INTRODUCTION TO CLINICAL ■ Treatment by the use of

PSYCHOLOGY magnets

OBJECTIVES: ○ Spiritualism and “mental healing”

● To understand the meaning, scope and ● Modern scientific psychology

nature of clinical psychology as a science ○ First psychological laboratory by

and a field of study Wilhelm Wundt (1879)

● To discuss the terms and concepts related ● First scientific clinical application of
th
to clinical psychology psychology Sigmund Freud (19 c.)

● To differentiate the practice of clinical ● Term “clinical psychology”

psychologists from other mental health ○ Ligtner Witmer (1867-1956)

practitioners ○ Father of modern clinical

CLINICAL PSYCHOLOGY psychology.

● integrates science, theory, and practice to ● Defined as “the study of individuals, by

understand, predict, and alleviate observation or experimentation, with the

maladjustment, disability, and discomfort intention of promoting change”

as well as to promote human adaptation, PROFESSIONAL PRACTICE

● Offer a range of professional services.
adjustment, and personal development.
● Provide psychological treatment
● focuses on the intellectual, emotional,
(psychotherapy)
biological, psychological, social, and
● Administer and interpret psychological
behavioral aspects of human functioning
assessment and testing
across the life span, in varying cultures,
● Conduct psychological research
and at all socioeconomic levels.‘‘
● Teach
CHARACTERISTICS OF CLINICAL PSYCHOLOGY
● Development of prevention and
● Emphasis on science treatment programs
● Emphasis on maladjustment ● Consultation (especially with schools and
● Emphasis on the individual businesses)
● Emphasis on helping ● Program administration
SCOPE OF CLINICAL PSYCHOLOGY ● Provide expert testimony
● To describe and analyze the human (forensic psychology)

behaviour like mental, emotional and Specializations

behavioural disorders. ● Specific disorders

● To assess, diagnose, treat and prevent ○ Trauma, addictions, eating, sleep,

mental disorders. sex, depression, anxiety, or

HISTORY phobias.

● 18
TH
C. Psy. Tx. Pseudo-scientific ideas. ● Neuropsychological disorders

○ Phrenology ● Child and adolescent

■ Personality by the shape of ● Family and relationship

the skull ● Health

○ Physiognomy ● Sport

■ Study of the shape of the ● Forensic

face ● Organization and business

○ Mesmerism ● School
 APPROACHES IN CLINICAL PSYCHOLOGY abnormal behaviors.
Pros and Cons in Taking A Specific Approach ● Foundations for behavior are set down in
PROS childhood through satisfaction or
● Organize the clinicians‘ thinking about frustration of basic needs and impulses.
behavior Early relationships with family, peers, and
● Guide their clinical decisions and
authority figures are given attention.
interventions
● This perspective grew out of Freud's
● Communicate with a common,
work; he believed that the unconscious
systematic language with their colleagues mind plays an important role in our
CONS behavior. Psychologists who utilize
● Narrow, closed, and rigid thinking about psychoanalytic therapy may use techniques

behavior due to complete biased on a such as free association to investigate a

client's underlying, unconscious motivations.
specific model.
Classical Psychoanalysis
● Blind adherence to a particular model can
● Main Proponent – Sigmund Freud o
reduce a clinician‘s functioning to a level
Mental Structure: id, ego, superego
where objective evaluation and subsequent
● Defense Mechanisms and anxiety
modification of professional practices
● Psychosexual development and fixation
become unlikely.
Evaluation of Freud‘s Model
● A clinical model eases communication
● Most comprehensive and revolutionary
among those conversant in it, but it can
theory of behavior
obstruct discussion between ―nativesǁ
● Vague abstractions: Concepts difficult to
and ―foreignersǁ.
measure and test scientifically
Clinical Models
● Irrefutability: A closed system leads to
● Psychodynamic – focusing on the inner
results that confirm Freudian principles
person
● Limited generalizability: Upper-class
● Behavioral – considering the outer person
patients in Vienna
Cognitive – examining the roots of
● Too much emphasis on the negative side of
understanding
human nature
● Phenomenological/Humanistic/
● Biases against women 2
Existential –concentrating on the
● Over-interprets behavior as indicative
unique experience
of unconscious motivation and related
● Evolutionary – focusing on biology as
pathology
the determinant of
● Overemphasis on childhood causes of
● development
adult behavior
● Sociocultural – emphasizing on the
Free association
support systems
● is a practice in
PSYCHODYNAMIC MODEL
psychoanalytic therapy. In
Psychodynamic approach:
this practice, a therapist
Basic Assumptions
● Psychic determinism – behavior is asks a person in therapy

