MCC 670 – Case Formulation

MCC 670 – objective vs subjective

​Ingram, (2012) provides a clear differentiation between subjective and objective data in the following statement: “What the client tells you goes in [Subjective Data}…how the client tells it goes in [Objective Data]” (p. 83). In other words, the subjective section contains information pertaining to the client’s own story (Ingram, 2012, p7). In contrast objective data refers to observations noted in how a client tells their story. For example, in the subjective data section, it is critical to exclude a therapist’s observations and theoretical formulations. Additionally, in the objective data section, information pertaining to a client’s own personal interpretations and verbal reports should be excluded.

The Importance of This Distinction

​Ingram (2012) states that it is essential to provide a separate section for objective and subjective data in order to clearly differentiate the information’s source. The purpose of the subjective data is to provide a place where the client’s own story can be told (Ingram, 2012). For this reason, it contains information from the client and the client’s family. It excludes clinical observations and hypothetical case formulations. In contrast, objective data includes information pertain to clinical observations, including tests, medical records or “therapist’s observations” (Ingram, 2012, p6). It excludes case formulations and information pertaining to the either the client or family members’ verbal reports (Ingram, 2012).

Examples of Objective vs. Subjective.

​The best examples I provided for this assignment come from the Practicum Course for this program. Those of you, who have completed it, are aware that we are to complete a series of 10 recordings of simulated therapy sessions. Since my recording partner backed out, I had to find somebody at the last minute. My recording partner was a fellow student from the Group Therapy course. For these recordings, she created a hypothetical client by the name of “Jessica”. The storyline that unfolded as a result of this process is also purely “hypothetical”. What follows are excerpts from these assignments.

SUBJECTIVE

Jessica states that her husband is very displeased with all recent changes that have occurred since she entered therapy and has become increasingly abusive. Apparently, she got into an altercation with her husband after an argument. She expresses great frustration with the entire therapeutic process and is disinterested in continuing. She openly acknowledges at this point that her only reason for being here is because her employer requires it as a condition of her employment. Currently she attributes her husband’s abusive behavior to a “bunch of crazy hopes”, and blames the therapist and support group for the recent events that have inspired. She feels very hopelessness regarding her situation and openly discusses suicidal thoughts. Although she has no plan at this time she will not enter a contract for safety but is willing to call me nightly.

OBJECTIVE

Jessica presents today in a state of extreme state of distress, crying uncontrollably at the beginning of our session today. She appears with sunglasses that cover two black eyes and her appearance is very disheveled. Jessica openly expresses suicidal thoughts throughout the session although no plan currently is in place. Speech is reflective of a very emotionally labile state. She is very hopelessness regarding her current life situation. Affect appears consistent with overall mood. Insight and judgment are very limited during this session. They are reflective of heightened emotions and a feeling of extreme hopelessness. Ability to control impulses is very poor in light of Jessica’s events.”

Conclusion

I’d like to add that the above examples are my own recent “best attempt” at differentiating between objective and subjective data and I’m very open to criticism (?). As you can see, my recording partner threw a couple of “curve balls” at me, and presented me with a very extreme hypothetical scenario. It was indeed challenging and very educational from an ethical standpoint.

References

Ingram, B.L. (2012). Clinical Case Formulations: Matching the Integrative Treatment
​Plan to the Client. (2nd ed.). Hoboken, NJ: Wiley.

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MCC 670 – Setting Outcome Goals

In the last post, I discuss the problem definition process that occurs during the 1st session of therapy…

“The development of a list of problem titles involves two separate processes…'(Ingram, 2012, p41).  Ingram, (2012), defines a problem as “difficulties, dysfunctions, complaints, and impairments that are identified by the client’ (p. 41)….Additionally, they should be defined as a ‘solvable target (Ingram, 2012, p. 45).  In other words.  what is the desire outcome for this specific problem?  

This post focuses on the process of defining outcome goals when we begin developing our treatment plan.

“Every problem title is paired with an outcome goal, a description of the desired state at the end of therapy – how you will know the problem is solved” (Ingram, 2012, p. 61).   Achievement of outcome goals is the definition of effectiveness.  Therapists gather evidence and progress with outcome goals in mind.  If no progress is made, it may be necessary to reconsider your original case formulation.

