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Clinical Case Formulations: Matching the Integrative Treatment Plan to the Client, 2nd Edition

ISBN: 978-1-118-12975-3
524 pages
November 2011
Clinical Case Formulations: Matching the Integrative Treatment Plan to the Client, 2nd Edition (111812975X) cover image


Praise for Clinical Case Formulations

Matching the Integrative Treatment Plan to the Client, Second Edition

"[Barbara Ingram has put] a career into the development of this book and it is wonderful! My students love that it was written with them in mind and they love the statements designed to reduce anxiety and normalize the learning process. This is an excellent book!"—Amy M. Rees-Turyn, PhD Associate Professor of Counseling Psychology, Lewis & Clark College

A step-by-step model for individualized case conceptualization

Fully revised and updated, the second edition of Clinical Case Formulations provides step-by-step tools and insightful guidance for moving from first contact with a client to the development of an effective, personalized treatment plan. Addressing the essential question every therapist faces—How do I create a treatment plan that is the best match for my client?—this unique resource provides a systematic and thoughtful method for integrating ideas, skills, and techniques from different theoretical approaches. It combines empirical research and clinical experience to create a case formulation that is tailor-made for the client.

This comprehensive resource offers two tools to guide case formulations: a problem-oriented framework, with a list of 28 standards for evaluating its application, and a set of 30 core clinical hypotheses derived from the knowledge bases of psychology, psychiatry, counseling, and social work professions.

The new edition includes:

  • Hypotheses on Emotional Focus, Trauma, and Metacognitive Perspective

  • More detailed attention given to empirically supported therapies such as Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT)

  • Discussion on the importance of bringing cultural competence to case formulation tasks with every client

  • Skill-building activities throughout the text

Offering a thorough framework to help clients experience effective clinical service, practitioners will learn to conceptualize clients' needs in ways that lead to strong and individualized treatment plans, as well as advice and guidance on what to do when selected interventions fail to produce the expected benefits.

