Research

CEFS 510

Counseling Project: Conceptualization

and Treatment Plan Template

Case conceptualization refers to the process in which one makes sense of a client's presenting concerns in the context of a theoretical framework. In other words, it refers to how one explains or understands the pseudo-client's symptoms, personality characteristics, cognitions, feelings, and behaviors in the light of a particular theory or integration of theories. Such understanding leads to the formulation of counseling goals and intervention strategies. For this class, students will explore interventions. Goal setting will take place in another course.

At this stage, you will conceptualize the client's case from one theoretical orientation at a time. The content of the conceptualization of the same case will differ according to the various theories depending on the aspect of human experiencing that each theory emphasizes. In general, however, the case conceptualization process (as with the counseling process itself) starts with an understanding of the client's presenting concerns (as presented in the case summary) from the perspective of the client.

Use the outline below to assist you in developing your Case Conceptualization according to the theory you choose to discuss.

Client's Presenting Concerns:

This is derived from your Case Summary.

Case Conceptualization:

Present information used to generate hypothesis regarding the origins of the client’s current problems. Use outside sources and the Jones and Butman textbook to explain the concepts utilized in this section. Below offers an outline of how to discuss these issues.

Psychoanalysis or Object Relations Theory:

1. Explore current and early relationships as they relate to issues of attachment and autonomy. This includes gaining an understanding of how the client understands the world and his/her relationships with others (e.g., the client’s mental representations based on internalized objects). Understanding the client’s internal frame of reference will help the counselor understand the client’s behaviors.

2. Describe the ideas and feelings about self that the client might have developed in the context of these early relations (internalized objects).

3. Establish a relationship between the client’s sense of self and current problems, identify conflictive patterns that the client may be repeating in current life, and explore to what extent current experiences trigger in the client’s emotional reactions elicited by past experiences (reliving the trauma).

4. Uncover defense mechanisms embedded in the client’s presenting concerns and other symptoms, and explain how they relate to the client’s current difficulties and past experiences.

5. Help the client become aware of issues described above, and help the client process and resolve early conflicts.

Individual Psychology:

1. Identify how presenting concerns relate to client's ability to successfully meet specific life tasks.

2. Explore family constellation to discover experiences that might have led the client to develop his/her specific faulty logic. Describe the content of this faulty logic and the sense of self the client developed in the context of these experiences.

3. Establish a connection between the content of the client’s faulty logic and (1) experiences in the family of origin, (2) problems in current life, and (3) the sense-of-self in relation to the world that the client developed.

4. Identify the underlining purpose of the client's problematic behavior, and describe how it prevents the client from successfully meeting the life tasks.

Person-Centered:

1. While exploring the client’s presenting concerns, the counselor will assume that internalized conditions of worth have led the client to disconnect from parts of himself/herself. This disconnect, in turn, has resulted in feelings of incongruency and anxiety, which has impaired his/her internal locus of control as well as thwarted his/her self-actualizing tendency.

2. Examine the discrepancy between the client’s self-concept and ideal self-concept. Since the theory proposes that given the adequate facilitative conditions (empathy, positive regard, and congruence) in the counseling relation, clients will be able to reconnect with themselves and find their own way, the theory does not offer much in terms of a framework to explain the particular issues of each client. This is more a theory of the change process itself than a theory of personality development.

Existential:

1. Identify how presenting concerns (problem behaviors/cognitions) relate to specific givens of existence.

2. Elucidate how these difficulties represent (as mechanisms of defense) or are the consequences of the client’s efforts to avoid facing the normal anxiety generated by specific givens of existence.

3. Describe how these defensive behaviors have led the client to experience of neurotic anxiety and/or neurotic guilt and further problems.

Behavioral/Cognitive/REBT:

1. Relate the presenting concerns to faulty learning, irrational thoughts, and/or faulty cognitions.

2. Identify the client's irrational thoughts (Ellis) and/or specific faulty cognitions or maladaptive thought patterns (Beck), and illustrate how these lead to the problematic behaviors.

3. Describe the antecedent behaviors and cognitions that trigger the client's maladaptive behaviors and thoughts (this is called behavioral assessment).

Interventions:

The information provided in the conceptualization process leads to specific counseling goals. Again, use outside sources to support your discussion of Goals and Interventions.

In the psychodynamic approaches (Object Relations and Individual Psychology), these will likely include:

· Resolving earlier conflicts

· Modifying negative aspects of the self

· Facilitating the development of positive aspects of the self in the context of the therapeutic relation

· Reconciling split-off aspects of the self,

· Changing aspects of the client’s sense of self (e.g., feeling unlovable)

· Identifying and modifying faulty logic

· Gaining encouragement to face life-tasks, and/or to develop social interest

· Identifying the underlining purposes of symptomatic behaviors.