Tips for Creating Good Outcome Goals…

Ingram (2012), suggests that outcome goals be specific and measurable in order to guide treatment planning.   Cognitive flexibility and critical thinking are important to help a therapist move from varied levels of abstraction.  Concrete goals can and measurable so success can be recognized.  However, this can limit one’s options at times if goals are too rigid and highly specified.   Other considerations listed in my Ingram (2012), are listed below:

  1. “Be aware of cultural biases and avoid becoming an agent of social conformity” (Ingram, 2012, p. 62).
  2. “Be sure to examine the values related to a stated goal” (Ingram, 2012, p. 62).
  3. “Question whether the client is accepting others’ definitions of happiness” (Ingram, 2012, p. 62)
  4. “How & when are not part of outcome goals….This is in the plan”  (Ingram, 2012, p. 62).

Benefits of Clearly Defined Future Goals…

  1. It can halve a positive effect on the client’s motivation.
  2. Creating a plan with the client can help instill.
  3. Clearly defined goals can help the client progress along the stages of change.
  4. Can help the client clearly define what they want (i.e. choice therapy).

Helping Clients Define Their Goals.

“Client’s usually put forth their problems without difficulty but they often need prodding and a good amount of creativity to put things in terms of a desired future” (Ingram, 2012, p. 63).  What follows are more tips from my textbook:

  1. SMART – Specific, Measurable, Attainable/Achievable, Realistic/Relevant & Time Specific
  2. PUERE – Standards for creating good goals…
    1. Use Positive Terms.  State what you do wan’t not what you don’t want.
    2. Outcome Goals must be Under your Own Control.
    3. Goals must be Evidence-Based, measurable, and operationalized.
    4. Goals must be Realistic and achievable.
    5. They must be ecological and holistic in nature.

Standards for Outcome Goals…

  1. “STANDARD ONE (LOGICAL CONNECTION) – Outcome goals are directly related to the problem title and endorsed by the client” (Ingram, 2012, p. 67)
    1. Should be evaluated for progress regularly
    2. Should ensure align with client’s goals
  2. “STANDARD TWO (THEORETICALLY NEUTRAL) – Do not contain the therapist’s connection” (Ingram, 2o12, p. 69)
  3. “STANDARD THREE: Outcome goals are realistic, attainable, and testable with evidence of real-world functioning.” (Ingram, 2012, p, 70).
    1. Not based on assumption of normal life difficulties.
    2. Not based on client’s agenda to change somebody else
    3. Not based on Utopian Beliefs or Perfectionist Standards.
  4. “STANDARD FOUR: Outcome goals do not contain the how of the treatment plan. People stifle ambitions based on perception of achievability of goals they set” (Ingram, 2012, p. 70).

References

Ingram, B.L. (2012). Clinical Case Formulations: Matching the Integrative Treatment
​Plan to the Client. (2nd ed.). Hoboken, NJ: Wiley.

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MCC – 670 Defining The Problem

“​The development of a list of problem titles involves two separate processes…”(Ingram, 2012, p41).  Ingram, (2012), defines a problem as “difficulties, dysfunctions, complaints, and impairments that are identified by the client” (p. 41).

FIRST, by gathering data and developing a preliminary list of problems. NEXT, by conceptualizing and giving titles to the problems we can better understand our treatment targets.  If they are defined by the client we refer to them as complaints.  Problems defined by significant others are relationship problems. Problems defined the professionals who counseling are called diagnoses.  Helping the client understand and gain some awareness regarding the nature of this problem is essential.

Step #1: Understanding the Goal

“When the goal is to arrive at a diagnosis, we check the list of criteria to see if there are enough to warrant the diagnosis, as if the criteria are a means to an end. When we think in terms of problem lists, the criteria are the end – they give us names of problems” (Ingram, 2012, p. 42)

The Presenting Problem

The presenting problem consists of the client’s stated reasons for seeking therapy in his/her own words.  It is not uncommon for the client’s presenting complaint to undergo a transformation as they develop a greater understanding of their problems.  For this reason, it is useful to record how it changes over time.

“SHOULD I JUST ACCEPT THE CLIENT’S STATED PROBLEMS OR AM I SUPPOSED TO GO FURTHER AND FIND OTHER PROBLEMS?”

