Beyond Diagnosis For Vic Meyer, in Memoriam Beyond Diagnosis Case Formulation in Cognitive Behavioural Therapy SECOND EDITION Edited by Michael Bruch This edition first published 2015 © 2015 John Wiley & Sons, Ltd. Registered Office John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial Offices 350 Main Street, Malden, MA 02148-5020, USA 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK For details of our global editorial offices, for customer services, and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell. The right of Michael Bruch to be identified as the author of the editorial material in this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. All rights reserved. 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Title. [DNLM: 1. Cognitive Therapy–methods. 2. Anxiety Disorders–diagnosis. 3. Anxiety Disorders–therapy. WM 425.5.C6] RC473.C37 616.89′14–dc23 2014026820 A catalogue record for this book is available from the British Library. Cover image: Magnifying glass with finger print © kostsov/iStockphoto. Fingerprint series © wh1600/iStockphoto Set in 10/12pt Sabon by SPi Publisher Services, Pondicherry, India 1 2015 Contents List of Contributors vii Foreword ix Preface xii 1 The Development of Case Formulation Approaches 1 Michael Bruch 2 The UCL Case Formulation Model: Clinical Process and Procedures 24 Michael Bruch 3 Case Formulation: A Hypothesis-Testing Process 53 Richard S. Hallam 4 Case Formulation and the Therapeutic Relationship 74 Peter G. AuBuchon 5 The Therapeutic Relationship as a Critical Intervention in a Case of Complex PTSD and OCD 96 Peter G. AuBuchon 6 Generalized Anxiety Disorder: Personalized Case Formulation and Treatment 133 Kieron O’Connor, Amélie Drolet-Marcoux, Geneviève Larocque and Karolan Gervais 7 Cognitive-Behavioural Formulation and the Scientist-Practitioner: Working with an Adolescent Boy 165 David A. Lane and Sarah Corrie vi Contents 8 Cognitive-behavioural Case Formulation in the Treatment of a Complex Case of Social Anxiety Disorder and Substance Misuse 194 Samia Ezzamel, Marcantonio M. Spada and Ana V. Nikčević Appendix: Invited Case Transcript: The Initial Clinical Hypothesis 220 Ira Daniel Turkat Index 231 List of Contributors Michael Bruch Research Department of Clinical, Educational and Health Psychology, University College London, London, UK Richard S. Hallam Department of Psychology, University of Greenwich, London, UK Peter G. AuBuchon Department of Psychiatry, Pennsylvania Hospital & University of Pennsylvania Health System, Philadelphia, PA, USA Kieron O’Connor Department of Psychiatry, University of Montreal, Montreal, Québec, Canada and OCD Spectrum Study Research Centre, Fernand‐Seguin Research Centre, Louis‐H. Lafontaine Hospital, Montreal, Quebec, Canada Amélie Drolet‐Marcoux Clinical Psychology Service, Department of Psychoeducation and Psychology, University of Quebec at Outaouais, Gatineau, Quebec, Canada Geneviève Larocque Clinical Psychology Service, Department of Psychoeducation and Psychology, University of Quebec at Outaouais, Gatineau, Quebec, Canada Karolan Gervais Clinical Psychology Service, Department of Psychoeducation and Psychology, University of Quebec at Outaouais, Gatineau, Quebec, Canada viii Contributors Samia Ezzamel Department of Mental Health and Learning Disabilities, London South Bank University, London, UK Marcantonio M. Spada Department of Psychology, London South Bank University, London, UK Ana V. Nikčević Department of Psychology, Kingston University, London, UK David A. Lane Institute for Work Based Learning, Middlesex University, London, UK and Professional Development Foundation, London, UK Sarah Corrie Institute for Work Based Learning, Middlesex University, London, UK and The Central London CBT Centre, CNWL Foundation Trust & Royal Holloway University of London, London, UK Foreword During the days I trained doctoral students in clinical psychology, I would begin with a very simple instruction: understand what you are dealing with before you do anything. This statement reveals the core of any effective and durable approach to treating a psychological problem. The genesis of this line of thinking has many roots, but the British Psychological Society in 2011 identified historically four ‘influential clini- cians’ as such in their landmark issuance of the Good Practice Guidelines on the Use of Psychological Formulation: Hans J. Eysenck, Victor Meyer, Monte B. Shapiro and I. Putting my own contributions aside (Turkat, 2014), each of the others had a profound impact on the field, and in my opinion, the present text represents primarily the influence of the lesser known of the three: Vic Meyer. Eysenck led the United Kingdom to develop clinical psychology as a pro- fession of science and not conjecture and became one of the most highly cited intellectuals in the history of mankind. Shapiro innovated brilliantly how to apply the experimental method to the individual case, taking our clinical responsibilities a step beyond the requisite reliance upon existing knowledge generated by basic scientific research. Both are considered to be founding fathers of clinical psychology in the United Kingdom, and their contributions are felt worldwide. But it was Meyer who devised a fascinating approach to formulating an individual case that met the criteria set forth by Eysenck and Shapiro that clinical actions be grounded in the knowledge produced by scientific research and that the scientific method be applied to the individual case. In so doing, Vic Meyer developed highly creative, impactful, and long-lasting contributions to the field at the practice level, unmatched by the vast overwhelming majority of mental health practitioners of the past half-century. His approach has touched clinical minds in every continent, including many unaware of his influence. x Foreword According to Vic, there was no standard intervention that could be effec- tive for all and thus he promoted the notion that treatment must always be based on the unique presentation of the individual. To get there, there were some obvious prior steps: examine the presenting behavioural problems in descriptive detail, carefully trace their history, develop a theory unique to those problems about why they came about and continue, and then subject your theory to evaluation. Unlike some forms of therapy in which the clinician would never, infre- quently, or minimally reveal one’s thinking about the patient’s psychopa- thology, Vic would explain his theory directly to the patient in detail, seek confirmatory and disconfirmatory evidence, and adapt accordingly. Vic viewed the therapist as a detective – searching for clues to come to an understanding and then subjecting that understanding to the reality of the clinical data. Once an explanatory theory was devised that was consistent with all of the data and was verifiable, then, one would be forced to create a treatment based uniquely on that theory. In this way, not only was treat- ment guaranteed to be individualized, it made the entire process open to scrutiny and therefore, accountability. For in the end, whatever you did would either positively impact your patient’s functioning or not, and that could be measured in an observable way. The fruits of this approach were many and their presentation is beyond the space limitations I face here, but easily illustrated with Meyer’s brilliant adaption of basic animal research to innovate a unique treatment for certain cases with significant history of treatment failure: those suffering from debilitating compulsive rituals. His development in the 1960s of treatment for obsessive–compulsive