determined by impulses, desires, motives, to freely share thoughts,

and conflicts that are unconscious. words, and anything else

● Intrapsychic factors cause both normal and that comes to mind. The
 thoughts need not Contemporary Psychodynamic

be coherent. But it may help if they are Approaches

authentic. ● Ego psychology

TRANSFERENCE ● Object relations theory - a child‘s inner

● transference definition in psychology is view or map of early relationships will

when a client redirects their feelings from guide his later relationships.

a significant other or person in their life to

the clinician. BEHAVIORAL MODEL

● Countertransference is when you as the Basic Assumptions

clinician transfer your feelings onto your ● Behavior is primarily influenced by

client. Often clinicians don’t realize when learning which takes place in a social

this happens. The countertransference context

definition can be thought of as the ○ Importance of environmental

clinician’s response to a influences on behavior o An

client’s transference. individual‘s unique learning

history, including his cultural

background

● Personality as behavioral consistency from

generalized learning and stable cognitive

abilities; inconsistency due to―behavioral

specificity
Transference & Countertransference examples:
● Measurable behavior: Overt and covert
Transference examples:
● Clinical assessment and treatment are
● The client places unrealistic demands on
integrated, and based on empirical
you
research
● .A client admires you and tells you how
Learning Theories
much you remind them of their best
● Operant conditioning (Skinner) - behavior
friend.
is learned based on environmental
● A client displaces anger onto you
consequences of reinforcement and
during a session when talking about his
punishment. (Functional analysis of
abusive parent.
behavior
Countertransference Examples
● Classical conditioning - conditioned
● A clinician offers advice versus listening to
behavior develops from the temporal
the client’s experience.
association between stimuli and responses
● A clinician inappropriately discloses
● Social learning - the role of cognition in
personal experiences during the session
learning a behavior (Observational
● A clinician doesn’t have boundaries with a
learning & Self-efficacy and outcome
client.
judgment)
Other Psychodynamic Theories

● Erik Erikson‘s Psychosocial theory Cognitive behavioral perspective:

● Carl Jung‘s Analytic Psychology ● This approach to clinical psychology

● Alfred Adler‘s Individual developed from the behavioral and

Psychology cognitive schools of thought. Clinical

 psychologists using this perspective will look

at how a client's feelings, behaviors, and

thoughts interact.

● Cognitive-behavioral therapy (CBT) often

focuses on changing thoughts and behaviors

that contribute to psychological distress. HUMANISTIC

● They believe that we choose to behave as

we do and to perceive things as we do,

and therefore we are personally responsible

for our actions and perceptions.

● They focus on the whole person rather

than on specific psychological processes.

Limitations
Humanistic therapists are concerned with
● Mechanistic view
the uniqueness of each individual, and they
● Inadequate conceptualizing human
focus on the person's natural tendency
problems of a complex, internal nature
toward growth and self-actualization.
● Principles of learning are not well-
● The humanistic therapist does not
established nor agreed on by learning
interpret the client's behavior (as would
theorists
a psychoanalyst) or try to modify it (as
● Not uniquely scientific or clearly validated
would a behavior therapist).
System desensitization
● The goal of the humanistic therapist
● relies heavily on classical conditioning. It’s
is to
often used to treat phobias. People are
facilitate exploration of
taught to replace a fear response to a
the individual's thoughts
phobia with relaxation responses. A person
and feelings and assist
is first taught relaxation and breathing
the individual in arriving
techniques.
at his or her solutions.
● Once mastered, the therapist will slowly
Humanistic Model
expose them to their fear in heightened
Basic Assumptions
doses while they practice these techniques.
● Behavior is determined by the person‘s

Aversion therapy perception of the world.

