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The Science and Practice of Case Conceptualization

Published online by Cambridge University Press:  01 November 2008

Willem Kuyken ,
Christine A. Padesky  and
Robert Dudley
Willem Kuyken*
Affiliation:
University of Exeter, UK
Christine A. Padesky
Affiliation:
Center for Cognitive Therapy, Huntington Beach, CA, USA
Robert Dudley
Affiliation:
Newcastle University, UK
*
Reprint requests to Willem Kuyken, Mood Disorders Centre, School of Psychology, University of Exeter, Exeter EX4 4QG, UK. E-mail: w.kuyken@exeter.ac.uk
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Abstract

Case conceptualization is a foundation of cognitive-behavioural therapy (CBT) because it describes and explains clients' presentations in ways that inform interventions. Yet the evidence base challenges the claimed benefits of case conceptualization. This paper reviews the rationale and evidence base for case conceptualization and outlines a new approach that uses the metaphor of a case conceptualization crucible in which a client's particular history, experience and strengths are synthesized with theory and research to produce an original and unique account of clients' presenting issues. The crucible metaphor illustrates three key defining principles of case conceptualization. First, heat drives chemical reactions in a crucible. In our model, collaborative empiricism between therapist and client provides the heat. Second, like the chemical reaction in a crucible, conceptualization develops over time. Typically, it begins at more descriptive levels, later a conceptualization incorporates explanatory elements and, if necessary, it develops further to include a longitudinal explanation of how pre-disposing and protective factors influence client issues. Finally, new substances formed in a crucible are dependent on the chemical characteristics of the materials put into it. Rather than simply look at client problems, our model incorporates client strengths at every stage of the conceptualization process to more effectively alleviate client distress and promote resilience.

Keywords

Case conceptualizationcase formulationcognitive therapycognitive-behavioural therapytherapistcollaborative empiricismresilienceclient strengthsmetaphor
Type
Process Issues
Information
Behavioural and Cognitive Psychotherapy , Volume 36 , Issue 6: Developments in the Theory and Practice of Cognitive and Behavioural Therapies , November 2008 , pp. 757 - 768
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2008

