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The Science and Practice of Case Conceptualization

Published online by Cambridge University Press:  01 November 2008

Willem Kuyken ,
Christine A. Padesky  and
Robert Dudley
Willem Kuyken*
Affiliation:
University of Exeter, UK
Christine A. Padesky
Affiliation:
Center for Cognitive Therapy, Huntington Beach, CA, USA
Robert Dudley
Affiliation:
Newcastle University, UK
*
Reprint requests to Willem Kuyken, Mood Disorders Centre, School of Psychology, University of Exeter, Exeter EX4 4QG, UK. E-mail: [email protected]
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Abstract

Case conceptualization is a foundation of cognitive-behavioural therapy (CBT) because it describes and explains clients' presentations in ways that inform interventions. Yet the evidence base challenges the claimed benefits of case conceptualization. This paper reviews the rationale and evidence base for case conceptualization and outlines a new approach that uses the metaphor of a case conceptualization crucible in which a client's particular history, experience and strengths are synthesized with theory and research to produce an original and unique account of clients' presenting issues. The crucible metaphor illustrates three key defining principles of case conceptualization. First, heat drives chemical reactions in a crucible. In our model, collaborative empiricism between therapist and client provides the heat. Second, like the chemical reaction in a crucible, conceptualization develops over time. Typically, it begins at more descriptive levels, later a conceptualization incorporates explanatory elements and, if necessary, it develops further to include a longitudinal explanation of how pre-disposing and protective factors influence client issues. Finally, new substances formed in a crucible are dependent on the chemical characteristics of the materials put into it. Rather than simply look at client problems, our model incorporates client strengths at every stage of the conceptualization process to more effectively alleviate client distress and promote resilience.

Keywords

Case conceptualizationcase formulationcognitive therapycognitive-behavioural therapytherapistcollaborative empiricismresilienceclient strengthsmetaphor
Type
Process Issues
Information
Behavioural and Cognitive Psychotherapy , Volume 36 , Issue 6: Developments in the Theory and Practice of Cognitive and Behavioural Therapies , November 2008 , pp. 757 - 768
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2008

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