How do Psychotherapists Develop a Case Conceptualisation? Thematic Analysis of Conceptual Maps

Abstract

The purpose of this study was to reconstruct the main ideas—universal but grounded in particular diagnostic experiences—used by psychotherapists during the case conceptualisation process. Authors focus on the process of diagnostic thinking expressed in graphic conceptual maps of a specific case. Two main questions were posed: (1) how do psychotherapists build patient understanding (a model of a patient)? (2) With what conceptual tools (categories, assumptions, ideas) do they think? The sample of fourteen conceptual maps from psychotherapists was used for the study presented here. The psychotherapists who were the authors of fourteen selected maps (years of experience: M = 21.38 years, SD = 13.53; 3 male, 11 female; age: M = 44.71; SD = 13.27) represented various approaches. A thematic analysis framework (Braun & Clarke, 2006) was used. Four major themes were identified across conceptual maps: (1) parental figures are depicted as pivotal; (2) basic assumptions about the “world order” are employed; (3) immersion in the patient’s inner world (or internal phenomena); and (4) maintaining the tolerance of indefiniteness. Joining those themes together shows that assessment for psychotherapeutic purposes proves to be a generally dynamic, hypothetical and adjustable process, but also seems personally engaging and prone to using fixed categories, such as patient’s parents and mental representations of them. Moreover, a psychotherapist’s uncertainty seems not to inhibit the patient’s understanding. This knowledge, based on generalized experience, can be particularly crucial for psychotherapists in monitoring their practice to direct their attention and reflection.