Case Formulation Research Articles

Case formulation-A vehicle for change? Exploring the impact of cognitive behavioural therapy formulation in first episode psychosis: A reflexive thematic analysis.

Formulation is considered a fundamental process of cognitive behavioural therapy for psychosis (CBTp). However, an exploration into the personal impact of different levels of case formulation (CF) from a service user (SU) perspective is lacking, particularly for those experiencing a first episode of psychosis. This Big Q qualitative design used semi-structured interviews. Reflexive thematic analysis (TA) was used to analyse 10 participant interviews. NVivo 12 computer-assisted qualitative data analysis software aided data organisation and analysis. One overarching theme 'CF - A vehicle for change?' was developed as a pattern of shared meaning across the data set. Three main themes related to the overarching theme: (1) Vicious cycles: 'I never really thought about it being me maintaining the problems' (including one subtheme - Self-empowerment: 'Only you can make the changes for yourself'); (2) Early life experiences: 'My experiences have shaped the person that I am, therefore, it's not my fault' (including one subtheme - Disempowerment: '[My] core beliefs have been damaged'); and (3) Keep it simple: 'Don't push it too far over the top in case it becomes like spaghetti'. Maintenance formulations may be experienced as self-blaming, but also self-empowering, which may help to facilitate change. Longitudinal formulations may be experienced as non-blaming, but also disempowering, which may inhibit change. Simple CF diagrams may also facilitate change, whereas overly complex CFs may inhibit change. How CBTp therapists might look to improve the impact of different levels of CF for service users (SUs) in first episode psychosis (FEP) are described.

Acceptance and Commitment Therapy for Social Anxiety Disorder in Adolescence: Preliminary Appraisal Based on a Case Study Approach

Social anxiety disorder (SAD) is characterized by marked and persistent fear in social situations in which one may be exposed and/or anticipates being exposed to external evaluation and in which embarrassment/humiliation may occur. Acceptance and Commitment Therapy (ACT) has been showing promising results in several disorders, including adult SAD. Considering this evidence and given that adolescence is typically the age of onset for SAD, we developed the ACT@TeenSAD, which is a manualized approach to adolescent SAD delivered via videoconference. It encompasses 10 weekly, 90-minute sessions targeting core pathological processes and fostering higher levels of psychological flexibility; it also includes two booster sessions. The current work illustrates the case conceptualization and therapeutic trajectory of a 17-year-old adolescent (Josie; pseudonym) with a 5-year history of SAD that underwent the ACT@TeenSAD. During the course of the intervention, Josie found purpose and learned life skills to cope with adversity, especially in socially relevant situations. This aligns with the pre- to post-intervention progress shown by Josie (using the Reliable Change Index), particularly in measures assessing acceptance, psychological inflexibility, and self-reported social anxiety. Josie’s case study gives preliminary evidence of the acceptability and feasibility of the ACT@TeenSAD, making it a helpful tool for therapists to become familiarized with. The current work also discusses the limitations of the intervention and presents practical challenges and suggestions thought to be useful for therapists.

A psychodynamic case formulation of a woman with an unresolved oedipal conflict: an analysis with a cultural perspective

Case formulation is a crucial component in the process of working with a client in psychotherapy. The client presented in the current work was troubled mainly by her fear of contamination and persisting difficulties in romantic relationships. Using psychodynamic conceptualisation, the formation of her symptoms can be explained by taking a close examination of her defence mechanisms, object relations, and oedipal conflict that have been repressed in her unconscious and revealed through her dreams. Clients who have not had their oedipal conflict properly addressed are likely to be fixated at the oedipal stage and to continue carrying these unspoken yet intricate feelings into their love life and marriage, which may cause continuing inner disturbance, mental symptoms, and difficulties in personal life. Moreover, in modern times, Chinese traditional cultural beliefs in gender roles and family dynamics still play a significant role in a woman's identity formation, which, if not properly addressed, is likely to impede her readiness to enter into romantic relationships.

Schema therapy for patients with borderline personality disorder and comorbid alcohol dependence: A multiple-baseline case series design study.

This study tested the effectiveness of schema therapy (ST) for borderline personality disorder (BPD) and comorbid alcohol dependence (AD). Twenty patients participated in a case series study with multiple baselines. The baseline phase consisted of treatment as usual. It was followed by a case conceptualization phase, an experiential techniques phase and a behavioural change phase. Patients showed a significant decrease in BPD and AD symptoms; change was mainly accomplished in the experiential techniques phase, with medium to large effect sizes. Three months after termination of therapy, 68% of the patients had remitted from BPD, and the number of drinking days decreased clearly. This study shows that, although treatment is challenging in this group of patients, meaningful change can be obtained in patients with BPD and AD using ST.