In response to this question, Ingram (2012), describes three different attitudinal perspectives. However, at the end of this discussion, Ingram, (2012), stay

Narrow Position

According to this position, the therapist should simply accept the client’s complaints without attempting to create awareness of needs the client hasn’t mentioned.

Intermediate Position

Here, the therapist focused on the client’s request but if other problems become obvious, they will invite client to consider them.

A Comprehensive List

According to this perspective, the therapist should be concerned about the whole person, and examine all aspects of function in terms of a holistic assessment of the individual.  Just because the client is able to identify some problems, that doesn’t mean they are accepted as critical for treatment. The approach this book upholds is to utilize a comprehensive problem list. It is better to be too inclusive than to miss something important.  Finally, it is important to note that “the therapist’ values inevitably enter the problem-identification process” (Ingram, 2012).

Step #2: Developing A Comprehensive Problem List.

With the attitude of someone who is brainstorming, write down every problem (Ingram, 2012, p43). Complete the following assessments.

THE BASIC SID

  1. BEHAVIOR – What is the person doing, and not doing; what can others observe; the quality of skills?
  2. AFFECT: Internal emotional experience and overt verbal and nonverbal expression of feeling.
  3. SENSATION: Awareness of the body; use of senses; what is seen and heard with minimal filtering through cognition.
  4. IMAGERY: Mental imagery about past, present, or future; fantasies and dreams
  5. COGNITIVE: Constructed meaning; self-talk, beliefs, and schemas; cognitive skills; mental abilities
  6. INTERPERSONAL, SOCIAL, & CULTURAL: Relationships with others; family context; membership in social groups; cultural issues; and issues of social injustice.
  7. DRUG AND BIOLOGICAL: Physiology; biology; genetics; medical issues; use of illegal drugs, including alcohol.

DOMAINS OF FUNCTIONING (WHODAS)

Ingram, (2012) lists several domains of function that can be found in the DSM-IV manual.  “Therapists need to balance a psychiatrists emphasis on pathology with a counselor’s concern for growth and development” (Ingram, 2012, p. 44).
These domains are listed below, (Ingram,2012, p. 44-45).

a. Health and safety
b. Home Management
c. Financial status
d. Life planning
e. Academic
f. Employment
g. Legal status
h. Leisure and Recreation
i. Communication
j. Friendship
k. Family
l. Emotional Intimacy
m. Sexuality
n. Parenting
o. Religion & Spiritual
p. Cultural

Also contained in the DSM-IV is the Global Assessment of Functioning. While it is currently an out-of-date assessment, I’m including a link of it here for the sake of thoroughness. It is important also to note that the new DSM-5 manual focuses instead on the WHODAS-2. I’m also including a link for this instrument, since it is utilized at my current place of employment.

Step #3 Creating The Preliminary Problem List

“The quantity of problems on the preliminary list might make you feel hopeless. Remember you can combine and condense the list until it is manageable”. (Ingram, 2012, p46).

Overall goal

When defining problems it is useful to think about they can describe the target of your future therapeutic efforts. Ingram, (2012) suggests that “the problem title is a brief specific phrase…[and] stay focused on the client’s reason for being in therapy, not yet moving to your conceptualization of the problem” (p 45). Additionally, “avoid using language that reveals our explanations that attribute a cause for their problem” (Ingram, 2012, p 45).  Finally, check to make sure you Problem List is comprehensive.  While it is vital that we address the client’s pain, we must not automatically accept the client’s understanding of the problem without critical examination.

Standards for Problem Definition

  1. Problems should be defined as a “solvable target” (Ingram, 2012, p.45) for therapy. In other words, what is the desired outcome.
  2. Problems must reflect the client’s current level of functioning and capture their real-life problems.
  3. Problems are specific and designed with an individual client in mind based on data gathered.  This will aid in the development of your treatment plan.
  4. Do not include technical jargon, or theoretical concepts.  These things reflect a clinical hypothesis.  Your goal is to summarize findings from your data gathering.  This can allow for a therapist to utilize whatever theory might best apply at a later point.  Ask yourself if what you’re writing down is s hypothesis or a problem definition.
  5. Be cautious of how your values and biases might color your understanding of the client’s problems.  “Does the problem title reflect the client’s values?” (Ingram, 2012,)</h6<
  6. “How do you handle a list of 20 or more problems? The solution is lumping and splitting.  Lumping involves combining separate problems into a single problem” (Ingram, 2011, p. 55).  This is useful if signs and symptoms overlap and stem from common cause.  Occasionally, this might involve the utilization of an umbrella title.  With outcome goals for each sub-Problem.  Splitting involves “dividing one problem into separate problems…” (Ingram, 2912, pp. 56) Instances in which splitting might be useful include those cases in which separate treatments are needed or if this aids in clarity,
  7. Finally, be sure your problem list is complete and comprehensive.  “The omission of problems is a much more serious error than inclusion of too many problems” (Ingram, 2012, p. 60).

