Näyttöön perustuva tapausjäsennys psykoterapiassa
At Formulator, we have digitalized the psychological case formulation process. Our psychologist, Sini-Sofia Savola, had the pleasure of interviewing Tracy Eells, the most famous clinician and researcher on the topic. In this blog post, we'll explore his toughts on evidence-based case formulation and how established models and theories can guide psychotherapists in understanding a patient's psychological and emotional state. The ideas and insights on this blog post are based on the interview.
What’s in Case Formulation?
Psychotherapists are trained to assess mental health conditions and formulate cases that explain patients' symptoms, behaviors, and emotions. Case formulation involves gathering information about the patient, creating a hypothesis about the underlying cause of the patient's symptoms, and developing a treatment plan to address the patient's needs. An evidence-based case formulation involves a structured approach that uses established models and theories to guide the process.
There's a psychodynamic explanatory models that can fit into this general formulation model. So can CBT (cognitive-behavioral), behavioral, emotion focused, ACT (Acceptance and Commitment Therapy) model can be fit into this general structure. And there's of course not just one version of each of these theoretical frame works. We will next explore more some common models that therapist use when doing an evidence based formulation.
“There's evidence for efficacy of multiple models of therapy and some disorders are probably more treatable with certain theoretical orientations.”
Tracy Eells
Evidence-Based Psychodynamic Case Formulation
One example of an evidence-based case formulation model is the CCRT model developed by Lester Luborsky in the 1970s. The CCRT model has three components: the patient's wishes, the expected responses of other people to those wishes, and the patient's response to the responses of others. A psychotherapist who uses the CCRT model would try to identify each component of the patient's experience and organize the information in a structured way. This helps the therapist understand the patient's underlying motivations, expectations, and emotional responses to interpersonal situations.
The wish-fear compromise model focuses on the patient's desires and fears. A therapist using this model would try to identify the patient's wishes and the fears that interfere with the patient's ability to achieve those wishes. The therapist would then look for ways that the patient compromises, such as by engaging in maladaptive behaviors or experiencing symptoms.
The Stress-Diathesis Model
There are many other tools, too, available to psychotherapists who want to use an evidence-based approach to case formulation. The diathesis-stress model suggests that symptoms are the result of a combination of stressors and vulnerabilities. A therapist using this model would try to identify the patient's vulnerabilities and the stressors in the patient's life that trigger symptoms.
Cognitive-behavioral models
Cognitive-behavioral models, such as schema-focused therapy or functional analysis, also provide a structured approach to case formulation. These models focus on the patient's thoughts and beliefs and how they relate to symptoms or maladaptive behaviors. By identifying the patient's automatic thoughts or schemas (patterns of thought), a therapist can help the patient understand how their thoughts and beliefs contribute to their emotional responses and behaviors.
The Benefits of Evidence-Based Case Formulation
By understanding the patient's underlying motivations, emotions, and behaviors, a therapist can develop a more effective treatment plan that addresses the patient's needs. Evidence-based case formulation provides a structured approach to understanding a patient's psychological and emotional state. The CCRT model, stress diathesis model, wish-fear compromise model, and cognitive-behavioral models are all useful tools for psychotherapists who want to use an evidence-based approach to case formulation.
Conclusion
In summary, evidence-based case formulation is a structured approach to understanding a patient's psychological and emotional state. Established models and theories can guide the process of gathering information, creating a hypothesis, and developing a treatment plan. By understanding the patient's underlying motivations, emotions, and behaviors, a therapist can develop a more effective treatment plan that addresses the patient's needs.