Abductive Method and Clinical Assessment in Practice

Abstract

Clinical reasoning is one of the central components of psychological assessment. The identification of a client's psychological difficulties and the subsequent depiction of their onset, development, and interrelationships enables clinicians to plan treatment in a systematic and effective manner. In a recent paper (Ward & Haig, 1997), we presented an abductive theory of method and showed how it offered a useful framework for highlighting and integrating the major phases of psychological assessment. These phases involve detecting clinical phenomena, postulating psychological mechanisms, developing a case formulation, and evaluating a case formulation. In this paper we outline the abductive theory and elaborate on the related clinical dimensions of assessment, while illustrating them with an ongoing case example.

An abductive perspective on clinical reasoning and case formulation

“…Therefore, for the purposes of explicating an abductive model of clinical reasoning and case formulation, the phenomena detection phase includes data collection, and the narrative of the case formulation is added as a fifth phase. This characterization of clinical reasoning and case formulation is more fully articulated than that presented in our previous article (Ward et al, 1999), and is a function of the subsequent development and refinement of ATOM (Haig, 2005b) and its application to clinical reasoning.…”

“…A case formulation is the culmination of the clinical reasoning process and is a comprehensive and, hopefully, integrated conceptualization of a case encompassing phenomenology, etiology, maintaining factors, prognosis, and treatment recommendations. It is a set of descriptive and explanatory hypotheses that attempts to explain why a client developed these problems at a particular time, what is maintaining them, and what should be done about them (Ward et al, 1999). The case formulation should demonstrate an understanding of a unique individual, with vulnerabilities and strengths, and explain how he or she comes to be in their current predicament.…”

“…There have been considerable efforts to make explicit the processes involved in clinical reasoning (e.g., Borleffs, Custers, van Gijn, & ten Cate, 2003;Elstein, Shulman, & Sprafka, 1978;Falvey, Bray, & Hebert, 2005;Schmidt, Norman, & Boshuizen, 1990), and to apply models of decisionmaking to clinical reasoning (e.g., Galanter & Patel, 2005;Ward, Vertue, & Haig, 1999).…”

Forensic Case Formulation

“…Some approaches to formulation go beyond mere description, statement of facts, or classification to make predictions-which may be in the form of speculations about possible futures, rather than precise or quantitative forecasts-and provide an explanation or justification for those predictions. We are convinced by arguments that formulation in mental health is best conceptualized as a form of abductive inference (Haig, 2008;Ward, Vertue, & Haig, 1999). Abduction is a form of inductive reasoning that involves generating rules from cases and results, in contrast to deductive reasoning, which involves generating results from rules and cases.…”

Therapeutic Jurisprudence and Sex Offenders: A Psycho-Legal Approach to Protection

“…For the higher risk offender, a more detailed plan based on an initial case formulation provides contextualized information. The information provided should include physical context (e.g., access to child victims or pornography), social context (e.g., relationship conflict, financial problems), mood (e.g., poor regulation of positive or negative emotions), and physiological change (e.g., sexual arousal) (Ward, Vertue, & Haig, 1999).…”