Reference

Ingram, B.L. (2012). Clinical Case Formulations: Matching the Integrative Treatment
​Plan to the Client. (2nd ed.). Hoboken, NJ: Wiley.

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MCC 670 – BASIC-SID

​Ingram (2012) describes the problem identification process as involving two key tasks: defining “the presenting problem…[and developing a] comprehensive problem list” (p43). The BASIC SID comprehensive problem framework involves assessing the following areas: “behavior, affect, sensation, imagery, cognitive, spiritual, interpersonal, [and medical]” (p43). Developed by Arnold Lazarus in the 1980’s, this assessment method allows a holistic assessment of clients, without the influence of theoretical conceptualization in the process (Ingram, 2012).

I begin by providing a brief description of the components of a “BASIC SID” Framework

  1. BEHAVIOR – what the person is doing / not doing / what others observe / quality of skills presented
  2. AFFECT – internal emotional experience and overt verbal/nonverbal expression of feelings.
  3. SENSATION – awareness of body, use of senses with degree of cognitive filtering of information.
  4. IMAGERY – nature of r/t past/present/future/ dream vs. reality
  5. COGNITION – meaning, self-talk, belief, schemas, etc….
  6. SPIRITUAL – religion/non-religion
  7. INTERPERSONAL/SOCIAL/CULTURAL = relationships with others, family context, social/cultural groups, acculturation levels.
  8. DRUG / ALCOHOL / MEDICAL HISTORY

Next, I provide a brief list of issues present in Illana’s case study (as assigned) then conclude with my impressions of this tool.

Ilana’s Preliminary Problems

Behavior

Little is provided in the case history that describes Ilana’s specific behaviors during the therapy session. At the same time, it is important that she is described as “significantly underweight” (Author, 2015), and appears depressed. Additionally, it should be noted that she is resistant to therapy and only sought counseling after “the doctor threatened to call child protective services” (Author, 2015).
Affect – Ilana is described as depressed and describes a history of suicidal behavior and cutting behavior (Author, 2015). She describes feelings of worthlessness and states “I’m a terrible wife and mother” (Author, 2015). Additionally, Ilana, describes herself as lonely and “unhappy all the time” (Author, 2015).

Sensation

Ilana describes a history of cutting behaviors and presents with cuts on her thighs and arms (Author, 2015). She states her cutting helps her cope because it makes her feel better afterwards (Author, 2015). Additionally, she also describes a complex history of eating disorders and states she “always felt better when…hungry” (Author, 2015).

Imagery

The “mental imagery” (Author, 2015), in Ilana’s case is rich in information on her life history. It provides a useful context with which to understand many underlying issues. Ilana describes her early childhood as idyllic (Author, 2015). She describes memories of her extended family and summer vacations at her grandparents’ lake house (Author, 2015). She describes details of an incident when she was five, of being fondled by an uncle, although states her memory of this incident is vague (Author, 2015). Regarding her eating disorder history, she reports the positive comments from family that encouraged her to maintain these weight loss efforts (Author, 2015). Finally, the early years of her marriage are filled with memories of loneliness and isolation (Author, 2015). She describes a difficulty pregnancy, while her husband is away at basic training, and then an extended assignment in Spain during this time (Author, 2015).

