The Unfolding Case Formulation: The Interplay of Description and Inference

Eells, Tracy D.

doi:10.14713/pcsp.v6i4.1046

Cited by 13 publications

(17 citation statements)

References 26 publications

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“…Charman (2004) found that clinicians include the word "intuitive" when describing the skills of effective psychotherapists. In my own research, expert case formulators developed higher quality case formulations than non-experts and did so using a mix of cognitive processes involving shortterm, data-near, intuitive leaps as well as more systematic deductive and inductive processes (Eells, 2010;Eells, Lombart, Kendjelic, Turner, & Lucas, 2005;Eells et al, 2011). Further, it is well documented that experts in a variety of skill domains are capable of accurate, insightful and intuitive judgment (Chi, Glaser, & Farr, 1988;Ericsson, Charness, Feltovich, & Hoffman, 2006;Klein, 1998 of expertise, these individuals quickly perceive large meaningful patterns, are faster than novices at performing the skill in question, and quickly solve problems with little error (Chi, 2006).…”

Section: In Defense Of Clinical Judgmentmentioning

confidence: 99%

In Support of Evidence-Based Case Formulation in Psychotherapy (From the Perspective of a Clinician)

Eells¹

2013

PCSP

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Persons (2013) has commented on my article (Eells, 2013) about revisiting the case formulation approach to psychotherapy research. I elaborate on her ideas by advocating for an evidencebased case formulation (EBCF) model of psychotherapy practice. The latter encourages clinician freedom of choice to select a case conceptualization and treatment plan, as long as those choices are empirically defensible. While the EBCF approach is intellectually challenging for clinicians, it has the advantage of being flexible in accommodating evidence, including but not limited to that derived from randomized clinical trials. The EBCF approach is preferable to the untenable position of relying primarily on one's personal experience as a therapist or primarily on intuition. The EBCF approach is an empirically defensible alternative to the empirically supported treatment (EST) movement. Clinical judgment is emphasized more in the EBCF approach than in ESTs. Conditions are described under which intuition in context can be trusted as one of a number of components of evidence-based practice. Finally, since therapists practicing ESTs tailor treatment to meet patient needs as they arise, a false dichotomy may exist between the EST and EBCF approaches when considering psychotherapy as it is actually practiced. A mixedmethods research agenda that examines the case formulation hypothesis can help determine whether such a false dichotomy exists, while advancing knowledge of psychotherapy as it unfolds in practice.

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Section: In Defense Of Clinical Judgmentmentioning

confidence: 99%

In Support of Evidence-Based Case Formulation in Psychotherapy (From the Perspective of a Clinician)

Eells¹

2013

PCSP

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“…Two papers, respectively authored by Eells (2010) and Edwards (2010), explore important aspects of psychotherapy: case formulation competencies and clinician responsiveness within the context of manualized treatments. Additionally, each paper reflects on the unique contribution of idiographic/qualitative methods in furthering our understanding of these complex phenomena.…”

Section: Overviewmentioning

confidence: 99%

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ABSTRACTIn this paper two research studies by Eells (2010) and Edwards (2010) evaluating case formulation and therapist responsiveness are summarized and critically evaluated. The central themes abstracted from these studies are subsequently articulated and integrated with existing research on the philosophical and theoretical competencies, clinical competencies, and quantitative competencies needed for effective case formulation.

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confidence: 99%

Evaluating Case Formulation Decision-Making and Therapist Responsiveness: A Perspective from the Area of Behavioral Assessment and Case Formulation

O’Brien

2010

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In this paper two research studies by Eells (2010) and Edwards (2010) evaluating case formulation and therapist responsiveness are summarized and critically evaluated. The central themes abstracted from these studies are subsequently articulated and integrated with existing research on the philosophical and theoretical competencies, clinical competencies, and quantitative competencies needed for effective case formulation. More specifically, I introduce and evaluate the work of Edwards and Eells in terms of a behavioral model of case formulation that is based on four general principles: functionalism; empiricism, cognitive-behavioral learning theory; and a multivariate perspective that stresses the importance of collecting multimodal and multimethod assessment data as the basis of a case formulation.Key words: case formulation; therapist responsiveness; behavioral assessment; functional analysis; quantitative analysis; case studies ___________________________________________________________________________________ OVERVIEWTwo papers, respectively authored by Eells (2010) and Edwards (2010), explore important aspects of psychotherapy: case formulation competencies and clinician responsiveness within the context of manualized treatments. Additionally, each paper reflects on the unique contribution of idiographic/qualitative methods in furthering our understanding of these complex phenomena.In this paper, a summary and critical review of each paper is provided. Subsequent to this, the common themes addressed by Eells and Edwards are discussed more fully. Finally, additional case formulation competencies are presented for consideration along with an argument EELLS' PAPER: SUMMARY AND COMMENTARY SummaryNoting that single subject research methods can complement nomothetic approaches, Eells (2010) sets out to evaluate the extent to which these methods capture unique and common information about clinical judgment among novice practitioners (graduate students in psychology), experienced clinicians (therapists with approximately 20 years of experience), and expert clinicians (therapists with 20 years of experience, publications relevant to case formulation, and extensive supervisory experience). To accomplish this goal, Eells developed six vignettes that presented different disorders (anxiety disorder, affective disorder, and borderline personality disorder) and two different levels of "prototypicality" (low, high). The clinicians read the vignettes and generated verbal accounts of their case formulation and treatment approach. The verbal accounts were then audio-recorded and coded for comprehensiveness, coherence, precision of language, the degree of elaboration of treatment plans, the complexity of information, the link between the formulation and treatment plan, and the degree to which the formulation development appeared to be systematic. Additionally, Eells evaluated the extent to which the therapists used forward reasoning (i.e., verbalizing a description of a behavior and then an inference about the causes...