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Table of Contents

List of Tables ix

Preface xiii

Acknowledgments xvii

Part One Case Formulation Skills 1

Chapter 1 A Framework for Clinical Case Formulations 3

Chapter 2 Gathering Data 19

Chapter 3 Defining Problems 41

Chapter 4 Setting Outcome Goals 61

Chapter 5 Organizing and Presenting the Database 73

Chapter 6 Creating the Formulation 87

Chapter 7 Writing the Treatment Plan 95

Part Two Thirty Core Clinical Hypotheses 111

Chapter 8 Crisis, Stressful Situations, Transitions, and Trauma 117

Chapter 9 Body and Emotions 157

Chapter 10 Cognitive Models 197

Chapter 11 Behavioral and Learning Models 225

Chapter 12 Existential and Spiritual Models 257

Chapter 13 Psychodynamic Models 289

Chapter 14 Social, Cultural, and Environmental Factors 331

Chapter 15 Practice, Practice, Practice 373

References 385

Appendix I Useful Charts 413

Appendix II Useful Forms 421

Appendix III Case Material for Practice 425

Appendix IV Answers and Samples for Activities 431

Author Index 461

Subject Index 473

List of Tables

Table 1.1 How to SOHP a Problem 6

Table 2.1 Four Frames for Exploring a Specific Problem 28

Table 2.2 The BASIC SID: An Adaptation of Lazarus’s BASIC ID 29

Table 2.3 Metamodel Questions 33

Table 2.4 Suggested Data Topics for Three Problems 38

Table 3.1 Strengths and Weaknesses in Domains of Functioning 44

Table 4.1 Criteria for Good Outcome Statements 64

Table 5.1 Organizing the Subjective Section 85

Table 7.1 Components of Treatment Plan 96

Table 7.2 Plans That Focus on the Therapeutic Relationship 102

Table 8.1 Assessment of Suicide Risk 120

Table 8.2 Steps in Crisis Intervention 129

Table 9.1 Sample Problems for Biological Cause (BE1) Hypothesis 160

Table 9.2 Elements in the Self-Management of Chronic Disease 165

Table 9.3 Sample Problems for Mind-Body Connections (BE3) Hypothesis 179

Table 9.4 Techniques of Relaxation Training 181

Table 9.5 Sample Problems for the Emotional Focus (BE4) Hypothesis 189

Table 9.6 Therapeutic Strategies for Awareness and  Processing of Emotions 191

Table 10.1 Underlying Schemas for Disorders and Problems 210

Table 10.2 Sample Errors in Thinking 216

Table 10.3 Sample Problems for Dysfunctional Self-Talk (CS4) Hypothesis 221

Table 10.4 Steps in Treatment to Modify Self-Talk 222

Table 11.1 Samples of Disorders Treated With Operant Interventions 235

Table 11.2 Behavior Change Strategies Using Operant Learning Principles 236

Table 11.3 Examples of Disorders Treated With Exposure Interventions 242

Table 11.4 Examples of Skills-Training Domains 250

Table 12.1 Sample Problems for Existential Issues (ES1) Hypothesis 263

Table 12.2 Sample Problems for Freedom and Responsibility (ES2) Hypothesis 274

Table 12.3 Stages of Self-Directed Responsible Action 277

Table 12.4 Sample Problems for Spiritual Domain (ES3) Hypothesis 282

Table 13.1 Sample Problems for Internal Parts (P1) Hypothesis 292

Table 13.2 Sample Problems for Recurrent Pattern (P2) Hypothesis 305

Table 13.3 Examples of Empirically Supported Short-Term Psychodynamic Psychotherapies 309

Table 13.4 Stages of Development of Self and Relational Capacities 313

Table 13.5 Mature Relational Capacities 315

Table 13.6 Sample Problems for Deficits in Self and Relational Capacities (P3) Hypothesis 319

Table 14.1 Family Systems Concepts 333

Table 14.2 Working With Couples 339

Table 14.3 Using Family System Concepts in Individual Therapy 340

Table 14.4 Issues of Lesbian, Gay, Bisexual, Transgender, Questioning, and Intersex Clients 345

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Author Information

BARBARA LICHNER INGRAM, PhD, is a Professor of Psychology at Pepperdine University in Los Angeles, California, where she has served on the faculty since 1978. She was instrumental to the creation of their APA-approved PsyD program in 1985 and continues to be an active participant in that endeavor.
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"[Barbara Ingram has put] a career into the development of this book and it is wonderful! My students love that it is written with them in mind and they love the statements designed to reduce anxiety and normalize the learning process. This is an excellent book!"
Amy M Reese-Turyn, PhD, Associate Professor of Counseling Psychology, Lewis & Clark College

"Dr. Ingram's book is a tremendous accomplishment and contribution. She provides a step-by-step, systematic guide to case formulation and treatment planning that is simultaneously creative, integrative, evidence-based, practical and wise. All clinicians, regardless of experience or theoretical orientation, would benefit from reading it."
Tracy D. Eells, MBA, PhD, Professor, Department of Psychiatry and Behavioral Sciences, University of Louisville

"This is an expanded version of what already was one of the most encompassing approaches to psychotherapy integration. Ingram also has added much important material on cultural considerations. The method that is described allows the clinician to approach each patient with a carefully thought out treatment plan. By taking existential and spiritual concerns into account, it goes well beyond the usual problem centered approaches. I am happy to recommend it to all practitioners."
George Stricker, Professor of Psychology, Argosy University, Washington DC

"Two major splits dominate the field of psychotherapy today: alienation between researchers and practitioners, and the fragmentation of theoretical approaches into self-contained, frequently warring subgroups. In this contentious environment, Ingram's important book is a wonderful breath of fresh air, for she develops a dramatically successful conceptual and practical model for bridging these splits. Her approach masterfully does this first by developing a generic case formulation paradigm that is both theory and data friendly for researchers, and individual-case friendly for practitioners. Second, in a far-ranging and seamless integration of the field, Ingram demonstrates how her case formulation model can incorporate concepts and principles from a wide variety of theoretical orientations, vividly showing how the different approaches can provide complementary perspectives on the same case. This complementarily in turn provides more options for treatment planning and intervention so as to best shape the therapy to the specific clinical needs and contexts of the individual client, while at the same time providing rich material to facilitate the further development and refinement of the theories."
Daniel B. Fishman, PhD, Professor, Graduate School of Applied and Professional Psychology, Rutgers University

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