Cognitive

Ilana describes  an extended history of depression, self-harm, and anorexia. Her self-talk reflects feelings of self-doubt as she describes her inadequacies as a mother, wife. Distant memories of her childhood with older sister Reyana also reflect this pattern, particularly when she describes herself as “the ugly duckling” (Author, 2015). Ilana’s cognitive skills do not currently reflect a great deal of self-awareness. Instead, Illana is highly resistant to therapy, and has only sought counseling upon her doctor’s assistance. Additionally, she doesn’t display a high degree awareness or self-responsibility regarding her eating disorder, cutting behavior, and suicidal thoughts. Her current mindset is overwhelmed by feelings of depression, loneliness, and inadequacy.

Spiritual

Not much is mentioned about Ilana’s spiritual and religious background. While her early childhood is described as idyllic and involving an extended family with “rich cultural traditions” (Author, 2015), nothing is known about religious aspects of her background.

Interpersonal, Social & Cultural

Ilana is a 28-year-old married mother of two young children ages five and three. (Author, 2015) She is of Hispanic descent and grew up in the Midwest with an older sister in a multigenerational setting. (Author, 2015) She graduated with a Bachelor’s degree in psychology and met her husband, David, in College (Author, 2015). According to the case study she was raised in a large family that is “rich with cultural traditions” (Author, 2015).

Drug & Biological

Ilana describes a history of cutting and is grossly underweight (Author, 2015). Additionally, it appears she has an extensive eating disorder and self-harming history (Author, 2015). In addition to being prescribed antidepressants, she has been hospitalized several times for suicidal behavior (Author, 2015). Finally it is important to note she was unwilling to contract for safety while visiting with her base doctor recently (Author, 2015)

Is This List Comprehensive?

The final part of this discussion board assignment requires us to comment on how comprehensive the BASIS SID assessment is. Firstly, regarding the case study above, the BASIS SID assessment provides a good preliminary overview of presenting issues. Further assessments are naturally critical to define the specific nature of her issues. I would like to assess her eating disorder and depression more closely. Finally, her history of self-harm is also quite concerning and requires closer examination. However, when utilized to develop a “comprehensive problem list”, this assessment method is quite useful. The one caveat I might include, is that the level of experience of its user determines the effectiveness of this tool.

Reference

Author, (2015) Case Study – Illana. Retrieved from:
https://cyberactive.bellevue.edu/bbcswebdav/pid-7724673-dt-content-rid-10879782_2/courses/MCC670-T301_2163_1/Case%20Study%20-%20Ilana.pdf
Ingram, B.L. (2012). Clinical Case Formulations: Matching the Integrative Treatment
​Plan to the Client. (2nd ed.). Hoboken, NJ: Wiley.

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Mcc670 – Metamodal Questions

Based on NLP which says that people create faulty mental maps of reality and fail to test these cognitive/linguistic maps against experiences from senses.  According to founders of Neuro-Linguistic Programing (NLP) individuals frequently have faulty conceptualizations of reality . In order to address this issue, metamodal questions are used in therapy to understand how a client constructs their personal representation of reality. Through the utilization of metamodal questions cognitive errors such as overgeneralization, or all-or-nothing thinking can be uncovered (Ingram, 2012). The goal of these questions is to understand how the client processes information and develop clear idea of what is going on (Ingram, 2012).

Understanding the problem according to NLP

metaperspective defined

This concept is defined as the act of understanding our representation of reality is not the same as the true nature of things.  I discussed this concept briefly in another post after a conversation with my sister.  When we fail to acknowledge that our meta perspective doesn’t always adequately reflect the true nature of things we run into a proble.

The Gap Problem…

NLP defines this issue as a “gap problem”.  The inevitable gap between our cognitive map of things and real world experience, the bigger a problem is.   So in light of this we must begin asking ourselves what information we’re deleting and what we’ve distorted.

Understanding the NLP Solution via metamodal questioning…

The Goal…

The goal of NLP is to gather information that can help us determine where our informational gaps lie and if metamodal violations exist that can cause insufficient cognitive maps of reality exist.  As therapists our primary goal consists of helping the client develop a clearer understanding of what is happening and develop better informational processing skills.

The Metamodal Questioning Process.

STEP ONE –

Begin by ask for real data of experience to be fully described.  In the context of an intake interview you might begin by simply giving the client some time to tell the story of what lead them to seek counseling.

STEP TWO – 

Next you might ask questions that can help clarify the information upon which the client is basing his view of reality on. For example, if the client states “everyone hates me” you might respond by asking for specific sensory data, interactions and/of events that lead you to this conclusion.

