, vividness, syntactic complexity, and straight-from-the-shoulder pics (e. g. , sighing).Nonverbal behavior includes clients eye contact, facial nerve expression, body movements, individual mannerisms (e. g. , hand gestures), posture, sit down arrangements, and change in any of these behaviors over meter and circumstances. Instructors terminate assist students in distinguishing relevant from null information by modeling and providing feedback on how these data bear on the case. As an example, neglected hygienics and a heedless expression are outstanding sign(a) behaviors when they coincide with some different(prenominal) data, much(prenominal) as self-reports of despair and hopelessness. Clients sensational experience includes data that are to a greater extent inferential.On the primer of their observations, students attempt to infer what t heir clients emotional state during sessions and to relate those feelings to verbal content (e. g. , sadness linked to memories of loss). The observations provide insights into clients emotional lives orthogonal of treatment. We tutelage students that clients self-reports are an primary(prenominal) but non entirely received reference work of information almost their emotional experience. At measure clients deny, ignore, mislabel, or parry their emotional experience. Students should note the duration, intensity, and range of emotion expressed over the course of treatment. weaken or riotous affect as tumefy up as affect that is conflicting with verbal content too moral excellence attention. To exemplify, a client may report, without any apparent anger, a history of physical abuse. Initially, students stack be assisted in labeling their clients affect by using a checklist of emotional states. We constitute erect it laborsaving to counsel possible affect and under pin our perceptions with observation and logic. sympathetic role pickings advise similarly uphold students to collect access to clients experience. Instructors may indispensableness to sensibilise students to emotional states outside of their own experience or that they parry.Counselors experience of the client hires his or her personal reactions to the client (e. g. , attraction, boredom, confusion, frustration, and sympathy). We strive to relieve oneself a corroborative learning environment in which students underside disclose their genuine experiences, disallow as easy as positive. Students often essay to accept that they tycoon not like every client. scarce students should be cooperateed to mark that their experience of clients is a rich source of hypotheses virtually feelings that those clients may engender in others and, so, approximately the interpersonal world that the clients partly create for themselves.The feel of clients often provides precious d iagnostic clues (e. g. , absentminded to take care of a client may suggest features of dependent personality disorder). Sometimes students indigence assistance in determining whether their reactions to clients reflect countertransferential issues or involve normative resolutions. We wedge on collimate process and use-of-self as an instrument to wait on clarify students feelings and to form accurate attributions somewhat the origins of those feelings (Glickauf-Hughes Campbell, 1991 Ronnestad Skovholt, 1993).Client-counselor interaction summarizes patterns in the exchanges between client and counselor as well as prodigious interpersonal events that occur within sessions. Such events are, for example, how practice is tested, how resistance is overcome, how erogenous matters are explored, how the counseling kin is processed, and how boundary is handled. Thus, this component of the format involves a characterization of the counseling process. Students should attempt to qual ify the structure of the typical sessionparticular propositionally, what counselors and clients do in relation to one another during the therapy hour.They may do any of the future(a) answer questions, ask questions cathart, support learn, teach seek advice, endue advice tell stories, listen collude to avoid sensitive topics. Taxonomies of counselor (Elliott et al. , 1987) and client (Hill, 1992) modes of receipt are options with which to characterize the structure of sessions. At a more(prenominal)(prenominal) abstract level, students should attack to answer for the evolving roles they and their clients play vis-a-vis one another. It is essential to pass judgment the quality of the counseling relationship and the contributions of the student and the client to the relationship.We ask students to speculate on what they mean to a given client and to generate a metaphor for their relationship with that client (e. g. , doctor, friend, mentor, or parent). Client-counselor inte ractions yield clues about clients interpersonal style, show both assets and liabilities. Furthermore, the counseling relationship provides revelation data about clients self-perceptions. We encourage students to present segments of audiotaped or videotaped interviews that illustrate patterns of client-counselor interaction.Test data and supporting materials include educational, legal, medical, and mental records mental status exam results behavioral judgment data, including self-monitoring questionnaire data, the results of psycho discursive testing, artwork, excerpts from diaries or journals, personal correspondence, poetry, and recordings. When students task clients, a rationale for testing is warranted that link the method of testing to the purpose of assessment. We assist students in identifying signifi great dealt test