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Case Conceptualization Process

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 should lead to the formulation of counseling goals and intervention strategies.

At this stage, you will conceptualize the client’s case from 1 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 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).

Goal Setting and 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

· Motivational interviewing

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.

  

The Intervention is for the most part the relationship in itself, which must include 3 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, goals may involve needing to:

· 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

· Motivational Interviewing

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 3)? In what ways is it not compatible (minimum of 3)? 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.

  

Counseling Project: 

Conceptualization and Treatment Plan 1 Instructions

You will complete 2 Conceptualization and Treatment Plans for the Counseling Project. Follow these instructions for the Conceptualization and Treatment Plan 1. The grading rubric and Sample Case Presentation are also available for you to utilize. 

SafeAssign is a plagiarism detection tool. The Case Summary and both Conceptualization and Treatment Plans are turned in using this tool. You have 1 draft link to submit your paper to SafeAssign before it goes to the paper repository. Remember, only the second SafeAssign link is graded. 

Late work will be penalized as stated in the Course Syllabus. If your instructor does not have access to your paper by the due date and time, then the paper is considered to be late. 

Below is the format you are to use for the Conceptualization and Treatment Plan 1 paper. The paper must be at least 8 pages, not counting the title, abstract, and reference pages. Current APA format is required. Everything must be written in third person except where designated below.

Title Page

Refer to your current APA manual for directions on formatting a title page. Be sure you include a running head, page number, paper title, your name, and the institution name (Liberty University).

NOTE: Your title and the running head must include the name of the theory you are writing about in this paper.

Abstract

Your abstract must give the reader a short overview (150–250 words) of your paper. Be sure your abstract summarizes the main ideas in your paper and what conclusions you came to. Use your current APA manual to make sure you write an effective abstract. 

Case Conceptualization using (place the name of your Chosen Theory here)

Below you will find the topics and structure you are required to include in your paper. For this first Counseling Treatment Plan paper, you are to choose only 1 of these 4:

· Object Relations Therapy

· Individual Psychology Therapy

· Person-Centered Therapy

· Existential Therapy

Spend at least 2 pages explaining the theory you have chosen and answering these questions. Address each question in its own paragraph:

· Who is/are the developer(s) of the theory?

· What did they believe about human nature and the counseling process?

· Explain any research that has been done showing the efficacy of this theory.

· What diagnoses has this theory been shown to be effective with (depression, anxiety, etc.)?

· What makes this theory appropriate for your client and the presenting problems you noted in the first paper?

· What are any potential ethical issues that may arise in using this theory with your client?

· What are any potential multicultural issues that may arise in using this theory with your client?

· Can this theory be used in crisis situations? Why or why not?

· Can this theory be used to treat clients with addictions? Why or why not?

Interventions

First, write a short paragraph giving a synopsis about the presenting problems you wrote about in the Case Summary and Presenting Problems paper. Detail is not needed, just a quick summary to remind the reader of these problems.

Second, write a short paragraph giving a synopsis about the 3 goals you also wrote about on the Case Summary and Presenting Problems paper. Again, detail is not needed, just a quick summary of the 3 goals that will be directing your interventions/techniques.

Third, based on the theory you chose above, you are to have a minimum of 3 different interventions/techniques according to that theory. (NOTE: While Person-Centered Therapy does not have specific techniques, it does have 3 core conditions that are to be used instead.) You must also clearly define each intervention from the other (i.e., write in 3 separate paragraphs with the name of the technique/intervention clearly shown in a level 2 heading [flush left and bold] in each paragraph, not just one long paragraph). 

As you write about each intervention/technique, discuss how it helps to achieve 1 of your treatment goals. You need to then give at least 1 example of how you would use that technique with your client. Be specific. 

Use the current APA manual for the proper headings format (hint: see how the headings in bold have been used in the Sample Case Presentation.). First person is allowed here.

Spiritual Application (Phase 1)

(NOTE: You must complete this section regardless of if your client does or does not want to receive Christian counseling at this time.) In what ways is this theory compatible (minimum of 3) with Christian beliefs? In what ways is this theory not compatible (minimum of 3) with Christian beliefs? You should make extensive use of the Jones & Butman text as well as some of your journal articles in this section.

NOTE: You must clearly delineate each compatibility/incompatibility for the reader. For example: “The first compatibility with Christianity is . . . ,” “The final incompatibility is . . . ,” etc.

  

Conclusion

What would you expect the outcomes of using this therapy to be, and what will be some of the most challenging aspects of the treatment? Again, use outside sources to support your conclusions.

References

One of your book sources must be the Jones & Butman text, and you must have a minimum of 5 additional professional references for your paper (minimum total of 6). These are to be a mix of journal articles and books. Websites are not allowed, and neither are dictionaries, encyclopedias, or mass-marketed popular psychology texts. Edited books and journal articles are always your best sources.

Be sure you format your references in current APA format and pay close attention to capitalization and italics. It is your responsibility to have the APA manual and use it. Using a website about APA is not the same as having the manual.

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