3005PSY Counseling Theory & Practice PDF

Welcome to this mini lecture, for 3005PSY Counseling Theory and Practice, in relation to case conceptualisation. So what is the case conceptualisation? It's an extremely important, imperative and unavoidable framework for making sense of a client's presenting concerns from a psychological perspectiv...

Welcome to this mini lecture, for 3005PSY Counseling Theory and Practice, in relation to case conceptualisation. So what is the case conceptualisation? It's an extremely important, imperative and unavoidable framework for making sense of a client's presenting concerns from a psychological perspective. Within the case conceptualisation, which we touched on briefly within our prior mini lecture, we can consider a range of different factors that help us to understand and make sense of a client's presenting concerns. And it can be really important to consider and to think about biological, psychological and social factors that may be part of that case conceptualization. Now, that's not to say that there always are biological, psychological and social, but it can really help us to make sure that we have considered all of the potential factors. A conceptualisation can guide interview questions, and so there is a lot of information that we do need to obtain from clients in the initial interview or interviews, and this can really help provide a structure and a framework to make sure that we're getting the right information, that we can really get a clear picture of this specific person about what's going on for them. It's dynamic, it changes throughout the course of counseling and therapy. You are regularly getting more information from the client about them and about their concerns, and they can be understanding more information about that as well as they are gaining perhaps more insight about what's going on. The case conceptualisation provides a lot of clarity for yourself as the counselor or the therapist and also for the client. It can be a really powerful tool for the client. It helps them to understand what is contributing to their concerns. What are the reasons that this has happened? What's the reason that they're stuck? People may feel very stuck within their symptoms. And as we touched on briefly, that can really be in relation to those perpetuating factors. A discussion and an explanation of that shows the client that you understand what's going on. And it also helps them to understand what's going on. And that can be really powerful in relation to the hope, the optimism, the motivation for moving forward with therapy. And they are an extremely important components of the therapy session, as I mentioned before, they are imperative. It's definitely something that needs to be completed before moving forward with treatment. And as I've got in the last point there, your formulation and your case conceptualizations, we use those terms interchangeably. It's used to inform your treatment plan. And this is one of the reasons why we complete this. It's important that we don't use things such as a diagnosis to think, OK, well, this person has social anxiety disorder, for example. And we know that these are the things we do to treat that. That certainly may come into it. And that's where the theory may apply and you utilize that. But this is where your sessions tailored to that specific person. And the perpetuating factors are really what we use to target different strategies and our treatment plan. So coming back to what are the four ps as a bit of a reminder. We've got our predisposing factors, have a think and see if you can think of some examples before I bring them up. Our precipitating factors. Perpetuating factors. And also our protective factors. So predisposing factors relate to a client's vulnerability to developing psychological concerns. Now, there's a range of different examples, and as I mentioned before, these can be biological, psychological and/or social. People who have experienced some of these events or have these predisposing factors, it doesn't mean that they will go on to develop concerns. It just shows that is a bit more of a vulnerability or an increased risk. Such examples for predisposing factors, and this is certainly not an exhaustive list, and include family psychiatric history, and that can be in relation to a genetic predisposition and be in relation to modeling. If parents have had mental health concerns that may have had an impact on bonding and attachment of your client when they were a child. So there's a range of different ways that that one factor can potentially increase someone's risk or their vulnerability. They may have had a background of abuse or neglect, almost all of the above in their childhood, or their adolescence. As I mentioned before, there can be an insecure attachment and that can be in relation to the connection, that bonding in their attachment when they were a baby and a young child with a parent. Their temperament, so, everyone has a different temperament, and that can be something that can increase people's risk. So, for example, having an anxious temperament. Someone's personality, so, very complex creatures we are, and we have a lot of different personality factors and certain components of someone's personality and certain personality types can increase someone's risk for different disorders and present concerns. And modeling, too, so people that are seeing how an important person in their life regulates their own emotions, how they respond to those, how they cope, a lot of different factors. So then precipitating factors, so they are circumstances or events that occurred prior to symptom onset, so they can trigger the development of concerns? Well, there might be an exacerbation of concerns that were already there. And this is certainly not a black and white sort of line in the sand. And what we find is they may be insidious. So it may be someone who's had a lot of vulnerabilities, a lot of stressors going on, and they find that their mood is gradually deteriorating. And there's not necessarily a specific event that's happened that they were "fine" psychologically before that and then not. But for other people, that can be the case. So an example of that could be someone who's had a car crash and that event, that traumatic injury, can then lead to certain psychological symptoms. So that can be repeated stressors. As I mentioned, a car crash, relationship breakdown. It can be a role change or a transition from one to another, loss of a job. Lot of different things can fit into precipitating factors. So our perpetuating factors is what is maintaining and/or exacerbating symptoms after they've developed. These can be quite complex because we can find that certain perpetuating factors may also fit into the predisposing factors. But it's really important for us to see once the client has developed their concerns, what's going on for them that is keeping that going. And this is really what we targeting. So it's really important that we have a thorough and clear consideration of these perpetuating factors so we can understand what are the