SUBMITTED BY:

Afifa sajjid

ROLL NO. 16

SUBMITTED TO:

Maam Nayab

COURSE:

COUNSELING PSYCHOLOGY
 OUTLINE

 What is case conceptualization?

 Purpose

 The eight P’s

 Presentation
 Predisposition

 Biological:
 Psychological
 Social
 Cultural:

 Precipitants
 Protective factors and strengths
 Pattern (maladaptive)
 Perpetuants
 Plan (treatment)
 Prognosis

 CASE EXAMPLE with case conseptualization

 What goes into a good case conceptualization
 Why it is important for counselors to formulate case conceptualization?
 CASE CONCEPTUALIZATION:

Case conceptualization is a framework used to

1) Understand the patient and his/her current problems

2) Inform treatment and intervention techniques

3) Serve as a foundation to assess patient change/progress.

Case conceptualization also aids in establishing rapport and a sense of hope for patients. Case
conceptualization is vital to effective treatment and represents a defining characteristic of expert
clinicians. Using these skills, clinicians are better able to define a treatment plan using
intervention techniques that provide the best opportunities for change. This focused and
informed approach provides the roadmap for both patients and therapists and should include a
foundation for assessing change/progress. Case conceptualization is particularly important for
short-term therapy, as it serves to focus both the patient and clinician on the salient issues so as
to avoid ancillary problems that often serve as distractions to core goals.

PURPOSE:

Case conceptualization is a method and clinical strategy for obtaining and organizing
information about a client, understanding and explaining the client's situation and maladaptive
patterns, guiding and focusing treatment, anticipating challenges and roadblocks, and preparing
for successful termination

THE EIGHT P’S

The format is based on eight elements for articulating and explaining the nature and origins of
the client’s presentation and subsequent treatment. These elements are described in terms of
eight P’s:

1. Presentation

Presentation refers to a description of the nature and severity of the client’s clinical presentation.
Typically, this includes symptoms, personal concerns and interpersonal conflicts.

2. Predisposition

Predisposition refers to all factors that render an individual vulnerable to a clinical condition.
Predisposing factors usually involve biological, psychological, social and cultural factors.

This statement is influenced by the counselor’s theoretical orientation. The theoretical model
espouses a system for understanding the cause of suffering, the development of personality traits,
and a process for how change and healing can occur in counseling. We can use a biopsychosocial
model.

Biological: Biological factors include genetic, familial, temperament and medical factors, such
as family history of a mental or substance disorder, or a cardiovascular condition such as
hypertension.

Psychological: Psychological factors might include dysfunctional beliefs involving inadequacy,

perfectionism or overdependence, which further predispose the individual to a medical condition
such as coronary artery disease. Psychological factors might also involve limited or exaggerated
social skills such as a lack of friendship skills, unassertiveness or over aggressiveness.
Social: Social factors could include early childhood losses, inconsistent parenting style, an
overly enmeshed or disengaged family environment, and family values such as competitiveness
or criticalness. Financial stressors can further exacerbate a client’s clinical presentations. The
“social” element in the biopsychosocial model includes cultural factors. We separate these
factors out, however.

Cultural: Of the many cultural factors, three are particularly important in developing effective
case conceptualizations: level of acculturation, acculturative stress and acculturation-specific
stress. Acculturation is the process of adapting to a culture different from one’s initial culture.
Adapting to another culture tends to be stressful, and this is called acculturative stress. Such
adaptation is reflected in levels of acculturation that range from low to high.

3. Precipitants

Precipitants refer to physical, psychological and social stressors that may be causative or
coincide with the onset of symptoms or relational conflict. These may include physical stressors
such as trauma, pain, medication side effects or withdrawal from an addictive substance.
Common psychological stressors involve losses, rejections or disappointments that undermine a
sense of personal competence. Social stressors may involve losses or rejections that undermine
an individual’s social support and status. Included are the illness, death or hospitalization of a
significant other, job demotion, the loss of Social Security disability payments and so on.

4. Protective factors and strengths

Protective factors are factors that decrease the likelihood of developing a clinical condition.
Examples include coping skills, a positive support system, a secure attachment style and the
experience of leaving an abusive relationship. It is useful to think of protective factors as being
the mirror opposite of risk factors (i.e., factors that increase the likelihood of developing a
clinical condition).

