In chapter 6 of Integrative Psychotherapy: Toward a Comprehensive Christian Approach, McMinn and Campbell take up the matter of case conceptualization. Thus far they have been discussing the foundations and features of their therapy model. Just before going into deeper looks and clinical applications of their 3 domains, they stop to look at the concept of assessment and case planning. Why does case planning matter?
“Assessment is the task of systematically observing what signs and symptoms a client experiences. These signs and symptoms are then understood through a particular theoretical grid, resulting in a case conceptualization (a framework for understanding the symptoms). Case conceptualization is an effort to understand the cause of the symptoms, the role the symptoms play in the person’s experience and treatment strategies to help the person improve.” (p. 145) The authors acknowledge that this task of assessment and conceptualization are neither linear nor without bias. As they say, the very questions one asks determines to some degree the data one gets and how one interprets that data.
They pose 3 questions for the Christian counselor. Is evaluation acceptable for Christians? Isn’t Christian assessment mostly a matter of identifying sin? How is Christian evaluation unique? I’ll dispense with the first two assuming we agree the answers are in order: yes. no, not only. How is Christian evaluation unique? It doesn’t settle for simplistic biological, behavioral, or volitional explanations of symptom manifestations. That probably isn’t unique. What is unique then? The starting point about human nature.
The rest of the chapter describes key assessment and conceptualization practices. Collect data from multiple sources. Make a diagnosis (they describe the benefits and drawbacks of making a DSM diagnosis and how it is the start of assessment, not the end). Consider etiology (predisposing, precipitating, and perpetuating factors). Consider client factors (client perceptions, expectations, ability to work with a therapist, additional strengths and resources). The authors also want IP counselors to assess the specific areas of maladaptive thoughts, schemas, and interpersonal relationships. They provide sample lines of questions to explore each area. Finally, they suggest that the counselor consider whether the data they collect in each of the above assessment areas is likely to facilitate or inhibit therapy. This action may guide clinicians as to where to start (if at all) and what kinds of goals might remove a specific therapy interfering behavior
My thoughts? I like this chapter. It provides a concise reminder to the beginning counselor regarding the basic data they should collect. It does remind us that our interpretive grids impact the data we get and the interpretations we make. We are not so objective. In light of that, I do wonder whether the DSM diagnosis is a good place to start. By starting there does not the clinician tempt herself to think only in light of classic psychiatric models. I would rather see the diagnosis happen at the end. In this way, the clinician can report to the client whether it is helpful to consider the diagnosis. For example, a child may look ADHD, but by collecting the other data, it may be clear that the child has a primary trauma or anxiety type problem.