clinical case formulation felícitas kort psychology projects coordinator clinical management...
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CLINICAL CASEFORMULATION CLINICAL CASEFORMULATION
Felícitas Kort
Psychology Projects Coordinator Clinical Management Consultants FREEDOM FROM FEAR
PSYCHOTHERAPY AS A FORMULATION
HYPOTHESIS
* Formulation *Treatment based in the formulation
*Monitor progress of treatment to proof the hypothesis
PSYCHOTHERAPY AS A FORMULATION
HYPOTHESIS
* Formulation *Treatment based in the formulation
*Monitor progress of treatment to proof the hypothesis
FORMULATIONOF A CLINICAL CASE*
FORMULATIONOF A CLINICAL CASE*
A frequent situation: the patient presents difficulties with a particularproblem
The question asked by the mental healthspecialist: What is the best for this patient at the present
moment ?
*Case formulation helps select the appropriate strategies
THE ANSWER TO THIS QUESTION REQUIRES AN:
THE ANSWER TO THIS QUESTION REQUIRES AN:
Evaluation
A develpment of a hypothesis of the case
Use the formulation to guide the intervention
An evaluation of the progress so as to observe the response of the intervention
EMPIRICAL TREATMENT OF A CASE
EMPIRICAL TREATMENT OF A CASE
1 EVALUATION
2 FORMULATION OF THE CASE
(HYPOTHESIS) 3 TREATMENT
MONITOR THE PROGRESS OF EACH
SESSION a) If it is positive continue
b)If it is inadequate:
EVALUATE AGAIN, OFFER ANOTHER HYPOTHESIS
AND PLAN OF TREATMENT
MONITOR THE PROGRESS OF EACH
SESSION a) If it is positive continue
b)If it is inadequate:
EVALUATE AGAIN, OFFER ANOTHER HYPOTHESIS
AND PLAN OF TREATMENT
FUNCTIONAL ANALYSIS OF PROBLEM BEHAVIORS
FUNCTIONAL ANALYSIS OF PROBLEM BEHAVIORS
ASK THE FOLLOWING QUESTION :
WHAT IS THE FUNCTION OF THIS BEHAVIOR ?
YOU NEED A HYPOTHESIS
YOU NEED THE DETAILS
A FUNCTIONAL ANALYSIS IN THE TREATMENT OF SUICIDAL BEHAVIOR
A FUNCTIONAL ANALYSIS IN THE TREATMENT OF SUICIDAL BEHAVIOR
FORMULATION : suicidal behaviors serve as a function of allowing the person to go to the hospital and find relief to the problems which are overwhelming, therefore
a)calls for attention b) escapes the problems
FUNCTIONAL TREATMENT: teaches skills which are more appropiate to problem solving
FORMULATION OF THE TREATMENT FOR SUICIDAL
BEHAVIOR
FORMULATION OF THE TREATMENT FOR SUICIDAL
BEHAVIORFORMULATION: suicidal behaviors are
caused by beliefs such as “since I am suffering so intensely this suffering will never pass” (hopelessness)
BEHAVIORAL AND COGNITIVE TREATMENT : Register thoughts and schedules of the activities to change thoughts and restructure new beliefs
FUNCTIONAL ANALYSIS OF PROBLEM BEHAVIORS
FUNCTIONAL ANALYSIS OF PROBLEM BEHAVIORS
ANTECEDENTS ( Signal or stimulus behavior ) BEHAVIORS CONSEQUENCES (If it influences the behavior or not, if it repeats itself or not
THE FORMULATION OF A CLINICAL CASE PRESENTS
THREE LEVELS :
THE FORMULATION OF A CLINICAL CASE PRESENTS
THREE LEVELS :
A situation
A psychiatric/psychological disorder or problem
A specific case
Examples of unuseful goals of treatment
Examples of unuseful goals of treatment
* “We would like to have a more loving relationship among each other”
* “I would like to get out of this rut I am in ”
* “I would like to feel better with myself ”
Examples of effective ways to reduce symptoms
Examples of effective ways to reduce symptoms
Reduce the symptoms of depression tolower levels
Reduce anxiety symptoms to lower levels
Eliminate panic attacks
Reduce worries ½ hr a day or less
