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Case Conceptualization from a Cultural-Clinical Framework

California State University, Northridge PSY 471: Cultural-Clinical Psychology

Jonathan I. Martinez, Ph.D.

Agenda

• Week 8 Quiz Review • All assignments have been graded on Canvas • Case Conceptualization Article Discussion • Breakout Activity • Thought Questions

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Case Conceptualization “...the ability to synthesize a large amount of complex and ambiguous information…into an overall understanding of the client’s level of functioning and producing viable treatment strategies (Loganbill & Stoltenberg, 1983).”

(Lee & Tracey, 2008)

Multicultural Case Conceptualization “The explicit incorporation of culture including personal, contextual, and sociopolitical factors in case conceptualization (American Psychological Association [APA], 2003; Sue & Sue, 2003)”

(Lee & Tracey, 2008)

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Implications for Psychotherapy Training “The results of our study have important implications for psychotherapy training. Most important was our finding that all trainees integrated more culturally relevant ideas into their conceptualizations regarding a client of color who explicitly expressed cultural issues as a concern. In psychotherapy training, it is crucial to highlight that all people are multicultural beings, and that considerations of culture should be made regardless of whether the client explicitly reports cultural issues as being problematic, and whether the client is a person of color. Therefore, psychotherapy training programs as a whole may wish to consider highlighting the pervasive importance of culture in their work. This focus should be reinforced in all aspects of training, coursework as well as clinical work. In an atmosphere wherein cultural dynamics are recognized and explored, psychotherapists are challenged to adopt a stance of critically thinking about culture as a context, a necessary and integral aspect of understanding human behavior, as opposed to a consideration reserved only for the few. The paradigm for training should be to incorporate all aspects of culture (race, ethnicity, gender, sexual orientation, ability, religion, and social status) into the overall understanding of the client, and that any understanding would be incomplete without considering each of these dimensions of cultural identity. It is hoped that eventually trainees would demonstrate similar levels of multicultural case conceptualization skills, regardless of client demographic or problem.”

Sample Case Conceptualization “Given Interpersonal Therapy’s focus on interpersonal disputes, role transition, and grief; it would make an excellent theoretical framework with which to conceptualize Walter’s presenting problems. It is clear that Walter does not manage interpersonal disputes well enough as evidenced by his violent outbursts and verbal abuse of others. Walter also seems to be forever haunted by the grief that has visited his life in the past (i.e. Vietnam War and divorce). This grief in his life is a result of Walter not being able to make a seamless role transition out of these situations. He was not able to effectively transition to a civilian lifestyle after the war and thus allows his past to dictate his future. Similarly, he was not able to transition from a married man to a single man and he continues to be a part of his ex-wife’s life which is preventing him from moving on. In both cases, Walter was aggrieved by feelings of helplessness in coping with the transitions as well as by the loss of members of his social support network (i.e. his fellow soldiers in the war and his wife in the divorce). In addition, the focus on the present will help Walter pull his thoughts away from the past so he can focus on the here-and-now. Also, the focus on Walter’s affect and emotional responses will make his anger management issues a central problem that must be addressed in order to function well in his world. Furthermore, it will be beneficial for Walter to focus on his current relationships (i.e. Donny and The Dude) and in turn, strengthen his social support network.”

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Breakout Activity

• Case conceptualization for Victor Luna (from video)

Student Thought Question “The article mentions that "trainees who completed more than two multicultural courses demonstrated greater multicultural case conceptualization skills than those who received less than two.” Therefore, shouldn’t all trainees be required to complete more than two multicultural courses in order to be able to have better multicultural case conceptualization skills, as opposed to only completing two or less multicultural courses? After all, it is very important to incorporate cultural issues in the trainees’ conceptualizations. Additionally, I wonder how we can have trainees integrate more culturally relevant ideas into their conceptualizations towards all people, as opposed to only clients of color. Trainees should emphasize the importance of culture for all clients, regardless of whether the client is a person of color or mentions specific cultural issues. This way, the client will have the most effective outcome from his/her session.

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