A Format for Case Conceptualisation

Many victor and personalisedised challenges confront practicum scholars as they work with guests. For example, scholars mustiness(prenominal) run aground a charge kind, take cargon attentively, express themselves clformer(a), probe for in arrangeion, and implement good skills in an honorable sort. Those counsellor work skills (Borders & Leddick, 1987) c make do to on what counselors do during sessions.At a cognitive level, bookmans must master actual knowledge, think integratively, generate and visitation clinical hypotheses, plan and pass interventions, and prize the intensity level of interposition. Those conceptualizing skills, within the cognitive operations utilize to construct casts that represent take in (Mahoney & Lyddon, 1988), utter how counselors think virtually guests and how they choose interventions. It is exceedingly desirable for instructors of practica to induce pedagogical methods to get ahead the culture both(prenominal) of couns el work skills and conceptualizing skills.Such methods should be diverse and flexible to beseem students at different levels of professional ontogeny and with distinct styles of accomplishment (Biggs, 1988 Borders & Leddick, 1987 Ellis, 1988 Fuqua, Johnson, Anderson, & Newman, 1984 Holloway, 1988 Ronnestad & Skovholt, 1993 Stoltenberg & Delworth, 1987). RATIONALE FOR THE selective info putting In this article, we present a fix up for skid preparation that we demonstrable to hold gaps in the literature on the conceptualisation of counselors (Borders & Leddick, 1987 Hoshmand, 1991).Although many existing methods incite charge performance skills, in that location argon a few(prenominal) established methods for t each(prenominal)ing students the conceptualizing skills conducted to record and treat customers (Biggs, 1988 Hulse & Jennings, 1984 Kanfer & Schefft, 1988 Loganbill & Stoltenberg, 1983 Turk & Salovey, 1988). We do non ignore the importance of counseling pe rformance skills, further we believe that they sack be utilise effectively only within a meaningful conceptual good example. That is, what counselors do depends on their evolving formulation of leaf nodes training in that conceptualization matters.Given the large quantity of in in pution coiffetingion that clients stag, students return the task of selecting and touch on germane(predicate) clinical in doion to arrive at a working model of their clients. Graduate architectural plans assume to assist students in intellectual how to collect, organize, and unify in initialiseion how to form and running clinical inferences and how to plan, implement, and mensurate interventions (Dumont, 1993 Dumont & Lecomte, 1987 Fuqua et al. , 1984 Hoshmand, 1991 Kanfer & Schefft, 1988 Turk & Salovey, 1988).Although systematic come outes to collecting and swear outing clinical in changeion atomic number 18 non new, the result conceptualization initialise presented here, as follows , has some(prenominal) distinguishing features 1. The format is comprehensive, serving both to organize clinical data (see Hulse & Jennings, 1984 Loganbill & Stoltenberg, 1983) and to consider conceptual tasks operational (see Biggs, 1988). The components of the format integrate and expand on two enforceable approaches to presenting exercises that atomic number 18 cited much and that are link up to yoked literature on command (a) Loganbill and Stoltenbergs (1983) six content areas of clients functioning (i. . , identifying data, presenting problem, germane(predicate) report, interpersonal style, environmental factors, and personality dynamics), and (b) Biggss (1988) three tasks of case conceptualization (i. e. , identifying observable and illative clinical endorse articulating dimensions of the counseling kindred and describing assumptions closely presenting concerns, personality, and treatment). In addition, the format makes clear the crucial promissory course surrounded by manifestation and inference, by separating facts from hypotheses.It advances the notion that thoughtfulnesss provide the earth for constructing and scrutiny inferences. Thus, the format fosters using of diminutive thinking that is more than than deliberate and little automatic than the ordinary formation of impressions. The approach is compatible with recommendations that counselors receive training in rational hypothesis assaying to cut illative errors (Dumont 1993 Dumont & Lecomte, 1987 Hoshmand, 1991 Kanfer & Schefft, 1988 Turk & Salovey, 1988). 2.The format mickle be adapted to the developmental stage of students by its charge on stage- inhibit components and implementing those components in stage- enchant slipway (Ellis, 1988 Glickauf-Hughes & Campbell, 1991 Ronnestad & Skovholt, 1993 Stoltenberg & Delworth, 1987). As an example, beginning students use the format to organize information and to learn the distinction between observation and inferenc e, whereas more go through students cogitate on exploitation the format to generate and test hypotheses. 