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COUN 510 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: HEADING This is derived from your Case Summary. Case Conceptualization: HEADING 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: HEADING 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. Describe the ideas and feelings about self that the client might have developed in the context of these early relations (internalized objects). 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). 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. Help the client become aware of issues described above, and help the client process and resolve early conflicts. Individual Psychology: HEADING Identify how presenting concerns relate to client’s ability to successfully meet specific life tasks. 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. 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. 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: HEADING 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. 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: HEADING Identify how presenting concerns (problem behaviors/cognitions) relate to specific givens of existence. 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. Describe how these defensive behaviors have led the client to experience of neurotic anxiety and/or neurotic guilt and further problems. Behavioral/Cognitive/REBT: HEADING Relate the presenting concerns to faulty learning, irrational thoughts, and/or faulty cognitions. 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. 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 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 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 And others 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. Desribe 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 8 of 8
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COUN 510 Counseling Project: Conceptualization and Treatment Plan 1 Instructions Below is the format you are to use for the Conceptualization and Treatment Plan 1 paper. The paper is about 8 pages, not counting title page, abstract, and references page. Current APA format is required. The entire paper should be written in 3rd person. 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 (Case Conceptualization Using ), your name, and the institution name (Liberty University). 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 be sure you write an effective abstract. Note that the abstract is not an introduction to the paper. 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 CTP paper, you are to choose 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. Separate each question into 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 their presenting problems you noted in the first paper? What are any potential ethical issues that may arise using this theory with your client? What are any potential multicultural issues that may arise using this theory with your client? Can this theory be used in crisis situations? 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 three 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 pursuant to that theory. (NOTE: while Person-Centered Therapy does not have specific techniques, it does have 3 core conditions that are to use 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 one of your treatment goals. You need to then give at least 1 example of how you would use that technique with your client. Specifics always matter. 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.). Spiritual Application NOTE: You are to do this section regardless of if your client wants to receive Christian counseling at this time. The spiritual application will be broken into 2 parts: 1. What spiritual challenges can you see in this case? How would you seek to handle this person’s case if they were interested in having Christian Counseling be a part of the treatment plan? 2. Finally, in what ways is this theory compatible (minimum of 3) with Christian beliefs? In what ways is it not compatible (minimum of 3) with Christian beliefs? You must make extensive use of the Jones & Butman text as well as journal articles. 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 you would expect the outcomes of using this therapy would be, and what will some of the most challenging aspects of the treatment be? 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). 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 this manual and use it. Using a website about APA is not the same as having the manual. The Conceptualization and Treatment Plan 1 paper is due via Blackboard by 11:59 p.m. (ET) on Sunday of Module/Week 4. Page 4 of 4
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COUN 510 Counseling Project: Conceptualization and Treatment Plan 1 Grading Rubric Criteria Points Possible Points Earned Title Page and Abstract 0 to 15 points Title page is in APA format with running head, page number, paper title, name of student, and institution name (5 points). The abstract is in APA format, is 15-250 words, and summarizes the main ideas and conclusion (10 points). Case Conceptualization Questions 0 to 40 points Solid synopsis of theory is included, answering all 8 questions thoroughly (5 points each). Understanding of Theory 0 to 40 points Client’s presenting problems and goals are summarized (10 points). Content demonstrates good understanding of theory, making appropriate application of key concepts and providing 3 techniques with examples specific to the client (10 points each). Christian