Improving Understanding and Treatment with the Temporal/Contextual Model – Savvy Essay Writers | savvyessaywriters.net
Improving Understanding and Treatment with the Temporal/Contextual Model – Savvy Essay Writers | savvyessaywriters.net
Volume 39/Number 3/July 2017/Pages 18 1-194/doi: 10 .17744/mehc.39.3.01
THEORY
Case Conceptualization: Improving Understanding and Treatment with the Temporal/Contextual Model
Lynn Zubernis, Matthew Snyder, and Cheryl Neale-McFall
Case conceptualization is a critical component o f diagnosis and treatment. This article intro duces a comprehensive, holistic model of case conceptualization called the temporal!contextual model. This model aims to improve the accuracy, efficiency, and effectiveness of the case con ceptualization process. The temporal/contextual model is applied to a case example, illustrating its efficacy in helping a client with an eating disorder.
Before counselors can decide on interventions and set goals with clients, they must have a thorough understanding of who the client is and the context within which that individual has developed and is currently living. Case con ceptualization is the process by which counselors come to this understanding, by eliciting and organizing information, developing and testing hypotheses, and working collaboratively with the client toward an integrated concept of the client’s life. Case conceptualization is a core competency for counselors and considered as integral to counseling effectiveness (Betan & Binder, 2010; Sperry, 2010).
Case conceptualization includes diagnosis, but this is only the beginning of the process. Once the client’s presenting problem and symptoms are known, the counselor and client together begin to explore the etiology and construct a framework that allows them both to understand the nature of the symptoms and what is maintaining them. Case conceptualization gives the counselor a blueprint for how to interact with, listen to, and ultimately help the client (Seligman, 2004). Neukrug and Schwitzer (2006) define case conceptualiza tion as a tool that helps the counselor observe, understand, and integrate a client’s behaviors, emotions, and thinking. When a thorough case conceptu alization is constructed, the counselor can better understand both the client’s needs and their strengths and support systems. Thus, interventions are likely to
Lynn Zubernis, Department o f Counselor Education, West Chester University o f Pennsylvania; Matthew Snyder, Department o f Counselor Education, West Chester University o f Pennsylvania; Cheryl Neale- McFall, Department o f Counselor Education, West Chester University o f Pennsylvania. Correspondence concerning this article should be addressed to Lynn Zubernis, Department o f Counselor Education, West Chester University, 1160 McDermott Drive, Suite 102, West Chester, PA 19383. E-mail: lzubernis@wcupa.edu
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mailto:lzubernis@wcupa.edu
be more appropriate and effective, which is a benefit in today’s managed care climate, with its focus on timeliness and efficacy.
The case conceptualization developed by a counselor subsequently impacts the way in which the counseling relationship proceeds. The concep tualization guides the counselor’s choice of theoretical perspective, suggests which questions need to be asked, and frames interpretation of the client’s answers. By employing an organized model of case conceptualization, the counselor can more easily see clearly where the client has been, where they are now, and where it is possible for them to go.
Case conceptualization includes assessment and evaluation —observing current symptoms and assessing the context within which those symptoms developed. The process also includes gathering background information — family history, relationships, identity, culture, sexual orientation, educational background, past trauma, and a plethora of other variables that together create the context of the client’s life. Background information includes not only data on the challenges facing the client, but also the strengths, coping skills, and support systems that have enabled them to be in the counselor’s office and will inform treatment interventions. In addition, the client’s readiness for change must be assessed, as this impacts the ways in which the counselor can most effectively encounter the client. Finally, the precipitating factors that brought the client to treatment are part of the evaluation phase.
Once the information is gathered, the organizational phase of case con ceptualization begins. Case conceptualization is far from a passive process; the counselor actively organizes data and observations in order to make inferences and identify themes and patterns. Once the client’s core issues become clear, the counselor can develop hypotheses about the etiology and maintenance of the presenting problem and begin to set goals for change along with the client. The amount of information a client may divulge can seem overwhelming for the counselor who is hearing it; an articulated model of case conceptualization helps the counselor organize and make sense of this information and deter mine which is relevant and which may not be. This helps the counselor focus subsequent sessions, again enabling effective and timely treatment outcomes.
