Beyond Diagnosis E-Book

Michael Bruch

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 497

Veröffentlichungsjahr: 2015

Beschreibung

The second edition of Beyond Diagnosis is a fully updated and expanded examination of Vic Meyer's pioneering case formulation approach and its application to cognitive behavioral therapy.

• Recommends dynamic, individualized assessment over standard diagnostic classification for complex individual problems
• Presents detailed analysis of advanced cases that are relevant for clinical practice
• Features a foreword by Ira Turkat, as well as discussion of the most up-to-date clinical procedures from a world-wide group of case formulation experts

Leseprobe

CONTENTS

Cover

Dedication page

Title page

Copyright page

List of Contributors

Foreword

References

Preface

References

1 The Development of Case Formulation Approaches

Case Formulation and Psychiatric Diagnosis

A Short History of Case Formulation

The Contribution of the Maudsley Group

The Contribution of Victor Meyer

Further Developments Based on Meyer’s Approach

The Contribution of Ira Turkat

The Contribution of David Lane

Concluding Remarks

References

2 The UCL Case Formulation Model

The Clinical Purpose

Foundations and Assumptions

The Initial Interview

Developing Hypotheses

Practical Steps

Summary

References

3 Case Formulation

Scientific Reasoning in Case Formulation

Single-Case Methodology

The Hypothesis-Testing Interview

Bringing It All Together: Abductive Reasoning

References

4 Case Formulation and the Therapeutic Relationship

Review of the Literature

The Case Formulation Approach

Beyond Therapist Style: Current Thinking on the Therapeutic Relationship

Summary and Conclusions

References

5 The Therapeutic Relationship as a Critical Intervention in a Case of Complex PTSD and OCD

Identifying Information and Presenting Problem

Session 2

Sessions 3–7

Comprehensive Problem List

D.’s Goals for Therapy

Commentary and Case Formulation

Response to Formulation-Guided Relationship and Initial Nonrelationship Interventions

Treatment of D.’s PTSD

Examples of Invalidation

Examples of Abandonment

Examples of Feeling Judged, Criticized or Blamed

Examples of Combined Abandonment, Being Criticized and Disappointment

Progress to Date

Concluding Comments

Acknowledgement

References

6 Generalized Anxiety Disorder

Introduction

Case 1 – John

Case 2 – Ann

Case 3 – Martin

Discussion

References

7 Cognitive-Behavioural Formulation and the Scientist-Practitioner

Introduction

The Functions of Formulation: A Review of the Key Debates

Do Formulations ‘Work’: A Brief Review of the Evidence

A Generic Framework for Developing Formulations: The Purpose–Perspectives–Process Model

A Process Model Derived From the Empirical Approach: DEFINE

Some Further Thoughts on the DEFINE Model and General Conclusions

References

8 Cognitive-behavioural Case Formulation in the Treatment of a Complex Case of Social Anxiety Disorder and Substance Misuse

Introduction

The Client

Phase 1: Definition of Problems

Phase 2: Exploration of problems

Phase 3: Formulation of problems

Phase 4: Intervention

Phase 5: Evaluation

Conclusions

References

Appendix: Invited Case Transcript

Case Material

Discussion

References

Index

End User License Agreement

List of Tables

Chapter 02

Table 2.1 Phases in the Case Formulation Process.

Table 2.2 The Behaviour Analysis Matrix.

Chapter 04

Table 4.1 Two sets of therapist Behaviours.

Chapter 08

Table 8.1 Functional Analysis of Struggling in Social Situations.

Table 8.2 Functional Analysis of Excessive Concerns Following Social Encounters.

Table 8.3 Reformulated Presenting Problems and Treatment Goals.

Table 8.4 Summary of the Course of Therapy.

Table 8.5 Changes in Standardized Outcome Measure Scores across the Course of Therapy.

List of Illustrations

Chapter 02

Figure 2.1 Functional analysis.

Chapter 06

Figure 6.1 General model. This schema shows how John’s anticipation of a negative thought elicited a negative reaction leading to the conflict between feeling he should attend to the thought and that he should not have the thought leading to avoidance.

Figure 6.2 This schema illustrated how John’s testing behaviour to check he was anxious far from keeping him anxious increased his anxiety, which made him abort his exposure and incubate the anxiety further.

Figure 6.3 This schema illustrated to John how his attempts to monitor his loss of control produced a fear of losing control and hence more anxiety.

Figure 6.4 This schema illustrates how John’s perfectionist and self-critical tendencies lead to a conflict between enjoying an activity and feeling bad. This activity might lead to enjoyment, losing control and hence transgress his values. This ambivalence in turn led to more self-criticism and anxiety.