Worldview 0 to 30 points 3 compatibilities and 3 incompatibilities with a Christian worldview are addressed (5 points each). Conclusion 0 to 10 points The expected outcome of using this therapy with the client is addressed (5 points). The challenging aspects of using this treatment are addressed (5 points). Current APA Format and Sources 0 to 20 points Current APA format is followed (1″ margins, ½″ indents, running headers, page numbers, and correct subheadings are used). Jones & Butman textbook is used with 5 additional academic sources (total of at least 6). No websites, dictionaries, or encyclopedias are used. Citations and references are in proper current APA format. Writing, Grammar, Spelling, and Organization 0 to 20 points Sentences are well phrased, flow smoothly, and vary in length and structure. Word choice is consistently precise and accurate; ideas are arranged logically to support the purpose of the assignment. Ideas flow smoothly and are clearly linked to each other; the reader can follow the line of reasoning. Total Instructor’s Comments:
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OBJECT RELATIONS CASE STUDY 10 , . Object Relations Case Study of Richard: A Conceptualization and Treatment Plan Bea A. Goodstudent Liberty University . A Abstract B egin a new page. Your abstract page should already include the page header as shown above. 2An abstract is a succinct summary of a longer piece of work, usually academic in nature, which is published in isolation from the main text and should therefore stand on its own and be understandable without reference to the longer piece. It should report the latter’s essential facts, and should not exaggerate or contain material that is not there. Its purpose is to act as a reference tool (for example in a library abstracting service), enabling the reader to decide whether or not to read the full text. Your abstract should be a single paragraph double-spaced. Your abstract should be between 150 and 250 words. Keywords: APA style, good paper style, headings, title page Chapter 2, 2.04, p. 25-27) (Figure 2.1, p. 41). “The example below focuses more on the details of the case and does not explain the process using outside sources. The portions in yellow-highlight are meant to give you guidance as to how to incorporate outside sources in a manner that would support the material you are presenting, therefore making a case study more of an assignment that is appropriate in an academic environment.” Object Relations Case Study of Richard: A Conceptualization and Treatment Plan Case Conceptualization of Object Relations You would want to write a good introduction to your paper here that would be one paragraph and would include your thesis statement. This should be different than your abstract which is a summary of your paper. This is where you will also answer the following questions (each in a separate paragraph without the “bullets”): 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 their presenting problems you noted in the first paper? What are any potential ethical issues that may arise using this theory with your client? What are any potential multicultural issues that may arise using this theory with your client? How can this theory be used in crisis situations? Treatment Plan and Interventions Presenting Problems: Richard presents himself as depressed following his recent divorce. He feels lonely and unworthy. He also reports feeling great anger towards his former wife and unable to move on with his life after the divorce. He considers that the divorce was caused mostly by lack of communication between him and his wife. Richard recognizes that he has had great difficulty in communicating with others throughout his life and that only recently he has become aware of this. He reports that previous to this marriage at the age of 44, relationships with women had been short and non-committal. Throughout the interview Richard revealed that both parents were alcoholic and that he was very isolated and angry as a child. He grew up moving frequently from the homes of relatives, including one of his grandmothers. Goals for Counseling Write a short paragraph giving a synopsis about the 3 goals you wrote about on the Case Summary paper. Again, detail is not needed, just a quick summary of the goals that will be directing your interventions/techniques. However, make sure they are specific to your client’s problems! From a psychodynamic and object relations perspective, the goal of therapy is to help Richard connect with his emotional self, feel the pain and rage associated with his early negative experiences to achieve emotional catharsis and gain insight regarding how these early experiences are related to the relationship problems he has experienced in his life. In the process it is also expected that by forming a close bond with the therapist, Richard may learn how to experience closeness in relationship at the same time maintaining appropriate boundaries. You would briefly tie these goals to the theory, again utilizing outside sources. Interventions You would want to offer a definition of each of the interventions you are using, explain why you choose to use this intervention, and what you hoped to accomplish with this intervention. Establishing the relationship. Given Richard’s lack of significant nurturing relationships in his life, issues of trust were particularly difficult with him. This was addressed, in an empathic way, early on in the relationship – I told him that I recognized and understood that it would likely be difficult for him to trust