ABSTRACT
Therapist reasoning in case formulation construction was investigated. Sixty-five psychodynamic or cognitive-behavioral therapists classified as experts, experienced, or novices generated "think aloud" formulations based on six standardized vignettes. Formulations were reliably transcribed, segmented into idea units, and content coded. ANOVA and sequential analysis compared formulation content and reasoning processes. Expert formulations contained more descriptive, diagnostic, inferential, and treatment planning information. They focused more on given and inferred symptoms, on adult relationship history, on inferred psychological mechanisms, on the need for further evaluation, and on plans to focus on treatment expectations and symptoms. They exhibited more forward (inferential) than backward (deductive) reasoning and, compared with non-experts, they exhibited more forward and backward reasoning. Results are discussed in terms of cognitive science models for expert problem solving and on implications for psychotherapy training, practice, and research.
Subject(s)
Cognitive Behavioral Therapy/methods , Mental Disorders/diagnosis , Humans , Mental Disorders/therapy , Patient Care Planning , Professional Competence , Psychology, Clinical/methods , Psychotherapeutic ProcessesABSTRACT
Sixty-five expert, experienced, and novice cognitive-behavioral and psychodynamic psychotherapists provided "think aloud" case formulations in response to 6 standardized patient vignettes varying in disorder and prototypicality. The 390 formulations were reliably transcribed, segmented into idea units, content coded, and rated on multiple dimensions of quality. As hypothesized, the formulations of experts were more comprehensive, elaborated, complex, and systematic. Judges did not rate them as more coherent or precise in the use of language. In addition, the treatment plans of experts were more elaborated and linked better to the formulations. Effect sizes for overall ratings of quality ranged from medium to large. Few differences based on therapy orientation were observed. Results are discussed in terms of therapist training.