5. Pattern (maladaptive)
Pattern refers to the predictable and consistent style or manner in which an individual thinks,
feels, acts, copes, and defends the self both in stressful and nonstressful circumstances. It reflects
the individual’s baseline functioning. Pattern has physical (e.g., a sedentary and coronary-prone
lifestyle), psychological (e.g., dependent personality style or disorder) and social features (e.g.,
collusion in a relative’s marital problems). Pattern also includes the individual’s functional
strengths, which counterbalance dysfunction.

6. Perpetuants

Perpetuants refer to processes through which an individual’s pattern is reinforced and confirmed
by both the individual and the individual’s environment. These processes may be physical, such
as impaired immunity or habituation to an addictive substance; psychological, such as losing
hope or fearing the consequences of getting well; or social, such as colluding family members or
agencies that foster constrained dysfunctional behavior rather than recovery and growth.
Sometimes precipitating factors continue and become perpetuants.

7. Plan (treatment)

Plan refers to a planned treatment intervention, including treatment goals, strategy and methods.
It includes clinical decision-making considerations and ethical considerations.

8. Prognosis

Prognosis refers to the individual’s expected response to treatment. This forecast is based on the
mix of risk factors and protective factors, client strengths and readiness for change, and the
counselor’s experience and expertise in effecting therapeutic change. 
CASE EXAMPLE

Amna is a 35-year-old Ph.D. student at an online university. She is white, identifies as

heterosexual and reports that she has never been in a love relationship. She is self-referred and is
seeking counseling to reduce her chronic anxiety and social anxiety. She recently started a new
job at a bookstore — a stressor that brought her to counseling. She reports feeling very anxious
when speaking in her online classes and in social settings. She is worried that she will not be able
to manage her anxiety at her new job because she will be in a managerial role.

Amna reports that she has been highly anxious since childhood. She denies past psychological or
psychiatric treatment of any kind but reports that she has recently read several self-help books on
anxiety. She also manages her stress by spending time with her close friend from class, spending
time with her two dogs, drawing and painting. She appears to be highly motivated for counseling
and states that her goals for therapy are “to manage and reduce my anxiety, increase my
confidence and eventually get in a romantic relationship.”
Amna describes her childhood as lonely and herself as “an introvert seeking to be an extrovert.”
She states that her parents were successful lawyers who valued success, achievement and public
recognition. They were highly critical of Joyce when she would struggle with academics or act
shy in social situations. As an only child, she often played alone and would spend her free time
reading or drawing by herself.

When asked how she views herself and others, amna says, “I often don’t feel like I’m good
enough and don’t belong. I usually expect people to be self-centered, critical and judgmental.”

Case conceptualization outline

We suggest developing a case conceptualization with an outline of key phrases for each of the
eight P’s. Here is what these phrases might look like for amna’s case. These phrases are then
woven together into sentences that make up a case conceptualization statement that can be
imported into your initial evaluation report.

Presentation: Generalized anxiety symptoms and social anxiety

Precipitant: New job and concerns about managing her anxiety

Pattern (maladaptive): Avoids closeness to avoid perceived harm

Predisposition:

 Biological: Paternal history of anxiety

 Psychological: Views herself as inadequate and others as critical; deficits in assertiveness
skills, self-soothing skills and relational skills
 Social: Few friends, a history of social anxiety, and parents who were highly successful
and critical
 Cultural: No acculturative stress or cultural stressors but from upper-middle-class
socioeconomic status, so from privileged background — access to services and resources

Perpetuants: Small support system; believes that she is not competent at work
Protective factors/strengths: Compassionate, creative coping, determined, hardworking, has
access to various resources, motivated for counseling

Plan (treatment): Supportive and strengths-based counseling, thought testing, self-monitoring,

mindfulness practice, downward arrow technique, coping and relationship skills training, referral
for group counseling

Prognosis: Good, given her motivation for treatment and the extent to which her strengths and
protective factors are integrated into treatment

What goes into a good case conceptualization?

