Beyond Diagnosis (eBook)

Case Formulation in Cognitive Behavioural Therapy

Michael Bruch (Autor)

eBook Download: EPUB

2015 | 2. Auflage
John Wiley & Sons (Verlag)
978-1-118-60037-5 (ISBN)

Infos

The second edition of Beyond Diagnosis is a fully updatedand expanded examination of Vic Meyer’s pioneering caseformulation approach and its application to cognitive behavioraltherapy.

• Recommends dynamic, individualized assessment over standarddiagnostic classification for complex individual problems
• Presents detailed analysis of advanced cases that are relevantfor clinical practice
• Features a foreword by Ira Turkat, as well as discussion of themost up-to-date clinical procedures from a world-wide group of caseformulation experts

 

Michael Bruch is a Consultant Cognitive-BehavioralPsychotherapist and Senior Research Associate in the Department ofPsychology at University College London. He is also a visitingprofessor in the Dept of Psychology at London MetropolitanUniversity. Previously, he was co-director of theCognitive-Behavioural Psychotherapy unit at UCL and visitingprofessor in the Dept of Mental Health Sciences.

He teaches CBT with particular emphasis on case formulation at anumber of universities across Europe.  His main researchinterests involve conceptualization of complex disorders,psychotherapy training and supervision, and case formulation. Hehas published widely, including five books on CBT.

Inhalt

Contributors vii

Foreword ix

Preface xii

1 The Development of Case Formulation Approaches 1
Michael Bruch

2 The UCL Case Formulation Model: Clinical Process and Procedures 24
Michael Bruch

3 Case Formulation: A Hypothesis-Testing Process 53
Richard S. Hallam

4 Case Formulation and the Therapeutic Relationship 74
Peter G. AuBuchon

5 The Therapeutic Relationship as a Critical Intervention in a Case of Complex PTSD and OCD 96
Peter G. AuBuchon

6 Generalized Anxiety Disorder: Personalized Case Formulation and Treatment 133
Kieron O'Connor, Amélie Drolet-Marcoux, Geneviève Larocque and Karolan Gervais

7 Cognitive-Behavioural Formulation and the Scientist-Practitioner: Working with an Adolescent Boy 165
David A. Lane and Sarah Corrie

8 Cognitive-behavioural Case Formulation in the Treatment of a Complex Case of Social Anxiety Disorder and Substance Misuse 194
Samia Ezzamel, Marcantonio M. Spada and Ana V. Nikèeviæ

Appendix: Invited Case Transcript: The Initial Clinical Hypothesis 220
Ira Daniel Turkat

Index 231

Textauszug

Preface

Since the first publication of Beyond Diagnosis, now 15 years ago, clinical as well as academic interest in case formulation has grown enormously. At the time researchers involved in developing cognitive–behavioural therapy (CBT) were mostly interested in treatment protocols and manuals whereas case formulation was largely ignored or undervalued by the academic community. For example, Beck (1976) stated that CBT developed without much explicit reference to case formulation, and Schulte and coworkers (1992) claimed that individualized tailored interventions offered no advantages over manualized treatment procedures.

The first edition of this book was enormously popular with clinicians and training institutions alike, and I believe that it had great influence in bringing case formulation to the attention of a wider audience. It is very gratifying to see that over the years, earlier attitudes have now changed considerably and there appears growing interest in paying more attention to clinical realities in a ‘bottom up’ approach as some may call it. This is evidenced by a growing body of literature on case formulation, especially for more complex cases. However, for some, this just seems to mean improving clinical outcomes whilst others have suggested much broader or eclectic definitions (e.g. Eels, 2007).

I also note that the British Psychological Society (2011), in their response to the latest DSM5 draft, is now expressing a strong commitment to case formulation–driven procedures in the assessment and treatment of behavioural disorders. This stance on formulation contrasts with the recent government initiative to improve access to psychological therapies (IAPT). Although this initiative has hugely transformed cognitive–behavioural psychotherapy services in the United Kingdom, from the case formulation point of view, there appears to be a renewed tendency to medicalize psychological problems and rely on manualized procedures rather than individually-tailored therapy.

As shall be detailed in Chapter 1, formulating cases on the basis of individualized assessments guided by learning principles and experimental psychology was originally proposed by Hans Eysenck. However, it was Victor Meyer, the clinical pioneer of individualized behaviour therapy, who delivered a viable procedure (now labelled, after several revisions, cognitive–behavioural case formulation). Meyer’s work has inspired many academics and clinicians since, and some of those have developed this model further, providing enhanced conceptual clarity and more precise definitions.

Unlike the first edition of this book, the current text is exclusively dedicated to Meyer’s pioneering work, also known as the ‘Middlesex approach’.

What is unique to Meyer’s model? Unlike many ideas and models coming out of academic ‘ivory towers’, Meyers’s approach is closely linked to the complexity of clinical realities, in particular to complex cases, and was developed and refined gradually over many years. This was done predominantly to the benefit of the patient as opposed to the furthering of academic ambitions. Vic himself was a rather reluctant publicist and always a little suspicious of research conducted in academic writings by scientists who he thought rarely saw ‘real patients’.

