Case formulation is the process of identifying the causes, antecedents, and maintaining factors related to a client’s emotional, interpersonal, and behavioral problems.
Where a therapist is using a module-based treatment manual, the clinical algorithms provided by the manual should be followed.
These provided an insight into Paul’s experiences in life.
I was able to recognise that speaking quietly was likely to be a behaviour that Paul was adopting to try to keep him-self safe socially. The distinct advantage of case formulation for the therapist in community practice is the flexibility it provides in determining a treatment plan for individuals who may or may not fit the criteria on which manual-based approaches were evaluated.For the purposes of this chapter, it will be assumed that the therapist has established, through appropriate assessment, that the targeted child or adolescent has an anxiety and/or a depressive disorder that is the basis for presentation to treatment (see Following thorough assessment, the therapist should select the nomothetic model that is appropriate for the presenting individual, his/her family, and the organizational setting in which treatment is being offered. The treatment plan must therefore The competent therapist must ensure that (s)he has a thorough understanding of the purpose of each specific CBT technique, so that (s)he can appropriately link it to the causal or maintaining factor(s) that it is designed to address. Therefore these behaviours prolonged the assessment and drew more attention to Paul, while also preventing effective, meaningful communication.As Paul’s therapist I was aware that safety behaviours would be an important feature of social anxiety he was experiencing, and therefore I was alert to recognising these behaviours from the commencement of therapy. Part of this journey involved completing a reflective journal following each session in which I could document my own emotions.Although the impact of transference and countertransference are normally associated with psychoanalytic psychotherapy, both clients and therapists within the CBT process can experience strong emotional reactions towards each other in what are termed transference and countertransference within therapy (Prasko As one of the principles of delivering CBT is that it is time-specific I was aware from the commencement of therapy that managing the process towards the ending of therapy was an important undertaking. All these factors would help to reduce his anxiety and alleviate fears that Paul might have about ending the therapeutic relationship (Cully and Teten 2008).The importance of undertaking relapse prevention work with Paul was established by conducting this work over a number of sessions.
On the basis of the case formulation, the therapist can overlay what specific CBT techniques will be used to address each component of the case formulation. Paul was encouraged to take an active role in the therapy and work towards becoming his own therapist.During the initial assessment Paul spoke quietly and with eyes averted at times, which made him difficult to hear and to engage.
As these systems are intertwined, change in one area impacts each of the other areas.
For Paul the SPAS and the SPI were utilised and the scores correlated with marked impairment.Clark and Wells’s (1995) social anxiety disorder model was utilised to understand the maintenance of the social anxiety cycle. Paul was asked to describe in detail a specific and recent social situation that was sufficiently anxiety-provoking. This involved explaining to Paul the principles of CBT, the evidence-based for CBT, how and why assessments are important, the necessity of completing homework outside of sessions and the potential interventions which would be available for Paul. Hence, by purposefully monitoring goals and their incongruity in the present moment of therapy, Paul would experience his therapist as being non-judgemental, warm, and empathic (Higginson et al 2011).It was important also during the course of therapy tobe mindful that individuals with mental health difficulties frequently have an extensive variety of requirements that may be social and psychological and my require input from a wider range of professionals.
The supervision was provided in one to one fortnightly sessions by an accredited supervisor whom was also a practicing CBT therapist.Therapy began with a detailed assessment and formulation of the problem, which was developed collaboratively between Paul and the therapist.
(2009) What do we mean by ‘socialization to the model’: A Delphi study, Skinner, Vanessa. (eds. Obtain a detailed understanding of the Paul was unable to identify any particular issues or negative experiences in his earlier life 0-5 years.
The core of social phobia appears to be a robust need to deliver a particular positive impression of one-self to others and there is noticeable uncertainty about one’s aptitude to do so (Clark and Wells 1995).
Each factor will also vary on the strength of its association with current problems. As Paul’s therapist I was particularly cognisant of building trust from the outset by showing appropriate levels of empathy and warmth in both my verbal and non-verbal manner.The early establishment of a therapeutic alliance is significant in that the alliance is a predominantly useful predictor of outcome when recognized and measured early in treatment (Castonguay et al 2006), and premature termination of treatment has been empirically connected with establishment of inadequate early alliance (Constantino et al 2002).