● is often used to treat problems such as ● Humans as active thinking people who
substance abuse and alcoholism. are responsible for their actions, and
● It works by teaching people to associate a capable of making choices about their
stimulus that’s desirable but unhealthy with behavior.
an extremely unpleasant stimulus. The ● No one can understand another unless
unpleasant stimulus may be something that he perceives the world through the
causes discomfort. person‘s eyes.
● For example, a therapist may teach you to ● All human activity is comprehensible
associate alcohol with an unpleasant when viewed from the point of view of
memory. the person being observed.

● The meaning and value of life is

 provided by the perceiver. factor in the onset of depression as well as

● Humanistic or Existential Perspective: continued depression.

○ Person-centered theory (Rogers) ● To improve the quality of a client’s
- self-actualization theory interpersonal relationships and social
○ Gestalt psychology functioning to help reduce their distress.
Limitations
● Too concerned with immediate conscious

experience and not enough with

unconscious motives, situational, and Transpersonal Psychology

biological factors ● Transpersonal (beyond personal) – refers

● Inadequate to explain the development of to states of consciousness that transcend

behavior (e.g., actualization) the normal limitations of the ego.

● Does not explore causes of behavior; simply ● Transpersonal psychology has emerged as

descriptive. Concepts are vague and an independent field of academic study

difficult to understand that encompasses and expands upon the

● Target Population: intellectual and cultural ―forces of psychoanalysis, behaviorism, and

background, capacity for introspection humanistic psychology. By looking beyond

EXISTENTIAL THERAPY the individual to a larger view of

● Existential therapy focuses on free consciousness, transpersonal psychology

will, self-determination, and the search creates a point of connection between

for meaning—often centering on you psychology and spirituality.

rather than on the symptom. ● Transpersonal psychology is concerned with

● find meaning in the face of anxiety by the study of humanity‘s highest potential,

choosing to think and act responsibly and and with the recognition, understanding,

by confronting negative internal thoughts and realization of unitive, spiritual, and

rather than external forces like societal transcendent states of consciousnessǁ

pressures or luck. (Lajoie & Shapiro, 1992).

● You learn to make more willful decisions ● Accepts the full spectrum of human

about how to live, drawing on creativity consciousness, working with the body,

and love, instead of letting outside events emotions, mind, and spirit. Accepts

determine your behavior. spiritual insight as a legitimate part of the

healing process, and it includes other

realms of experience, wisdom, and

creativity beyond the personality such as

mystical experience, ecstasy, enlightenment

INTERPERSONAL
● That focuses on you and your relationships

with other people. It's based on the idea

The Family System
that personal relationships are at the
● Family Systems Any stress or pain
center of psychological problems.
experienced by one member is felt and
● change in social environment is a key
 reacted to in some way by all the members

of the family, each in his own way.

● “Identified Patient” (IP) – the family

member who is most affected manifests

the family stress or

pain—the symptom carrier; usually fulfills the

function of sending signals that the family

system is in crisis, and therefore, in need of

help from outside sources

● The symptomatic behavior of the IP is a signal

of the rigid structuring of family relationships. Clinical psychology – involves using clinical

● Aloneness and Togetherness: Undifferentiated judgment to apply scientific knowledge from the

ego mass and individual differentiation discipline of clinical psychology in clinical practice

● The individual needs to see himself as with clients and patients.

independent from his family. What is a clinical psychologist:

● Maladaptive: A low degree of differentiation 1) A research-oriented scientist-practitioner –

