Using the “assumption model” described in the first chapter (which you read in UNIT 3 of the course) of
Berman, P. S. (2015). Case conceptualization and treatment planning: Integrating theory with clinical practice (3rd ed.). Thousand Oaks, CA, US: Sage Publications, Inc.
Choose two different theoretical approaches, and provide a case conceptualization and a treatment plan from two different theoretical approaches (do not choose integrative approach), separately for the case at the end of this document. There are chapters in the book with examples from different theoretical approaches.
The content of the conceptualization of the same case will differ according to the various theories depending on the aspect of human experience that each theory emphasizes.
The case conceptualization should include an explanation of the client’s presenting problems and diagnosis in the context of the theoretical framework.
A case conceptualization and treatment plan for a client you evaluate is usually quite comprehensive. For this exercise, since you are limited by the information I provided, I want you focus on certain components. What I want to be able to assess is your knowledge of the two theoretical frameworks you choose, your ability to analyze the case from those perspectives and your ability to develop a treatment plan based on your case conceptualization based on the theoretical models you choose.
Components of a case formulation for this assignment:
Identifying information
Presenting problem
Hypotheses/premise- Brief statement of your understanding of the problem from the theoretical perspective you chose. How is the problem explained from the theory’s perspective? This statement can include the diagnosis of the client.
Background- This is a detailed case analysis that supports the previous statement. It explains the history and background of the client as well as current situation. It includes the client’s strengths and weaknesses from the perspective of the theoretical framework.
- How do you explain or understand the client’s symptoms, personality characteristics, cognitions, feelings, and behaviors based on the particular theory? How does the theory explain how the problem developed and is maintained? How is it that this person came to have these particular problems? Where are these problems stemming from?
- Depending on the theory you chose, you may also include: What are this person’s strengths?
Treatment plan
Based on the theoretical framework you chose, develop a treatment plan describing the goals of treatment and long and short term goals. From the theoretical perspectives you chose, state:
- The goals for treatment (be specific/express in operational terms).
- The interventions you would recommend based on the theory (be specific in terms of what you would do, what types of questions would you ask the client, what techniques you would use to address the problems identified). The treatment recommendations should follow the theory’s beliefs about what makes people change. Explain why you would recommend these particular interventions. You can give some examples of what you think the dialogue between you and this client would look like.
- Your expectations of the client’s responses to the treatment would be.
The paper should probably be 8 to 12 pages long (longer, if you are including a lot of examples of dialogue between therapist and client).
The Case of Mary
Mary is a 37 year old naturalized American citizen. She was born in Germany. Her parents divorced when she was a baby and she was raised, primarily, by her mother and grandmother, although her mother did remarry when Mary was eight. Mary did not know who her biological father was until she was eleven, when her mother confessed that a man who had functioned as a family friend and sort of “uncle” to Mary was actually her father.
Mary’s mother, Mrs. P, was a prominent woman in the business community in the city where she lived. She had a good bit of money and Mary went to the best schools and dressed in the best clothes. On the surface, her life seemed serene. However, appearances can be deceiving. Mary’s mother was a difficult, demanding, and judgmental woman. She controlled Mary’s every move, never allowing her an independent thought or movement. She berated her daughter constantly for being fat, stupid, ugly, or selfish. No matter what Mary tried to do to please her mother, nothing worked.
But this was not the worst of it. Mrs. P had a serious mental illness in which she had recurrent bouts of suicidal and homicidal feelings. Mary vividly remembers an incident that occurred when she was about five or six in which her mother was holding her hand as she walked them both into the river near their home, apparently planning to drown them both. Mary remembers her mother saying: “It’s alright, it won’t hurt, it will be very peaceful.” She remembers crying and struggling, saying, “I don’t want to die, mother, please don’t.” She doesn’t remember why her mother stopped, but she thinks it was because she remained upset and wouldn’t calm down. In those days mental illness carried even more stigma than it does today, so Mrs. P’s family attempted to cover up her illness rather than seek treatment, although Mary remembers that her mother did spend some time in a psychiatric hospital at some point during Mary’s childhood. She can’t remember exactly when or for how long, though.
Fortunately, Mary had an unusually loving and trusting relationship with her grandmother. Even though she was Mrs. P’s mother, Mary’s grandmother could not have been more different in temperament and behavior. She was there to comfort Mary after her mother or stepfather had verbally or physically abused her. They laughed together and played together. From her grandmother, she learned how to keep house, and how to love another person. Her grandmother always tried to keep Mary connected to her mother by making excuses for her or urging Mary to forgive and forget. Mary believes that her grandmother’s presence saved her life, both emotionally and in reality.
Mary also had a good life at school. While a bit shy, she was a good student and well- liked by both teachers and peers. Her outward success was about the only thing in which her mother took any pride, so Mary strove as hard as she could. She felt that if only she could be a better student, a better daughter, a better person, then her mother would be able to love her.
Nobody in the community ever reacted to the abuse Mary suffered at home. She believes people must have known about it because she often came to school with bruises from her mother’s beatings.
From age ten or eleven on, Mary suffered from symptoms of panic disorder. These were characterized by difficulty breathing, pain in the chest and lightheadedness. She was terrified of dying. Gradually these attacks, which lasted from minutes to hours, became more frequent and longer in duration. She was never taken for treatment.
Not surprisingly, Mary married young. At nineteen she married a young man who turned out to be physically abusive. She had two daughters from that marriage, and after she divorced him, her husband dropped out of sight. A year later, Mary met and soon married a young American soldier, who seemed kind and considerate. After they married, they moved to the United States. This marriage has lasted to the present, although it too, was not without its share of troubles.
Mr. H had a violent temper, as had her mother, stepfather, and first husband. In the early years of their marriage, he beat, choked and shoved her whenever she displeased him. When she cowered or tried to run or hide, he beat her worse. The beatings only stopped when Mary started therapy and, with the help of the therapist, decided to call the police when her husband attacked her. She had him jailed once, which, though it infuriated him, stopped him from laying hands on her again. She also stopped cowering. Instead, she learned to hold her ground and tell him that if he touched her, he would go to jail. Apparently, he learned that she meant it.
Why did she stay? Mary says that she didn’t find what she was living with particularly odd. She had always been beaten. Besides, her husband was a good provider, often fun to be with, and he treated her two girls exactly like the two other children they subsequently had together. In fact, he was a wonderful father to all of the children. She loved him, and she felt fairly certain that he loved her as well.
Mary first requested mental health treatment when she was twenty-six years old. She sought treatment for her panic symptoms and she was seen for a few sessions. She had a few more sessions for the same problem at twenty-eight. Then three years later, following the birth of her fourth child, she suffered a serious post-partum depression. Her mood gradually worsened, she had difficulty sleeping and had thoughts of harming her baby. Because of concern that she might hurt the child, she was hospitalized in a psychiatric unit of a general hospital for about two weeks. There she was treated with antidepressant medication as well as individual and group psychotherapy. Her thoughts of harming her baby receded, and she continued to do well with medication and outpatient psychotherapy. Two years after this episode, Mary’s therapist left the mental health center. Mary had difficulty attaching to the new therapist and sine she had felt well for some time, she gradually stopped going to the center and taking medication.
Mary remained symptom free for three more years until recently when, in the midst of some family turmoil regarding the need to place her mother in a nursing home in Germany, she began again to display the symptoms of depression: early morning awakenings, lack of interest in her appearance or her usual activities of daily living, and the reappearance of suicidal thoughts as well as symptoms of panic. She comes to you for outpatient treatment at a community mental health center.