STEP THREE  –

Finally, take time to explore further, any  information that may or may not support and not supporting the client’s perspective.  Here are a few Practicing Metamodal Questions (Examples) from Ingram (2012).

  1. Is the client missing some important details? (where, when, what, whom)
  2. Does the client use ague pronouns leading to generalizations (i.e. Everyone)? Ask for clarification and specifics
  3. Does the client tell his/her story with vaguely with few observable actions & behaviors ?  Again ask for them to clarify.
  4. All-Or-Nothing Thinking.  Is the client jumping to conclusions?
  5. Is the client making assumptions about others’ feelings?
  6. Cause/Effect Error.  Is the client assuming that “a” caused “b”? Attempt to and disconfirm the link between a & b.
  7. Is the client imposing values upon others? inquire on source of belief…

What follows are three examples of metamodal questions that could be utilized in the Case study of Clara assigned in my MCC 670 course.

Example One

In the Clara’s case study, she is said to making the following statement: “But my brother is an idiot and he’s just sticking around to get what money my father has left – I’m not going to let him win this one” (Author, 2015). Ingram, (2012) suggests a statement like this can reflect a cognitive error best described as “mind reading” (p34). A great multimodal response to this comment might be: “What is it specifically about your brother’s actions that has lead you to this conclusion?” When worded in this way, this asks the Clara to provide detail to support this assessment, while not making her feel you’re either negating or challenging this assertion.

Example Two

Clara also makes the following statement in an intake interview with the therapist: “Everybody has always shoved me around, telling me what to do. I’ve got a brain.” Our Ingram (2012) textbook would classify this statement as a potential overgeneralization (p33). A useful multimodal response, would require her to provide more detail in support of this generalized assumption (Ingram, 2012). For example, the therapist might state: “What is it that people do to make you feel this way? Can you provide examples?”

Example Three

Clara makes the following brief statement about her mother: “Mother believed in using the switch if everything wasn’t done just the way she wanted it.” This statement provides an opportunity to gather more information about a possible abuse history. In this example, my response would focus on gathering the missing details so I could develop a clearer idea of the specific incidents related to this comment. In this instance, I might say: “How does your mother like things done? Is it difficult to maintain your mother’s standards as her primary caretaker?

References

Author, (2015) Case Study – Clara.  Retrieved from: https://cyberactive.bellevue.edu/bbcswebdav/pid-7724670-dt-content-rid-​10879816_2/courses/MCC670-T301_2163_1/Case%20Study%20_Clara.pdf
Ingram, B.L. (2012). Clinical Case Formulations: Matching the Integrative Treatment
​Plan to the Client. (2nd ed.). Hoboken, NJ: Wiley.

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MCC 670 – Data Gathering

Ingram (2012) describes the intake interview as an assessment phase that typically occurs in 1-3 sessions. Oftentimes employers set specific requirements including a timeline for completion along with a predetermined format. However, Ingram (2012) states that the degree of structure and limitations on flexibility affect the client’s ability to engage in a storytelling process. Ingram (2012) defines problem solving as ideally involving minimal influence in order to gather information and identify the goals and problems. Testing a potential hypothesis exists as the initial stage of solution formulation in this process.

​According to Ingram (2012) the Intake Interview occurs in three phases. During the phase one, the client is allowed to tell their story as the counselor remains attentive and expresses understanding. In the second phase of the intake interview process, the counselor directs the clients toward key topic areas in an effort to complete this initial assessment (Ingram, 2012). Two key goals during this stage include determining of a crisis intervention is needed, and testing clinical hypotheses (Ingram, 2012). During the final phase, taking time to summarize progress thus far is important alongside a discussion and overview of the counseling process.This can help the client understand what to expect from therapy.

Ingram (2012) begins by describing the counseling as a problem-solving process that occurs in stages as follows:

  1. STEP ONE – Gather data —>

  2. STEP TWO – Identifying problem–>

  3. STEP THREE – Decide on goals—>

  4. STEP FOUR – Test hypothesis—>

  5. STEP FIVE – Move toward solution—>

Ingram (2012) encourages us to minimizing our influence over the problem solving process in the early data-gathering stage.