Individual Psychology in 2023

Individual Psychology in 2023 Jon Sperry and Len Sperry We are most pleased to share this open issue with you. This issue consists of five noteworthy articles that offer clinical and theoretical applications of Individual Psychology. These editors' notes were written during an unprovoked invasion of Ukraine. As the war rages on, many of our Adlerian colleagues have embodied the spirit of social interest by housing Ukrainian refugees, offering counseling services to Ukrainians in need of mental health services, and donating funds for various essential items. We are hopeful that the Adlerian community will continue to find ways to support and contribute to those experiencing unnecessary suffering and who are geographically displaced by this war. This issue begins with an article titled "Freud's Disavowal of Adler and Adler's Subsequent Influence on Psychoanalytic Thought," by Richard Watts, Noah Thorne, and Marina Bluvshtein. This article is particularly meaningful, as its original version was written by Richard Watts while he was a doctoral student. He informed us that this will be his last publication because of his current health status. As editors, we are beyond grateful to Richard for his various articles, conference presentations, and other contributions to this theory. The next article, by Shantell A. Johnson, Natalie Noble, Lily Slavin, and Timothy Hartshorne, offers a wonderful contribution to the CHARGE and Individual Psychology literature in "Fathers and CHARGE Syndrome: Impact on the Life Tasks." The authors present their study that examined how 93 fathers of children with CHARGE syndrome experience the life tasks. They examined the challenges and resiliency of the fathers faced with parenting a child with this rare genetic condition. Len Sperry's article, "Adlerian Case Conceptualization and Therapy: The Pattern-Focused Approach," compares his pattern-focused case conceptualization and psychotherapy approach to the more common way in which Adlerian therapy is conceptualized and practiced. Described are the [End Page 423] clinical value, indications and counterindications, and the evidence base of this new approach. Then case material illustrates similarities and differences between the approaches. Calvin Armerding presents a timely article, "Contemptuous Political Partisanship: An Adlerian Conceptualization and Call to Action." The increasing ideological polarization in the United States and around the globe makes political compromise or cooperation seem almost impossible. Armerding conceptualizes this sociopolitical trend with an Adlerian framework and also proposes that Adlerians must model healthy political engagement by engaging in Gemeinschaftsgefühl in political discourse with one another and their respective communities. The final article, by Philip Davis, an internal medicine physician, reviews an article written by Rudolf Dreikurs in 1934 that highlighted the mind–body connection for a patient with gastrointestinal symptoms and psychological symptoms. Davis's article, "Rudolf Dreikurs Speaking Truth Across the Ages," identifies the present-day relevance of Dreikurs's original article in his daily practice, particularly with patients experiencing gastrointestinal symptoms. [End Page 424] Copyright © 2022 University of Texas Press

Evaluating the ICF Framework as a Model of Community Participation for People with Disabilities

<h3>Research Objectives</h3> To evaluate ICF constructs (demographic covariates, impairment-related symptoms, functional disabilities, contextual factors)as predictors of community participation in a sample of individuals with chronic health conditions and disabilities living in the community <h3>Design</h3> Survey: an abbreviated ICF measurement battery was designed to assess high-order descriptors. A hierarchical regression analysis was conducted. <h3>Setting</h3> General community. <h3>Participants</h3> A convenient sample of 952 people with disabilities and over 18 years of age were recruited via Amazon Mechanical Turk. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Main outcome is level of Community participation. It is assessed by Wisconsin Community Participation Scale, which includes 12 meaningful roles. Final score is calculated based on the perceived importance and participation level of each role. <h3>Results</h3> Older age, low income, higher functional disability were negatively associated with community participation. Married, educated, hope, core self-evaluation. positive social support and environmental were positive predictors of community participation. These predictors accounted for 48% (R^2 = .48, f^2 = .92) of the variance in community participation scores (a large effect size). The results support the utility of the ICF as a model of community participation for people with chronic health conditions and disabilities. <h3>Conclusions</h3> Findings of the present study: (1) underscored the significant negative effect of functional disability on community participation; (2) provide strong empirical evidence to support the use of the ICF model of community participation as a theoretical model for case conceptualization, assessment, treatment plan development, and selection of empirically supported interventions to help people with chronic health conditions and disabilities continue to assume meaningful life roles in the community during and after the health crisis. <h3>Author(s) Disclosures</h3> The author has no conflict of interest

Tail Redundancy and its Characterization of Compression of Memoryless Sources

We formalize the tail redundancy of a collection of distributions over a countably infinite alphabet, and show that this fundamental quantity characterizes the asymptotic per-symbol minimax redundancy of universally compressing sequences generated i.i.d. from a collection P of distributions over a countably infinite alphabet. Contrary to the worst case formulations of universal compression, finite single letter minimax (average case) redundancy of P does not automatically imply that the expected minimax redundancy of describing length-n strings sampled i.i.d. from P grows sublinearly with n. Instead, we prove that universal compression of length-n i.i.d. sequences from P is characterized by how well the tails of distributions in P can be universally described, showing that the asymptotic per-symbol redundancy of i.i.d. strings is equal to the tail redundancy.