3. The format is atheoretical, thereby permitting students to ncorporate constructs from any paradigm into their case conceptualizations. In this sense, the format resembles the cognitive scaffolding exposit in the constructivist perspective (Mahoney & Lyddon, 1988). Rather than be an explicit template through which observations are filtered to conform to an imposed re debutal model, the format provides an abstract set of cognitive schemas. With the schemas, the student actively makes a conceptual framework from which to order and assign meaning to observations.Simply put, the format is a generic structure that the student uses to construct his or her reality of the case. COMPONENTS OF THE fix up The format has 14 components, sequenced from observational to inferential as follows screen background data, presenting concerns, communicative content, verbal style, nonverbal behavior, clients emotional screw, counselors reckon of the client, client-counselor interaction, test data and provideing materials, diagnosing, inferences and assumptions, goals of treatment, interventions, and evaluation of outcomes. dry land data accepts 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, use of prescribed or illicit substances, former treatment, legal status, living arrangements, religious affiliation, intimate preference, social network, current functioning, and self-perceptions. Initially, students are overwhelmed by the data that they assume undeflectableness to be collected. Guidance must be provided on how students are to differentiate meaningful from inconsequent information.In our program, for example, we ask students to label the relevance of b ackground data, for instinct clients presenting concerns and for developing treatment plans. We notify students to ex bunk to for relevance rather than comprehensiveness. Presenting concerns make up of a thorough account of each of the clients problems as viewed by that client. This task baron begin with information contained on an use of goods and services form. We assist students in developing cover and detailed definitions of clients concerns by showing them how to champion clients identify precise fixive, behavi oral exam, cognitive, and interpersonal features of their problems.For example, the measly academic performance of a client who is a college student mogul collect maladaptive behavior (e. g. , procrastination), cognitive deficits (e. g. , problem in concentrating), proscribe moods (e. g. , anxiety), and interpersonal problems (e. g. , involvement with instructors). Counseling students should too look the parameters of presenting concerns, including f ormer numberrence, onset, duration, frequency, severity, and relative importance.We further suggest that students explore how clients exact attempted to cope with their concerns and that they project what clients expect from treatment, in scathe of service as easily as their cargo to mixture. In addition, students should valuate immediate or impending dangers and crises that their clients whitethorn face. Finally, we instruct students in identifying environmental stressors and supports that are cerebrate to presenting concerns. literal content buns be organized in two ways. A laconic summary of each session is appropriate for cases of limited duration.Alternatively, verbal content target include summaries of identified themes that have emerged across sessions. Occasionally, those themes are inter drug-addicted or hierarchically arranged. For example, a client may enter treatment to deal with anger toward a supervisor who is perceived as raw and, in later sessions, d isclose having been inveterate demeaned by an older sibling. We inculcate students to sort central data from peripheral data through feedback, mannikin, and probing questions. Students expect to focus their sessions on areas that are keyed to treatment.For instance, we establish out that clients focal concerns, along with the goals of treatment, sight serve as anchors, preventing the content of sessions from drifting. verbal style refers to qualitative elements of clients verbal showing (i. e. , how something is said rather than what is said) that students deem momentous because they reflect clients personality characteristics, emotional states, or both. Those elements cornerstone include tone of component part and volume, changes in modulation at detailed junctures, fluency, quantity and rate of verbalization, vividness, syntactic complexity, and outspoken characterizations (e. g. , sighing).Nonverbal behavior includes clients eye contact, facial expression, clay movem ents, idiosyncratic mannerisms (e. g. , hand gestures), posture, seating arrangements, and change in any of these behaviors over eon and circumstances. Instructors good deal assist students in distinguishing relevant from un primal information by modeling and providing feedback on how these data bear on the case. As an example, neglected hygiene and a listless expression are important nonverbal behaviors when they coincide with early(a) data, much(prenominal) as self-reports of despair and hopelessness. Clients emotional experience includes data that are more inferential.On the background of their observations, students attempt to infer what their clients feel 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 outside of treatment. We wariness students that clients self-reports are an important but not entirely reliable source of information close their emo tional experience. At cadences clients deny, ignore, mislabel, or misrepresent their emotional experience. Students should note the duration, intensity, and range of emotion expressed over the course of treatment.Blunted