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CLINICAL CASE FORMULATION

CLINICAL CASE FORMULATION

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CLINICAL CASE FORMULATION

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  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