● Lack of differentiation – imbalance of bound by quantitivism & rules – needs to be
emotionality over rationality effective.
● Family Mythology – refers to the beliefs or 2) A practice-oriented practitioner-scholar – more
belief system which the family adheres to, of a therapist – they’re engaging/learning by
which becomes part of the individual‘s self- doing = it’s vocational.
concept or self-definition 3) A reflective practitioner – more of a counselor-
● Family Rules – emerge from the family type
mythology The family member who acts and What should a clinical psychologist do? – They’re
behaves to destroy the family myth is most judged on what research they know, NOT what
likely to become the IP. they do and how they apply it scientifically.
● The rules and expectations that come from 1) Assessments – some questions/case notes /
the beliefs are usually unarticulated. medical history/practitioner experience /
● The strength or force of this family mythology opinions (following a consistent model of practice
comes from the fact that it is usually formulating an opinion based on the assessment).
unconscious. 2) Diagnosis
● Genogram – a family map is constructed to 3) Prescribe drugs – e.g. depression = anti-
explore the historical development of the depressants.
family. 4) Formulation – the process of decision making –

you create some kind of reasoning for why the

person has that problem – from that reason,

intervention = created

5) Interventions/therapy.

ψ Clinical judgment – developed through

supervised clinical practice while

undertaking professional training & and

accumulated clinical practice.

 ψ Clinical practice – assessment, treatment &  Unconscious mind: biological

prevention of psychological problems. drives & and instincts that

have a significant influence
ψ Scientific knowledge – developed through
on our behavior &
initial academic training, continual
personality – contains bad
professional development (CPD) and
memories that have been
training – read about research. repressed/forgotten – has 2
components = personal &
collective.

Adults go through psychosocial

development which derives from
psychosocial conflict

Personality = controlled by the mind

– id, ego & superego – personality =
formed in early life

through interactions

Structure of personality:
Traditional views of psychopathology:
1) id – operates on pleasure
If psychopathology can be treated principle – present at birth
with the introduction of a substance – unconscious drives &
then there are four specific instincts – demands instant
assumptions – assumptions = gratification
straight-forward & non-negotiable =
2) ego – works on reality
they’re true = biological or medical
principle – mediator between
model of psychopathology.
id & superego – develops at
4 assumptions: around 2yrs – supposed to
1) Assumption1 - Behaviour can be reduce the conflict between
predicted – classic reductionist the demands of the id &
argument – you superego = does by this
must know what happens next – defense mechanisms.
HOWEVER, A PROBLEM WITH THIS 3) superego – formed at the
ASSUMPTION IS THAT IN end of the phallic stage – our
MODERN PSYCHOLOGICAL internalized sense of
PRACTICE, ONE MUST CHOOSE A right/wrong – based on the
STREAM. morality principle.

Psychoanalytic – behavior =
genetically pre-determined – an Behaviorism – behavior = predictable
individual’s personality if its parts can be identified
determines their behavior -Behavior = determined by the
 Behaviour = consciously & interaction between the individual
unconsciously determined: and the environment through

 Conscious mind: ‘tip of the stimulation – human attribute =

iceberg’ –the conscious mind extension of their behavioral

is part of our mind that we dispositions.

know about and are aware -Empiricism, positivism, replicability

of. & objectivity = cornerstones of
predicting behavior. BIOLOGY TO LINK BEHAVIORS.

-Evolutionary continuity between - It’s not the neurotransmitter that’s

animals & man = similarities in their the issue, it’s the receptor we must
behaviors. target.

Cognitive 1 – mind = NOT an - Increased concentration of

indefinable/unconscious quantity = chemicals increases behavior
it’s a processor of external - Must assume that biology is broken.
info and created by the brain 3) Assumption 3 – Everyone is
Isomorphism – mind & physical structurally & and functionally the
brain = interchangeable. same – for drugs to work for

-Brain = evolved as a general- everyone, we all have to be the same

purpose organ to deal with our social otherwise why would it exist for

& and physical environment. everyone (mass market).

