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Clinical Case Formulations


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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

About the Author

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.


"[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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