Description
Review the assigned case study. Utilizing your selected treatment model, develop a Case conceptualization based on your model of
choice, and respond to the questions as indicated below in a scholarly format addressing the following criteria.
1. Develop a Case Conceptualization using the model of your choice
2. Include all identifying client information as indicated in the case.
3. Include all evidence of the core concepts and related information of the family in the case, based on your selected model.
4. Include- if any- the effects of culture/diversity/inclusion on the case presented
5. In scholarly format, respond to the following:
a. Describe how you would conduct the first session of therapy based on your chosen model of therapy. Include at
least three questions (and proposed responses) you would ask, and how you would establish the initial goals of
therapy. Note: A complete response demonstrates congruence between the clinical model and clinical choices in
questions and goal setting. Be specific in the actual question and proposed answer.
b. Kathy returns for a follow up session. In this session, she mentions to you that she sometimes wonders if she can
“go on” or if she’s “made a terrible mistake” in her life. What are your next steps? A complete answer includes
specific questions the PMNHP would ask the client with specific steps you would take based on the responses.
6. Paper should be in narrative format – maximum 3 pages excluding the title and reference page.
7. Include an introductory paragraph, purpose statement, and a conclusion.
8. Include level 1 and 2 headings to organize the paper.
9. Write the paper in third person, not first person (meaning do not use ‘we’ or ‘I’) and in a scholarly manner. To clarify: I,
we, you, me, our may not be used.
10. Include a minimum of two professional peer-reviewed scholarly journal references to support the paper
11. APA format required (attention to spelling/grammar, a title page, a reference page, and in-text citations)
Unformatted Attachment Preview
Case Study for Case Conceptualization
Background
Kathy, was referred by her primary care provider (PCP) for her depression, anxiety, and
anger which emerged 18 months earlier after her husband’s new job in the agricultural
industry brought the family to middle Tennessee from Jefferson City, Missouri. At the
time of the initial visit, Kathy was age 37, married 15 years to her husband Richard (40),
and the mother of three children—Rachel, age 8; Elizabeth, age 6; and William, age 2.
She acknowledged prior times of anxiety and depression—at age 5 when her parents
divorced, during stressful times at college, and after the birth of her second child—but
“never as bad” as this current episode.
Kathy reports that both her parents are still alive. They are Margaret (62) and John (65).
She expresses she is very close to her mother and calls her quite often. Her father John
and her do not communicate often due to recent family conflict. Her husband’s parents
are both deceased.
Her PCP had initiated antidepressant medication (a selective serotonin reuptake
inhibitor) with only partial symptom response. As part of your initial evaluation, you were
able to rule out bipolar disorder, confirm recurrent major depression, and change
medication to a different antidepressant medication (selective serotonin and
norepinephrine reuptake inhibitor). However, the medication adjustment alone would not
address the underlying issues fueling Kathy’s depression.
Kathy attributed the progressive worsening of her symptoms to her unhappiness since
relocating to middle Tennessee, missing her friends, her church, her life as the wife of a
university professor in agricultural sciences, her part-time work as a research assistant
for another faculty member, and her extensive support system. She bitterly resented her
husband’s new job for tearing her away from a lifestyle and close-knit community in
Missouri that she now idealized. She worried that her depression, anxiety, and anger
were affecting her relationship with her children and that she was a “bad mother.” She
struggled with guilt for being short-tempered with the children, feeling paralyzed by her
depression and unmotivated to unpack boxes and organize their new home, or make
any effort to build new relationships with neighbors or at her daughter’s elementary
school. She was withdrawn and resentful, verbalizing that the family would be “better off
without me.”
Questions:
Instructions: Review the above case. Construct your responses based on the Model you
have selected.
1. Complete a genogram demonstrating the emotional and relational connections of
the family in this case.
2. Describe how you would conduct the first session of therapy based on your
chosen model of therapy. Include at least three questions you would ask, and
how you would establish the initial goals of therapy. Note: A complete response
demonstrates congruence between the clinical model and clinical choices in
questions and goal setting. Be specific in the actual question and proposed
answer.