Elements based in empirical evidence
Elements based in empirical evidence
Backup your results with latest research findings
Theoretical hypothesis
Ideografic evaluation
CASE FORMULATION :A DEFINITION
CASE FORMULATION :A DEFINITION
The formulation of a case is a hypothesis of the problems of the patient
The function of the formulation is to develop a plan to treat the problems
First we want to know where to guide the intervention and
Second understand it
EMPIRICAL EVIDENCE: AN INDIVIDUAL CASE
EMPIRICAL EVIDENCE: AN INDIVIDUAL CASE
Problem list Treatment plan
Objetives Measures Strategies
Progress follow up
Problem HierarchyProblem HierarchyCase formulation
Probability of certainty
Its impact in daily functioning
Its impact in social impact
OBJECTIVESOBJECTIVES
Short term : sub-goals motivate more
Concrete and specific
Measurements
CREATING OBJECTIVESCREATING OBJECTIVES
Evaluate a typical day vs. an ideal day :
Identify a goal associated with the main
problem
Identify if the patient achieved the goal
OBJECTIVESOBJECTIVES
TREATMENT DATE : ----------- PHASE I
OBJECTIVES 1.____________________________________ 2._____________________________________
3._____________________________________
CRITERIA FOR MEASUREMENT CRITERIA FOR MEASUREMENT
Aplicability
Acceptable and friendly
Validity and confiability
Sensitive to change
QUESTIONS TO BE ASKEDWHEN YOU CHOOSE MEASURES
QUESTIONS TO BE ASKEDWHEN YOU CHOOSE MEASURES
1. How can I use these data ?
2. How frequently should I measure?
3. What is the expectative of change ?
4. Should I include other significative
persons in the evaluation?
5. Should I measure only the symptoms associated with the problem or general measures ?
6. Can I design my own measures ?
TREATMENT STRATEGIES TREATMENT STRATEGIES
The more specific the better
Treatment manuals
Evidenced based protocols
The more specific the better
Treatment manuals
Evidenced based protocols
REVIEW OF PROGRESSREVIEW OF PROGRESS
“If there is not a pattern which measures behaviors
it is quite difficult to judge how the progress is
coming along and whether the capabilities are
developed at their best” Bandura & Schunk (1981)
“If there is not a pattern which measures behaviors
it is quite difficult to judge how the progress is
coming along and whether the capabilities are
developed at their best” Bandura & Schunk (1981)
TOOLS NEEDED FOR THE CHARTSTOOLS NEEDED FOR THE CHARTS
Microsoft Excel
Paper and pencil
Charts previously prepared
Microsoft Excel
Paper and pencil
Charts previously prepared
REVIEW OF PROGRESS Stage 1
REVIEW OF PROGRESS Stage 1
Goals
Potencially modify the treatment plan
Continue to another stage of treatment
Termination of behavior and cognitive therapy
Goals
Potencially modify the treatment plan
Continue to another stage of treatment
Termination of behavior and cognitive therapy
INITIATING A NEW STAGE INTREATMENT
INITIATING A NEW STAGE INTREATMENT
When the goals have been fulfilled
New issues arise
Share the results with the patient
When the goals have been fulfilled
New issues arise
Share the results with the patient
BIOPSYCHOSOCIAL REVIEWBIOPSYCHOSOCIAL REVIEW
Clinical crisis Healthy behaviors
Self-destructive behaviors Risk behaviors
Family funcioning Culture and spirituality
Ocupational School & Community functioning
Clinical crisis Healthy behaviors
Self-destructive behaviors Risk behaviors
Family funcioning Culture and spirituality
Ocupational School & Community functioning