The Procrustean Dilemma

THE MYTHOLOGICAL CHARACTER PROCRUSTES

WAS A HOST WHO INVITED PASSERS-BY TO HIS
HOUSE, CLAIMING THAT ALL VISITORS,
WHATEVER THEIR SIZE, WOULD FIT THE BED IN
HIS GUEST ROOM. SUCH A GRAND AND MAGICAL
CLAIM ATTRACTED A LOT OF ATTENTION.
WHAT PROCRUSTES DID NOT TELL HIS GUESTS WAS
THAT HE WAS WILLING TO EITHER CUT OFF HIS
GUEST’S LEGS OR STRETCH THEM ON A RACK TO
MAKE THEM FIT THE BED.
In the Greek myth, Procrustes was a son of Poseidon. He had a bed in
which he insisted that every passer-by spend the night. If a guest was
shorter than the bed, Procrustes would set to work on them with his
smith's hammer to stretch them to fit. If the guest proved too tall,
Procrustes would amputate the excess length because Procrustes
demanded an exact fit.
Hence, a Procrustean bed is an arbitrary standard to which
exact conformity is forced. Therapists who employ Procrustean bed
approaches to psychological treatment basically have a single method
or intervention that they use on everyone. Rather than modifying their
therapeutic approach to fit the needs of unique individuals, they insist
their clients conform to their preferred method.
CASE CONCEPTUALIZATION
 Identifying the various
factors on understanding
OBJECTIVE the clients’ nature of the
problem.
CASE CONCEPTUALIZATION
Includes the counselor’s hypothesis about the causes, precipitants, and maintaining
influences of a person’s problem. It delves into the why, when, with whom, and how a
client’s concern developed (Eells, 1997).
Focuses on identifying and connecting the primary problems and their predisposing,
precipitating, and perpetuating factors. It also assesses the severity of the
psychosocial stressors and the highest level of functioning that the individual can use
to handle the concern.
PRESENTING PROBLEM/REASON FOR REFERRAL
oPresenting Problem- term used if the client voluntarily enters counseling or assessment
oReason for Referral- term used if the person was referred by someone (by family
members, friends, authorities such as teachers and police, other health professionals,
etc.)
othe initial symptom for which a person seeks help from a therapist, doctor,
psychiatrist, or other provider.
oNot necessarily the most serious problem, or even the one that will lead to the most
accurate diagnosis.
oFor example, when a person goes to the doctor complaining of a rapid heart rate,
the doctor might ask about his/her stress level to determine if the problem is a
cardiac one or related to anxiety.
 ELEMENTS OF CASE The 4Ps
CONCEPTUALIZATION
PREDISPOSING FACTORS
Causes; Remote past- Includes childhood/home factors
PRECIPITATING FACTORS
Precipitants; Immediate past- what just happened that triggered the problem
PERPETUATING FACTORS
Maintaining influences; Current psychosocial and environmental factors that maintain
the problem and affect the diagnosis, treatment and prognosis
PROTECTIVE FACTORS
Strength; conditions or attributes (skills, strengths, resources, supports or coping
strategies) in individuals, families, communities or the larger society that help people
deal more effectively with stressful events and mitigate or eliminate risk in families
and communities.
HIGHEST LEVEL OF FUNCTIONING
oGood, Fair, Poor
oClient’s overall level of functioning- capacity to think and decide independently and
to act upon the decision
oMay be assessed through psychological tests or interview
RECOMMENDED TREATMENT
oWhat needs to be done with what the client is experiencing
oAppropriate counseling approaches, techniques and procedures
ASSESSMENT OF PROGNOSIS
oGood, fair, or poor
oPrognosis- likelihood of development of a disease; will it get better or worsen over
time?
oPrediction of the outcome of a problem or treatment
REFERENCES
PsychDB. (2020, February). Biopsychosocial Model and Case Formulation. Retrieved
from PsychDB: https://www.psychdb.com/teaching/intermediate/biopsychosocial-
formulation
Villar, I. (2011). Counseling and psychotherapy in the Philippines. Makati: Aligned
Transformations Publications.
Walter, I. (2018, June). How to write a case summary. Retrieved from Family Therapy
Basics: https://familytherapybasics.com/blog/therapy-case-summary