Case Mis-Conceptualization in Psychological Treatment: An Enduring Clinical Problem.

Case conceptualization, an integral component of mental health treatment, aims to facilitate therapeutic gains by formulating a clear picture of a client's psychological presentation. However, despite numerous attempts to improve this clinical activity, it remains unclear how well existing methods achieve their purported purpose. Case formulation is inconsistently defined in the literature and implemented in practice, with many methods varying in complexity, theoretical grounding, and empirical support. In addition, many of the methods demand a precise clinical acumen that is easily influenced by judgmental and inferential errors. These errors occur regardless of clinicians' level of training or amount of clinical experience. Overall, the lack of a consensus definition, a diversity of methods, and susceptibility of clinicians to errors are manifestations of the state of crisis in case conceptualization. This article, the 2nd in a series of 5 on thematic mapping, argues the need for more reliable and valid models of case conceptualization.

A Case Conceptualization Using Thematic Mapping.

This article, the last in a series of 5, presents a detailed case summary in which thematic mapping, a novel method of case conceptualization, was used to conceptualize an adult struggling with chronic depression. The case illustrates the process and therapeutic outcomes that resulted from the therapist's use of the 3-stage thematic mapping model: theme identification, theme interpretation, and theme intervention. The article also demonstrates how the case formulation guided the therapist in selecting therapeutic techniques that matched to the client's goals, needs, and interpersonal style. Overall, this article aims to demonstrate how thematic mapping utilizes transtheoretical and transdiagnostic approaches to create a case formulation that is client-centered, process-oriented, and useful across a broad spectrum of training.

The Process of Thematic Mapping in Case Conceptualization.

This article, the 4th in a series of 5, introduces the 3-stage process of thematic mapping: theme identification, theme interpretation, and theme intervention. Theme identification is based on inductive reasoning, in which clinicians seek to discover and describe behavioral patterns in emotionally charged episodes. Theme interpretation subsequently initiates a process of deductive reasoning, wherein clinicians distill the generalized pattern into dominant and subthemes. Each theme is then labeled with a compelling metaphor that is representative of the theme interpretation. In the 3rd stage, theme intervention, clinicians seek to change the dysfunctional dominant and subthemes through collaboration with the clients. The process unfolds within 5 overarching parameters: a focus on comprehensiveness, simplification, maximal objectivity/impartial subjectivity, observation and inference, and an idiographic approach. Alternative models of case formulation are offered in comparison to thematic mapping.

The Conceptual Framework of Thematic Mapping in Case Conceptualization.

This article, the 3rd in a series of 5, introduces the conceptual framework for thematic mapping, a novel approach to case conceptualization. The framework is transtheoretical in that it is not constrained by the tenets or concepts of any one therapeutic orientation and transdiagnostic in that it conceptualizes clients outside the constraints of diagnostic criteria. Thematic mapping comprises 4 components: a definition, foundational principles, defining features, and core concepts. These components of the framework, deemed building blocks, are explained in this article. Like the foundation of any structure, the heuristic value of the method requires that the building blocks have integrity, coherence, and sound anchoring. We assert that the conceptual framework provides a solid foundation, making thematic mapping a potential asset in mental health treatment.

Thematic Mapping in Case Conceptualization: An Introduction to the Special Section.

Case conceptualization is an essential clinical activity in which clinicians, in one form or another, gather and synthesize data about their clients in order to formulate clinical pictures and maximize therapeutic gains. However, a myriad of methods of case conceptualization that vary in complexity and theoretical bases currently reflects an almost complete lack of standardization in this most fundamental activity of mental health treatment. The lack of standardization in case conceptualization is especially daunting to trainees and clinicians who are early in their careers. This special section, comprising 5 articles, introduces thematic mapping, a transtheoretical and transdiagnostic method of case conceptualization. The method aims to overcome or minimize many of the problems inherent in current practice. In this first article, we provide a rationale for the special section and lay the groundwork for the subsequent four articles. Overall, we assert that thematic mapping holds promise as a systematic method of case conceptualization.

Multicultural counseling competencies: an analysis of research on clients' perceptions: comment on Owen, Leach, Wampold, and Rodolfa (2011).

J. Owen, M. M. Leach, B. Wampold, and E. Rodolfa (see record 2010-24976-001) tested the hypotheses that (a) some therapists express more multicultural competencies (MCCs) more than other therapists and (b) clients' perceptions of their therapists' MCCs are a function of specific client or therapeutic factors. In the present analysis, the authors critiqued 3 major components of the study: conceptual and methodological underpinnings, interpretation of research findings, and implications for future research. Although the authors agree with the importance of this line of research, the authors also believe that some of the researchers' underlying assumptions are worthy of examination; alternate interpretations of the findings are possible, and several recommendations for future research are imperative.

The health disparities industry: is it an ethical conundrum?

Reducing health disparities is the purported mission of a huge network of professionals representing many specialties and organizations offering a variety of products and services. Given its elaborate infrastructure and specialized set of activities, we identity the network as the health disparities industry. In this article, we question the ethics of this industry. Specifically, we ask whether the public mission is trumped by questionable industry leadership, ethics, and quality assurances. Drawing on general principles of ethics and differentiating ethical concerns from ethical problems, we conclude that the collective behaviors within the industry may represent an ethical conundrum. The article concludes with a call for the cross-examination of the industry practices.

Beyond common factors: multilevel-process models of therapeutic change in marriage and family therapy.

A number of scholars have proposed the common factors perspective as the future direction of marriage and family therapy (MFT). Although intuitively appealing, the case for the common factors perspective is not as clear-cut as proponents portray. In its current form, the common factors perspective overlooks the multilevel nature of practice, the diversity of clients and settings, and the complexity of therapeutic change. In contrast, comprehensive process-based change models are an alternative to the limitations of common factors. In this article, we consider the limitations of the common factors perspective and propose the necessary and sufficient components and processes that might comprise comprehensive, multilevel, process-based therapeutic change models in MFT.

Implications of a moderated common factors approach: does it move the field forward?

There are a number of similarities between the moderated common factors proposal of Sprenkle and Blow (this issue) and the multilevel, process-based therapeutic change presentation of Sexton, Ridley, and Kleiner (this issue). Despite these areas of agreement there are fundamental differences in our respective positions. We suspect that these differences are not unique to the respective authors, but instead represent the current debate in the field regarding common factors. In this commentary, we discuss what we think are important issues to have emerged from these articles. Our hope is that the issues we present below will take the debate and discussion one step further.