Caseconceptualization Robey Fulkerson

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CASE CONCEPTUALIZATION
AND TREATMENT PLANNING
Presented by
Patricia Robey and Mike Fulkerson
WGI-US 2015 Conference
Las Vegas, Nevada
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What is Case Conceptualization?

A case conceptualization is a report that is based on
information gathered, organized, and assessed to provide
an explanation of a client’s behavior.
Counselors look for emotional, stated, non-verbal, and
behavioral information that will help to develop a picture of
the client’s experience and will lead to collaboration with
the client on goals for change.
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Process of Case Conceptualization

1. Listen to the client’s story/presenting problem
2. Gather information about how the client perceives his/her world
3. Obtain demographic information
4. Explore social, historical, and cultural context
5. Assess client’s strengths, coping skills
6. Assess for risk; create problem list
7. Diagnose
8. Apply theoretical orientation and
hypothesize about the nature of the problem
9. Develop goals
10. Plan interventions
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Theoretical Hypothesis
Apply theory to information gathered in initial interview
• How does the counselor understand the client?
• What patterns of thinking, actions,
and feelings need to be addressed?
• How does theory inform goals
for counseling?
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Choice Theory Case Conceptualization

• Enduring issues are related to relationship problems
• Clients are internally motivated to meet 5 basic needs:
Power, Love and belonging, Freedom, Fun, and Survival.
• Needs are met through very specific people, places, things, beliefs, in
what is called the client’s Quality World pictures.
• Total behavior consists of 4 components; acting, thinking, feeling, and
physiology.
• If we change our actions and thinking, we change feelings and
physiology.
• Behaviors are learned, chosen, and may be effective or ineffective.
• Behavior is purposeful and is the client’s effort to satisfy basic needs.
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TRADITIONAL TREATMENT PLANNING

• Based on the Medical Model and/or External Control Psychology
• Diagnosis is viewed as the cause of the client’s presenting problem(s)
• Diagnosis is the central guidance mechanism in development of the
treatment plan
• Goals and objectives are based on treating mental illness and are
often negatively-stated
• Interventions are focused on correcting or treating deficits
• The mental health practitioners is considered “the expert” in
developing the treatment plan
• Based on the DSM
(Fulkerson, 2015)
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REALITY THERAPY TREATMENT PLANNING

• Based on a Public Health Model and Choice Theory
• Diagnosis is viewed as a description of the symptoms of the
presenting problem(s)
• Basic Needs and Quality World Pictures are used as diagnostic
schema and the central guidance mechanism
in treatment plan development
• Goals and objectives are based on building
psychological strength and positively-stated
• Interventions are focused on building psychological strength
• The client is viewed as “the expert” in developing the treatment plan
• Can be integrated with the DSM (Fulkerson, 2015)
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TREATMENT PLANNING DEFINITIONS

FROM A REALITY THERAPY PERSPECTIVE
• Targeted Behaviors: The actions which will be monitored during
treatment.
• Baseline: Response measure prior to or at the beginning of

treatment.
• Goal: A goal is what the client expects to accomplish by the end of

therapy. It is written in terms of what the client will do.
(Fulkerson, 2015)
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TREATMENT PLANNING DEFINITIONS

FROM A REALITY THERAPY PERSPECTIVE
• Objective: A necessary step in the process to achieve a goal which is

written in terms of what the client will do. Just like we fulfill our needs
through quality world pictures, we achieve our goals through our
objectives.
• Intervention: Methods/techniques the mental health practitioner will

use to assist the client.
(Fulkerson, 2015)
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CHARACTERISTICS OF EFFECTIVE
TREATMENT OUTCOME MEASURES
SMART goals
– Simple/Specific
– Measurable
– Attainable/Achievable
– Realistic/Results Oriented
– Time limited
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BEHAVIOR MANAGEMENT PLAN

A = Antecedents:
B = Behaviors:
C = Consequences:
D = Determine the quality world picture tied to the behavior:
E = Evaluate the effectiveness of past interventions:
F = Find more effective interventions:
G = Assist the client in setting a new Goal:
(Fulkerson, 2015)
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References
• Fulkerson, M. H. (2015). Treatment planning from a reality therapy
perspective. Bloomington, IN: iUniverse.
• Glasser, W. (1998). Choice Theory. New York: Harper Collins.
For further reading:

• Eells, T. D. (2015). Psychotherapy case formulation. American
Psychological Association.

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1

What is Case Conceptualization?

Process of Case Conceptualization

Choice Theory Case Conceptualization

TRADITIONAL TREATMENT PLANNING

REALITY THERAPY TREATMENT PLANNING

TREATMENT PLANNING DEFINITIONS

• Baseline: Response measure prior to or at the beginning of

• Goal: A goal is what the client expects to accomplish by the end of

TREATMENT PLANNING DEFINITIONS

• Objective: A necessary step in the process to achieve a goal which is

• Intervention: Methods/techniques the mental health practitioner will

BEHAVIOR MANAGEMENT PLAN

For further reading:

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