The Plan Formulation Method from Control Mastery Theory and Management of Countertransference.

The aim of this article is to show how the plan formulation method (PFM), an empirically validated method for case formulation based on control mastery theory (CMT), can help clinicians make sense of and use what they feel during sessions to better understand and treat their patients. We give a brief overview of the main psychoanalytic conceptions about countertransference, provide a brief introduction to CMT, and describe the concept of the plan and the PFM. We then show, using several brief clinical examples, how the components of the plan (patient's goals, pathogenic beliefs, traumas, tests, and insights) may help understand clinicians' in-session feelings.

예비전문상담교사 교육실습 개선을 위한 델파이 연구

Purpose: The purpose of this study was to explore the contents of the educational practicum required for pre-service professional counseling teachers, its problems, and its improvement from the perspective of the professional counseling teachers in the school field, which can present an effective operation plan for the educational practicum. Methods: For this research purpose, we selected fifteen professional counselors working at various school levels as an expert panel and collected their opinions through three Delphi surveys. Results: The research results are as follows. The contents of the training practicum for pre-service school counselors proposed by the Delphi expert panel include training on transfer procedures to external organizations, education &amp; guidance for parents and teachers, promotion &amp; planning of Wee-Class events, counseling case conceptualization, guidance on how to write a counseling log, and planning and operation of peer counseling clubs. In addition, the current educational practicum problems include the absence of a manual or curriculum for educational practice, ethical issues that arise when entrusting various types of counseling to trainees, non-payment of tutors' allowances during training, and difficulties in obtaining the consent of clients and their parents during counseling practice for educational trainees. Conclusion: We suggest that it is necessary to develop a training manual and curriculum for pre-service school counselors in order to improve the current educational practicum. In order to make a more effective educational practicum system, it is also necessary to listen carefully to the diverse voices of professional counseling teachers in the field and to actively reflect their opinions in the practicum. Through this, we hope that the educational practicum for pre-service professional counseling teachers will be continuously improved in a direction that is helpful to the enhancement of the practical competencies of trainees.

An exploratory investigation of schema modes in social anxiety disorder: Empirical findings and case conceptualization.

Current "gold standard" treatments for social anxiety disorder (SAD) are limited by the limited emphasis of key etiological factors in conceptualization, and many individuals with SAD experience residual symptoms posttreatment. Hence, the novel application of the Schema Therapy Mode Model may provide a helpful framework for extending clinical understanding and treatment options for SAD. This exploratory study aimed to investigate the presence and pattern of schema modes among SAD individuals. Forty individuals with SAD completed questionnaire measures of symptomatology, social anxiety-relevant cognitions, schema modes, childhood trauma, and parental style. Key maladaptive schema modes identified in SAD were Vulnerable Child, Punitive Critic, Demanding Critic, Compliant Surrender, and Detached Self-Soother. Outcomes provide the basis for a proposed schema mode case conceptualization for SAD and are hoped to provide a rationale for testing the applicability of Schema Therapy as a novel treatment for SAD. Key limitations are discussed.

Pain dynamics: an integrative roadmap for navigating through the experiential process

ABSTRACT The authors present a theoretical integrative model of pain-dynamics for the categorization and transformation of emotional pain in person-centered and experiential psychotherapies. Integrating data from research literature and clinical work, the model distinguishes between three types of emotional pain: basic emotional pain, relational pain, and self-pain. The authors show how each type of emotional pain has not only distinct developmental etiology and evolutionary function, but also how each type requires a fundamentally different transformational process to be healed. Though clients experience all three types of pain in their life, usually one particular pain is dominant in the session. The model provides markers for identifying the active pain in the session, directing the therapist to one of three transformational paths. It thus provides a focus for the work, but also leaves plenty of room for intuitive moment-to-moment tracking of emerging experience. Although this new conceptual model emerged from the integration of the authors’ AEDP practice with EFT principles, pain dynamics can help to systematically select interventions and techniques from a variety of experiential models. Conceptualizing the active pain in the session combines the advantages of case conceptualization and moment to moment work of process formulation.