-Brain = made up of 2 distinct - must be the same between species

hemispheres = they’re autonomous of too if we test it on animals first –

each other but reliant on each we must all use it the same way.

other to process the world (parallel 4) Assumption 4 – Any drug must

processing) be specific and selective – anything

added to

the animal = binds to its intended

Cognitive 2 – each hemisphere has
target
distinct anatomical parts = that can
operate independently of one another Specificity – the chemical must bind

– info = is processed in serial in each to the receptor active site

half of the brain. Selectivity – homology (how

-Each anatomical part = is identical are the 2 chemicals?) &

responsible for processing one type of affinity (how likely is the chemical to

info (specialization) bind to one receptor over another).

-Brain has a limited capacity

-to save cognitive resources, Strengths of the biological model:

information processing organization Medicalization of mental health has

is conserved through experience given us three things:
(cognitive scripts) creating 1) it has given us a diagnosis.
predictable patterns of behavior.
2) It gave us the Mental Health Act
-Info processing is stored as memory and the right to intervene
engrams
3) It gave us the use of deductive
quantitative scientific methods in
2) Assumption 2 – Behavior has psychology.
distinct neuroanatomical & Preferences of the biological model:
neurochemical roots – traditional This school prefers to use:
views of behavior can't just state that
- Longitudinal studies
the brain is responsible for behavior =
- Randomize controlled trials.
must state that behavior = is nothing
- Medical assessment methods using
more than the firing of specific brain
sophisticated monitoring tools.
cells – HOWEVER, AN ISSUE IS
THAT THERE ISNT ENOUGH They prefer to treat with:
- Psychopharmacology differentiate the two =

- Electroconvulsive therapy justification edict.

- Psychosurgery Psychopathology assumptions:

- It stems from the inappropriate

use of defenses.

- Defences work to limit our

aggressive & sexual nature in society.

- The defenses manifest

psychosomatic symptoms if they’re
inappropriate.

- The point of therapy = elicit

transference to the therapist is such
a way as to uncover the

root cause.

- With acknowledgment comes

enlightenment & the symptoms
disappear.

Achievements:

- Discovery of the unconscious as an

active set of psychological processes.

- Give meaning to ‘meaningless’

behaviors.
- Based on the form of Plato's
- People have a limited & stable set
philosophy suggesting that reality =
of relationship maps that they use in
beyond the perception of man
adulthood.
‘knowledge through justification’
- The first of the talking cures.
- Freudian justification = based on
Cognitive Therapy:
his clinical experience:
- Based on critical rationalism –
- The infant moves through stages of
knowledge is the falsifying of
amorphous sexuality to a genitally
hypotheses – Aristotle.
preoccupied
- Therapy aids the client by getting
sexuality.
them to state beliefs and then testing
- Any form of trauma will lead to these against
repression of the id by the super-ego.
reality.
- Personality differences stem from
- Beliefs are then altered if the
differences in development.
outcome is falsified.
- Problems stem from regression to
- Emotional distress is lowered when
previous fixation points and prohibit
the conflict between belief & reality
the individual from
is lowered
developing.

Modern psychoanalysis tries to

distance itself from the traditional
formulation.

- It believes that experience

trumps evidence – it doesn’t
 behaviour is eliminated.

Operant vs respondent
conditioning:

-Respondent = stimulus-stimulus
pairing

-Operant = stimulus-consequence
pairing

-Behavior is: “measurable

displacement in space through
action: time”
Central Tenants -Operant behavior is: “any
- Collaborative Empiricism – testing behavior whose frequency is
hypotheses in the real world. determined

- Targeting maladaptive cognitions primarily by its history of

and altering them based on evidence consequences”.

- Altered cognitions increase coping, -Operant conditioning is “the

decrease perceived vulnerability and process and selective effects of
distress consequences

Central Tenants: on behavior”.

- Antecedent regulation -In effect CONSEQUENCE predicts

1) Cognitive reappraisal BEHAVIOUR…

2) Situational modification

3) Attentional deployment.