3. Kathy returns for a follow up session. In this session, she mentions to you that
she sometimes wonders if she can “go on” or if she’s “made a terrible mistake” in
her life. What are your next steps? A complete answer includes specific
questions the PMNHP would ask the client with specific steps you would take
based on the responses.
4. Develop a Case Conceptualization using the Model you have selected.
5. Construct a session note from one of your therapy appointments with Kathy.
Bowen Intergenerational Family Therapy Conceptualization 4.0
For use with individual, couple, or family clients
Date:
Clinician:
Client/Case #:
Introduction to Client & Significant Others
Identify significant persons in client’s relational/family life who will be mentioned in case conceptualization:
Adult(s)
Adult Age: Gender:
Adult Age: Gender:
Ethnoracial identity:
Ethnoracial identity:
Select Status Occupation:
Select Status Occupation:
Child(ren)
Child Age: Gender:
Child Age: Gender:
Child Age: Gender:
Ethnoracial Identity:
Ethnoracial Identity:
Ethnoracial Identity:
School/Grade:
School/Grade:
School/Grade:
Additional identifiers:
Additional identifiers:
Additional identifiers:
Additional identifiers:
Additional identifiers:
Others in Household/Family/Significant Persons:
Presenting Concerns
Client’s Description(s) of Problem(s):
Adult Age:
Adult Age:
Child Age:
Child Age:
Child Age:
Additional:
Broader System Problem Descriptions: From referring party, teachers, relatives, legal system, etc.:
Extended Family:
Name:
Name:
Background Information
Trauma/Abuse History (recent and past):
Substance Use/Abuse (current and past; self, family of origin, significant others):
Precipitating Events (recent life changes, first symptoms, stressors, etc.):
Related Historical Background (earlier incidents, family history, related issues, prior treatment, etc.):
Emotional Triangles and Cutoff
Triangles within current partnership: Describe:
Triangles with family of origin: Describe:
Other triangles:
Emotional cut-offs in extended family: Describe all:
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© 2022. Diane R. Gehart, Ph.D. All rights reserved. www.TherapyThatWorksInstitute.com
Intergenerational Patterns from Genogram
Construct a family genogram and include all relevant information including:
▪ Names, ages and birth/death dates
▪ Relational patterns
▪ Occupations
▪ Psychiatric disorders and alcohol/substance abuse
▪ Abuse history
▪ Personality adjectives
3-generation genogram should be attached to report. Summarize key findings below:
Substance/Alcohol Abuse:
NA
History:
Sexual/Physical/Emotional Abuse:
NA
History:
Parent/Child Relations:
NA
History:
Physical/Mental Disorders:
NA
History:
History Related to Presenting Problem:
NA
History:
Describe family strengths, such as the capacity to self-regulate and to effectively manage stress:
Patterns of Differentiation and Fusion
Describe how the couple/family promotes togetherness and separateness; provide examples:
Describe each person’s relative level of differentiation and ability to effectively manage conflict without reactivity;
provide examples:
Describe patterns of fusion, in current and past generations; provide examples:
Sibling Position
Describe sibling position patterns that seem to be relevant for the family, current, and earlier generations:
Family Projection Process
Describe evidence of parental projection onto their child(ren), such as emotionally reactive behavior between family
members; describe how it relates to symptoms, etc.:
Multigenerational Transmission Process
Describe multigenerational transmission of functioning, attending to acculturation issues, residual effects of trauma
and loss, significant legacies, use of alcohol and drugs etc.:
Multigenerational Patterns Informed by Diversity Factors
Describe how multigenerational patterns are informed by relevant diversity factors, including those related to
cultural, ethnicity, racial, immigration, acculturation, religious, socio-economic, ability, and sex/gender identity:
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© 2022. Diane R. Gehart, Ph.D. All rights reserved. www.TherapyThatWorksInstitute.com
Concise Systemic Case Study 4.0
For use with individual, couple, or family clients
Name:
Date:
Instructions
▪ Maximum page limit : 4 pages
▪ Attach one 3-generation genogram that includes ages, occupations, relational patterns, significant
medical/psychiatric history, and abuse patterns.
▪ Provide concise, focused descriptions; try to limit answers to 1-2 clear sentences.
