1 / 28

CLINICAL CASE FORMULATION

CLINICAL CASE FORMULATION. Felícitas Kort Psychology Projects Coordinator Clinical Management Consultants FREEDOM FROM FEAR.

Lucy
Télécharger la présentation

CLINICAL CASE FORMULATION

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CLINICAL CASEFORMULATION Felícitas Kort Psychology Projects Coordinator Clinical Management Consultants FREEDOM FROM FEAR

  2. PSYCHOTHERAPY AS A FORMULATION HYPOTHESIS * Formulation *Treatment based in the formulation *Monitor progress of treatment to proof the hypothesis

  3. FORMULATIONOF A CLINICAL CASE* A frequent situation: the patient presents difficulties with a particular problem The question asked by the mental health specialist: What is the best for this patient at the present moment ? *Case formulation helps select the appropriate strategies

  4. THE ANSWER TO THIS QUESTION REQUIRES AN: • Evaluation • A develpment of a hypothesis of the case • Use the formulation to guide the intervention • An evaluation of the progress so as to observe the response of the intervention

  5. EMPIRICAL TREATMENT OF A CASE 1 EVALUATION 2 FORMULATION OF THE CASE (HYPOTHESIS) 3 TREATMENT

  6. MONITOR THE PROGRESS OF EACH SESSIONa) If it is positive continueb)If it is inadequate:EVALUATE AGAIN, OFFER ANOTHER HYPOTHESIS AND PLAN OF TREATMENT

  7. FUNCTIONAL ANALYSIS OF PROBLEM BEHAVIORS ASK THE FOLLOWING QUESTION : WHAT IS THE FUNCTION OF THIS BEHAVIOR ? YOU NEED A HYPOTHESIS YOU NEED THE DETAILS

  8. A FUNCTIONAL ANALYSIS IN THE TREATMENT OF SUICIDAL BEHAVIOR FORMULATION : suicidal behaviors serve as a function of allowing the person to go to the hospital and find relief to the problems which are overwhelming, therefore a)calls for attention b) escapes the problems FUNCTIONAL TREATMENT: teaches skills which are more appropiate to problem solving

  9. FORMULATION OF THE TREATMENT FOR SUICIDAL BEHAVIOR FORMULATION: suicidal behaviors are caused by beliefs such as “since I am suffering so intensely this suffering will never pass” (hopelessness) BEHAVIORAL AND COGNITIVE TREATMENT : Register thoughts and schedules of the activities to change thoughts and restructure new beliefs

  10. FUNCTIONAL ANALYSIS OF PROBLEM BEHAVIORS ANTECEDENTS ( Signal or stimulus behavior ) BEHAVIORS CONSEQUENCES (If it influences the behavior or not, if it repeats itself or not

  11. THE FORMULATION OF A CLINICAL CASE PRESENTS THREE LEVELS : • A situation • A psychiatric/psychological disorder or problem • A specific case

  12. Examples of unuseful goals of treatment * “We would like to have a more loving relationship among each other” * “I would like to get out of this rut I am in ” * “I would like to feel better with myself ”

  13. Examples of effective ways to reduce symptoms • Reduce the symptoms of depression to lower levels • Reduce anxiety symptoms to lower levels • Eliminate panic attacks • Reduce worries ½ hr a day or less

  14. Elements based in empirical evidence • Backup your results with latest research findings • Theoretical hypothesis • Ideografic evaluation

  15. CASE FORMULATION :A DEFINITION • The formulation of a case is a hypothesis of the problems of the patient • The function of the formulation is to develop a plan to treat the problems First we want to know where to guide the intervention and Second understand it

  16. EMPIRICAL EVIDENCE: AN INDIVIDUAL CASE • Problem list • Treatment plan • Objetives • Measures • Strategies • Progress follow up

  17. Problem Hierarchy • Case formulation • Probability of certainty • Its impact in daily functioning • Its impact in social impact

  18. OBJECTIVES • Short term : sub-goals motivate more • Concrete and specific • Measurements

  19. CREATING OBJECTIVES • Evaluate a typical day vs. an ideal day : • Identify a goal associated with the main problem • Identify if the patient achieved the goal

  20. OBJECTIVES TREATMENT DATE : ----------- PHASE I OBJECTIVES 1.____________________________________ 2._____________________________________ 3._____________________________________

  21. CRITERIA FOR MEASUREMENT • Aplicability • Acceptable and friendly • Validity and confiability • Sensitive to change

  22. QUESTIONS TO BE ASKEDWHEN YOU CHOOSE MEASURES • How can I use these data ? • How frequently should I measure? • What is the expectative of change ? • Should I include other significative persons in the evaluation? • Should I measure only the symptoms associated with the problem or general measures ? • Can I design my own measures ?

  23. TREATMENT STRATEGIES • The more specific the better • Treatment manuals • Evidenced based protocols

  24. REVIEW OF PROGRESS “If there is not a pattern which measures behaviors it is quite difficult to judge how the progress is coming along and whether the capabilities are developed at their best”Bandura & Schunk (1981)

  25. TOOLS NEEDED FOR THE CHARTS • Microsoft Excel • Paper and pencil • Charts previously prepared

  26. REVIEW OF PROGRESS Stage 1 • Goals • Potencially modify the treatment plan • Continue to another stage of treatment • Termination of behavior and cognitive therapy

  27. INITIATING A NEW STAGE INTREATMENT • When the goals have been fulfilled • New issues arise • Share the results with the patient

  28. BIOPSYCHOSOCIAL REVIEW Clinical crisis Healthy behaviors Self-destructive behaviors Risk behaviors Family funcioning Culture and spirituality Ocupational School & Community functioning

More Related