There’s a tendency for many therapy theories to claim they work for all types of suffering. A number of evidence-based therapies tend to be effective for a number of difficulties. But if you’ve been practicing for a while, you probably noticed that one size does not fit all. If it did, we as a profession would have found that perfect approach and already have helped everyone learn how to heal themselves.
Clients come to therapy with more reasons for struggle than any therapy manual can tell us. But we do know that some therapy approaches work well for certain difficult experiences. How do therapists choose which mode of therapy to use? In-step the case conceptualization approach.
An individual’s own personal history and unique experiences are important. Case conceptualization involves the use of evidence based therapies to study groups of people, and whose results assist clinicians in meeting people and their unique needs. This approach involves assessing which primary experience or experiences contribute to the struggles the individual brings to therapy.
This assessment should take place early in therapy. It should be thorough in order to help confidently link an individual’s experiences to how they have become depressed and/or anxious, for example. Or how they have developed relationship difficulties. Linking these experiences helps the therapist choose an effective therapy approach to target those contributing experiences.
How we choose depends on many psychological processes, learning histories, and individual differences. This is referred to the case conceptualization approach. To note, this approach does not blame clients for what they experience. It is rather an objective way to view client’s experiences, which provides guidance on the best way to help.
A few examples help illustrate the case conceptualization approach.
A classic one concerns depression. Some individuals become depressed due to continued negative thoughts in the moment or negative beliefs about themselves. For example “Those people don’t like me” or “I am a bad person.” However, other individuals grow depressed from losing contact with activities that give them a sense of meaning, purpose, or accomplishment. They then lose a sense of reward in life. The negative thoughts/beliefs experience is usually more fitting for CBT approaches, which challenge these beliefs, and can improve mood. The second experience is more fitting to behavioral activation in order to provide more reward and boost mood.
This assessment may also find strong evidence that a client’s depression is maintained by how they respond to close others or are treated in family dynamics. In this case, Interpersonal therapy (IPT) or a family systems / Minuchin style approaches may be warranted. On the other hand, a client may find it difficult to accept emotional responses or to engage in behaviors that are aligned with their values. ACT could be a good approach to try with this latter client.
Case conceptualization may help choose exposure-based approaches for trauma maintained by raw fear of traumatic reminders (e.g., Prolonged Exposure; EMDR). On the other hand, trauma maintained by shame and beliefs about one’s role in what happened may suggest cognitive approaches (e.g., Cognitive Processing Therapy-CPT; traditional CBT for PTSD). This approach may be why research finds it is important to present a “menu” of evidence-based options in order to focus effective substance abuse treatment to a given individual.
The case conceptualization approach can make us more effective in our practice. It leads therapists to train in multiple approaches. Much like musicians being able to play more styles of music (e.g., rock, blues, jazz, classical, etc. ), this helps therapists improve our skills overall. Jacqueline Person’s great book on this approach provides an excellent therapist resource for those from any theoretical perspective who want to learn more.
The case conceptualization approach seems to complicate things for therapists at first, but it actually fosters simplicity in the long run. It provides a framework to effectively choose how to best help each unique client. And it’s nice to feel more confident about the therapy we provide.
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