Perhaps because of this, Vic’s seminal work did not receive the publicity and academic attention it should have had; however, he was greatly acknowledged by clinicians and students all over the world for his clinical and training skills.

In comparison to other developments in behaviour therapy, Meyer’s approach was predominantly rooted in the psychiatric setting, where ‘treatment as usual’ was rarely effective or appropriate when treating the more severe and complex cases that were referred. From work with these complex cases, it appeared that an individual case formulation approach, guided by experimental psychology and based on learning principles, achieved better results with patients than did the more ubiquitous approach of matching patient symptoms to specific techniques (the mainstay of proponents of psychiatric diagnosis).

Why was such an approach more effective and helpful to patients (and therapists)? This is for mainly for two reasons: (1) even seemingly similar presenting complaints showed great individual variation regarding development, presentation and maintenance and (2) it was unsatisfactory if not impossible to understand and conceptualize more severe, complex problems according to diagnostic categories, particularly when either multiple or non-specific complaints were reported.

Unfortunately, since these pioneering days, clinical case formulation has remained very much a backwater as the interest of mostly academic psychologists shifted to developing standard protocols suited to randomised controlled trials (RCT) research methodologies and geared towards psychiatric disorders. The goal was to create evidence-based protocols to treat the ‘symptoms’ grouped within psychiatric syndromes.

However, the wheel has now turned full circle and it is back to basics with increasing interest in complex and challenging problems. Over the past two decades, case formulation has gradually gained more attention and recognition as a fitting solution to such problems. It is exciting to see that this trend has accelerated strongly since the publication of the first edition of this book, as can be testified by a growing number of publications, conference presentations and training activities.

I feel it is timely now to offer an update of the UCL model including new clinical case examples to illustrate this. The authors were mostly trained in this approach or have extensive experience of its clinical application. I also hope that the clinical–experimental procedures of this model have been described in more practical terms for the clinician and trainee alike. I believe these improvements are timely to satisfy the growing interest in CBT training and practice.

The exclusive focus on the ‘Middlesex approach’ in this edition, or as it is now labelled, the ‘UCL Case Formulation Model’, will allow better descriptions of process and procedures. This time I have tried to achieve more transparent and detailed explanation and commentary of the clinical–experimental process as well as have suggested step-by-step procedures. Also, in view of the growing popularity of the case formulation approach, it appears timely and necessary to remind students and clinicians alike of the basic principles of case formulation as a clinical–experimental process rather than as matching techniques to symptoms. There is some concern that other recent models, despite offering improvements in clinical practice, might still be oriented to psychiatric nosology and standardization of techniques modelled on group-based research trials. We also recognize that in some countries, notably North America, it is mandatory to arrive at a diagnosis for legal and remuneration purposes!

As before, this text is intended for clinical and health psychologists, psychiatrists, psychiatric nurses, social workers and other mental health practitioners who are interested in the application of cognitive–behavioural methods to psychological problems and psychiatric disorders. And of course, once again I anticipate this book to be very useful and popular for training courses and students of CBT.

In Chapter 1, I provide an overview of the history and development of individualized clinical–experimental approaches, now labelled ‘case formulation’, from the early beginnings of behaviour therapy. I shall focus on three related aspects which have inspired and promoted this undertaking: (1) complex disorders in the psychiatric setting, (2) purpose and limitations of the diagnostic model and (3) problems with the standardization of techniques. The need for a comprehensive understanding of individual problems (problem formulation) and individually tailored treatment interventions will be argued. In addition, some issues of divergence and similarity in recent case formulation models will be discussed briefly.

In Chapter 2, I provide an overview of conceptual issues in case formulation followed by a description of the clinical application and procedures as developed and practised within the UCL model. I discuss the role of the initial interview, suggested clinical-experimental procedures, the ‘problem formulation’, clinical measurement and evaluation procedures, the self-schema model for complex problems and the role of the therapeutic relationship.

In Chapter 3, Richard Hallam presents and discusses clinical–experimental methodology in case formulation with particular emphasis on how to generate clinically relevant hypotheses about presenting problems and how to turn these into relevant questions to be tested during the interview and beyond.

Peter AuBuchon (with V Malatesta) had already presented his ground-breaking formulation-guided model for the therapeutic relationship in the first edition of this text. In Chapter 4, he now provides an updated account of his approach as it has evolved since and matured in clinical practice. He explains how his extensive clinical work with difficult and complex cases has shaped his thinking on the subject since the first edition.

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Produkt-Details

• Erscheint lt. Verlag: 20.1.2015
• Sprache: englisch
• Themenwelt: Geisteswissenschaften ► Psychologie ► Klinische Psychologie
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Psychiatrie / Psychotherapie
• Schlagworte: case formulation • CBT • Clinical psychology • Cognitive behavioral therapy (CBT) • Health Psychology • individual assessment • Klinische Psychologie • Kognitive Verhaltenstherapie • Psychologie • Psychology • Vic Meyer
• ISBN-10: 1-118-60037-1 / 1118600371
• ISBN-13: 978-1-118-60037-5 / 9781118600375