- Consequential regulation

- Toleration

- Suppression

Cognitive therapy treatment &

change:

- Allows clients to realistically and

accurately appraise situations for
themselves

- Doesn’t seek to help regulate

emotions.
Functional behavior:
Behavioral therapy:
- Attention
- Based on utilitarianism – inductive
- Escape
quantitative methods
- Tangible
- Observe behavior designated
problematic – no hypothesis only - Internally motivated.

belief/perception Changing behavior – behavior =

- Find the appropriate dependent about reinforcement & punishment.

measure 1) Reinforcement:

- Find the function of the behavior - Positive RI – reward = give them

- Formulate intervention & measure something they want – receiving a

frequency – continue until the reward when a certain behavior is

performed. -For an applied behaviour analyst,

- Negative RI – aversion = take away there’s no such thing as pathology.

something they don’t like – happens All behaviour = based on an

when avoiding individual’s history of reinforcement

something unpleasant. & and punishment.

2) Punishment: unpleasant Individual differences = the history of

consequence of behavior reinforcement- we would all end up

that way with the same history.
- Positive – punish – give them
something they don’t want Pathology = is not useful because it
describes & defines the person by a
- Negative – penalty – take away
label.
something they have & value.
Applied behavior analysts simply
Types of reinforcers:
define a behavior – consider its social
Conditioned vs unconditioned
impact & if it’s a problem then
correct it.

-Unconditioned reinforcers = subject

to deprivation & satiation

-Conditioned reinforcers = subject to

context specificity & value change.

Complexity in human behavior:

-Behavior = externally motivated by

a stimulus leading to complex
repertoires of responses to gain

a known complex multifaceted.

CBT
-Individuals look for the consequence.
- Combines both methods – effective
-Complex behavior = range of – take distressed habits of thought &
behaviors happening at any one time behavior = replaces
to achieve multiple
them with adaptive alternatives.
consequences OR is the expression of
- It’s the ability to identify
a response sequence to achieve a
automatic inaccurate cognitions
difficult-to-attain
coupled with cognitive distortions
consequence. that lead to poor outcomes for the
-Alternatively, the response sequence patient.
may be an illogical set of occurrences - Therapy teaches them to challenge
whereby each link in & replace these thoughts.
the sequence is related to the last Achievements of CBT:
and only the last.
-Ensures an evidence-based
(I put away something, I find approach to brief effective treatment
something I forgot I had, it reminds for a wide range of psychological
be to do something else, that is problems.
paired with another behaviour etc…) - Development of the treatment
Individual differences & pathology package approach to interventions to
allow more tailor-made
interventions for patients. perfection. Utopianism = belief that

-It’s relatively easy to teach a wide life is always meant to be

range of professions in psychology fair

interventions allowing

psychology to be practiced outside of Family systems / Family

psychology.
therapy / Systemic psychology:

Emotional Therapy – REBT (Rational

-Suggests that pathology is
emotive behaviorism therapy) - aims
maintained by interaction with
to identify and dispute irrational
significant others & the belief
thoughts – a patient might talk
systems of
about how unlucky they’ve been /
the family.
how unfair things seem
-Not a single therapy – it’s a
– REBT therapists would then
collective term for numerous other
identify examples of utopianism &
‘therapies.’
challenge this irrational thought.
Achievements of family therapy:
-Seriously lacks data –
-Decentralises the problem –
- Based on the rationalizing didactic
pathology = isn’t the fault of the
method – places the therapist as the
individual, it’s the fault of a group.
teacher of the client,
-Most brief forms of therapy = cheap
- Based on the work of Ellis working
-Useful in the management of
at the same time as Skinner = both
complex multifaceted hard to treat
may have influenced each other
cases.

Understanding disorder and writing

a report:

Abnormal – simply confusing other

people with your behavior –
something that isn’t the ‘norm’

The five D’s of disorder:

1) Deviance: The violation of social

consensus of proper mental
functioning.
Musturbation = we must always
Psychological mandate – if it works
succeed or achieve
then leave it alone. Duration is key in distinguishing all

Deviance = a spectrum of conditions. other D’s accept danger.

