Integrative Psychotherapy VI: Assessment and Conceptualization

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.


Filed under book reviews, christian counseling, christian psychology

4 responses to “Integrative Psychotherapy VI: Assessment and Conceptualization

  1. Katie

    I would have to disagree with your suggestion to make a diagnosis “at the end” for a couple of reasons. (Although I have to admit I’m sure what beginning and end we’re referring to…I assume it is at the beginning and end of treatment) One, if the clinician is working within any system that does billing, a diagnosis will be required before a treatment plan can even be developed or recommended. Two, if a clinician has done a thorough (60 to 90-minute) intake, they ought to have enough information to make an accurate diagnosis (especially if there is also psychological testing data). If not, I would argue that the right questions are not being asked. Just a couple thoughts…
    I would like to say thank you for going through the book and offering thoughtful commentary chapter by chapter.

  2. Katie,

    Thanks for your comment. I actually meant to say that we ought to do the diagnosis at the end of assessment/conceptualization. in IP, the authors seem to talk about it before they look at conceptualization. Personally, I make only tentative diagnoses after the first session and do not confirm for 3-4 more hours of meeting. But, I’m glad to point out that I didn’t mean the end of treatment. Then there wouldn’t be much point in it.

    Thanks for stopping by.

  3. Marc

    Hi there,
    I am a Psychiatrist from Switzerland. I´d like to network with other christians, working in this field. I have some practical experience in trying to bring together christian counselling and psychiatrie-psychotherapy, have been working in a christian psychiatric unit close to Frankfurt-Germany.
    But I´d like to get acces to theoretical sources, authors, books and most of all- contacts, maybe even some sort of Intervision by Internet.
    Anybody out there??

  4. kimwinters

    How is Christian evaluation unique? This is a really good question. I think one of the unique aspects to Christian evaluation is our (Lord willing) dependence on the Holy Spirit. We will utilize all the best and latest in terms of excellent and helpful scientific tools, but we have the added benefit (if we have submitted to God’s terms for being in alignment with Him) of being intrinsically linked to the Wonderful Counselor as well – gaining internal (and eternal!) insight from Him. This is just one of the unique elements that comes to mind. Thanks again for these helpful posts on this important book.

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