cycles that are going on for that client, what's keeping those problems going on? Why are they not getting any better? Why are they getting worse? And then we can ensure that we use evidence based practice to think about different strategies and interventions that are going to target each of these perpetuating factors. So some examples of those include negative core beliefs, if we're thinking from a cognitive theoretical point of view. So, for example, I'm worthless, I'm not good enough, I'm useless, I'm unlovable. Those sorts of beliefs really strong, intense core beliefs. We could have cognitive distortions, and so that's in relation to your negative automatic thoughts and thoughts that pop into people's minds within certain situations. So, for example, I should have done better. So "shoulds" are definitely a cognitive distortion. It could be black and white thinking. It may be avoidance of situations. So we find perpetuating factors aren't necessarily only psychologically what's going on. It can also be socially and behaviorally or something that someone is doing. And as I've mentioned in our prior mini lecture, avoidance can have that negative reinforcement. So it removes the discomfort that feels better for people. They go "oh, that relief". So that means that they might continue that avoidance, but for a range of different reasons that avoidance itself can keep their problems going. If we're thinking about obsessive compulsive disorder, then the engagement in the compulsion, for example, continuous checking that door's locked. Substance use can be perpetuating for a range of different reasons, social isolation or people removing themselves from social situations or withdrawing from others. And there's a range of different reasons that that can keep their concerns going. And if we're thinking from an acceptance and commitment therapy point of view, then something called values incongruent action, that when people have their own values about the type of person that they want to be, but then they engage in a behavior that conflicts with that and they don't match together and that can cause a lot of distress and concern for people. Now, the perpetuating factors is often where we find that different theoretical approaches are going to make sense of concerns in a lot of different ways. So it's really important to be clear in your conceptualization in relation to what is the theoretical approach, because that can help to inform the concepts and the characteristics and the factors that have been considered within this third "p" of perpetuating. And that's really going to be important in relation to your second assignment as well. So finally, our 4th "P" - protective factors and so these can prevent problems from becoming worse, they can facilitate adaptive coping. They may increase resilience, promote recovery. Again, there's a range of different examples here, and these are only a few. Can be having a social network that's really supportive. Having secure employment which is flexible. People feel that they can take reduced hours of sick leave when they need it. And knowing that that stability is there. Further in relation to stability is having safe housing. Protective factors can include people's intelligence, their insight into their presenting concerns. Their ability to access treatment is certainly a protective factor. And the motivation to engage in therapy, that's really important, and that is really because we know therapy works, but the person needs to come in and be ready and willing to engage in that therapeutic process. And physical health as well can be another protective factor. But as I mentioned before, different theoretical approaches can approach a case conceptualisation in different ways and different theoretical approaches can be quite diverse from each other. Some have some similarities and some are a bit of a combination. And so the specific details that go right into a case conceptualisation are informed by that specific theoretical approach. So to provide a bit of an example with that. If we think about a case conceptualisation from an acceptance and commitment therapy theoretical framework, and if we're here within this example, just looking at the perpetuating factors, then maintaining factors. Considerations from an ACT point of view can be factors such as a lack of contact with the present moment. One of the considerations within act and one of the strategies is mindfulness and sitting in the present moment. And if someone's feeling disconnected from that, if they're constantly in the past. If they're in the future, where we find anxiety comes in, people worrying about the future, then they're having that lack of contact with the now. A lack of values clarity for people, not understanding really about what's important to them, the type of person that they want to be and how they would like to move forward in their life in a way that means something to them. Values incongruent action, as I mentioned, on one of the earlier slides. Another consideration is something referred to as the self is content or attachment to a conceptualized self. Cognitive fusion. So that's when people feeling very fused with their negative thoughts and they find it hard to separate themselves as a person from these thoughts and worries that are going on. And experiential avoidance, so avoiding some of the situations that might be congruent with their values. So then if we think about a cognitive behavioral therapy point, you might see that some of them seem slightly similar, but they understand it or approach it in a different way. And some of them are quite different. If we're thinking about perpetuating factors from a CBT point of view, then some considerations of that are going to be negative core beliefs and negative automatic thoughts, as we spoke about earlier. So being in a situation and a negative thought pops into our head, oh, I'm not good at this. This is pointless. I should have done better. Rumination, so people ruminating over something, continuing to think it over and over and over, particularly if it's an unhelpful thought or an irrational thought. So social and behavioral withdrawal. So, for example, people who are feeling depressed, they often stop engaging in activities that they used to. They've lost that sense of enjoyment and they feel like they can't be bothered. What's the point? So they don't go out there and engage with people socially. They don't go out and do activities that they enjoyed. And that sort of passion can then further contribute to that depression. Avoidance, so that can tie into behavioral withdrawal or we could be thinking about avoidance in relation to anxiety that we've discussed. And maladaptive substance use as well. So there's a range of different reasons, but that can be one of the behaviors that someone's doing. So you can see they're within the perpetuating factors because it is cognitive behavioral therapy framework that we have a combination of cognitive factors. As well as behavioral perpetuating. Thank you so much for listening to this mini lecture on case conceptualisation.