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“…There are large similarities between the kind of problems presented to researchers by case formulation, the focus of Eells' (2010) research, and by therapist responsiveness during treatment, the focus of my (Edwards, 2010) contribution to this PCSP issue. In both areas, practitioners engage in complex behaviors that involve moment-to-moment decision making in response to an ongoing flow of data in the form of the behavior of or information provided by the client.…”

Section: ____________________________________________________________mentioning

confidence: 99%

“…In both areas, practitioners engage in complex behaviors that involve moment-to-moment decision making in response to an ongoing flow of data in the form of the behavior of or information provided by the client. In assessment and case formulation, which Eells examines, the focus is on gathering information in order to develop an understanding of the client's problems in terms of their severity, developmental history, precipitants, and current maintaining factors, a process aptly summarized in Figure 8 of Eells' (2010) article. In my contribution to this PCSP issue, the focus is on the treatment phase of posttraumatic stress disorder (PTSD) and the challenge of: implementing a treatment plan while at the same time building and safeguarding the working relationship with the client; reinforcing and enhancing the client's motivation; tailoring the treatment to the contextual aspects of the client's life; and being alert for new information that might call for revision of the formulation and treatment plan.…”

Section: ____________________________________________________________mentioning

confidence: 99%

Languages of Science and the Problem of Applied Clinical Knowledge: A Mixed Methods Appraisal of Eells' Case Formulation Research

Edwards

2010

PCSP

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This article is a methodological commentary on Eells' (2010) summary of his research on case formulation. It draws attention to an epistemological tension between a positivist and a qualitative/hermeneutic paradigm. I argue that the kinds of questions researchers are most concerned with in the field of case formulation are ones with direct relevance for practice and that an exclusively positivist paradigm is problematically suited to answer these, an observation that emerges from a consideration of Eells account of his research. While Eells' account of his case-based strategy is initially positivist in intent, the introduction of a hermeneutic approach opens the field up considerably. I conclude (a) that a "mixed methods" paradigm, which integratively and rigorously combines quantitative and qualitative methods and which has recently been called a "third research paradigm," offers a particularly attractive epistemological framework for planning research on case formulation that can directly guide and improve practice; and, following from this point, (b) that the meaning and direction of Eells' research can be enhanced by explicitly conceptualizing it within such a mixed methods paradigm.Keywords: psychotherapy case formulation; mixed methods research; therapist responsiveness; positivist vs. interpretive methods; quantitative vs. qualitative methods; case studies __________________________________________________________________________There are large similarities between the kind of problems presented to researchers by case formulation, the focus of Eells' (2010) research, and by therapist responsiveness during treatment, the focus of my (Edwards, 2010) contribution to this PCSP issue. In both areas, practitioners engage in complex behaviors that involve moment-to-moment decision making in response to an ongoing flow of data in the form of the behavior of or information provided by the client. In assessment and case formulation, which Eells examines, the focus is on gathering information in order to develop an understanding of the client's problems in terms of their severity, developmental history, precipitants, and current maintaining factors, a process aptly summarized in Figure 8 of Eells ' (2010) article. In my contribution to this PCSP issue, the focus is on the treatment phase of posttraumatic stress disorder (PTSD) and the challenge of:

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The Unfolding Case Formulation: The Interplay of Description and Inference

Cited by 13 publications

References 26 publications

In Support of Evidence-Based Case Formulation in Psychotherapy (From the Perspective of a Clinician)

In Support of Evidence-Based Case Formulation in Psychotherapy (From the Perspective of a Clinician)

Evaluating Case Formulation Decision-Making and Therapist Responsiveness: A Perspective from the Area of Behavioral Assessment and Case Formulation

Languages of Science and the Problem of Applied Clinical Knowledge: A Mixed Methods Appraisal of Eells' Case Formulation Research

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