or excessive discover as healthy as instill that is discrepant with verbal content also merit attention. To embellish, a client may report, without any apparent anger, a history of physical abuse. Initially, students post be aided in labeling their clients affect by using a checklist of emotional states. We have fix it serveful to suggest possible affect and support our perceptions with observation and logic. Empathic percentage taking bottomland also help students to gain access to clients experience. Instructors may need to sensitize students to emotional states outside of their give birth experience or that they avoid.Counselors experience of the client involves his or her personal reactions to the client (e. g. , attraction, boredom, confusion, fru stration, and sympathy). We strive to establish a supportive education environment in which students shtup disclose their genuine experiences, negative as soundly as positive. Students often struggle to pass judgment that they dexterity not like every(prenominal) client. But students should be helped to recognize that their experience of clients is a rich source of hypotheses active feelings that those clients may engender in opposites and, thus, swell-nigh the interpersonal world that the clients partially pull in for themselves.The feel of clients often provides blue-chip diagnostic clues (e. g. , wanting to take care of a client may suggest features of dependent personality disorder). Some durations students need help in ascertain whether their reactions to clients reflect countertransferential issues or involve normative retorts. We draw on parallel process and use-of-self as an agent to help clarify students feelings and to form perfect attributions about the or igins 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 signifi hatfult interpersonal events that occur within sessions. Such events are, for example, how trust is tested, how impedance is overcome, how sensitive matters are explored, how the counseling family is processed, and how termination is handled. Thus, this component of the format involves a characterization of the counseling process. Students should attempt to dispose the structure of the typical sessionspecifically, what counselors and clients do in relation to one some other during the therapy hour.They may do any of the by-line answer questions, ask questions cathart, support learn, teach try out advice, give advice tell stories, hear collude to avoid sensitive topics. Taxonomies of counselor (Elliott et al. , 1987) and client (Hill, 1992) modes of response are resources with wh ich to characterize the structure of sessions. At a more abstract level, students should try to describe the evolving roles they and their clients see vis-a-vis one another. It is essential to assess 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 interactions yield clues about clients interpersonal style, revealing both assets and liabilities. Furthermore, the counseling relationship provides revealing 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 psychological records mental status exam results behavioral assessment data, including self-monitoring questionnaire data, the results of psychological testing, artwork, excerpts from diaries or journals, personal correspondence, poetry, and recordings. When students assess clients, a rationale for testing is warranted that links the method of testing to the decide of assessment. We assist students in identifying signifi usher outt test data and supporting materials by examining how much(prenominal) information converges with or departs from other clinical data e. g. , reports of family turmoil and an elevated stigmatize on Scale 4, Psychopathic Deviate, of the atomic number 25 Multiphasic Personality Inventory-2 MMPI-2 Hathaway & McKinley, 1989). Assessment, as well as diagnosis and treatment, must be conducted with esthesia toward issues that affect women, minorities, disadvantaged clients, and disabled clients, because those persons are not necessarily understood by students, perhaps due to limited experience of students or the homogenized focus of t heir professional preparation.Diagnosis includes students impression of clients diagnoses on all v axes of the Diagnostic and Statistical Manual of genial Disorders, fourth edition (DSM-IV, American psychiatrical Association, 1994). We guide students efforts to support their diagnostic thinking with clinical evidence and to consider competing diagnoses. Students can apply taxonomies other than those in the DSM-IV when appropriate (e. g. , DeNelsky and Boats 1986 coping skills model).Instructors stage the function of diagnosis in organizing scattered and diverse clinical data and in generating tentative hypotheses about clients functioning. Inferences and assumptions involve configuring clinical hypotheses, come downd from observations, into meaningful and expedient working models of clients (Mahoney & Lyddon, 1988). A working model consists of a clear definition of the clients problems and formulations of how hypothesized psychological mechanisms pay off those problems.For ins tance, a clients primary complaints might be frequent bouts of depression, pervasive feelings of isolation, and unrealised longing for intimacy. An account of those problems might establish the cause as an alienation schema, early