The research in the mental health field and the Commission for Counselor and Pertaining Educational Programs have both concluded that clinical case conceptualization is a necessary skill. Even though it is essential, there is not much written about how school educational pedagogy and the acquisition of clinical case conceptualization skills affect what students learn and how they learn it (John & Segal, 2015). Family therapy usually aims to improve communication, solve family problems, help families to understand and deal with special situations, and make the home a better place to live. It also includes exploring the interpersonal communication dynamic nature of the family and how they relate to psychiatric disorders, mobilizing the family’s core competencies and functional materials, restructuring dysfunctional interactional family styles, and improving the family’s ability to solve problems (Macneil et al., 2012). However, families can be scary at times, but they can also be very rewarding if clinicians know how to deal with them. The paper has discussed some problems when working with families, such as being too eager to help, having incompetent leadership, concentrating only on the affected person, and being biased toward any family member.
The idea of conceptualizing a clinical case is both critical and hard to understand. (John & Segal, 2015)’s peer-reviewed article illustrates that case conceptualization is the cognitive activity a counselor uses to figure out a client’s core or fundamental problems and then use that information to find an effective treatment. The goal of therapy is to help bring about good results by getting a clear clinical presentation of how the client is feeling. Based on research done by Macneil et al., 2012, putting together a case formulation involves getting short, meaningful information about the client’s symptoms, how they are doing now, and their history. It should also include predisposing and precipitating factors, a firm grasp of the client’s problems, and a summary of the intervention that should be given based on the clinician’s hypothesis.
Clinical conceptualization is so hard to understand because it does not have a clear definition or a list of basic parts that make it up. “Overall, clinicians vary on the information, methodology, ambiguity, conceptual framework, and variety of data included in case formulation,” it says in the article” Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice” (Macneil et al., 2012). In order to think of a clinical case, mental health counselors have to look at the information they have gathered, come up with a hypothesis, and formulate a treatment plan based on what the client needs. A big part of conceptualizing a clinical case is using the data collected to define a presenting problem using the client’s descriptors instead of just restating a current condition (Ridley et al., 2017). In the work done by Ridley et al., 2017, it is proceeding to conclude that “previous findings suggested two things: mental health clinicians’ case formulations mostly contain specific information instead of explanations, and it is ambiguous how much treatment choices are centered on case formulations.”
In short, it is significant to utilize the information gathered to form a hypothesis and read between the lines, and figure out what the client’s problems really mean. It is vital to look for the mentioned non-verbal, psychological, and behavioral data that will assist psychology/psychiatry in understanding what the patient is going through and what objectives should be set to bring about change. The Cognitive Behavioral Case Formulation is an example of a case conceptualization tool. It comprises five parts, including the problem itself, what caused it, what keeps it going, and what keeps it from getting worse (Macneil et al., 2012). The Care Plan from a Psychodynamic Perspective is another example of a tool for making sense of a case. With this tool, mental health clinicians must develop a working theory about the causes, development, maintenance, and starting points of a client’s problems (Varghese et al., 2020). Even though there is no clear definition of “application,” it is crucial to make a case conceptualization to list the critical parts of a case and make a hypothesis for how to treat it in the future.
Market and national regulations have made case theories and models critical in personal, couple, and marriage counseling. However, therapists, instructors, and supervisors are becoming more aware of their clinical value and use in everyday practice. Case conceptualization is an integral part of mental health treatment. Its goal is to help the client progress in therapy by giving a clear picture of their feelings (Varghese et al., 2020). Nevertheless, despite many attempts to improve this activity, it is still unclear how well the methods already in place do what they are supposed to do. Case formulation is defined and used differently in the literature and practice. Many different methods vary in their level of complexity, theoretical basis, and empirical support. This act comes with several problems that clinicians have to handle.
Being too willing to help
This practice might happen with new therapists because they want to help immediately and are eager to give advice. However, if the mental health practitioner starts talking, giving advice, making suggestions, making comments, asking questions, and trying to figure out what is going on from the start, the family stops talking (Varghese et al., 2020). it is best to ask open-ended questions to get more information about the family.
It is good for the mental health clinician to be in charge of the sessions. Sometimes, other people or family members may be in charge and have the upper hand (Varghese et al., 2020). For example, when the family is in a crisis and cannot work together, the clinician should take charge of the conversation and set conditions that give the best chance of success in his professional opinion.
Having only one patient in mind
Many families think that the index patient is the cause of their problem, but focusing on this individual might be a mistake at first. Doing this may be agreeing with the family’s idea that this person is the cause of their problem. Instead, it is best to tell the family immediately that the problem might be with the family as a whole and not inherently with any one person (John & Segal, 2015). This aspect is critical when the family is referred to a therapy that involves more than one person.