Ingram (2012) cautions that predefined approaches shape and restrict the client’s storytelling process and content that is provided – be flexible.  My biggest problem – thus far has been learning to balance a need for note taking with the development of a rapport.  Additionally it is important to be aware of how the process of social exchange can further influence the outcome of the data gathering process.  Ingram (2012) provides the following examples of how our level of influence can vary during the intake interview:

  1. Minimal influence – “allow silence, follow-up questions, encouragers, paraphrasing, reflection of feeling.” (Ingram, 2012).

  2. Mild influence- selective summary, probing topic chosen by the therapist, offer a bunch, reassurance

  3. Moderate influence – challenging questions, give suggestions, confrontation if inconsistence

  4. Maximal influence- interpret, teach, set limits, direct.

Ingram (2012) describes the intake interview as a process that occurs in three stages.

Phase One

Invite clients to tell stories in their own way unobstructed while you track this story and express understanding.  The primary goals are as follows:

  1.  During first session goals
  2. Gather cultural data
  3. Create good rapport & establish credibility
  4. Be sensitive and ask questions rather than rely on assumptions

Phase Two

This is the exploration phase (Ingram, 2012). It involves directing client toward topics of your choosing so you can complete the intake process.  The goals during this phase include   (1) testing the emergency hypothesis, to rule out need for crisis intervention, and (2) testing clinical hypotheses with questions, in order to assess your understanding of the problem.  What follows is a list of tips to minimize your influence during the data gathering portion of the intake interview (Ingram, 2012).

  1. Leading client to areas that you think are important, by blending listening with questioning.
  2. Do not bombard with questions.  Create bridge between client discuss and u r ?’s
  3. No agenda setting at this point.  The focus is on data gathering…
  4. Be aware that some exploratory questions carry advice
  5. Keep in mind, some questions encourage the client to think differently

Phase Three

Closing involves keeping track of time without being distracting and summarizes session. Psychoeducation important along with helping client understanding what to expect, (i.e. informed consent, & intake paperwork).

Data Gathering & The Therapeutic Relationship

Finally, Ingram, (2012), provides a few important suggestions for attending to the establishment of a therapeutic relationship during this phase.

  1. Empathetic listening and nonjudgmental acceptance are critical during this phase since this can impact what the client shares…
  2. Self-Awareness is vital and should be part of your training.  In addition to understanding. how other people perceive and respond to you, be mindful of the impact values, emotional reactions, cognitive filters and defensive tendencies, or cultural biases might have.
  3. Cultural Competence – Counseling doesn’t occur in a vacuum in the sense that we bring to the tables our sociocultural perspective as the filter through which we view life. An understanding of diverse cultures other than your own is especially critical.

Finally, Ingram, (2012) provides a quick overview of a few essential data gathering tools frequently utilizing during the intake process.

  1. ADDRESSING (Age, development, disability, religion, ethnicity, socioeconomic status, sexual orientation, indigenous status, national origin, gender.)
  2. GENOGRAM(Family Tree Diagram) – Includes  three generations using symbols to represent nature of relationships, gender, marriages, Etc
  3. FOUR (problem, outcome, obstacles, and resources)
    1. PROBLEM – what is wrong? Since when? How:
      1. Describe problem
      2. Discuss onset and developmental course.
      3. Progressive deterioration and history….
      4. Past attempts to solve
    2. OUTCOME – What do you want to happen?
      1. Your vision of the future?
      2. Where do you want to be?
    3. OBSTACLESBarriers to what you want?
      1. Internal barrier?
      2. Environmental obstacles
      3. Cultural / Social Issues
    4. RESOURCE & SUPPORT –what would help you get what you want?
      1. Environmental changes
      2. Applying new habits and skills. Etc…
    5. BASIC SID(Behavior, affect, sensation, imagery, cognition)
    6. Check out this description of Multimodal questions…
  4. OTHERS
    1. Evidence-based self-Reporting Instruments – Beck Depression Inventory, etc….
    2. Behavioral Observation Rating – Child-Symptom-Inventory 4
    3. Self-Monitoring Charts – antecendents/consequence/Trauma….

References

Ingram, B.L. (2012). Clinical Case Formulations: Matching the Integrative Treatment
​Plan to the Client. (2nd ed.). Hoboken, NJ: Wiley.

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