childhood loss, interpersonal rejection, negative self-schemas, or social skills deficits. We help students to elaborate on and refine incompletely organize inferences by identifying related clinical data and relevant theoretical constructs (Dumont, 1993 Mahoney & Lyddon, 1988).We also assist students in integrating inferences and assumptions with formal patterns of conceiveing draw from theories of personality, psychopathology, and counseling (Hoshmand, 1991). As with their instructors, students are not immune from making bad inferences that can be traced to logical errors, such as single-cause etiologies, the representative heuristic, the availability heuristic, avowatory bias, the ingrained attribution error, and illusory correlations (Dumont, 19 93Dumont & Lecomte, 1987). As an example, counselors tend to seek data that support their preexistent notions about clients, thus restricting the development of a more complete understanding of their clients. We alert students to the likelihood of bias in data gathering, peculiarly when they seek to confirm existing hypotheses. Furthermore, we demonstrate how to generate and evaluate competing hypotheses to counteract biased information processing (Dumont & Lecomte, 1987 Kanfer & Schefft, 1988).Instructors, therefore, must teach students to think logically, sensitizing them to indicators of awry(p) inferences and providing them with strategies for validating clinical hypotheses as well as disconfirming them (Dumont & Lecomte, 1987 Hoshmand, 1991). The proposed format can accomplish this task because it separates inferences from the clinical data utilise to test inferences and thus deautomatizes cognitive operations by which inferences are formed (Kanfer & Schefft, 1988 Mahoney & Lyddon, 1988).We have 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 cash in ones chips to faulty inferences. Although students intuition is an invaluable source of hypotheses, instructors need to caution them that intuition must be evaluated by empirical testing and against grounded patterns of understanding (Hoshmand, 1991). We also model caution and support for competing formulations and continued observation.This approach fosters appreciation of the inexactness and richness of case conceptualization and helps students to make do such uncertainty without fear of negative evaluation. With the development of their conceptualizing skills, students can appreciate the viability of choice and hybrid inferences. Moreover, they become more alert of the occasional coexistence and interdepende nce of clinical and inferential contradictions (e. g. , the simultaneous experience of sorrow and delectation and holistic concepts such as animateness and death).The increasingly elaborate conceptual framework created from the sustained application of conceptualizing skills also enables students to shout the effect of interventions more accurately. Goals of treatment must be linked to clients problems as they come to be understood after presenting concerns have been explored. Goals include short-term objectives along with long-run outcomes of treatment that have been negotiated by the client and trainee. Typically, goals involve changing how clients feel, think, and act. Putting goals in order is important because their priorities will captivate treatment decisions.Goals need to be incorporated with students inferences or established theories and techniques of counseling. In their zeal, students often overestimate the probable long-term aims of treatment. To help students avoi d disappointment, we remind them that certain factors process the formulation of goals, including constraints of time and resources, students own competencies, and clients competency for motivation for change. Interventions comprise techniques that students implement to strain agreed-on goals of treatment.Techniques are ideally compatible with inferences and assumptions derived earlier targets of treatment consist of hypothesized psychological structures, processes, and conditions that produce clients problems (e. g. , self-esteem, information processing, family environment). Difficulties in technical carrying into action should be discussed candidly. We provide opportunities for students to advert and practise pragmatic applications of all strategies. Techniques derived from any guess of counseling can be reframed in concepts and processes that are more congruent with students cognitive style.To illustrate, some students are able to understand how a learned fear response can be counterconditioned by the counseling relationship when this phenomenon is defined as a consequence of providing unconditional 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 establish 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 efficient ways to evaluate proficiency over the course of treatment given the presenting concerns, clients motivation, and available resources. USES OF THE FORMAT We developed the format for use in a year-long practicum in a masters degree program in counseling psychology. Instructors describe t he format early in the first 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 helpful 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 incorporate descriptive data about the client. Later in their development, when students are prepared to confront issues that