A pattern is a succinct description of a client’s characteristic way of perceiving, thinking, and responding. It links the client’s presentation with the precipitant, and makes sense of the situation. Patterns are driven by the client’s predispositions and refl ect the client’s perpetuants. (중략) A pattern may be situation-specific or longitudinal. 34
Two basic premises are useful in understanding the integrative case conceptualization model. The fi rst premise is an understanding about personality development, psychopathology, and psychotherapy. It is that individuals unwittingly develop a self-perpetuating, maladaptive pattern of functioning and relating to others (personality development). Inevitably, this pattern underlies a client’s presenting issues (psychopathology). Effective treatment always involves a change process in which the client and practitioner collaborate to identify this pattern, break it, and replace it with a more adaptive pattern. At least two outcomes result from this change process: Increased well-being and resolution of the client’s presenting issue (psychotherapy). The second premise is that pattern change is at the heart of the case conceptualization process. 38-39
Explaining how the maladaptive pattern developed and is maintained is the realm of the clinical formulation and cultural formulation, while a plan for replacing it with a more adaptive pattern is the realm of the treatment formulation. 39
The value of a case conceptualization, particularly the clinical formulation component of it, is the degree to which the clinical formulations offers an accurate and compelling explanation of why clients act, think, perceive, and feel the way they do. 44
Explanatory power is a function of the accuracy and “fit” of the clinical formulation between the explanation offered and data from a particular case. 44
Forward reasoning involves moving from data to one or more hypotheses until a solution is achieved. 46
In short, forward reasoning is characterized by facts-to-inference reasoning while backward thinking is characterized by inference-to-facts reasoning. 47
This involves ongoing study of exemplary case conceptualizations and deliberate practice in modeling the requisite skills of focused inductive reasoning, inference making, forward reasoning, pattern recognition, and then drafting versions of the diagnostic, clinical, cultural, and treatment formulations until a sufficient level of explanatory and predictive power is achieved. 47-48
The predisposition is derived largely from the developmental, social, and health histories which provide clues about likely predisposing factors, and refl ect the client’s biological, psychological, and social vulnerabilities. 49
Perpetuants are also called maintaining factors. Essentially, perpetuants are processes in which a client’s pattern is reinforced and confi rmed by both the client and the client’s environment. (중략) Because the infl uence of these factors seem to overlap, at times it can be diffi cult to specify whether a factor is a predisposition or a perpetuant. 49
Noteworthy is that the practitioner initially utilized the Biopsychosocial method and then turned to the Cognitive-Behavioral method to guide his efforts to increase the explanatory power of his developing clinical formulation. 53
The importance of determining the mix of cultural and personality dynamics is critical in decisions about the extent to which culturally sensitive treatment may be indicated. 56
댓글