▪ Use active voice, avoid passive voice (e.g., instead of “there was substance abuse in family of origin” say
“client’s father abused alcohol throughout her childhood.”
▪ Use precise, technical and behavioral descriptions, avoiding any language that evaluates outside of
standard professional terms (e.g., instead of “the client experienced horrific abuse” say “the client
experienced physical and sexual abuse by her father from ages 5-7).
I. Introduction to Client & Significant Others
List all significant others who will be included in the case conceptualization.
Additional identifiers may include: religion, language, sexuality, immigration status, economic status, neurodiversity, chronic health
conditions, mental health diagnoses, client’s position/role within their system(s), significant hobbies/interests or similar information.
Adult(s)
Adult Age: Gender:
Adult Age: Gender:
Race/Ethnicity:
Race/Ethnicity:
Select Status Occupation:
Select Status Occupation:
Child(ren)
Child Age: Gender:
Child Age: Gender:
Child Age: Gender:
Race/Ethnicity:
Race/Ethnicity:
Race/Ethnicity:
School/Grade:
School/Grade:
School/Grade:
Additional identifiers:
Additional identifiers:
Additional identifiers:
Additional identifiers:
Additional identifiers:
Others in Household/Family/Significant Persons:
Concise Systemic Case Conceptualization
1. Presenting Problem
What is the (a) presenting concern, (b) its reported origin, and (c) potential solution as described by each
person in the system (collaborative/systemic)? Include client reports of family and extended system
members opinions who may not be in session. Include diagnosis if relevant.
▪
▪
▪
2. Interaction Cycle & Role of Symptom
What is the problem interaction pattern (pathologizing interaction pattern; PIP) around the problem scenario
(systems, EFT, CBFT)? Behaviorally describe each party’s role in the PIP: rise of tension, escalation,
___________________________________________________________ 1 ___________________________________________________________
© 2022. Diane R. Gehart, Ph.D. All rights reserved. www.TherapythatWorksInstitute.com
symptom, return to normal. If presenting issue is intrapsychic, describe the client’s behavioral sequence
related to the symptoms.
Provide a description of a single incident that is characteristic of the primary problem.
▪
▪
▪
▪
Describe “Normal”/Baseline behaviors related to symptom:
Describe start of Tension/Symptom:
Describe height of Tension/Symptom:
Describe return to “Normal”/Baseline:
Describe the complementary dynamics in the cycle (e.g., pursuer/distancer, over/underfunctioner, good/bad
caregiver, logical/emotional, positive/negative):
What is the role of the symptom in maintaining relational homeostasis (systemic, FFT)? How might the
symptom serve to maintain connection, create independence/distance, establish influence, reestablish
connection, or otherwise help organize the client’s primary relational system?
The symptom serves to
3. Structure, Attachment, Trauma and Intergenerational Factors
a.
b.
c.
d.
Structural Issues (boundaries, hierarchy, coalitions/triangles, family life stage):
Attachment, Differentiation and/or Survival Stances (EFT, Bowen, Satir, psychodynamic):
Trauma History and Precipitating Events (structural, EFT, Satir, trauma-informed):
Intergenerational Patterns (attach 3-generation genogram with relational patterns, occupations, mental
health, and other relevant information):
4. Sociocultural Discourses
What are the socio-cultural factors that inform (a) the PIP and (b) individual/family identity
(narrative/collaborative/socioculturally attuned therapy)?
▪
Ethnic, Race, Class, Immigration Status, and Religious Discourses: How do key cultural
discourses inform client identities, what is perceived as the problem, and possible solutions (be as
specific as possible e.g., Italian American rather than White)?
▪
Gender and Sexuality Discourses: How do gender and sexuality discourses inform identities, what is
perceived as a problem, and the possible solutions? How do these intersect with ethnicity, religion, or
other identities?
▪
Community, School, Work and/or Societal Discourses: How do other important community
discourses (e.g., professional norms, school culture, societal trends, systemic racism, current events)
inform client identities, what is perceived as a problem, and the possible solutions?
▪
Problem-Related Identity Narratives: How has the problem shaped the client’s identity?