Development of an MMPI reference group for outpatients with persisting symptoms following mild TBI

ABSTRACT Objective To develop an MMPI-2-RF reference group for persistently symptomatic patients with mTBI in order to aid interpretation and better evaluate atypical scale elevations. Method Using the Q Local MMPI-2-RF Comparison Group Generator (CGG), 200 valid MMPI-2-RF profiles were aggregated for mTBI outpatients with persisting symptoms 2–24 months post injury. Results Compared to established MMPI general population norms, individuals with persisting symptoms demonstrated elevations on several scales, primarily in cognitive and somatic domains. T scores > 60 and standard deviations > 10 were observed for the F-r (Infrequent Responses), Fs (Infrequent Somatic Responses), FBS-r (Symptom Validity), RBS (Response Bias Scale), RC1 (Somatic Complaints), MLS (Malaise), HPC (Head Pain Complaints), NUC (Neurological Complaints), and COG (Cognitive Complaints) scales. All other scales were consistent with established norms for the general population. Conclusion This study is the first to establish an empirically derived MMPI reference group for individuals with persisting symptoms following mTBI. By comparing MMPI profiles of patients with mTBI against this reference group, clinicians may be better able to identify abnormal symptomatology. Evaluating profiles within this context may allow for more accurate case conceptualization and targeted treatment recommendations for those patients who demonstrate disproportionate symptomatology outside the range of the mTBI reference group.

Formulation in psychiatry - a guide to developing competence.

This paper highlights the importance of psychiatric formulation and provides guidance to those learning the art of formulation. To achieve this, we explore the guidance on formulation that has been previously published in Australasian Psychiatry, identify the key components of psychiatric formulation, and outline an approach to comprehensive formulation in routine clinical practice. Formulation is the foundation of good psychiatric practice but presents a considerable challenge to the novice practitioner. Understanding the ingredients of formulation and a method for meaningfully putting these together will guide deliberate practice to learn the art of psychiatric formulation.

Integrative systemic and family therapy for social anxiety disorder: Manual and practice in a pilot randomized controlled trial (SOPHO-CBT/ST).

Social anxiety disorders (SAD) are among the most prevalent mental disorders (lifetime prevalence: 7-12%), with high impact on the life of an affected social system and its individual social system members. We developed a manualized disorder-specific integrative systemic and family therapy (ISFT) for SAD, and evaluated its feasibility in a pilot randomized controlled trial (RCT). The ISFT is inspired by Helm Stierlin's concept of related individuation developed during the early 1980s, which has since continued to be refined. It integrates solution-focused language, social network diagnostics, and genogram work, as well as resource- and problem orientation for both case conceptualization and therapy planning. Post-Milan symptom prescription to fluidize the presented symptoms is one of the core interventions in the ISFT. Theoretically, the IFST is grounded in radical constructivism and "Cybern-Ethics," multi-directional partiality, and a both/and attitude toward a disorder-specific vs. non-disorder-specific therapy approach. SAD is understood from the viewpoint of social systems theory, especially in adaptation to a socio-psycho-biological explanatory model of social anxiety. In a prospective multicenter, assessor-blind pilot RCT, we included 38 clients with SAD (ICD F40.1; Liebowitz Social Anxiety Scale, LSAS-SR > 30): 18 patients participated in the ISFT, and 20 patients in Cognitive Behavioral Therapy (CBT; age: M = 36 years, SD = 14). Within-group, simple-effect intention-to-treat analyses showed significant reduction in social anxiety (LSAS-SR; ISFT: d = 1.67; CBT: d = 1.04), while intention-to-treat mixed-design ANOVA demonstrated the advantage of ISFT (d = 0.81). Per-protocol analyses supported these results. The remission rate based on blind diagnosticians' ratings was good to satisfactory (Structured Clinical Interview, SCID; 78% in ST, 45% in CBT, p = 0.083); this has yet to be verified in a subsequent confirmatory RCT. The article will present the ISFT rationale and manual, including a special focus on multi-person settings, and the central findings from our pilot RCT.

Data-Informed Case Formulation with the Trier Treatment Navigator

The current article presents a way of practising case formulation using technology augmentation in the context of data-informed psychotherapy. First, we explain how case formulation guides the decision-making processes in psychotherapy and how decisions made under an intuitive clinical judgement can be biased. The use of actuarial methods is pointed out as a way of addressing these biases, mainly through clinical decision support systems based on statistical tools and machine learning algorithms. We present the Trier Treatment Navigator (TTN), a clinical decision support system developed in a University research-based clinical training programme. We show how the TTN can contribute to an initial case formulation and its dynamic adaptations during treatment with a clinical case. Finally, we discuss how case formulation and data-informed psychotherapy are aimed at the same goal: treatment personalisation. We argue that case formulation and data-informed psychotherapy enrich and feedback on each other.

