|
Article Excerpt
The authors describe instructional methods used to teach comprehensive and individualized case conceptualization and treatment planning in a graduate-level Advanced Counseling Procedures course. Students participate in a theory-driven, simulated multidisciplinary treatment team and meet with recruited client actors to bring "to life" the process of integrating multiple clinical perspectives into a cohesive service plan for a client. Feedback from students and recommendations for course enhancement are provided.
**********
Comprehensive, individualized case conceptualization can be easily overlooked in favor of expedient diagnostic categorization to manage large client caseloads. Faced with restrictions on resources and the demand of funding sources to provide clients with immediate services, counselors may use standardized clinical profiling to expedite the process of care. This lack of individualized care has been identified as a failure of the community mental health movement in the United States today (Hadley, Turk, Vasko, & McGurrin, 1997). Mumma (2001) identified such practice as highlighting a difference between nomothetic-aggregate and intraindividual-idiographic approaches: The former uses structure and quantification to capture common characteristics among persons designated within a particular group; the latter isolates and exposes the unique or idiosyncratic characteristics of an individual.
The idiographic approach to case conceptualization is emphasized in a graduate-level Advanced Counseling Procedures course in an effort to teach students the process of constructing individualized and realistic treatment plans for clients. Experiential methods used to accomplish this task are (a) assignment of students to simulated multidisciplinary treatment teams, with each team responsible for devising a comprehensive case conceptualization and treatment plan for an assigned and shared client and (b) recruitment of actors to portray the client (hereinafter referred to as client actors) in the assigned cases and to meet with their respective treatment teams on three occasions during the semester.
This article presents case conceptualization as the necessary first step in personalized treatment planning and provides a rationale for the multidisciplinary treatment team as the preferred (and increasingly standard) format for the planning of treatment. We also describe the use of client actors who meet with treatment teams during class time to bring the written client case "to life." Students' evaluations of instructional methods and the Simulated Treatment Team Project are provided, and recommendations are presented for continued improvement of course design.
Comprehensive Case Conceptualization
Case conceptualization is the counselor's intentional, focused, and ongoing effort to understand a particular client case. It precedes and makes possible individualized treatment planning (Mumma, 2001; Persons, Davidson, & Tompkins, 2001) and involves the systematic interpretation of all information obtained about a client in order to propose a course of action in counseling that is relevant and feasible for that client. This is consistent with the former U.S. Surgeon General's pronouncement that "[t]o be effective, the diagnosis and treatment of mental illness must be tailored to all characteristics that shape a person's image and identity" (Satcher, 2000, p. 13). Indeed, the more that is known about a client, the more likely that an individualized treatment plan can be constructed (Radwin, 1995).
Often referred to as "case formulation," this counselor activity is intended to generate hypotheses that summarize and explain the nature and etiology of a client's presenting issues, including how such problems fit together and are maintained (Brems, 2000; Eells, 1997; Mumma, 2001; Weerasekera, 1993; Woody, Detweiler-Bedell, Teachman, & O'Hearn, 2003). Several authors (e.g., Berman, 1997; Bieling & Kuyken, 2003; Murdock, 1991) have recommended that case conceptualization be theoretically driven, which challenges clinicians to intentionally integrate theory and practice and avoid what Persons et al. (2001) referred to as "hit-or-miss decision-making" (p. 26).
Multidisciplinary Treatment Teams
Multidisciplinary treatment teams are quickly becoming a standard model for health care services in the United States. Schmitt (2001) explained this trend as a response to a managed care system that requires comprehensive, coordinated, and integrated care. Cordess (1996) added that with the development of mental health subspecialties, it has become "increasingly unrealistic" (p. 97) for any single clinician to know all the relevant information or provide all the necessary care for a particular client. For persons with multiple and complex needs (e.g., co-occurring mental illness/substance use disorders, eating disorders), a team-based approach is indicated (Hadley et al., 1997; Munetz, Birnbaum, & Wyzik, 1993; Roesler, Gavin, & Brenner, 1995; Weiner, 1999) and has become the dominant organizational model of treatment (Mueser, Noordsy, Drake, & Fox, 2003).
Although treatment team practice originated in the medical profession and psychiatrists continue to be regarded as treatment team leaders (Rodenhauser, 1996), Munich (2000) has observed that today's multidisciplinary treatment team "more truly integrates its members with defined areas of responsibility and expertise and operates on a broadly functional rather than a narrowly medical or hierarchical basis" (p. 488). Counselors, therefore, have a unique opportunity to become prominent members of treatment teams. Counselor preparation programs, however, do not emphasize interdisciplinary collaboration, and students are not "provided with skills to work in collaborative teams comprised of varying professions" (Bemak, 1998, p. 282). Greater attention needs to be given, therefore, to familiarizing students with their future role as members and leaders of multidisciplinary treatment teams (Hoge, Jacobs, Belitsky, & Migdole, 2002). Without such emphasis during formal training, counselor credibility may be jeopardized (Seligman & Ceo, 1996).
Use of Client Actors
Historically, medicine has used client/patient actors more consistently in its formal training programs than have the other helping professions. Often referred to as "standardized patients," these persons are recruited to interact "live" with medical students and...
|