· Work through conflicts in attachment and autonomy

Interventions may include:

Psychoanalytic and Object Relations:

· Free association

· Dream analysis

· Confrontation

· Interpretation

· Gaining insight

· Analysis of the transference

Individual Psychology:

· Lifestyle assessment

· Paradoxical Intention

· Spitting in the Soup

· Catching oneself

· “Acting as if”

· Task setting

In the Person-Centered approach, the goal is to create a safe, trusting relationship that will allow clients to explore the parts of themselves that they have denied or distorted. This will entail recognizing and giving up the internalized conditions of worth. Clients will likely then develop an internal locus of evaluation, become more open to experience, and achieve self-trust. This is a nondirective approach trusting in clients’ self-actualization.

The Intervention is for the most part the relationship in itself, which must include three conditions:

· Congruence or genuineness

· Positive regard

· Accurate empathic understanding

Specific counselor’s behaviors to facilitate the relationship and to foster client change include:

· Reflection of feeling

· Paraphrasing, rephrasing

· Questions for clarification

In the Existential approach, goal:

· Help clients to gain awareness of the choices they are making in their lives

· Encourage clients to face the givens of existence that they may be avoiding, and helping them to become aware of the defenses they are using to avoid the normal anxiety generated by the givens of existence.

· Help clients to become aware of the negative effects these defensive behaviors/cognitions have in their lives and to recognize how these defensive behaviors are related to their presenting concerns.

· Encourage clients to take responsibility for their lives and to make active choices regarding the life situations they are facing.

Interventions may include:

· Confrontation

· Process interpersonal dynamics of the counseling relationship, attending to the emotions generated by the counseling process in the context of the here and now relationship with the counselor

· Paradoxical intention

· Situational reconstruction

· Compensatory self-improvement

·

In the Behavioral/Cognitive Behavioral/REBT approaches, counseling goals are likely to emphasize resolving the presenting concerns by learning new behaviors, changing environmental conditions, and replacing irrational thinking with more rational thoughts.

Interventions may include:

· Modeling

· Behavioral rehearsal

· Skills development training (e.g., assertiveness, social behavior)

· Self control or self-monitoring

· Stimulus control

· Contingency contracting

· Systematic desensitization

· Recognizing and changing irrational thoughts

· Cognitive restructuring to change maladaptive thought processes

· Learning a new internal dialogue

· Relaxation training

· And others

Evidence-Based Approaches

Not only should you be able to demonstrate competence in using the counseling interventions but you should also know how to identify evidence-based approaches.  It is not only a best practice to use a treatment, methodology, or approach that is supported by the best available clinical evidence (outcome based research studies), but some insurances also require it.  The ACA codes of ethics state counselors will use empirically supported treatment.  You should make sure you are using the most effective treatment for your clients.  Also if called into court because a client claims something you did caused them harm you would need to be able to explain why you did what you did and demonstrate that it is a standard of practice.  The best way to do this is to demonstrate you used an evidence-based approach.  

 

Make sure you are able to cite the actual research studies that demonstrate the theoretical interventions you are recommending have been found to be effective in treating the client’s presenting problems, symptoms and diagnosis. You should cite actual studies not just someone that made the claim that it is evidence-based.  It is not good enough that your textbook claims the theory is evidence-based.  You need to be able to evaluate that yourself and be able to provide evidence. So search for those studies and discuss the results of research outcomes.  

Multicultural Considerations:

It is essential to develop multicultural competencies as you learn to apply theoretical interventions. Read research articles and your multicultural counseling book to see more about cultural concepts. Find research articles that inform about your clients cultural needs. Also look for literature that discusses using the theoretical orientation you chose with your client. Discuss how you might modify the theoretical interventions to meet diverse client needs. For example, does research on the client’s culture demonstrate that family considerations or religious values are important. If so then cite that research and discuss how you would modify the theoretical interventions to include those aspects.

Ethical Considerations:

Download the codes of ethics for your specialization (e.g. ACA codes of ethics, AAMFT codes of ethics). It is essential that you learn how to apply the ethical standards to your case conceptualization. Discuss the codes that are applicable to the case. Discuss any ethical challenges and ways to meet the ethical standards. There are all kinds of ethical considerations when working with clients.  You can touch on do no harm, valuing autonomy, competence, etc.…. The list can go on and on.  The best way to make sure you are considering all possibilities is look through and cite your codes of ethics.  They are the standards of practice that you supposed to adhere to so you should be able to apply them and know how to cite them.

Spiritual Application:

What spiritual challenges can you see in this case? How would you seek to handle this person’s case if he/she was interested in having Christian counseling be part of the treatment plan? How do you think Christian principles and worldview mesh with the theory you are using? In what ways is it compatible (minimum of three)? In what ways is it not compatible (minimum of three)? What resources/referrals (in addition to church) can you recommend to the client as part of this area of counseling?

Conclusion:

Conclude with why this theoretical orientation was chosen, e.g., how it fits the client’s problem. Describe what you would expect the outcomes of such therapy to be, and what some of the most challenging aspects of the treatment would be. Again, use outside sources to support your conclusions. These sources need to be professional, not pop psychology or internet sources such as Wikipedia. Edited books and journal articles are your best sources.

Page 7 of 7