influence the counseling relationship, components involving personal and interpersonal aspects of treatment can be explored.As students mature 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 use comprehensivel y to each case. Rather, it can be condensed without losing its ability to organize clinical data and to derive interventions. The format can be utilize 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 options for treatment (cf. Biggs, 1988 Hulse & Jennings, 1984 Loganbill & Stoltenberg, 1983). For example, practicum seminar can feature debuts of cases organized check 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. pen details that accompany a presentation are also fashioned by a student presenter according to the format.The student presenter can address such material before the presentation so that members of the class have time to prepare. During the presentation, participants assume responsibility 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). Supervision and case notes can also be structured more flexibly with the use of the case conceptualization format to give students opportunities to relate observation to inference, inference to treatment, and treatment to outcome (Presser & Pfost, 1985).In fact, lapse is an ideal setting to tailor the format to the cognitive and personal attributes of the students. In control, 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 extract inferences from it, and to evaluate the veracity of students inferences by direct observation (Holloway, 1988). FUTURE APPLICATIONS AND search The format is a potentially valuable resource for counselors to make the collection and integrating of data systematic when they intervene with populations other than individual clients.Application of the format to counseling with lucifers 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 that entity. By targeting relationships and systems in this way, the format can also be used to leaven understanding of and improve interventions in supervision and with distressed units or organizations.Although research has been conducted on how counselors collect data, few studies have investigated how counselors process information when testing hypotheses (e. g. , Strohmer, Shivy, & Chiodo, 1990). Empirical evidence of the effectiveness of various approaches to the conceptual training of counselors is long overdue. Avenues of inquiry include determining whether the format contributes to the acquisit ion of conceptualizing skills and to facilitative conditions and techniques Thai may be mediated by such skills (e. . , empathy and clear communication). There are several written measures available with which to evaluate students conceptualizing skills. Examples of those measures are the Clinical Assessment Questionnaire (Holloway & Wolleat, 1980) Intentions tilt (Hill & OGrady, 1985) and Written Treatment Planning fashion model (Butcher, Scofield, & Baker, 1985). Interpersonal process recall of audiotaped and videotaped sessions, case notes (Presser & Pfost, 1985), and direct observation can also be used.Other promising directions for research include comparing the effect of the format with other approaches to training, isolating components of the format that produce the sterling(prenominal) gains in conceptualizing skills, and determining the outcomes when the format is utilize with the use of different instructional strategies and with students at varying levels of developm ent. Finally, investigation into how the format produces cognitive and performance gains would be valuable, particularly if corporate with literature on cognitive development and effective learning strategies.Nonetheless, the format has several limitations. Although students will eventually learn to apply the format more efficiently in their professional practice, it remains cumbersome and time consuming. Explicit and comprehensive application of the format in supervision and in the moment management of individual caseloads is particularly awkward. In those contexts, the format must be applied tacitly as a heuristic, with specific components used more deliberately when obstacles to progress are encountered.For example, focus on a clients affective experience can promote accurate empathy in the student and lead to more helpful interventions. Moreover, given the differences in the cognitive development of students (Biggs, 1988 Borders & Leddick, 1987 Ellis, 1988 Fuqua et al. , 1984 Ronnestad & Skovholt, 1993 Stoltenberg & Delworth, 1987), the format cannot be applied rigidly or uniformly as a pedagogical tool. author students and those who think in simple, concrete ground seem to profit most from learning environments in which instructors provide direction, expertise, feedback, structure, and support.Conversely, more experience students and those who think in complex, abstract terms learn more readily when instructors fashion autonomous, collegial, flexible, and interactive environments (Ellis, 1988 Glickauf-Hughes & Campbell, 1991 Ronnestad & Skovholt, 1993 Stoltenberg & Delworth, 1987). Hence, the format must be applied creatively and tailored to students capabilities, to avoid needless discouragement, boredom, or threats to personal integrity (Fuqua et al. , 1984 Glickauf-Hughes & Campbell, 1991 Ronnestad & Skovholt, 1993 Stoltenberg & Delworth, 1987)