Review of Individual case formulation.

Abstract

Individual Case Formulation, by Richard S. Hallam, London, UK: Academic Press Elsevier, 2013, 280 Pages (ISBN: 978-0-12- 398269-8, $48).Reviewed by KIERON O 'CONNORDOI: http://dx.doi.org/1 ft 103 7/a003 7598Why tliis problem? Why now? Why me? Typify the first trilogy of questions that occur to the clinician on presentation of a new case. As Elallam notes in the introduction to his excellent book on Individual Case Formulation, there are very few books detailing how to do individual case formulation (ICF), although the term is in frequent currency. As Elallam points out, ICF is art and craft, a hard won skill, the main stay of the evaluation process, requiring skills and abilities to tease out information, surprises, and con- straints of formulating a client's problem. In tliis relatively short book, Elallam discusses a lot of technicalities and shares his experience of all aspects in the case formulation process of ICF, starting from first principles. Elallam is concerned to balance flexibility and empathy with rigour, pragmatically blending meth- ods to suit the person and situations. Elallam argues for a theoret- ical, but not technical, eclecticism (a blind works ap- proach), and that whatever the ideology, the ICF can be rigorous, impartial, and scientific, with perhaps the exception of psycho- analysis, where so many concepts simply cannot be operational- ized.He is concerned with observational skills and, in particular, open-minded observation, and describes several strategies to en- sure the formation remains patient centered, not therapist centered, such as a sensitivity to small cues and seeking regular feedback. Elis approach is almost phenomenological, bracketing assump- tions, avoiding premature interpretation, and Bayesian in detailing that common clinical sense dictates multiple hypotheses before a client.I also liked the emphasis on treating ICF as a process, gradually evolving as a result of a number of prospective reasoning pro- cesses, in particular, abductive reasoning. Ele considers that ICF should seamlessly blend reasoning and practice. Elallam also deals variously with old chestnuts, such as the role of nonspecific factors, therapist competence, and therapist biases.The highlights for me are the concern to move toward a problem solving, rather than medical, nosology, which, as Elallam notes, is what all practitioners do in practice anyway. Ele offers illuminating asides on pathology as metaphor, and includes a critique of evidence-based randomized controlled trials due to their selectivity and relevance.Perhaps the most useful nuggets are to be found in the guide- lines at the end, where case studies bring the method alive and draw on the author's seminal experience. …