Taking a side with any family member
It can be easy to take one person’s side during sessions, which makes the other person doubt the therapist’s fairness and judgment (Cox, 2021). For example, if a therapist has worked with one partner in a marriage for a few workshops, his or her views on the couple may be heavily influenced by those sessions. Therapists should know about this effect and try to be as neutral as possible while keeping each person’s privacy. The therapist’s cognitive dissonance can easily cause him or her to take sides. This idea is especially true in families that blame each other right from the start or when one member is aggressive or submissive during the sessions. This concept must be kept in mind from the beginning of the sessions.
Sessions that do not include everyone
Often, therapy does not work because essential family members are absent. Therefore, it is best to find out who the important people are and who should attend the sessions (Cox, 2021). Sometimes, it is best to get everyone involved first and then tell them to come back to therapy when needed.
Jackson’s family presents an openness to therapeutic help in the first session with the therapy and highlights the fundamental problems for the counseling before allowing any views from another family member. Tracy, whom the family focuses on how they needed assistance, seems, at first, to be a prominent person in this family. She describes the family as “a typical family that looks good, but they are falling apart” based on how she figures out her efforts are in vain. The family’s focus on Tracy’s answer indicates that therapy might be Tracey’s idea or the reason behind their seeking help. It should also be noted that Andre and his wife seem to have negative core beliefs about what a family should and should not look like, as indicated by their descriptions of problem areas. Kenya’s response indicated the present problem with the family by explaining that the key problem the family encounters is the miscommunications within themselves, which contribute primarily to their falling apart. However, in his answer, she declares that the family is not falling apart. Although this may be presented as the main problem in Kenya, there seems to be an underlying issue between Andre and Tracy.
As explained by the children’s reactions and statements, Tracy and Andre do not speak to each other unless they are in the presence of others, Andre and Tracy present an apparent strain between them when asked how they are. The couple shows an apparent reluctance to discuss their problems, pointing to a more significant issue than presented. Andre shows physical discomfort about discussing their relationship but is forthcoming regarding the issues with her kids. Tracy and Andre’s pattern is to expect total perfection from family members in order to control outsiders’ perceptions and beliefs about their family. This phenomenon is indicated in the description of their kids’ issues. Tracy goes on to lament how Andre does not recognize her efforts for family stabilization. Kiyan sides with her mother’s opinions and places his arms around her mother, indicating they have similar opinions. Kenya is not about this companionship and shows her dissatisfaction.
This reaction indicates that Tracy is overly controlling and could be described as violating the boundaries of family members and stifling their individual development. The more the family, particularly Tracy, attempts to project the image of a perfect family without dealing with her and Andre’s issues, the more control she feels she needs over her children. Based on stated, nonverbal, emotional, and behavioral information, the hypothesis for this family is that, despite relayed issues regarding the children, Tracy and Andre’s relationship seems to be the core problem this family is facing. Therapeutic focus on the parents should be implemented. The family’s current functioning is moderate, except for Andre and Tracy’s relationship. Andre and Tracy’s refusal to deal with their issues maintains the families’ difficulties.
In this essay, the idea of “clinical case conceptualization” is broken down, and different ways to make a case are given. From this essay, it is clear that clinical case conceptualization can be hard to understand because it does not have a clear definition or a clear way to use it. However, it is crucial to figure out how a client’s mind works. This essay also analyzes a family problem, making it easier to understand how a client’s case should be considered. Case conceptualization is one of the most critical skills that mental health workers are expected to learn. In the past, some specialists did not want to learn this skill because they thought case conceptualizations were not valuable in the real world and that learning how to do them was too hard and took too much time. As discussed earlier in this paper, neither traditional clinical knowledge nor new research backs up this idea. Studies show that case conceptualizations are helpful in clinical settings, are based on evidence-based practice, and improve treatment results.
Cox, A. (2021). IRL @ UMSL IRL @ UMSL Dissertations UMSL Graduate Works Clinical Case Conceptualization Skill Development and Clinical Case Conceptualization Skill Development and Counseling Pedagogy: A Constructivist Grounded Theory Study Counseling Pedagogy: A Constructivist Grounded Theory Study. https://irl.umsl.edu/cgi/viewcontent.cgi?article=2216&context=dissertation
John, S. E., & Segal, D. L. (2015). (PDF) Case Conceptualization. ResearchGate. https://www.researchgate.net/publication/313965874_Case_Conceptualization
Macneil, C. A., Hasty, M. K., Conus, P., & Berk, M. (2012). Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice. BMC Medicine, 10(1). https://doi.org/10.1186/1741-7015-10-111
Ridley, C. R., Jeffrey, C. E., & Roberson, R. B. (2017). Case Mis-Conceptualization in Psychological Treatment: An Enduring Clinical Problem. Journal of Clinical Psychology, 73(4), 359–375. https://doi.org/10.1002/jclp.22354
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