1. MENTAL STATUS EXAM

A mental status exam (MSE) is often described as the psychological equivalent to a physical
examination. The MSE includes both objective and subjective observations and is designed to
develop a quick snapshot into the presenting status of a client. The MSE can be highly
structured, but some clinicians will use a less formal approach. If communicating about your
client with another professional, you could mention how you obtained the information, e.g.,
unstructured clinical interview, structured clinical forms, or combination thereof. The
components of an MSE include:

1. Appearance
2. Behavior
3. Cooperativeness
4. Speech
5. Mood
6. Affect
7. Thought content and process
8. Cognition
9. Insight/Judgment

2: PRESENTING PROBLEM:
The presenting problem refers to the client’s perception of the problem or, in other words, what
brought them to therapy. It is not what the clinician thinks the problem is. This speaks to the
importance of client autonomy and self-determination. Whether you are sitting for the MFT,
social work, or PCC exam, you may see questions designed to test you understand the
importance of the client’s self-determination and ensure you do not impose your personal beliefs
on clients.
3. HISTORY:

This section of the case conceptualization should include treatment history, medical history, drug
& alcohol history, and (with a lengthier focus) relational history. This allows the therapist to
consider the contextual factors at play in the client’s presenting problem.
4. DIAGNOSIS:

In most cases, you will start with a provisional diagnosis. Once you
complete a comprehensive assessment, you can make a formal diagnosis. The DSM 5
provides the criteria for all mental health diagnoses. Not only do you need to include
a diagnosis in a client’s medical record to meet the standard of care, your ability to
differentiate diagnoses will definitely be tested on your clinical exam.
5. JUSTIFICATION OF DIAGNOSIS:

Here you will begin to weave your analysis of the

client’s situation using elements from their history, MSE, and description of the
presenting problem that align with the criteria listed in the DSM 5.
6. THEORETICAL ORIENTATION:

If you have not decided on your orientation or choose

to practice “eclectically”, it is a good idea to determine which theory might help this
client best and why. Some things to consider when making this decision include:
Is your theoretical choice based on the symptoms you see?
Is it based on your personal preference?
Do your client’s goals lend themselves to a particular approach?
Does your agency require you to use a particular therapeutic modality?
7. TREATMENT PLAN & COURSE OF TREATMENT:

This is the dynamic road map to your client’s recovery. The therapist would collaborate with
their client to identify both short and long-term treatment goals. The therapist would then
identify measurable objectives and interventions tied to each goal. The goals, objectives, and
interventions should align with your theoretical orientation and be unique to each
client. Forming a therapeutic alliance is almost always a first goal. However, if there
is a crisis, that would take priority. This is not a one-time deal, you will continually
need to evaluate the goals, objectives, and interventions, and adapt them to the
evolving therapeutic relationship, your client’s response to interventions and their
changing needs.
8. HUMAN DIVERSITY CONSIDERATIONS:

Human diversity is a broad concept that refers to the unique aspects of a client that make them
different from those around them and affect the client’s experience in the world. Such
differences can include ethnicity, marital status, gender, age, religion, socioeconomic status, and
specific group affiliations, among others. It is important to consider how the client’s unique
cultural background influences their presenting issue, their engagement in the therapeutic
process, and their relationship with the therapist.

9: LEGAL & ETHICAL ISSUES:

Always consider your legal and ethical obligations as you conceptualize your case. Do you have
any possible mandates? Have you obtained signed releases? Minor consent? Are there ethical or
possible unethical dual relationships? Are there safety issues that must be managed? Are there
necessary referrals or health professionals involved in the client’s treatment?
10. PROGNOSIS:

This final part of the case conceptualization refers to the likely course and outcome of treatment.
When considering the prognosis, you want to assess the internal and external protective factors
that will aid in the client’s recovery. These will be factors you want to build on and incorporate
in the treatment plan. Conversely, you would also want to consider those factors that could
impede treatment progress so these can be adequately addressed during treatment.
The above is a useful format to use for a formal case presentation in group supervision or
case consultation.

Why Is It Important For Counselors To Formulate A Case Conceptualization?

Well case conceptualization can provide a useful framework for the therapeutic process; it
allows the therapist to develop an effective treatment plan, speak intelligently about their client
in supervision and consultation, and collaborate with other professionals