___________________________________________________________ 2 ___________________________________________________________
© 2022. Diane R. Gehart, Ph.D. All rights reserved. www.TherapythatWorksInstitute.com
Comprehensive Systemic Case Conceptualization 4.0
For use with individual, couple, or family clients
Date:
Clinician:
Client #:
I. Introduction to Client & Significant Others
List all significant others who will be included in the case conceptualization.
Additional identifiers may include: religion, language, sexuality, immigration status, economic status, neurodiversity, chronic health
conditions, mental health diagnoses, client’s position/role within their system(s), significant hobbies/interests or similar information.
Adult(s)
Adult Age: Gender:
Adult Age: Gender:
Race/Ethnicity:
Race/Ethnicity:
Select Status Occupation:
Select Status Occupation:
Child(ren)
Child Age: Gender:
Child Age: Gender:
Child Age: Gender:
Race/Ethnicity:
Race/Ethnicity:
Race/Ethnicity:
School/Grade:
School/Grade:
School/Grade:
Additional identifiers:
Additional identifiers:
Additional identifiers:
Additional identifiers:
Additional identifiers:
Others in Household/Family/Significant Persons:
II. Presenting Concern(s)
Client’s Description(s) of Problem(s):
Adult Age:
Adult Age:
Child Age:
Child Age:
Child Age:
Extended Family Description(s) of Problems:
Broader System Problem Descriptions: Description of Problem from referring party, teachers, relatives, legal
system, etc.:
Name:
Name:
Relevant mental health diagnoses (if applicable):
III. Background Information
Trauma/Abuse History (recent and past):
Substance Use/Abuse (current and past; self, family of origin, significant others):
Precipitating Events (recent life changes, first symptoms, stressors, etc.):
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© 2022. Diane R. Gehart, Ph.D. All rights reserved. www.therapythatworksinstitute.com
Related Historical Background (family history, related issues, previous counseling, medical/mental health history,
etc.):
IV. Client/Family Strengths and Diversity
Strengths and Resources, including those related to social location and associated supportive communities.
Personal:
Relational/Social:
Spiritual:
Diversity: Resources and Limitations
Identify potential resources and limitations available to clients based on their age, gender, sexual orientation, cultural background,
socio-economic status, religion, regional community, language, family background, family configuration, abilities, etc.
Unique Resources:
Potential Limitations:
V. Family Structure
Family Life Cycle Stage (Check all that apply)
Single adult
Divorce
Committed Couple
Blended Family
Family with Young Children
Launching/Boomerang Children
Family with Adolescent Children
Later Life
Describe struggles with mastering developmental tasks in one or more of these stages:
Boundaries with/between
Primary Couple:
Enmeshed
Clear
Disengaged
NA
Example:
Adult 1 & Children:
Enmeshed
Clear
Disengaged
NA
Example:
Adult 2 & Children:
Enmeshed
Clear
Disengaged
NA
Example:
Siblings: Enmeshed
Clear
Disengaged
NA
Example:
Extended Family:
Enmeshed
Clear
Disengaged
NA
Example:
Friends/Peers/Other:
Enmeshed
Clear
Disengaged
NA
Example:
Triangles/Coalitions
Cross-generational coalitions: Describe:
Coalitions with family of origin: Describe:
Other coalitions:
2
© 2022. Diane R. Gehart, Ph.D. All rights reserved. www.therapythatworksinstitute.com
Hierarchy between Parents and Children
NA
Adult 1:
Effective
Insufficient (permissive)
Adult 2:
Effective
Insufficient (permissive)
Description/Example to illustrate:
Complementary Patterns between
Pursuer/Distancer
Over/Under-Functioner
Excessive (authoritarian)
Excessive (authoritarian)
Inconsistent
Inconsistent
and
:
Emotional/Logical
Good/Bad Parent
Other:
Example of pattern:
Satir Communication Stances: Describe most commonly used stance under stress.
