Psychology Oral Exam: Anatomy of a Case Conceptualization

Anatomy of a Clinical Case Conceptualization: Psychology Oral Exam

By: Dr. Evelyn Jagpat

Psychology Oral Exam Study Tips and Psychology Oral Exam Preparation:

In psychology, a good clinical case conceptualization should tell a story. Think about a character in a book or a film. By definition, a conceptualization is a theoretically based understanding of a client, who she is and why she behaves as she does. It contains a history of the client, which is theoretically based and also includes a formulation of the client’s problems (Berman, 1997). In essence, a good conceptualization helps to generate a well-rounded, deeper and more richly layered understanding of who that character is.

Anatomy of a Clinical Case Formulation (Psychology)

Artist Asudev’s painting: Humanity Uprooted

It helps to generate an understanding of what has contributed to who that person is in the world. It should consider the client’s:

thoughts
feelings,
behaviors,
motivations,
dreams, hopes,
struggles, challenges, problems,
approaches to life and situations that she faces, her “weapons” of survival, coping strategies,
her gifts, talents, expression of creativity,
areas for development and maturity,
her perceptions, interpretations and the meaning she generates from experiences and events,
her experiences and interactions with others, her relationships with self and others, and
her sense of being in the world and personal and global sense of spirituality.

This understanding includes a better understanding of that person’s physiological, historical, familial, spiritual, cultural, social, political and economic contexts. It also considers the impact of each on the person, who she is and her self-expression in the world. This includes an expression of her challenges, symptoms and problems, as well as ways of coping and attitudes about change and experiencing a better quality of life.

By extension, a good case conceptualization is also a beautiful and highly effective tool which helps the clinician to more fully empathize with a client and to more deeply experience the client’s world from the perspective of the client. Once you have been able to join the client in her world, even if only as a visitor, companion or observer, you as a clinician can better connect with her strengths, hopes, dreams, struggles and areas of feeling stuck or even hopeless. As a clinician you will then be better able to help your client by communicating and expressing true empathy, understanding, nonjudgmental acceptance and compassion. In so doing, you will deepen the connection between you and your client and promote a stronger and healthier therapeutic alliance. Further, you will be better able to meet your client where she is at and become more effective in helping her to move towards generating goals and a treatment plan which are uniquely tailored to address her individualized needs, characteristics, circumstances, etc. It should be underscored that the very experience of feeling understood by another is in and of itself healing and reparative.

Sounds complicated? Well it is in some respects but it does not have to be, especially for the purposes of taking your Psychology Oral Exam. The case vignette that you are presented with will likely have very sketchy details. Often you may get additional details thrown into a question, which you may then need to integrate into your initial formulation. This, however, is similar to what happens in treating a real client. You will often have to readjust initial formulations and treatment plans when more information is gathered. As such, a good formulation is also flexible and open to amendment. For the Psychology Oral Exam, you may have to extrapolate from information given. Further, it may be to your benefit to discuss things that you would want to explore, based on indications in the vignette, in developing your formulation and treatment plan. You may also identify ways you would obtain this clinical information, including consideration of the use of specific psychometric instruments and referrals.

Whatever, conceptualization model you use, hit the major points:

Provide brief data about the client (including demographics, reason for referral)
Describe the symptoms and major concerns and issues
Consider strengths and weaknesses of the client
Integrate relevant social, relational and environmental factors
Consider historical roots
Explain why the symptoms developed and what elicits or maintains them.

For more about developing a clinical case formulation and things to consider for 3 specific types of formulations (CBT, Interpersonal, and Cultural), please read the Study Manual by Dr. Evelyn Jagpat.

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