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References

Beck, A. T. (2002). Prisoners of hate. Behaviour Research and Therapy, 40, 209–216.CrossRefGoogle ScholarPubMed
Beck, A. T., Emery, G. andGreenberg, R. L. (1985). Anxiety Disorders and Phobias: a cognitive perspective. New York: Basic Books.Google Scholar
Beck, A. T., Freeman, A., Davis, D. and Associates (2003). Cognitive Therapy of Personality Disorders. (2nd ed.) New York: Guilford.CrossRefGoogle Scholar
Beck, A. T., Rush, A. J., Shaw, B. F. and Emery, G. (1979). Cognitive Therapy of Depression. New York: Guilford Press.Google Scholar
Beck, A. T., Wright, F. D., Newman, C. F. and Liese, B. S. (1993). Cognitive Therapy of Substance Abuse. New York: Guilford.Google Scholar
Beck, J. S. (1995). Cognitive Therapy: basics and beyond. New York: Guilford Press.Google Scholar
Beck, J. S. (2005). Cognitive Therapy for Challenging Problems. New York: Guilford.Google Scholar
Bieling, P. J. and Kuyken, W. (2003). Is cognitive case formulation science or science fiction? Clinical Psychology-Science and Practice, 10, 52–69.CrossRefGoogle Scholar
Butler, G. (1998). Clinical formulation. In Bellack, A. S. and Hersen, M. (Eds.), Comprehensive Clinical Psychology (pp. 1–24). New York: Pergamon Press.Google Scholar
Chadwick, P., Williams, C. and Mackenzie, J. (2003). Impact of case formulation in cognitive behaviour therapy for psychosis. Behaviour Research and Therapy, 41, 671–680.CrossRefGoogle ScholarPubMed
Clark, D. A., Beck, A. T. and Alford, B. A. (1999). Scientific Foundations of Cognitive Theory and Therapy of Depression. New York: Wiley.Google Scholar
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470.CrossRefGoogle ScholarPubMed
Craske, M. G. and Barlow, D. H. (2001). Panic disorder and agoraphobia. In Barlow, D. H. (Ed.), Clinical Handbook of Psychological Disorders: a step-by-step treatment manual (3rd ed., pp. 1–59). New York: Wiley.Google Scholar
Eells, T. D. (2007). Handbook of Psychotherapy Case Formulation. (2nd ed.) New York: Guilford Press.Google Scholar
Ehlers, A. and Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345.CrossRefGoogle ScholarPubMed
Ehlers, A., Clark, D. M., Hackmann, A., McManus, F. and Fennell, M. (2005). Cognitive therapy for post-traumatic stress disorder: development and evaluation. Behaviour Research and Therapy, 43, 413–431.CrossRefGoogle ScholarPubMed
Evans, J. and Parry, G. (1996). The impact of reformulation in cognitive-analytic therapy with difficult-to-help clients. Clinical Psychology and Psychotherapy, 3, 109–117.3.0.CO;2-U>CrossRefGoogle Scholar
Flitcroft, A., James, I. A., Freeston, M. and Wood-Mitchell, A. (2007). Determining what is important in a good formulation. Behavioural and Cognitive Psychotherapy, 35, 325–333.CrossRefGoogle Scholar
Ghaderi, A. (2006). Does individualization matter? A randomized trial of standardized (focused) versus individualized (broad) cognitive behavior therapy for bulimia nervosa. Behaviour Research and Therapy, 44, 273–288.Google Scholar
Kendjelic, E. M. and Eells, T. D. (2007). Generic psychotherapy case formulation training improves formulation quality. Psychotherapy, 44, 66–77.CrossRefGoogle ScholarPubMed
Kohlenberg, R. J. and Tsai, M. (1991). Functional Analytic Psychotherapy: creating intense and curative therapeutic relationships. New York: Springer.CrossRefGoogle Scholar
Kuyken, W. (2006). Evidence-based case formulation: is the emperor clothed? In Tarrier, N. (Ed.), Case Formulation in Cognitive Behaviour Therapy. Hove: Brunner-Routlege.Google Scholar
Kuyken, W., Fothergill, C. D., Musa, M. and Chadwick, P. (2005). The reliability and quality of cognitive case formulation. Behaviour Research and Therapy, 43, 1187–1201.Google ScholarPubMed
Kuyken, W., Kurzer, N., DeRubeis, R. J., Beck, A. T. and Brown, G. K. (2001). Response to cognitive therapy in depression: the role of maladaptive beliefs and personality disorders. Journal of Consulting and Clinical Psychology, 69, 560–566.CrossRefGoogle ScholarPubMed
Kuyken, W., Padesky, C. A. and Dudley, R. (2008). Collaborative Case Conceptualization: working effectively with clients in cognitive-behavioral therapy. New York: Guilford Press.Google Scholar
Mumma, G. H. and Mooney, S. R. (2007). Comparing the validity of alternative cognitive case formulations: a latent variable, multivariate time series approach. Cognitive Therapy and Research, 31, 451–481.CrossRefGoogle Scholar
Mumma, G. H. and Smith, J. L. (2001). Cognitive-behavioral-interpersonal scenarios: interformulator reliability and convergent validity. Journal of Psychopathology and Behavioral Assessment, 23, 203–221.CrossRefGoogle Scholar
Nelson-Gray, R. O., Herbert, J. D., Herbert, D. L., Sigmon, S. T. and Brannon, S. E. (1989). Effectiveness of matched, mismatched, and package treatments of depression. Journal of Behavior Therapy and Experimental Psychiatry, 20, 281–294.CrossRefGoogle ScholarPubMed
Padesky, C. A. and Greenberger, D. (1995). Clinician's Guide to Mind over Mood. New York: Guilford Press.Google Scholar
Pain, C. M., Chadwick, P. and Abba, N. (2008). Clients' experience of case formulation in cognitive behaviour therapy for psychosis. British Journal of Clinical Psychology, 47, 127–138.CrossRefGoogle Scholar
Persons, J. B. (1989). Cognitive Therapy in Practice: a case formulation approach. New York: Norton.Google Scholar
Persons, J. B. and Bertagnolli, A. (1999). Inter-rater reliability of cognitive-behavioral case formulations of depression: a replication. Cognitive Therapy and Research, 23, 271–283.CrossRefGoogle Scholar
Persons, J. B., Mooney, K. A. and Padesky, C. A. (1995). Interrater reliability of cognitive-behavioral case formulations. Cognitive Therapy and Research, 19, 21–34.CrossRefGoogle Scholar
Persons, J. B., Roberts, N. A., Zalecki, C. A. and Brechwald, W. A. G. (2006). Naturalistic outcome of case formulation-driven cognitive-behavior therapy for anxious depressed outpatients. Behaviour Research and Therapy, 44, 1041–1051.CrossRefGoogle ScholarPubMed
Rutter, M. (1999). Resilience concepts and findings: implications for family therapy. Journal of Family Therapy, 21, 119–144.CrossRefGoogle Scholar
Schneider, B. H. and Byrne, B. M. (1987). Individualizing social skills training for behavior-disordered children. Journal of Consulting and Clinical Psychology, 55, 444–445.CrossRefGoogle ScholarPubMed
Schulte, D. and Eifert, G. H. (2002). What to do when manuals fail? The dual model of psychotherapy. Clinical Psychology-Science and Practice, 9, 312–328.CrossRefGoogle Scholar
Schulte, D., Kunzel, R., Pepping, G. and Shulte-Bahrenberg, T. (1992). Tailor-made versus standardized therapy of phobic patients. Advances in Behaviour Research and Therapy, 14, 67–92.CrossRefGoogle Scholar
Snyder, C. R. and Lopez, S. J. (2005). Handbook of Positive Psychology. New York: Oxford University Press.Google Scholar
Strauman, T. J., Vieth, A. Z., Merrill, K. A., Kolden, G. G., Woods, T. E., Klein, M. H., Papadakis, A., Schneider, K.L. and Kwapil, L. (2006). Self-system therapy as an intervention for self-regulatory dysfunction in depression: a randomized comparison with cognitive therapy. Journal of Consulting and Clinical Psychology, 74, 367–376.CrossRefGoogle ScholarPubMed
Tarrier, N. (2006). Case Formulation in Cognitive Behaviour Therapy: the treatment of challenging and complex cases. Hove, UK: Routledge.CrossRefGoogle Scholar
Weierich, M. R. and Nock, M. K. (2008). Posttraumatic stress symptoms mediate the relation between childhood sexual abuse and nonsuicidal self-injury. Journal of Consulting and Clinical Psychology, 76, 39–44.CrossRefGoogle ScholarPubMed
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