Some deviance = acceptable (high Key to this is forgiving & and

end), whereas, some allowance. Behavioral

deviance = unacceptable of expression/response to a variety of

functioning (lower end). stimuli can be

Consider the appropriateness of odd. Experience, tolerance,

action and reaction here. Look to the perception & and disposition all

stimuli, the environment and attenuate a response.

consider is the behavior under the Formulation of thought:

control of a specific stimulus with a -All psychologists must develop a

unique learning history. formulation = a hypothesis. In

2) Distress/Disproportionate: If research terms, it’s a case study.

deviance is socially defined then Definition of formulation – Calem –

distress is personal. 2002

Emotional reaction to the expression

of the behavior or symptoms of the
illness.

A person’s response to their

symptoms == not always distressing,
sometimes they’re

disproportionate.

E.g. Manic stage in bipolar disorder;

honor in being chosen by the ‘voices’
in schizophrenia. The formulation must include – Eels,
3) Dysfunctional: if deviance Kendjelic & Lucasm – 1998
considers the dysfunctional mind,
then dysfunctional consider

their ability to care for themselves.

They’re unable to do any of the

following:

- Symptoms interfere with daily

functioning

- Can’t care for themselves properly

- Participate in ordinary social

relationships/gatherings

- Work effectively or optimally. Common features of the formulation:

4) Danger: Is the behavior -Formulation = a concise &

dangerous? condensed report – offers insight

into the assessment & diagnostic
Danger can be to either themselves
or others. process.

5) Duration: All disorders will denote -Formulation = reliant on a

that the symptoms must have been rationalization rather than intuition.

present for a specific -Intuition may be important (we call

length of time. it expertise or experience), however,

the formulation should contain only 4) Observation vs inference
verifiable and evidence-based 5) Individual vs general.
commentary.

-No need for an opinion unless you

can back it up.

-Key to the initial formulation = set

Psychoanalytic case formulation –
of overarching psychological concepts
Messer & Wolitzky – 1997
that define the important
"Psychoanalytic case formulation [is
variables.
defined] as a hierarchically organized
-The psychological concepts will also
set of clinical inferences about the
allow what is and what isn’t
nature of a patient's
permissible in terms of language &
psychopathology and, more
relationships of variables within the generally, about his or her
formulation itself. The theory personality structure, dynamics and
provides the structure of the report development."
itself. "[This] creates a narrative
-Formulation = a guide – It is what structure...to provide a coherent,
will define you as a competent comprehensive, plausible and hopefull
therapist. accurate account of the individual's
-The formulation will map out what personality development and current
further assessment is required, which functioning that is based on the life
multi-disciplinary history of a particular patient"

individuals are needed, what key This is one example of a case

marker must be achieved who should formulation by this school.
be involved when. Following a series of discussions with
-Must include the key outcomes and set therapeutic sessions with obese
objectives to achieve and the order in women, the therapist concluded the
which they need to be following statements to be true. This
was based on the client being aware
achieved.
of these salient points.
-Formulation defines what is and
what is not a successful outcome.
The psychoanalytic
Different approaches have different
explanation/formulation:
formulations.
A. Client had to modify the eating
- Behavioral = environmental is the
pattern in mealtime behavior
cause of abnormality.
B. Early in development she had
- Psychoanalytic = history is the
learned to get everything available
cause.
immediately in case it was removed.
- Cognitive = underlying beliefs &
C. Learn ways to reduce anxiety
cognitive structure as cause.
D. Had to grieve over the many
The 5 (con)tensions of formulation –
unfortunate aspects of her life.
Eells - 1997
E. The client felt that if she stayed
1) Immediacy vs Comprehensive
obese she would have her
2) Complexity vs simplicity
grandmother's positive qualities and
3) Clinical bias vs objectivity
if she became thin she would have
her mother's negative qualities. intelligence rather than her

F. The client was in a post-traumatic appearance?

state where other people were 8. She had a concern that if she lost
molesters weight she might die like her father,

