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Anna Słysz ANALYSIS of BARBARA INGRAM's CORE CLINICAL

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Anna Słysz ANALYSIS of BARBARA INGRAM's CORE CLINICAL Studia Psychologiczne. t. 53 (2015), z. 2, s. 19-28 PL ISSN 0081-685X DOI: 10.2478/V1067-010-0129-5 Anna Słysz Adam Mickiewicz University of Poznan, Institute of Psychology ANALYSIS OF BARBARA INGRAM’S CORE CLINICAL HYPOTHESIS CONCEPT FOR SUITABILITY IN PSYCHOLOGICAL ASSESSMENT The aim of this article is to present and analyze the core clinical hypothesis concept (Ingram, showing that the use of this concept can increase quality of the case conceptualization. The Keywords: case conceptualization, psychological assessment, heuristic, cognitive error INTRODUCTION of imposing a complex structure upon a diagnosis (including case conceptualization). The structured There are many studies on case conceptualiza- formulation of a case may lead to: 1) identifying tion within particular schools, including the - complex causes of behavioral issues of a client by Nancy McWilliams (2012) and Virues-Ortega, Haynes, 2005); 2) reducing bias (2013). I believe that focusing on a single theoreti- cal approach carries a certain risk. For instance, in Virues-Ortega, Haynes, 2005). I would like to a psychologist or psychotherapist may overlook hypothesis concept. Also, I will provide examples schemas if these components are missing from showing that relying on this kind of concepts in psychological diagnostic may contribute to reducing thus an opportunity to minimize this problem by heuristics and cognitive errors in clinical evalua- also drawing from additional transtheoretical con- tions. Therefore, the article aims not as much at cepts in the case conceptualization area. One such proposal is the concept of core clinical hypothesis strategy as for the diagnostic quality. In literature, the discussions of cognitive heu- proposes a structured formulation of a case. Bearing ristics and errors in diagnosis focus mainly on the in mind this characteristic, I shall take as the start- description of their types (e.g. Croskerry, 2003; ing point the advantages, described in literature, Psychological Studies, volume 53, issue 2 - 20 Anna Słysz The hypotheses the author has compiled refer include above all directions on nosologic diagnosis to the potential causes (biological, situational, and (e.g., a recommendation to refer to the DSM or ICD environmental) of the client’s problems and models (behavioral, cognitive, existential, and psychody- functional or causal diagnosis are far less common namic), which explain the root of these problems. (Morrow, Deidan, 1992). The concept proposed group. Each hypothesis has been labeled with the same alphanumeric symbol as used by the author of the concept. of some symptoms in nosological diagnosis, using I. Biological hypotheses (B) a list of core clinical hypotheses allows us to avoid B1: The problem has a biological cause – the overlooking various causal factors in explaining. client needs medical intervention to protect life Moreover, such a list of hypotheses enables the and prevent deterioration or needs psychosocial assistance in coping with illness, disability, or other the sense of applying an external reference point biological limitations. and reducing the subjective factor in interpretation. B2: There are medical interventions that should be considered. B3: Mind-body connections lead to treatments PRESENTATION OF THE CONCEPT for psychological problems that focus on the body OF CORE CLINICAL HYPOTHESIS and treatments for physical problems that focus on the mind. The B2 hypothesis is of least importance for case a core hypothesis as a set of ideas which facilitate conceptualization because it leads to a decision to structuring the data received from the client and make a medical intervention (e.g., medication or lead to a better understanding of his/her problems, surgery). It may then be the role of a psychothera- reach sound decisions, and choose the appropriate pist to draw the medical roots of the problem into intervention method. attention and recommend a visit to a physician. - Conversely, the hypotheses B1 and B3 may be cally, during case conceptualization, which of the included in psychological explanation (the mecha- nism of disorder development). The client may need diagnostic data and which can be used to explain psychological assistance in coping with a disease, the particular client’s problem. The hypotheses disability, or other biological limitations. comprise the aspects lying in the heart of various theoretical approaches (behavioral, cognitive, psy- II. Crisis, stressful situations, and transitions (CS) chodynamic, and existential), also including cultural CS1: The client’s symptoms constitute an emer- and environmental factors. This concept seems to gency – immediate action