CASE

CONCEPTUALIZATION

Prepared by:
AP. DR MASTURA MAHFAR
&
AP DR. SITI ROKIAH
CASE CONCEPTUALIZATION
• Case conceptualization refers to the way that
professional counselors make meaning out of the
information they have gathered.

• Formulating a case conceptualization involves:

Identifying patterns and themes associated with the
information gathered during the assessment phases
CASE CONCEPTUALIZATION
• A case conceptualization is a process and cognitive map for
understanding and explaining a client’s presenting issues
and for guiding the counselling process.

• Case conceptualizations provide counselors with a coherent

plan for focusing treatment interventions, including the
therapeutic alliance, to increase the likelihood of achieving
treatment goals.
CASE CONCEPTUALIZATION

• Applying a theory by considering how issues such as

race, ethnicity, religious beliefs, socioeconomic status,
family structure, trauma and/or sexual and gender
orientation impact a client’s presenting concerns.
This failure to develop an adequate and
appropriate case conceptualization is not just a
shortcoming of trainees, however. it is also
common enough among experienced counselors.

Jon Sperry and Len Sperry

Case conceptualization using 8 P’s
formula: Key to highly
effective counselling
By Jon Sperry and Len Sperry
Eight (8) P’s format of Case
conceptualization (Sperry and Sperry)
• The advantages / uniquenuess of 8P’s format
- brief, quick to learn
- forming a mental picture : a cognitive map of client
- help to make decisions about treatment
- writing and initial evaluation report
eight P’s:
• Presentation
• Predisposition (including culture),
• Precipitants,
• Protective factors and strengths,
• Pattern,
• Perpetuants,
• Plan (treatment), and
• Prognosis.
1. Presentation
• A description of the nature and severity of the client’s clinical presentation.
• Typically, this includes symptoms, personal concerns and interpersonal
conflicts.

2. Predisposition
• All factors that render an individual vulnerable to a clinical condition.
Predisposing factors usually involve (“Biopsychososial” Model) :
i) biological,
ii) psychological,
ii) social,and
iv) cultural factors (e.g. acculturation)

This statement is influenced by the counselor’s theoretical orientation.

3. Precipitants – “Why now?”

• Physical, psychological and social stressors that may be

causative or coincide with the onset of symptoms or
relational conflict.
• Physical stressors - trauma, pain, medication side effects or
withdrawal from an addictive substance.
• Common psychological stressors - losses, rejections or
disappointments
• Social stressors - losses or rejections that undermine an individual’s
social support and status.
4. Perpetuants
• Processes through which an individual’s pattern is reinforced and
confirmed by both the individual and the individual’s environment.
- These processes may be:
i) Physical - impaired immunity or habituation to an addictive
substance;
ii) Psychological - losing hope, secondary irrational beliefs, low self-
resilient, etc
iii) Social – being neglected by family members.

“Sometimes precipitating factors continue and become perpetuants”.

6. Pattern (maladaptive)

• 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 - 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).
5. Protective factors and strengths AND Risk factors
• Protective factors – 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.

• Strengths - psychological processes that consistently enable individuals to think

and act in ways that benefit themselves and others.
• E.g mindfulness, self-control, resilience and self-confidence

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• Risk factors - e.g. suicidal intention, diagnosed bipolar disorder, etc.
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.
In a nut shell
DEFINITIONS
“Basically, a case conceptualization is a method
and process of summarizing seemingly diverse
clinical information about a client into a brief,
coherent statement or ‘map,’ which elucidates the
client’s basic pattern and which serves to guide
the treatment process” (Sperry 20210p. 109 )
FUNCTIONS
Serving as a bridge between the client’s concerns
and the choice of specific interventions (Sperry,
2005)

Provides a working hypothesis about the nature

and origin of the client’s difficulties and leads to
an initial treatment plan