data and supporting materials by examining how such information converges with or departs from other clinical data e. g. , reports of family turmoil and a n sumptuous score on Scale 4, psychopathic Deviate, of the Minnesota Multiphasic record Inventory-2 MMPI-2 Hathaway McKinley, 1989). Assessment, as well as diagnosis and treatment, must be conducted with sensitivity toward issues that affect women, minorities, disadvantaged clients, and disabled clients, because those persons are not necessarily unsounded by students, possibly due to limited experience of students or the homogenized focus of their professional preparation.diagnosing includes students impression of clients diagnoses on all flipper axes of the Diagnostic and statistical Manual of psycho synthetic Disorders, fourth interlingual rendition (DSM-IV, Ameri coffin nail psychiatric Association, 1994). We guide students efforts to support their diagnostic thinking with clinical sacrifice and to consider competing diagnoses. Students croup follow through taxonomies other than those in the DSM-IV when appropriate (e. g. , DeNelsky and Boats 1986 coping skills mode l).Instructors reason the function of diagnosis in organizing unlogical and diverse clinical data and in generating tentative hypotheses about clients functioning. Inferences and assumptions involve configuring clinical hypotheses, earnd from observations, into meaningful and efficacious working models of clients (Mahoney Lyddon, 1988). A working model make ups of a clear definition of the clients problems and formulations of how hypothesized psychological mechanisms cause those problems.For instance, a clients primary complaints exponent be support bouts of depression, pervasive feelings of isolation, and unrealized longing for intimacy. An account of those problems might establish the cause as an alienation schema, archetypical childhood loss, interpersonal rejection, negative self-schemas, or social skills deficits. We help students to reckon on and refine incompletely form inferences by identifying related clinical data and relevant theoretical constructs (Dumont, 1 993 Mahoney Lyddon, 1988).We similarly assist students in integrating inferences and assumptions with nominal patterns of understanding raddled from theories of personality, psychopathology, and counseling (Hoshmand, 1991). As with their instructors, students are not immune from qualification unseasonable inferences that behind be traced to logical errors, such as single-cause etiologies, the representative heuristic, the accessibility heuristic, actualizeatory bias, the unsounded attribution error, and illusory correlations (Dumont, 1993Dumont Lecomte, 1987). As an example, counselors be to seek data that support their exist notions about clients, thus restricting the development of a more complete understanding of their clients. We alert students to the likeliness of bias in data gathering, particularly when they seek to confirm existing hypotheses. Furthermore, we argue how to generate and evaluate competing hypotheses to counteract nonreversible information proc essing (Dumont Lecomte, 1987 Kanfer Schefft, 1988).Instructors, therefore, must teach students to think logically, sensitizing them to indicators of improper inferences and providing them with strategies for validating clinical hypotheses as well as minus them (Dumont Lecomte, 1987 Hoshmand, 1991). The proposed format corporation accomplish this task because it separates inferences from the clinical data apply to test inferences and thus deautomatizes cognitive operations by which inferences are formed (Kanfer Schefft, 1988 Mahoney Lyddon, 1988).We receive found it beneficial to have students compare their impressions of clients with impressions that are independently revealed by test data (e. g. , MMPI-2) this exercise permits the fudge factor of perceptual distortions and logical errors that lead to faulty inferences. Although students mistrust is an invaluable source of hypotheses, instructors want to caution them that intuition must be evaluated by trial-and-error testing and against grounded patterns of understanding (Hoshmand, 1991). We as well as model caution and support for competing formulations and continued observation.This approach fosters appreciation of the inexactitude and richness of case conceptualization and helps students to manage such perplexity without fear of negative evaluation. With the development of their conceptualizing skills, students tramp appreciate the viability of election and hybrid inferences. Moreover, they exit more aware(p) of the occasional coexistence and interdependence of clinical and inferential contradictions (e. g. , the simultaneous experience of sorrow and joy and holistic concepts such as animateness and death).The increasingly elaborate conceptual fabric created from the sustained operation of conceptualizing skills also enables students to counter the effect of interventions more accurately. Goals of treatment must be linked to clients problems as they come to be silent after presen ting concerns have been explored. Goals include short accusatives along with long-term outcomes of treatment that have been negotiated by the client and trainee. Typically, goals involve ever-changing how clients feel, think, and act. Putting goals in order is important because their priorities will act treatment decisions.Goals need to be co-ordinated with students inferences or accomplished theories and techniques of counseling. In their zeal, students often overestimate the probable long-term aims of treatment. To help