me, the therapist, but that as he felt comfortable it was important for him to gain some trust so that the therapy may work. I also encouraged him to communicate to me how he felt regarding being or not being able to trust me, even if it felt uncomfortable for him to talk about trust issues. Initially Richard was very guarded, tended to make jokes or become hostile with me when the counseling came close to painful issues for him. In some of these instances I pointed out his behavior and asked him what he might have been feeling about himself and about me (immediacy of the relationship) just before he said the remark. Sometimes, instead of asking, I reflected to him feelings of discomfort or anger that I picked up in relation to the issues we were discussing. Sometimes, I shared with him (immediacy of the relationship) how his jokes and/or angry remarks made me feel in the relationship with him (e.g. “when you respond in that way – make a joke about something serious we are talking about or respond angrily at me – makes me feel like you are pushing me away”). And, using parallel process, other times I wondered out loud to what extent others in his life may feel like me when he behaves that way. Analysis of transference. I helped Richard recognize and process when he was pushing me away. In these instances I asked him to stay with and explore the feelings that he was experiencing – which often included fear, anxiety, pain, disbelief that the therapist cares. As he was able to recognize and label these feelings I encouraged him to make connections with other times in his life when he had felt in similar ways. As I described above, these intervention entailed confronting Richard with what was happening in the here and now of the counseling relationship. Insight. As part of the therapy process Richard came to understand how his early deprivation, which was not his fault, led him to not trust himself or others and feel bad about himself, and how these feelings have made it very difficult for him to enter in close relationships with others. In summary this process involved both emotional and intellectual insight. With the support of the therapist, he allowed himself to get in touch – feel – the pain generated by his early deprivation, which lies beneath the strong anger that he feels today. During this process my role as a therapist included providing emotional support, helping Richard “hold” and “contain” the strong pain and anger that had been pent up in him for so long, and feel accepted as he was. I often assure him that his feelings were reasonable given the experiences he had had, and communicated to him (verbally and non-verbally) that it was ok to express them and that I was not overwhelmed by his pain, anger, and fear. In some ways, he was able to re-live his painful childhood experiences in the context of a relationship where he felt accepted, and psychologically taken care of. These experiences constituted a “corrective emotional” experience. With this new insight and corrective emotional experiences, Richard started to be less defensive and more open in relationships with women. He realized that his search of perfection in others was in part an effort to cover his strong sense of inadequacy (insight) that also served to keep others away. This realization helped him to work towards accepting himself and others (shedding away the mechanism of defense) as they are, with good and not so good things. Spiritual Applications Here, you want to make sure you show three ways the theory you chose is compatible and three ways it is not compatible with a Christian worldview (from your standpoint). Don’t forget to show your resources and referrals here. Compatibilities: Object Relations therapy is compatible with Christian principles in some ways. First, in OR therapy, clients are seen as having the potential to change and grow, which aligns with Scripture (Jones & Butman, 2011). Second, . . . Incompatibilites: Object Relations therapy is also incompatible with a Christian worldview in several ways. First, in OR therapy, clients . . . Conclusions With time it is hoped that Richard would become better at recognizing his anger and confronting the feelings associated with it. It is thought that Richard will experience the connection between his early experiences of abandonment and his current difficulties as he allows himself to experience and accept the pain of his lost childhood, and the anger he felt toward his parents for the constant fighting in the house and for not loving and caring for him. During these times it would be important for the therapist to assured Richard that regardless of the parents’ problems, their behavior had been wrong and that as a child he deserved better. This would serve as a corrective emotional experience. It is believed that Richard would eventually be able to understand that his anger was justified and that another person, the therapist, was able to accept him with his anger whereas in the past he interpreted his feelings of anger as further proof of his badness and feared that if the parents knew of this anger they would further reject him. NOTE: This case study is adapted from a case study retrieved from: http://www.coe.uh.edu/arbona/courses/epsy6325/readings/Outline%20Case%20Conceptualization.doc References Good , W. A . (2004). Always be sure to use the best sources that you can find: It will help your paper to be better. Peer Reviewed Articles Are Best, 1 (2), 22-26 . B ooks, T. N., & Notes, F. G. (2010). Use your textbooks whenever possible. (2nd ed.). New York, NY: Plenty Publishing.