During the organizational phase, the counselor begins to piece together an explanatory framework for the client’s issues, creating a “map” of the client’s life story, which can then guide treatment decisions. This framework is based on culture and environment as well as on internal personality constructs (IPCs) and physiological factors. The counselor’s understanding of hew the client’s problems developed and what is sustaining them is also informed by the theo retical perspective adopted. As the case conceptualization process unfolds, the counselor selects and draws from relevant theories of change, which also guides hypotheses and intervention possibilities. Research has not demonstrated the relative efficacy of any one theoretical model; rather, case conceptualization allows the counselor to choose the theoretical approach that fits their emerging understanding of the client’s issues.
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Case Conceptualization
CASE CONCEPTUALIZATION USING THE TEMPORAL/CONTEXTUAL MODEL
The importance of case conceptualization is well recognized by counsel ors. However, the process is often not explicitly taught in training programs. In addition, many models of case conceptualization are specific to a particular theoretical orientation, limiting their usefulness. The temporal/contextual model (T/C model; Zubernis & Snyder, 2015), in contrast, is a holistic and atheoretical model that can be used with a wide variety of clients and pre senting problems. A visual flowchart and worksheet demystify the process and make the model well suited for collaborative work with clients. The model’s developmental approach encourages an accurate reflection of the complexity of the client’s experience, while helping the counselor identify specific targets for change.
The T/C model provides a framework for gathering information and making sense of the client’s often complex history; assessing a wide range of internal and external influences; and explicitly reminding counselors to gather information on strengths, resources, coping skills, and supports. This emphasis on strengths is particularly important when working with clients with long standing issues who may feel hopeless and helpless after years of struggle. Finally, the model includes a timeline, which allows a focus on past experi ences and future goals and reminds the counselor of the importance of the here-and-now experience. While the incorporation of a timeline is not unique to the T/C model (see Bronfenbrenner’s [1981] chronosysrem, for example), the inclusion of the timeline in the graphic model encourages the counselor to “go backwards” if needed and always to keep the client’s imagined future in mind.
THE TEMPORAL/CONTEXTUAL MODEL
The Triangle In the T/C model, a triangle represents the three major elements of human
experience and expression: behavior, cognition, and affect (Greenberger & Padesky, 1995). The triangle can be viewed as the client’s experienced world, both psychological and physiological. The client’s personality is part of the triangle, including the IPCs that form the client’s values, beliefs, self-concept, worldview, attachment style, sense of self-efficacy, and self-esteem (see Figure 1). IPCs influence how the client perceives their environment and how well they cope, which connects to the client’s readiness for change (Prochaska & DiClemente, 1982, 1986).
Behavior, cognition, and affect are the points of the triangle and also connect to the client’s external world. Behavior is what clients do, including eating, sleeping, and level of activity, and the counselor’s observations of the client during a session. Cognition includes the client’s beliefs about self and others, the way in which the client perceives and interprets information, their attachment status, and the customary ways in which they relate to others. These beliefs and interaction patterns are developed over time through inter-
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TEMPORAL CONTEXTUAL ( T/C ) MODEL OF CASE CONCEPTUALIZATION
Internal Personality
Characteristics
• ATTITUDES • VALUES • BELIEFS • SELF-ESTEEM • SELF-EFFICACY • ATTACHMENT
STYLE
COGNITION
CLIENTS INTERNAL WORLD
‘S MIMOMOI OC,
►I PCs
Biology
Physiology
COPING’ SKILLS AND
.STRENGTHS
READINESS FOR | CHANCE
CLIENT’S OUTSIDE WORLD / ENVIRONMENT:
• CULTURE • RELATIONSHIPS • SOCIETAL INFLUENCES • COUNSELING
RELATIONSHIP
CLIENT’S INTERACTION WITH THE OUTSIDE WORLD
Past <— – Present Future
F igure I . Th e te m p o ra l/c o n te x tu a l m odel o f case co n cep tu a liza tion . F rom Case Conceptualization and Effective Interventions: Assessing and Treating Mental, Emotional, and Behavioral Disorders, by L. Z u be rn is and M . Snyder, 2015, Thousand O aks, C A : SAGE (p . 55). C o p…
