Clinical Case Formulations

Clinical Case Formulations: Matching the Integrative Treatment Plan to the Client by Barbara Lichner Ingram. John Wiley & sons, Inc. Hoboken, New Jersey.

Getting my hands on this book has been very timely - for the last few months myself and colleagues have been attempting to reach some sort of a consensus on a working definition for Case Conceptualisation, Case Formulation; as well as how and what tools and techniques we ought to use in our practice. I personally have been influenced by the work of Sperry and do fall back on (to some extent at least) grouping patient and client information in terms of the 5P's: presentations, predispositions, precipitants, perpetuates and prognosis.

And so, I was quite keen to read this very large book (666 pages) and look for approaches and insights we might not be familiar with. The book has three main sections, broadly;

1. Case Formulation skills,

2. Twenty-Eight Core Clinical Hypotheses, and

3. Steps to Complete Case Formulation

I should say right from the start this book is suited for the reader who has completed clinical psychology studies and is pitched at professional practitioners in this field. This is not to say students would not benefit from this text - however, in parts this book is difficult, and probably more complicated than it needs to be.

Possibly the biggest criticism I have of this book is that it [Prof Barbara Ingram] seems to avoid the therapeutic techniques or modalities that have been developed and adopted over the history of psychology. Instead, it's as if she has created her own version of psychotherapy with its own schema, approaches and language. For example, the style of case summary and evaluation is unique to her and not followed elsewhere. There are 28 "core clinical hypotheses." There are 33 "standards for evaluating case formulations."

And so, I thought Part One of the book was somewhat valuable while Part Two, mostly because of a schema which is difficult to follow and different from systems we are more accustomed to was less useful.Part One - discusses a step-by-step method for developing a case plan consists of: gathering data, defining problems, specifying outcome goals, organizing and presenting the data-base, creating the plan by applying core clinical hypotheses, and writing a treatment plan and monitoring progress. I was particularly impressed by the explicit call for "monitoring progress" as, many may agree, that some see the development of a treatment plan as the end of the intervention.

Her method is similar to many conventional methods of creating a treatment plan as it defines goals and problems, provides possible explanations, interventions are focused on resolving problems, and monitors progress.