Initial Assessment Case Conceptualization And Treatment Planning

Mark A. Whisman Lauren M. Weinstock

With the trend toward manualization of psychosocial interventions, there have been increased attempts to clarify a distinction between the "essence" of a treatment and its specific components (Abramowitz, 2006); that is, along with certain techniques that make up an intervention, it is important that there exist an empirically based theoretical rationale to guide the treatment. This approach is at the heart of evidence-based practice generally, and of cognitive therapy (CT; Beck, Rush, Shaw, & Emery, 1979) for depression specifically. CT is grounded in an empirical and conceptual model that implicates certain underlying and maladaptive cognitive schemas as risk factors for depression onset and maintenance (Clark, Beck, & Alford, 1999). Building upon this model, the aim of the therapist is to work collaboratively with the patient to identify and modify negative cognitions, using specific strategies such as automatic thought monitoring and cognitive restructuring. As such, cognitive therapists utilize a "nomothetic template" that comprises well-defined theoretical and practical considerations in their clinical approach (Persons, 2006).

It is important to emphasize that this nomothetic template does not exclude an individualized approach to CT. Indeed, using the CT model as a guide, it is important that clinicians assess the unique presenting problems and generate for each patient an individualized case conceptualization representing a hypothesis about the mechanisms that underlie the patient's problems. Such hypotheses provide clues to the clinician as to what may be most relevant or clinically useful for the patient, and guide selection of specific CT techniques to be used in the treatment. Furthermore, as therapy proceeds, the case conceptualization provides a framework for hypothesis testing, and for refinement and revision of the treatment plan. Thus, CT rooted in such a case conceptualization benefits from being both personalized and flexible, within a coherent empirical and theoretical framework.

As discussed throughout this volume, there are many ways to adapt or tailor CT to treat various presentations of depression more effectively. In this chapter, we focus on the use of assessment-driven case conceptualization as a guiding force in deciding when and how to adapt treatment to the needs of individual patients. Specifically, we first provide an overview of initial assessment, then discuss how assessment data can be incorporated into cognitive case conceptualization; finally, we propose ways in which this conceptualization can be used to guide decisions regarding modification of CT for depressed individuals based upon their presentation.

Exploring EFT

Exploring EFT

EFT stands for Emotional Freedom Technique. It works to free the user of both physical and emotional pain and relieve chronic conditions by healing the physical responses our bodies make after we've been hurt or experienced pain. While some people do not carry the effects of these experiences, others have bodies that hold onto these memories, which affect the way the body works. Because it is a free and fast technique, even if you are not one hundred percent committed to whether it works or not, it is still worth giving it a shot and seeing if there is any improvement.

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