G. Client must enjoy some element of who died of cancer.

vanity

H. Client becomes panicky when they A judgement on psychoanalysis –

lose weight Sturmey - 2008

"Psychoanalytic case formulation is

-It is narrative. weak. The basis for the formulations

is explicitly speculative, and intuitive
-Based on hunches, subjectivity &
and depends on divining the distant
and the search for meaning.
history of the events that can neither
-Belief that case formulation is an
be confirmed nor linked to current
artistic pursuit, not a
problems in any satisfactory way.
scientific one.
The availability of other more simple,
-Advocates multiple causalities. economical and efficient forms of
-Rejects parsimony (do/say the least therapy with strong empirical bases
to get the maximum documenting their effectiveness,

outcome) challenge psychoanalytic case

formulation to demonstrate if it has
-Rejects rationality in favor of
any place in current therapeutic
intuition.
practice"
-Reports a 500+ word inference
discourse on the
Cognitive case formulations:
therapist’s belief about the sessions
held with the patient. -Humans have 3 ‘faces’ – mood,
behavior & and cognition.

-All of these are controlled by

Psychoanalytic case formulation –
underlying psychobiological
Williams – 1999
mechanisms.
1. A genetic predisposition to obesity
-Underlying mechanisms might be
2. Her mother has been over-
neurology or belief.
concerned about her eating and put
-Dysfunctions in the underlying
her on a rigid feeding schedule, but
mechanisms lead to deviations in the
acted hurt if she did not eat all her
three faces of the person. All 3
food.
faces = affected in their unique way.
3. She had a family history of using
food to reduce anxiety and shame -If we can alter the underlying
mechanism then we can alter the
4. She identified with her obese
individual’s behavior.
grandmother
Therapist’s action plan for CCF:
5. She had a history of child abuse
leading her to deliberately appear 1) Generate a problem list together

unattractive 2) Therapist identifies the underlying

6. She reduced her negative mood by cognitive mechanism responsible for

eating alone the list

7. Her self-esteem is related to her 3) The therapist proposes a way the

mechanism can cause the problems behaviorists believe in and

4) Therapist identifies precipitants to engage with emotions (and

the current problems always have), it's just that

they do not believe they are
5) Therapist describes the potential
ALWAYS the explanation for
origins of the problem
the behavior. Therefore, a
6) Therapist identifies obstacles to
behaviorist is keen to keep all
treatment.
three of these faces separate
CCF:
at all times.
-Based on a solid therapeutic
relationship
Extending upon the ABC, behavioral
-Ground rules are necessary in terms
formulation starts with a SORKC
of the sessions being problem &
analysis.
symptom-oriented with a
S = prior stimulation
direction to solving these.
O = biological state of the organism
-All sessions must be structured,
R = response repertoire
time-limited & and directive.
K = contingency
-Client must assent to wanting to
C = consequence
change along with completing a
variety of assignments before SORKC = unofficial formulation – it’s
the implicit structure to reporting
each session.
the formulation.
-Once the beliefs are identified,
Most formulation reports = are
they’re then formulated into evidence
structured into paragraphs or
‘for’ & and evidence ‘against’
sections that are SORKC in nature.
them being true. The point of the
sessions is to test these against
‘collected data.’ How effective is therapy?

-The average person in therapy is

better off than ¾ of people with the
Behavioral case formulation:
same condition who aren’t.
 The previous approaches are
-Adults have slightly better outcomes
very much therapist-driven.
from therapy than children.
Behaviorists do not believe
that formulation should be -But it’s highly variable – different

delivered to the client; conditions have differential outcomes.

rather, the client should -Different clinicians have different

discover it for themselves outcomes.
once their behavior has been -The statistical analysis of effect size
altered. The client becomes indicates that therapy of any kind
aware of the control the when combined, has a large
environment they are in has
impact on the person.
on them.
-Efficacy concerns the therapy of
 The cognitive position of the
‘clean’ individuals (no co-morbidities)
'three faces' is an extension of
delivered in the best places
behavioral work. Behaviorists
by the best specialist therapists in a
believe in the mind (and
specific type of therapy).
always have), and
-Effectiveness concerns the therapy
delivered in the ‘real world’ in
average centers with no

exclusions criteria on who can take

part.

The difference between the two is

about 6% against untreated cases.

Percentage variance effects specific

to treatment is roughly 14% & 8%
respectively.