The respondents identified a number of practitioner‐specific benefits of using conceptualisation. These include the utility of case conceptualisation as a clinical tool; and for its use as a map for therapeutic intervention. These are now discussed in detail.
1.1. Utility of conceptualisation as a clinical tool.
Respondents identified two purposes of conceptualisation within therapeutic practice: Descriptive and prescriptive. As previously discussed in the literature (See page 21) the descriptive component of conceptualisation assists the practitioner to organise large amounts of (sometimes complex and confusing) client data; link the individual symptoms to underlying mechanisms; incorporate theoretical knowledge and provide hypotheses to account for the client’s current predicament. This ensures a coherent account of all client factors. This attitude is mirrored by the following respondents, for example:
“A case conceptualisation gives a workingdezcription [sic] that, were possible, provides an understamding [sic] of the factors, interactions etc that have contributed to the development [sic] of a clinical problem and of the current factors that are maintaining the problem.” (Respondent five)
“Case formulation is a way of working out the significant beliefs and behaviours the client holds / uses that are the psychological contribution to their problems.” (Respondent 19)
Respondent 28 additionally highlighted some specific ways that conceptualisation assists them to link things together, for example:
“The case conceptualisation provides a framework for helping to understand the connection between NATS (Negative Automatic Thoughts) and deeper level beliefs. It also provides an understanding of how thinking structures maintain dysfunctional behaviour or compensatory strategies.” (Respondent 28)
According to the literature the prescriptive component of conceptualisation flows from the descriptive; with practitioners utilising the organised information to inform intervention. The following quotations indicate that respondents are adhering to this process:
“It is the thepretical [sic] framework we use to help us make sense of the information gathered in assessment... a framework for understanding what can be done about it.” (Respondent two)
“...organising information known about a client (gained from an assessment process) to construct a hypothesis about the current difficulties. This hypothesis then informs our treatment plan.” (Respondent 13)
“CC is about constructing a meaningful explanation of the client [sic] current presentation withon [sic] the context of his/her external and internal world in order to determine treatment.” (Respondent 34)
“understanding of the clients presenting issues and assists in intervention of their problems.” (Respondent 28)
In this sample it would appear that for the practitioner, the primary purpose of the descriptive component is to inform its prescriptive counterpart; which in turn is valued for its ability to inform treatment. This is indicated by the following:
“The conceptualisation directly influences the therapy. It is on the basis of the formulation that the prioritised list for intervention arrives.” (Respondent five)
“(although) CBT conceptualization underpins the gathering of data for all reports, it is more formally used with treatment.” (Respondent 28)
“It is a working hypothesis which helps to guide treamtn [sic].” (Respondent 33)
As the below quotation reveals, practitioners feel that utilising conceptualisation, will assist them to achieve the best possible treatment.
“The conceptualisation drives the entire treatment... You have to have (a) conceptualisation to understand and plan for the best possible treatment for the particular individual.” (Respondent 19)
1.2. Conceptualisation as a map for therapeutic intervention.
As identified above, practitioners place emphasis on case conceptualisation for informing their treatment plan. In fact, to this particular set of practitioners, the
overarching purpose of case conceptualisation seems to be its ability to act as a map, guide, or blueprint for the therapeutic process; as indicated by the following respondents:
“A framework that provides a map for therapy.” (Respondent 35)
“A road map for change.” (Respondent 24)
“The conceptualisation guides therapy and enables you to plan the treatment accordingly.” (Respondent 13)
Practitioners appear to continually refer to the conceptualisation at each stage of intervention;
“Case conceptualisation always informs the next step as a clinician.”
(Respondent four)
“It’s the basis of ongoing therapy; frequent references back to conceptualisation for ‘roadmap’” (Respondent 24)
Specifically, as a guide to which interventions to use, and what homework to incorporate:
“...conceptualisation determines nature of exercises and homework.” (Respondent nine)
“I base my therapy plan on my formulation and the client goals. It also guides the timing of which technique or goal we will work on, and when.” (Respondent 31)
As well as to the potential obstacles to therapy, including client factors such as motivation:
“I consider potential roadblocks in therapy... this assists with planning intervention.” (Respondent 13)
“I also go back to my formulation to understand my client’s response to therapy, and the therapy relationship.” (Respondent 31)
As indicated by the above quotations, respondents appear to believe that conceptualisation assists them in each stage of the therapeutic process. First, by organising information into a meaningful framework that accounts for all aspects of the client (both descriptive and inferential); second, by providing a treatment plan that includes; the best interventions and homework exercises to use, and any obstacles that may be encountered along the way.