Figure 6.5 This figure described how Ann's narrative sequence become imaginary and played on her anxiety about her personal vulnerability of being stranded and helpless in an end of world scenario.

Figure 6.6 This figure describes how an alternative scenario for a natural disaster was built up using Ann's ability to be immersed in a narrative chain.

Figure 6.7 Vicious circle of anxiety. This schema illustrates specifically the link between Martin’s work, stress, health, anxiety and coping fears and his somatic and cognitive complaints. Self-sabotaging strategies elevated the anxiety into panic.

Figure 6.8 Vicious circle of anxiety. This schema describes the principal components of Martin’s overall vicious circle, including interpersonal, perfectionist, family, work, health and coping concerns and how they interacted around the fear of not possessing competence.

Figure 6.9 This schema describes how Martin’s hydraulic model of stress interacted with his rigid view of his relationship with clients to produce a paralyzing tension and apparently intolerable conflict.

Chapter 08

Figure 8.1 Timeline of Steve’s life.

Figure 8.2 Idiographic case formulation.

Guide

Cover

Table of Contents

Begin Reading

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For Vic Meyer, in Memoriam

Beyond Diagnosis

Case Formulation in Cognitive Behavioural Therapy

SECOND EDITION

Edited by

Michael Bruch

This edition first published 2015© 2015 John Wiley & Sons, Ltd.

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Library of Congress Cataloging-in-Publication Data

Beyond diagnosis (Bruch)Beyond diagnosis : case formulation in cognitive behavioural therapy / edited by Michael Bruch. – Second edition.  p. ; cm. Includes bibliographical references and index. ISBN 978-1-119-96076-8 (cloth) – ISBN 978-1-119-96075-1 (pbk.)I. Bruch, Michael, editor. II. Title.[DNLM: 1. Cognitive Therapy–methods. 2. Anxiety Disorders–diagnosis. 3. Anxiety Disorders–therapy. WM 425.5.C6] RC473.C37 616.89′14–dc23

      2014026820

A catalogue record for this book is available from the British Library.

Cover image: Magnifying glass with finger print © kostsov/iStockphoto.Fingerprint series © wh1600/iStockphoto

List of Contributors

Michael Bruch

Research Department of Clinical, Educational and Health Psychology, University College London, London, UK

Richard S. Hallam

Department of Psychology, University of Greenwich, London, UK

Peter G. AuBuchon

Department of Psychiatry, Pennsylvania Hospital & University of Pennsylvania Health System, Philadelphia, PA, USA

Kieron O’Connor

Department of Psychiatry, University of Montreal, Montreal, Québec, Canada

and

OCD Spectrum Study Research Centre, Fernand-Seguin Research Centre, Louis-H. Lafontaine Hospital, Montreal, Quebec, Canada

Amélie Drolet-Marcoux

Clinical Psychology Service, Department of Psychoeducation and Psychology, University of Quebec at Outaouais, Gatineau, Quebec, Canada

Geneviève Larocque

Clinical Psychology Service, Department of Psychoeducation and Psychology, University of Quebec at Outaouais, Gatineau, Quebec, Canada

Karolan Gervais

Clinical Psychology Service, Department of Psychoeducation and Psychology, University of Quebec at Outaouais, Gatineau, Quebec, Canada

Samia Ezzamel

Department of Mental Health and Learning Disabilities, London South Bank University, London, UK

Marcantonio M. Spada

Department of Psychology, London South Bank University, London, UK

Ana V. Nikčević

Department of Psychology, Kingston University, London, UK

David A. Lane

Institute for Work Based Learning, Middlesex University, London, UK

and

Professional Development Foundation, London, UK

Sarah Corrie

Institute for Work Based Learning, Middlesex University, London, UK

and

The Central London CBT Centre, CNWL Foundation Trust & Royal Holloway University of London, London, UK

Foreword

During the days I trained doctoral students in clinical psychology, I would begin with a very simple instruction: understand what you are dealing with before you do anything. This statement reveals the core of any effective and durable approach to treating a psychological problem.

The genesis of this line of thinking has many roots, but the British Psychological Society in 2011 identified historically four ‘influential clinicians’ as such in their landmark issuance of the Good Practice Guidelines on the Use of Psychological Formulation: Hans J. Eysenck, Victor Meyer, Monte B. Shapiro and I. Putting my own contributions aside (Turkat, 2014), each of the others had a profound impact on the field, and in my opinion, the present text represents primarily the influence of the lesser known of the three: Vic Meyer.

