The science and practice of case conceptualization

Case conceptualization is a foundation of cognitive-behavioural therapy (CBT) because it describes and explains clients\u27 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\u27s particular history, experience and strengths are synthesized with theory and research to produce an original and unique account of clients\u27 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. \ua9 2008 British Association for Behavioural and Cognitive Psychotherapies

Assessing the Factorial Validity of the Attitudes and Belief Scale 2-Abbreviated Version: A Call for the Development a Gold Standard Method of Measuring Rational and Irrational Beliefs

Rational Emotive Behaviour Therapy (REBT) does not possess a measure of rational and irrational beliefs that meets internationally recognised standards for acceptable psychometric properties. Without such a measure the theory/practice of REBT cannot be rigorously evaluated, thus undermining its scientific veracity. The current study investigates the validity and reliability of a recently developed measure of rational and irrational beliefs: the Attitudes and Belief Scale 2-Abbreviated Version (ABS-2-AV). University students from three countries completed the ABS-2-AV (N = 397). An alternative models framework using confirmatory factor analysis indicated that a theoretically consistent eight-factor model of the ABS-2-AV provided the best fit of the data. A number of post-hoc modifications were required in order to achieve acceptable model fit results, and these modifications revealed important methodological limitations with the ABS-2-AV. Results indicated that the validity of the ABS-2-AV was undermined due to items measuring both the psychological process of interest (rational and irrational beliefs) and the context in which these beliefs processes are presented. This is a serious methodological limitation of the ABS-2 and all questionnaires derived from it, including the ABS-2-AV. This methodological limitation resulted in the ABS-2-AV possessing poor internal reliability. These limitations are discussed in relation to the broader REBT literature and the impact such problems have on research and practice. A call is made for REBT researchers to come together to develop a “gold standard” method of assessing rational and irrational beliefs that meets international standard for psychometric excellence

The science and practice of case conceptualization

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. © 2008 British Association for Behavioural and Cognitive Psychotherapies

The science and practice of case conceptualization

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. © 2008 British Association for Behavioural and Cognitive Psychotherapies

Disorder specific and trans-diagnostic case conceptualisation.

Case conceptualisation is the process of integrating the unique experience of the individual with psychological theory and is often described as a central process in effective therapy. Hence, a key question facing a clinician working from a cognitive behavioural perspective is which theory should be chosen as the basis of the conceptualisation with a particular client? We address this question by first considering the strengths and limitations of the disorder specific and trans-diagnostic approaches. From this, the differences between the approaches are framed as a conundrum or puzzle that is solved through a principle based approach to case conceptualisation that allows clinicians to individualise therapy by selecting and incorporating the most appropriate theory and research. Furthermore, by considering how to achieve lasting improvement for the client we emphasise incorporating client strengths and resilience into both disorder specific and trans-diagnostic approaches. To achieve this we necessarily extend beyond consideration of models of disorders, and draw on models of wellbeing, and resilience, and by doing so require theoretical accounts not only of disorders but also of resilience

Unresolved Issues Regarding the Research and Practice of Cognitive Behavior Therapy: The Case of Guided Discovery Using Socratic Questioning

This article presents a panel discussion on the integration of collaborative empiricism, specifically Socratic Questioning, into cognitive behaviour therapy. The panel comprised experts in research and practice who had been invited as keynote presenters for the 34th National Conference for the Australian Association of Cognitive and Behaviour Therapy, held in Sydney, Australia. Experts responded to questions regarding (a) the definition of Socratic dialogue, and (b) whether the purpose of Guided Discovery using Socratic Questioning is to impart information, correct, or dispute patient cognitions. The session was well attended by mental health professionals from around the globe and the panel enjoyed the opportunity to discuss questions and comments from those in attendance. This article presents this exchange so that the broader AACBT membership may benefit from the ideas and comments generated. © The Author(s)