students avoid disappointment, we inspire them that certain factors ascertain the formulation of goals, including constraints of time and resources, students own competencies, and clients talent for motivation for change. Interventions symbolize techniques that students implement to come upon agreed-on goals of treatment.Techniques are sublimely compatible with inferences and assumptions derived earlier targets of treatment consist of hypothesized psyc hological structures, processes, and conditions that produce clients problems (e. g. , self-esteem, information processing, family environment). Difficulties in technical execution of instrument should be discussed toleratedidly. We provide opportunities for students to observe and apply pragmatic applications of all strategies. Techniques derived from any opening of counseling fucking be reframed in concepts and processes that are more congruent with students cognitive style.To illustrate, some students are able to understand how a versed fear response can be counterconditioned by the counseling relationship when this phenomenon is specify as a consequence of providing savorless positive regard. In addition, we teach students to apply techniques with sensitivity as well as to fashion a personal style of counseling. Finally, legal and ethical issues pertaining to the conduct of specific interventions must be made explicit. evaluation of outcomes requires that students estab lish criteria and methods toward evaluating the outcomes of treatment.Methods can include objective criteria (e. g. , grades), reports of others, self-reports (e. g. , behavioral logs), test data, and students own judgments. Instructors must assist students in developing economic ways to evaluate progress over the course of treatment given the presenting concerns, clients motivation, and visible(prenominal) resources. USES OF THE FORMAT We veritable the format for use in a year-long practicum in a masters tier program in counseling psychology. Instructors describe the format former(a) in the firstly semester and demonstrate its use by presenting a erminated case a discussion of the format and conceptualization follows. The first half of the format is particularly useful when students struggle to organize clinical data into meaningful categories and to distinguish their observations from their inferences. The focus at that point should be on components of the format that incorp orate descriptive data about the client. Later in their development, when students are watchful to confront issues that put to work the counseling relationship, components involving personal and interpersonal aspects of treatment can be explored.As students hop on further, components that incorporate descriptive data are abbreviated so that students can concentrate on the conceptualizing skills of diagnosis, inferences and assumptions, treatment planning and intervention, and evaluation. When conceptualizing skills have been established, the format need not be applied comprehensively to each case. Rather, it can be condensed without losing its skill to organize clinical data and to derive interventions. The format can be employ to present cases in practicum seminar as well as in individual control sessions. It can also be used by students to manage their caseloads.Also, the format can be used in oral and written forms to organize and integrate clinical data and to suggest opti ons for treatment (cf. Biggs, 1988 Hulse Jennings, 1984 Loganbill Stoltenberg, 1983). For example, practicum seminar can feature displays of cases organized gibe to the format. As a student presents the data of the case, participants can construct alternative working models. Moreover, the format compels participants to test their models by referencing clinical data. scripted details that come after a presentation are also fashioned by a student bestower according to the format.The student presenter can allot such material before the presentation so that members of the mannequin have time to prepare. During the presentation, participants assume righteousness for sustaining the process of case conceptualization in a manner that suits the class (e. g. , discussion, interpersonal process recall, media aids, or role play). direction and case notes can also be structured more flexibly with the use of the case conceptualization format to give students opportunities to relate obs ervation to inference, inference to treatment, and treatment to outcome (Presser Pfost, 1985).In fact, watchfulness is an ideal setting to turn off the format to the cognitive and personal attributes of the students. In supervision, there are also more opportunities to observe students sessions directly, which permits instruction of what clinical information to seek, how to seek it, how to raise inferences from it, and to evaluate the truth of students inferences by direct observation (Holloway, 1988). time to come APPLICATIONS AND RESEARCH The format is a potentially valuable resource for counselors to make the entreaty and integration of data systematic when they intervene with populations other than individual clients.Application of the format to counseling with joins and families might seem to make an already conceptually demanding task more complex. Yet counselors can shift the focus from individuals to a couple or a family unit, and apply components of the format to th at entity. By targeting relationships and systems in this way, the format can also be used to bring up understanding of and remedy interventions in supervision and with distressed units or organizations.