A Format for Case Conceptualisation

Topics: Clinical psychology, Cognition, Concept Pages: 12 (4129 words) Published: March 28, 2013
Many professional and personal challenges confront practicum students as they work with clients. For example, students must establish a counseling relationship, listen attentively, express themselves clearly, probe for information, and implement technical skills in an ethical manner. Those counseling performance skills (Borders & Leddick, 1987) center on what counselors do during sessions. At a cognitive level, students must master factual knowledge, think integratively, generate and test clinical hypotheses, plan and apply interventions, and evaluate the effectiveness of treatment. Those conceptualizing skills, within the cognitive operations used to construct models that represent experience (Mahoney & Lyddon, 1988), show how counselors think about clients and how they choose interventions. It is highly desirable for instructors of practica to have pedagogical methods to promote the development both of counseling performance skills and conceptualizing skills. Such methods should be diverse and flexible to accommodate students at different levels of professional development and with distinct styles of learning (Biggs, 1988; Borders & Leddick, 1987; Ellis, 1988; Fuqua, Johnson, Anderson, & Newman, 1984; Holloway, 1988; Ronnestad & Skovholt, 1993; Stoltenberg & Delworth, 1987). RATIONALE FOR THE FORMAT

In this article, we present a format for case conceptualization that we developed to fill gaps in the literature on the preparation of counselors (Borders & Leddick, 1987; Hoshmand, 1991). Although many existing methods promote counseling performance skills, there are few established methods for teaching students the conceptualizing skills needed to understand and treat clients (Biggs, 1988; Hulse & Jennings, 1984; Kanfer & Schefft, 1988; Loganbill & Stoltenberg, 1983; Turk & Salovey, 1988). We do not discount the importance of counseling performance skills, but we believe that they can be applied effectively only within a meaningful conceptual framework. That is, what counselors do depends on their evolving conceptualization of clients; training in that conceptualization matters. Given the large quantity of information that clients disclose, students have the task of selecting and processing relevant clinical data to arrive at a working model of their clients. Graduate programs need to assist students in understanding how to collect, organize, and integrate information; how to form and test clinical inferences; and how to plan, implement, and evaluate interventions (Dumont, 1993; Dumont & Lecomte, 1987; Fuqua et al., 1984; Hoshmand, 1991; Kanfer & Schefft, 1988; Turk & Salovey, 1988). Although systematic approaches to collecting and processing clinical information are not new, the case conceptualization format presented here, as follows, has several distinguishing features: 1. The format is comprehensive, serving both to organize clinical data (see Hulse & Jennings, 1984; Loganbill & Stoltenberg, 1983) and to make conceptual tasks operational (see Biggs, 1988). The components of the format integrate and expand on two useful approaches to presenting cases that are cited often and that are linked to related literature on supervision: (a) Loganbill and Stoltenberg's (1983) six content areas of clients' functioning (i.e., identifying data, presenting problem, relevant history, interpersonal style, environmental factors, and personality dynamics), and (b) Biggs's (1988) three tasks of case conceptualization (i.e., identifying observable and inferential clinical evidence; articulating dimensions of the counseling relationship; and describing assumptions about presenting concerns, personality, and treatment). In addition, the format makes explicit the crucial distinction between observation and inference, by separating facts from hypotheses. It advances the notion that observations provide the basis for constructing and testing inferences. Thus, the format fosters development of critical thinking that is more deliberate and less...
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