Adult 1:
Congruent
Placater
Blamer
Super-reasonable
Irrelevant
Adult 2:
Congruent
Placater
Blamer
Super-reasonable
Irrelevant
Child 1:
Congruent
Placater
Blamer
Super-reasonable
Irrelevant
Child 2:
Congruent
Placater
Blamer
Super-reasonable
Irrelevant
Describe pattern(s):
Gottman’s Divorce Indicators
Criticism
Adult 1:
Defensiveness
Adult 1:
Contempt
Adult 1:
Stonewalling
Adult 1:
Failed Repair Attempts Adult 1:
Not Accept Influence Adult 1:
Harsh Start Up
Adult 1:
NA
Adult 2:
Adult 2:
Adult 2:
Adult 2:
Adult 2:
Adult 2:
Adult 2:
Describe:
Describe:
Describe:
Describe:
Describe:
Describe:
Describe:
VI. Interactional Patterns
Problem Interaction Pattern (A B):
Describe client “normal”/homeostasis (no/minimal symptoms):
Start of tension/symptom:
Conflict/symptom escalation/symptom:
Return to “normal”/homeostasis:
Hypothesized homeostatic function of presenting problem: How might the symptom serve to maintain connection,
create independence/distance, establish influence, reestablish connection, or otherwise help create a sense of
balance in the family?
VII. Intergenerational & Attachment Patterns
Construct a family genogram and include all relevant information including:
▪ Names, ages and birth/death dates
▪ Relational patterns
▪ Occupations
▪ Psychiatric disorders and alcohol/substance abuse
3
© 2022. Diane R. Gehart, Ph.D. All rights reserved. www.therapythatworksinstitute.com
▪
▪
Abuse history
Personality adjectives
Genogram should be attached to report. Summarize key findings below.
Substance/Alcohol Abuse:
Sexual/Physical/Emotional Abuse:
Parent/Child Relations:
Physical/Mental Disorders:
History Related to Presenting Problem:
Family Strengths:
NA
NA
NA
NA
NA
History:
History:
History:
History:
History:
Describe:
Attachment Patterns: Describe most common attachment pattern for each
Adult 1:
Secure
Anxious
Avoidant
Anxious/Avoidant. Describe:
Adult 2:
Secure
Anxious
Avoidant
Anxious/Avoidant. Describe:
Child 1:
Secure
Anxious
Avoidant
Anxious/Avoidant. Describe:
Child 2:
Secure
Anxious
Avoidant
Anxious/Avoidant. Describe:
Child 3:
Secure
Anxious
Avoidant
Anxious/Avoidant. Describe:
VIII. Solution-Based Assessment
Attempted Solutions that DID NOT work:
1.
2.
3.
Exceptions and Unique Outcomes (Solutions that DID work): Times, places, relationships, contexts, etc. when
problem becomes less of a problem; behaviors that seem to make things even slightly better:
1.
2.
3.
Miracle Question Answer: If the problem were to be resolved overnight, what would client be doing differently the
next day? (Describe in terms of taking action: doing X rather than not doing Y).
1.
2.
3.
IX. Postmodern and Cultural Discourse Conceptualization
Dominant Discourses informing definition of problem:
What are the sociocultural factors that inform (a) the problem interaction pattern and (b) individual/family
identity (narrative/collaborative/socioculturally attuned therapy)?
4
© 2022. Diane R. Gehart, Ph.D. All rights reserved. www.therapythatworksinstitute.com
▪
Ethnic, Race, Class, Immigration Status, and Religious Discourses: How do key cultural
discourses inform client identities, what is perceived as the problem, and possible solutions (be as
specific as possible e.g., Italian American rather than White)?
▪
Gender and Sexuality Discourses: How do gender and sexuality discourses inform identities, what is
perceived as a problem, and the possible solutions? How do these intersect with ethnicity, religion, or
other identities?
▪
Community, School, Work and/or Societal Discourses: How do other important community
discourses (e.g., physical/mental ability to interact with others, professional norms, school culture,
societal trends, systemic racism, current events) inform client identities, what is perceived as a
problem, and possible solutions?
▪
Problem-Related Identity Narratives: How has the problem shaped the client’s identities?
X. Client Perspectives
Areas of Agreement: Based on what the client(s) has(ve) said, what parts of the above assessment do they agree
with or are likely to agree with?
Areas of Disagreement: What parts do they disagree with or are likely to disagree with? Why?
How do you plan to respectfully work with areas of potential disagreement?
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© 2022. Diane R. Gehart, Ph.D. All rights reserved. www.therapythatworksinstitute.com
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