Neuropsychological deficits associated with medical conditions: Implications for psychological services in criminal legal settings.

Criminal legal system-involved populations are disproportionally impacted by chronic health conditions relative to the general population. These discrepancies are thought to be due to both health disparities and increased likelihood to engage in health-compromising behaviors. Medical conditions can significantly influence neuropsychological functioning and, in turn, thinking and behavior relevant to clinical forensic decision-making and psychological practice in criminal legal settings. The aim of this article is to review medical conditions commonly observed among system-involved populations-specifically cardiovascular disease, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), traumatic brain injury, cancer, diabetes, and medication side effects-and describe the complex and important links between these conditions, their associated neuropsychological deficits, and applications to psychological assessment and treatment in criminal legal settings. Ultimately, this discussion will be useful to staff providing psychological services in these settings by increasing their familiarity with these concepts, and providing practical applications to inform their case conceptualization, assessment, and treatment services with system-involved individuals. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Innovative Moments and Case Formulation

At the beginning of the therapeutic process, clients frequently feel immersed in their problems, and demoralized, with a negative perspective of different areas of their lives. The clients´ discourse is specially focused on difficulties and previous ineffective attempts to overcome their problems. Even though positive aspects of the clients’ life continue to exist, such as resources and strengths, they have little visibility in the clients’ speech and, consequently, in the therapist’s assessment and intervention planning. Moreover, most psychotherapy models emphasize a focus on the deficits of the clients, centered on the correction of difficulties as a way to achieve mental health. In this context, we highlight the importance of integrating resources and strengths of the clients’ life in case assessment, clinical formulation, and treatment planning. This information can be collected in the assessment phase, but in order to make it explicit the relevance of this information we created a protocol designed for this purpose (Feedback Initiated Narrative Development Protocol [FIND]). The first component of FIND invites clients to reflect on aspects beyond their problem like their personal strengths, significant values, positive autobiographical episodes, and useful strategies that have been adopted in the past. This interview was largely influenced by narrative therapy and innovative moments research, and it provides information regarding clients’ resources that may be useful to psychotherapists from different approaches. In this paper, we presented a clinical case formulation considering resources evaluated with the FIND protocol.

A clinical PREMISE for personalized models: Toward a formal integration of case formulations and statistical networks.

Over the past decade, the idiographic approach has received significant attention in clinical psychology, incentivizing the development of novel approaches to estimate statistical models, such as personalized networks. Although the notion of such networks aligns well with the way clinicians think and reason, there are currently several barriers to implementation that limit their clinical utility. To address these issues, we introduce the Prior Elicitation Module for Idiographic System Estimation (PREMISE), a novel approach that formally integrates case formulations with personalized network estimation via prior elicitation and Bayesian inference. PREMISE tackles current implementation barriers of personalized networks; incorporating clinical information into personalized network estimation systematically allows theoretical and data-driven integration, supporting clinician and patient collaboration when building a dynamic understanding of the patient's psychopathology. To illustrate its potential, we estimate clinically informed networks for a patient suffering from obsessive-compulsive disorder. We discuss open challenges in selecting statistical models for PREMISE, as well as specific future directions for clinical implementation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Language and Acculturation: Neuropsychological Sequalae of COVID-19 in Indian Americans

Coronavirus 2019 (SARS-CoV-2; COVID-19) has significant mental health and neuropsychological consequences, but data are insufficient on these specific implications of COVID-19, especially for Indian American patients. Few studies have critically explored risk factors and neuropsychological assessment considerations from a cultural and linguistic perspective, including how they impact the evaluation process for Indian Americans. The present paper focuses on cultural and linguistic considerations for case conceptualization, ethical challenges for best practices, and a specific example with a middle-aged Indian American woman. The need for a greater contextual understanding is emphasized as a step forward in establishing methodological and procedural guidelines for working with patients of Indian descent in the United States.

Reflection on Culture and Social Structure in Comprehensive Case Formulation: A Proposal for a Culture-Sensitive Assessment of Mental Health Challenges From a Developmental Perspective.

∗De Evenaar, Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Beilen †De Hemisfeer, Den Bosch, the Netherlands. Send reprint requests to Simon P.N. Groen, PhD, De Evenaar, Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, P.O. Box 30007, 9400 RA Assen, the Netherlands. E-mail: [email protected].