Eysenck led the United Kingdom to develop clinical psychology as a profession of science and not conjecture and became one of the most highly cited intellectuals in the history of mankind.

Shapiro innovated brilliantly how to apply the experimental method to the individual case, taking our clinical responsibilities a step beyond the requisite reliance upon existing knowledge generated by basic scientific research.

Both are considered to be founding fathers of clinical psychology in the United Kingdom, and their contributions are felt worldwide. But it was Meyer who devised a fascinating approach to formulating an individual case that met the criteria set forth by Eysenck and Shapiro that clinical actions be grounded in the knowledge produced by scientific research and that the scientific method be applied to the individual case. In so doing, Vic Meyer developed highly creative, impactful, and long-lasting contributions to the field at the practice level, unmatched by the vast overwhelming majority of mental health practitioners of the past half-century. His approach has touched clinical minds in every continent, including many unaware of his influence.

According to Vic, there was no standard intervention that could be effective for all and thus he promoted the notion that treatment must always be based on the unique presentation of the individual. To get there, there were some obvious prior steps: examine the presenting behavioural problems in descriptive detail, carefully trace their history, develop a theory unique to those problems about why they came about and continue, and then subject your theory to evaluation.

Unlike some forms of therapy in which the clinician would never, infrequently, or minimally reveal one’s thinking about the patient's psychopathology, Vic would explain his theory directly to the patient in detail, seek confirmatory and disconfirmatory evidence, and adapt accordingly.

Vic viewed the therapist as a detective – searching for clues to come to an understanding and then subjecting that understanding to the reality of the clinical data. Once an explanatory theory was devised that was consistent with all of the data and was verifiable, then, one would be forced to create a treatment based uniquely on that theory. In this way, not only was treatment guaranteed to be individualized, it made the entire process open to scrutiny and therefore, accountability. For in the end, whatever you did would either positively impact your patient's functioning or not, and that could be measured in an observable way.

The fruits of this approach were many and their presentation is beyond the space limitations I face here, but easily illustrated with Meyer's brilliant adaption of basic animal research to innovate a unique treatment for certain cases with significant history of treatment failure: those suffering from debilitating compulsive rituals. His development in the 1960s of treatment for obsessive–compulsive motor rituals by response prevention stemmed from this approach and remains today one of the most effective tools available for appropriately formulated cases.

This example of Vic's innovations brings us to a fundamental distinction raised by his work and debated among mental health professionals for decades: psychiatric diagnosis. I will leave this debate to other forums, but it is critical to understand that Vic would never advocate response prevention for all cases of motor rituals. Why? Because it is the formulation of the individual case that sets the groundwork for developing a uniquely designed treatment that may or may not borrow or improvise upon existing techniques. More simply: it is not the diagnosis that drives the treatment but the conceptualization of the idiosyncratic attributes of the presenting case. As such, one must go beyond diagnosis if the goal is to truly understand the psychopathology in front of your eyes in order to be in a position to provide the proper intervention.

With this distinction between formulation and diagnosis, the present volume highlights the former. And there is no person better suited to bring this approach to you today than Michael Bruch, who not only practices, teaches and supervises others along these lines in London and elsewhere, but has devoted his entire career to evolving Vic's approach to clinical phenomena.

The reader will find this second edition of Beyond Diagnosis to be a most welcome addition to the clinical psychology literature.

Ira Turkat

References

Turkat, I. D. (2014). An historical perspective on the impact of case formulation.

The Behavior Therapist

, 37, 180–188.

Preface

Since the first publication of Beyond Diagnosis, now 15 years ago, clinical as well as academic interest in case formulation has grown enormously. At the time researchers involved in developing cognitive–behavioural therapy (CBT) were mostly interested in treatment protocols and manuals whereas case formulation was largely ignored or undervalued by the academic community. For example, Beck (1976) stated that CBT developed without much explicit reference to case formulation, and Schulte and coworkers (1992) claimed that individualized tailored interventions offered no advantages over manualized treatment procedures.

The first edition of this book was enormously popular with clinicians and training institutions alike, and I believe that it had great influence in bringing case formulation to the attention of a wider audience. It is very gratifying to see that over the years, earlier attitudes have now changed considerably and there appears growing interest in paying more attention to clinical realities in a ‘bottom up’ approach as some may call it. This is evidenced by a growing body of literature on case formulation, especially for more complex cases. However, for some, this just seems to mean improving clinical outcomes whilst others have suggested much broader or eclectic definitions (e.g. Eels, 2007).