Psyc 440
Case conceptualization
 What is a case conceptualization?
 Any ideas?
Case Conceptualization
 Many psychological treatments are only used with one specific disorder
i.e. depression, anxiety etc.
 In ACT, the assumption is that the six core processes can be used to
explain and treat any psychological disorder i.e. it is trans-diagnostic
 From this perspective, case conceptualization involves applying the six
core processes of ACT to each client and then using this understanding
to guide the selection and evaluation of treatment interventions
 In essence, an ACT approach to case conceptualization seeks to answer
the following question;
 What unique factors in this clients life have given rise to his or her
particular problems and led to this clients particular version of life
constriction and psychological inflexibility
How to conduct a case
Begin the process with the presenting problem, as
understood by the client
2. Discover the most central thoughts, feelings,
memories, sensations and situations the client is
fused with or avoiding
3. Consider behaviors that function as experiential
avoidance of the events described in the previous
4. Consider domains in which behavior is excessively
narrowed or constricted, or in which living is avoided
5. Consider other core ACT processes that contribute to
psychological inflexibility and their treatment
Consider factors that can limit motivation for change
Consider the clients social and physical environment
and its influence on the clients ability to change
Examine client strengths that could be harnessed to
build psychological flexibility
Describe a comprehensive treatment plan
Re-evaluate the conceptualization through
treatment; revise functional analysis, targets and
Case conceptualization in practise
 Now I want you to move through each of the 10 steps
with a practise case.
 Sandra
 Read the information then fill in the case
conceptualization form
The therapeutic stance
 Decades of research has shown that the therapeutic
relationship is consistently correlated with clinical
outcome, for virtually all types of therapy (Martin, Graske
& Davi, 2000)
 Importantly however, knowing the therapeutic relationship
is crucial does not tell us how to produce good therapeutic
 Indeed attempts to train therapists to build effective
alliances have so far produced insignificant findings (CritsChristoph et al, 2006)
Therapeutic stance in ACT
 The ACT model provides clear suggestions about how to
improve the therapeutic relationship
 Although some supportive data exists (Gifford et al, under
review) at this point these inferences are made on the basis
of the theory underlying ACT
 Essentially the job of therapist is to maintain a stance that
instigates and reinforces psychological flexibility
 Over the next few pages we will outline some of these basic
but flexible rules
The ACT therapist speaks to the client from an equal,
vulnerable, compassionate, genuine, and sharing
point of view, and respects the clients inherent
ability to move from unworkable to workable
2. The therapist is willing to self disclose about
personal issues when it serves the interest of the
3. The therapist avoids the use of canned ACT
interventions, instead fitting interventions to the
particular needs of the client. The therapist is ready
to change course to fit those needs at any moment
4. The therapist tailors interventions and develops new
metaphors/experiential exercises/behavioral tasks to fit
the clients experience and language practices, and the
social, ethnic and cultural context
The therapist models acceptance of challenging content
while also being willing to hold the clients difficult ideas,
feelings and memories without any need to resolve them
6. The therapist always brings the issue back to what the
clients experience is showing, and does not substitute his
or her opinions for that genuine experience
The therapist does not argue with, lecture, coerce, or
attempt to convince the client
The importance of self-ACT
 In order to better serve the clients needs ACT therapists also apply the
model to themselves
 This happens in two forms
 Firstly, they apply the model to their everyday lives
 Secondly, they apply the model during the therapy session
 The second point is very important, as during the therapy process it is
important, as a clinician, to catch the times when you are avoidant,
fused or out of contact with the present moment and distant from ones
valued directions
 Lets think of a few examples when the core ACT processes would be
helpful for the therapist
 Many ACT therapists attend workshops and read ACT based self help
books (Mindfulness for two, Wilson and DuFrene, 2010) to apply the
model to their own lives. Certain ACT therapists also go to therapy
The importance of the relationship
 One of the main aims of therapy is to generalise the
advances made in the therapy room to the outside world
 The therapeutic relationship can be a great tool in
achieving this
 Namely, because many clients manifest the problems they
have in relationships with other people, in the therapy
room, with the therapist
 The affords the therapist the opportunity to work on these
issues first hand, in the service of broader generalization to
the outside world
 This relationship can also be used as an assessment i.e. if a
client is reporting greater willingness to have social anxiety,
but anxiety in the therapy room is avoided, then something is
probably wrong!
 Let look at the video!

Case conceptualization and the therapeutic stance