is necessary. be all the more interesting and useful because it CS2: The client’s symptoms result from iden- allows a psychologist or psychotherapist to perceive even these aspects of the client’s problem which traumatic experience. are not recognized as key in the framework of the CS3: The client is at a developmental transition therapist’s theoretical approach yet may turn out and deals with issues related to moving to the next to be important to explaining this problem. stage of life. Psychological Studies, volume 53, issue 2 - Analysis of barbara ingram’s core clinical hypothesis concept for suitability in psychological assessment 21 C2: Limiting and outdated elements in the faulty help during bereavement or for a loss-related prob- cognitive map (e.g., maladaptive schemas, assump- lem. tions, rules, beliefs, and narratives) are causing the problem or preventing solutions. C3: The client demonstrates faulty information session, given the serious consequences of ne- processing (e.g., overgeneralization, all-or-nothing glecting to take appropriate action. For instance, - this concerns cases where the patient should be ible cognitive style. hospitalized or was the victim of abuse or vio- C4: The problem is triggered and/or mainteined lence. When considering the CS2 hypothesis, it is by dysfunctional self-talk. important to assess whether the client’s symptoms states that psychotherapists should avoid setting Interventions based on the CS3 hypothesis may in contracts such goals like attaining a perfect, prevent the transformation of a crisis (e.g., in ado- problem-free life. The client may wish to com- lescence) into a long-term disorder. With respect to pletely eliminate unpleasant emotion, which are an inevitable part of life. With respect to the C2 loss can be external (e.g., due to a death, divorce, hypothesis, the author suggests that assisting the or natural disaster) or internal (the loss of certain patients in modifying their way of thinking does opportunities due to disease or age). not result from some arbitrary standard of proper thinking but rather from the fact that faulty cog- III. Behavioral and learning hypotheses (BL) nitive maps may limit, e.g., meeting the needs, BL1: A behavioral analysis of both problem be- achieving goals, and satisfaction with life (Ingram, haviors and desired behaviors should yield informa- tion about antecedents (triggers) and consequences (reinforcers) that will be helpful in constructing an skills and the maladjustment of the cognitive style intervention. to the client’s goals and the context in which he BL2: A conditional emotional response (e.g., anxiety, fear, anger, and depression) is at the root of excessive emotion, avoidant behaviors, or mala- dysfunctional self-talk causes painful feelings and daptive mechanisms for avoiding painful emotions. maladaptive behavior. lack of competence in applying skills, abilities, and V. Existential and spiritual hypotheses (ES) knowledge to achieve goals. ES1: The client is struggling with existential A full behavioral analysis allows to detect the issues, including the fundamental philosophical antecedents and consequences of a given person’s search for the purpose and meaning of life. behavior. It is assessed if the desirable behaviors ES2: The client is avoiding the freedom and are in the client’s behavioral repertoire. Also, many autonomy that come with adulthood and/or does not problems recognized as pathological can be formu- accept responsibility for present and past choices. ES3: The core of the problem and/or the re- sources needed for resolving the problem are found IV. Cognitive hypotheses (C) in the spiritual dimension of life, which may (or may not) include religion. “miseries of everyday life” and has unrealistic As regards expanding the ES1 hypothesis, expectations of what life should be like. existential problems may include the purpose and Psychological Studies, volume 53, issue 2 - 22 Anna Słysz meaning of life, morality, death-related issues, and The P2 hypothesis refers to the assumptions of various theories that early childhood experiences points out that, while considering this hypothesis, psychotherapists should remember that everyone - - tions. A therapist should refrain from taking the role in her commentary to the ES2 hypothesis, Ingram that one can precisely determine the developmen- tal phase when the disturbance took place based take one of several forms: maintaining childhood illusions, blaming others, or becoming dependent Wheras in the discussion of the P4 hypothesis, the on other people. When clients are ready to engage authors indicates problems which may ensue the in responsible behavior, they may need assistance in making decisions (e.g., which educational path to reactions to traumatic events. choose, which job, etc.), as well as in making and
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