Case Formulation
What are The Four Questions of Case Formulation
1. WHAT IS MAINTAINING THIS PRESENTATION?
2. WHY IS THIS MAINTAINING VARIABLE PERSISTING?
3. WHAT DOES THIS PERSON NEED TO LEARN OR EXPERIENCE TO PRODUCE CHANGE?
4. WHAT IS IN THE WAY OF THAT LEARNING?
What are 5 treatment approaches for Major Depressive Disorder/PDD?
What is behavioral activation, cognitive behavioral therapy-depression (CBT-D), interpersonal psychotherapy (IPT); Cognitive Behavioral Analysis System of Psychotherapy (CBASP), and or medical coordination
What would the primary differentials be for a client presenting with depressed mood and anhedonia
MDD vs BPII vs PDD vs ADHD vs Hypothyroidism vs PTSD
Major Depressive Disorder is maintaining social withdrawal that looks like Social Anxiety, which do you treat first?
ADHD maintaining executive function failures that produces depression and anxiety, which do you treat first?
Depression is a secondary condition produced by PTSD, maintaining hypervigilance and avoidance, which do you treat first?
What is MDD; What is ADHD; What is PTSD
Client presenting with MDD and Anxiety disorder
What is treat simultaneously-both these disorders respond to overlapping treatment components
What are the 5 main domains we assess to assess why a variable/problem is presenting?
1. Cognitive
2. Behavioral
3. Emotional/Physiological
4. Interpersonal
5. Biological/Historial
Which three diagnoses can be treated with CBT, the Intolerance of Uncertainty model, ERP, medication, and video feedback?
What are GAD, Panic Disorder, and Social Anxiety Disorder
What would the primary differentials for a client presenting with excessive worry
What is GAD vs MDD vs social anxiety vs OCD vs ADHD
These diagnoses should be treated with first medication stabilization before psychotherapy
1. Bipolar
2. MDD, Severe: before intensive psychotherapy
3. PTSD with dissociation: before exposure-based treatment
Client presents with MDD and PTSD
What is PTSD first or simultaneous; depression is frequently secondary to PTSD
Should you have a complete case formulation at intake? True or False?
False
Specific phobias may be treated with in vivo hierarchy. Can you give an example of what that would look like?
1. Car Accident/Trauma: Sitting in a parked car
2. Contamination OCD: Touch a doorknob in public and not immediately wash hands
3. Agoraphobia: Walking to the mailbox
4. Social Anxiety/Public Speaking: Ask a cashier for the time
What would the primary differentials for a client presenting with emotional dysregulation and impulsivity
What is BPD vs BP vs ADHD vs PTSD vs substance-induced
Should you formulate treatment if comorbidities are present?
Yes, because even if Dx1 is maintaining and producing Dx 2 we should be formulating at intake and the treatment plan should document when and how you will shift focus from Dx 1 to Dx2
Client has been diagnosed with ADHD and MDD
What is ADHD first or simultaneous; treating ADHD effectively often produces substantial MDD improvement without direct targeting
To have a good formulation of a client it is not_________, but it is _________.
What is the focus on the Client's diagnosis, but it is focused on the diagnosis being maintained by specific cognitive, behavioral, emotional/physiological, interpersonal, and/or biological/historical patterns in the client's life.
What are 4 treatment approaches for ASD?
What is CBT for comorbidities, PEERS (group), functional skills, and accommodation advocacy
What would the primary differentials for a client presenting with concentration difficulty
What is AHDD vs MDD vs GAD vs PTSD vs ASD vs Sleep Disorder
When both Dx are independent and neither is maintaining the other, where should treatment start
What is starting with the Dx that is causing greater functional impairment
Client has been diagnosed with OCD and MDD
What is MDD first is Severe (PHQ score is greater or equal to 15) or simultaneous ERP; severe depression reduces motivation and cognitive capacity for ERP, SSRI serves a dual function; MDD is mild to moderate, ERP can proceed and improvement in OCD often produces MDD improvement
Is it appropriate to share the clinical formulation you have with your client?
Because formulation if not a private theory of the therapist and should be shared with the Client by session 4 (client agreement with the formulation=alliance and disagreement=forumation revision material)
If at intake, a Client indicates they have received a diagnosis of Bipolar I or II after a complete Psychological Evaluation (report was provided), what would need to be a primary treatment approach?
What is pharmacoptherapy(active participation in medication services)
What would the primary differentials for a client presenting with re-experiencing, hyperarousal, and avoidance
What is PTSD vs Complex PTSD vs Adjustment Disorder vs Acute Stress Disorder
These are an immediate clinical priority that supercedes all treatment planning.
What is Active SI with plan or intent, active psychosis, acute mania, and acute substance intoxication or withdrawal
Client has been diagnosied with Social Anxiety
What is treated simultaneously with an integrated formulation; these dx have a high co-occurrence-behavioral activation targets MDD, ERP targets social anxiety, and combined treatment is more efficent than sequential.