Case_Conceptualization_Outline

Adlerian Case Conceptualization Additional Considerations One problem we have noted is that students tend to take the idea too literally that the five axes of the DSM-IV can be though of as corresponding to aspects of the Adlerian case conceptualization. If they try to apply this idea mechanically, they miss the philosophical assumptions underlying the approach of using Individual Psychology to formulate what is going on with a client (for example, that all behavior is purposeful, that a person acts in a unitary fashion to strive toward goals, and that the personality is self-constructed based on selective/subjective perception of experiences in life).. Len Sperry and Jon Carlson (two hard-core Adlerians) wrote a book that was published in 1993 called Psychopathology and Psychotherapy: from Diagnosis to Treatment. They have a section on relating diagnostic categories to an Adlerian conceptualization; and in it they made an important point; that the DSM system is based on a pathological model and a psychology of possession, while the Adlerian approach is based on a growth model and a psychology of use. They refer the student back to Mosak's personality "themes" (getter, controller, driver, and so on) as one way to look at the unity of personality as it relates to symptom development in the face of environmental stressors. This is different than simply pasting the personality type from Axis II into the Adlerian case formulation. Sperry and Carlson also bring in Millon’s personality typology, and try to show that his descriptors (Active/passive, ambivalent, dependent, detached, independent) approach the Adlerian view more closely than a purely diagnostic label approach. But they still lack the movement component and the idea of trying to find a place in life. Sperry and Carlson list some descriptors of their own which may be useful for Adlerian case conceptualization, here further expanded upon: 1. Behavior (appearance) – how the client comes across 2. Interpersonal behavior and relationship qualities – how the client operates with others 3. Cognitive style – the “filters” that the client uses 4. Feeling style – how the client attempts to move the self and others through emotion 5. Parental injunctions and environmental factors – the rules that the client has deduced from experience 6. Biological and temperament factors – predispositions, organ inferiorities, disabilities 7. Self-view – “I am…” 8. World View – “The world is…” 9. Behavioral Mandates and rules (“So my way of approaching life is to…”) [Shulman’s “therefore…”] 10. Self and System Perpetuant (Factors within the individual and immediate environment which reinforce and maintain the pattern) Rather than a "cookbook" approach, though, students need to keep in mind a set of “Adlerian questions” to guide their thinking about their case. These include: 1. How has the client tried to fit in and belong in his or her social environment' 2. What discouraging beliefs and self-assessments has the client developed' 3. Where might they have gotten those beliefs (i.e., how did their development and the influences within the family constellation operate)' 4. How do those beliefs affect the client’s ability to meet the challenges of the tasks of life' This is more of a “bottom-up” approach, starting with understanding the client as a person, as opposed to a top down approach, starting with the presenting problem and trying to construct a framework to explain it.