Psychology case conceptualization project

Psychology case conceptualization project

Final examination paper work 50% of graduate clinical psych course grade. Case conceptualization using process based therapy EEM, and ACT

Process-Based Therapy Case Conceptualization

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Case Vignette

 

Michelle Adams, a 51-year-old former hairdresser, came to a psychology clinic at the urging of her primary care doctor. A note sent ahead revealed that she had been tearful and frustrated at her last medical appointment, and her doctor, who had been struggling to control her persistent back pain, felt that an evaluation by a psychologist might be helpful.

 

Greeting Ms. Adams in the waiting room, the psychologist was struck by both her appearance and her manner: here was a woman with shaggy silver hair and dark sunglasses, seated in a wheelchair, who offered a limp handshake and a plaintive sigh before asking the psychologist if she would mind pushing her wheelchair into her office. She was tired from a long commute and, she explained, “Nobody on the street offered to help me out. Can you believe that?”

 

Once settled, Ms. Adams stated that she had been suffering from unbearable back pain for the last 13 months. On the night “that changed everything,” she had locked herself out of her apartment and, while trying to climb in through a fire escape, had fallen and fractured her pelvis, coccyx, right elbow, and three ribs. Although she did not require surgery, she was bed-bound for 6 weeks and then underwent several months of physical therapy. Daily narcotic medication was only moderately helpful. She had seen “a dozen” doctors in various specialties and tried multiple treatments, including anesthetic injections and bioelectric stimulation therapy, but her pain was unrelenting. Throughout this ordeal and for years prior, Ms. Adams smoked marijuana daily, explaining that a joint enjoyed in hourly puffs softened her pain and helped her to relax. She did not drink alcohol or use other illicit drugs.

 

Prior to the accident, Ms. Adams had worked at a neighborhood salon for more than 20 years. She was proud to have a number of devoted clients, and she relished the camaraderie with her colleagues, whom she referred to as “my real family.” She had been unable to return to work since her accident on account of the pain. “These doctors keep telling me I’m good to go back to work,” she said with visible anger, “but they don’t know what I’m going through.” Her voice broke. “They don’t believe me. They think I’m lying.” She added that although friends reached out after the accident, lately they had seemed less sympathetic. She let the calls go to voicemail most of the time because she just did not feel up to socializing on account of the pain. In the last month, she had stopped bathing daily and gotten slack about cleaning her apartment. Without the structure of work, she often found herself up until 5:00 AM, and pain woke her several times before she finally got out of bed in the afternoon. As for her mood, she said, “I’m so depressed it’s ridiculous.” She often felt hopeless of any possibility of living without pain but denied ever thinking of suicide. She explained that her Catholic faith prevented her from considering taking her own life.

 

Ms. Adams had never seen a psychologist before and did not recall ever having felt depressed prior to her accident, although she described a “hot temper” as a family trait. She spoke of only one meaningful romantic relationship, years ago, with a woman who was emotionally abusive. When asked about any legal difficulties, she revealed several arrests for theft in her 20s. She was “in the wrong place at the wrong time,” she said, and was never convicted of a crime.

 

 

Instructions for Case Conceptualization Paper

 

The final paper will be a case conceptualization from a process-based therapy perspective. You will be provided with basic details about a case. You can invent additional details about the case as needed. Your paper should include:

 

  • A description of the case in terms of evidence-based practice in psychology
  • A clear and theoretically consistent case conceptualization
  • A rationale for using process-based therapy with this case
  • A treatment plan based on your case conceptualization
  • Evidence to support your identified treatment processes and “kernels,” including the order in which you would employ them
  • Hypothetical outcomes
  • At least three figures (EEMM related to your case, relevant processes of change at pre and post)
  • References

 

Your paper should be free some spelling or grammatical errors and follow APA 7th edition format. Papers will be graded on a 0-100 point scale. The final paper will be due by 11:59 pm on Thursday 4/21/22. Please submit papers via the dropbox on e-learning.

 

 

Acceptance and Commitment Therapy Case Formulation Template (version 2.0)

 

What problems or issues is the client looking for help with?

 

 

 

 

 

What private events is the client struggling with?

 

Thoughts / beliefs

 

 

 

 

 

 

 

 

 

Emotions / feelings Physiological sensations Urges

 

 

 

 

 

 

 

 

 

 

 

What do they typically do (or have done in the past) when these private events come up?

 

What they do What they hope will happen Actual consequences

Short term

Actual consequences Long term Workability

(High or Low)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

       

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If this wasn’t such a struggle for them, how would life be different, what could they do?

 

Valued life area

 

 

 

 

 

 

 

 

 

 

Specific goals What things get in the way most?

 

How flexible or inflexible is the person’s behaviour and what ACT processes seem to be most prominent?

 

 
Pervasive avoidance of

private events

0 1 2 3 4 5 6 7 8 9 10 Reliably carries private events willingly, openly, non defensively  
Pervasive entanglement in thinking, dominated by rules and unhelpful ‘mindyness’ 0 1 2 3 4 5 6 7 8 9 10 Experiences thoughts as mental events, holding them lightly  
Unhelpful attachment to and dominance of the story of self and what is possible 0 1 2 3 4 5 6 7 8 9 10 Flexible perspective taking on self, can reliably experience a sense of ‘containing’ and not being defined by difficult self content  
Dominated by past and future, pervasive difficulty being here and now 0 1 2 3 4 5 6 7 8 9 10 Can reliably and persistently contact the present moment  
Lack of clarity or contact with values, doesn’t know what matters, not freely chosen 0 1 2 3 4 5 6 7 8 9 10 Clarity and contact with values, knows what they care about and chooses it freely  
Pervasive pattern of inactivity or impulsive actions, or acting to avoid situations and private events, not acting on values 0 1 2 3 4 5 6 7 8 9 10 Regular and persistently takes actions towards values, reliably commits and follows through  
How much will workability / creative hopelessness need to be emphasised with this client?

 

 

 

 

 

 

What aspects of this client’s context may undermine or support the work? (E.g. poverty, access to resources, unsupportive partner, harassing environment, supportive partner, stable upbringing, etc.)

 

 

 

 

 

 

 

 

 

 

 

Plan for your first few therapy sessions (e.g. early therapist’s goals, stance, interventions, strategies, monitoring, likely pace, potential obstacles, memos to self, things to watch for etc.)

 

 

 

 

 

 

 

 

 

 

 

This ACT case formulation template is provided free of charge and is not for profit. It can be copied and distributed for any clinical or research purpose without permission.                                                   (David Gillanders November 2013)