Mikä on tapausjäsennys?

Oletko koskaan miettinyt, mikä on tapausjäsennys? Tai miksi se on niin olennainen osa mielenterveysalan ammattilaisen ja asiakkaan välistä suhdetta?

Tieteellinen johtajamme, psykologian tohtori ja KAT-kouluttajapsykoterapeutt Katri Kanninen, kertoo, mikä on tapausjäsennys, miten se tehdään, mistä se rakentyy ja miksi se on niin tärkeä osa-alue jokaisen mielenterveyspalvelujen tarjoajan jokapäiväisessä työkalupakissa.

Structures and more coherent understanding

It is sometimes quite a puzzle to understand which bits and pieces belong where in the client's story. Case formulation contains structures that permit the clinician to understand and summarize the information about the person. It is a process of developing a hypothesis about the causes, precipitants, and maintaining influencesof a person’s psychological, interpersonal, and behavioural challenges, as well as a plan to address these problems. The use of case formulation is seen as a central part of good clinical praxis. When compared to assessment as usual, high-quality case formulation ensures a more coherent understanding of the client's goals, tasks and commitment to change. It simply helps to treatment to be more focused.

The purpose of case formulation

The purpose of case formulation is, together with the client,build an understanding of what brought the client to therapy and for this understanding to serve as a blueprint guiding the treatment. Overall, the tone of case formulation demonstrates overt sympathy and understanding for the current plight of the client. Case formulation is also a way to find a common language to discuss challenging issues. 

The case formulation 

• states clearly the current target problem 

• states triggering events and issues in the life that may have taken place 

• makes connections between past challenging experiences of neglect, abuse and trauma and current patterns of functioning

• identifies the typical dysfunctional roles that the client takes up in the present and links these to past events 

• may help to reflect upon and predict how the client may rely on old maladaptive patterns even in the mental health professional - client relationship

Moreover, it offers a realistic notion of what may be achieved during therapy and states the identified goals of the work. Its role in strengthening the alliance is especially important through making the goals and tasks more transparent. This, in turn, gives more agency to client, promoting the experience of “I can, I will” make this change happen. 

Benefits of case formulation

The use of case formulation is seen as a central part of good clinical praxis. However, there is scarce research on its importance. Formulating is a challenging and time-consuming task. Case formulation increases patient-centered care and all the valuable outcomes of it. When compared to assessment as usual, high-quality case formulation ensures a more coherent understanding of the client's and the employee's goals, tasks and commitment to care.

It is widely accepted that what shows early in treatment plays also vital part later on. The faster one gets to the core of problems, the more useful and meaningful client experiences therapeutic interventions. This is related to success of therapy as well.

References

Eells, T. D. (2015). Psychotherapy case formulation. American Psychological Association.