Psychodynamic case formulations without technical language: a reliability study

Øystein Sørbye, Hanne-Sofie J Dahl, Tracy D Eells, Svein Amlo, Anne Grete Hersoug, Unn K Haukvik, Cecilie B Hartberg, Per Andreas Høglend, Randi Ulberg, Øystein Sørbye, Hanne-Sofie J Dahl, Tracy D Eells, Svein Amlo, Anne Grete Hersoug, Unn K Haukvik, Cecilie B Hartberg, Per Andreas Høglend, Randi Ulberg

Abstract

Background: To bridge the gap between symptoms and treatment, constructing case formulations is essential for clinicians. Limited scientific value has been attributed to case formulations because of problems with quality, reliability, and validity. For understanding, communication, and treatment planning beyond each specific clinician-patient dyad, a case formulation must convey valid information concerning the patient, as well as being a reliable source of information regardless of the clinician's theoretical orientation. The first aim of the present study is to explore the completeness of unstructured psychodynamic formulations, according to four components outlined in the Case Formulation Content Coding Method (CFCCM). The second aim is to estimate the reliability of independent formulations and their components, using similarity ratings of matched versus mismatched cases.

Methods: This study explores psychodynamic case formulations as made by two or more experienced clinicians after listening to an evaluation interview. The clinicians structured the formulations freely, with the sole constraint that technical, theory-laden terminology should be avoided. The formulations were decomposed into components after all formulations had been written.

Results: The results indicated that most formulations were adequately comprehensive, and that overall reliability of the formulations was high (> 0.70) for both experienced and inexperienced clinician raters, although the lower bound reliability estimate of the formulation component deemed most difficult to rate - inferred mechanisms - was marginal, 0.61.

Conclusions: These results were achieved on case formulations made by experienced clinicians using simple experience-near language and minimizing technical concepts, which indicate a communicative quality in the formulations that make them clinically sound.

Trial registration: linicalTrials.gov Identifier: NCT00423462 . https://doi.org/10.1007/s00432-018-2781-7 ., January 18, 2007.

Keywords: Case formulations; Psychodynamic; Reliability.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. APA Presidential Task Force on Evidence-Based Practice. Evidence-based practice in psychology. Am Psychol. 2006. 10.1037/0003-066X.61.4.271.
    1. Yager J, Kay J. Assessing psychotherapy competence in psychiatric residents: getting real. Harv Rev Psychiatry. 2003. 10.1080/10673220303956.
    1. Eells TD. Psychotherapy case formulation. Washington, DC: American Psychological Association Books; 2015.
    1. Eells TD, Lombart GL, Kendjelic EM, Turner LC, Lucas CP. The quality of psychotherapy case formulations: a comparison of expert, experienced, and novice cognitive–behavioral and psychodynamic therapists. J Consult Clin Psychol. 2005. 10.1037/0022-006X.73.4.579.
    1. Levenson H, Strupp HH. Cyclical maladaptive patterns: case formulation in time-limited dynamic psychotherapy. In: Eells TD, editor. Handbook of psychotherapy case formulation. New York: Guilford Press; 1997.
    1. Perry JC, Cooper SH. A preliminary report on defenses and conflicts associated with borderline personality disorder. J Am Psychoanal Assoc. 1986. 10.1177/000306518603400405.
    1. Ridley CR, Jeffrey CE. The conceptual framework of thematic mapping in case conceptualization. J Clin Psychol. 2017. 10.1002/jclp.22353.
    1. Horowitz MJ. Formulation as a basis for planning psychotherapy treatment. Washington DC: American Psychiatric Press; 1997.
    1. American Board of Psychiatry & Neurology . Psychiatry and neurology core competencies - version 4.1. 2009.
    1. Tasman A, Riba MB, Silk KR. The doctor-patient relationship in pharmacotherapy: improving treatment effectiveness. New York: Guilford Press; 2000.
    1. Flinn L, Braham L, das Nair R. How reliable are case formulations? A systematic literature review. Br J Clin Psychol. 2015. 10.1111/bjc.12073.
    1. Eells TD, Lombart KG, Salsman N, Kendjelic EM, Schneiderman CT, Lucas CP. Expert reasoning in psychotherapy case formulation. Psychother Res. 2011. 10.1080/10503307.2010.539284.
    1. Kuyken W, Fothergill CD, Musa M, Chadwick P. The reliability and quality of cognitive case formulation. Behav Res Ther. 2005. 10.1016/j.brat.2004.08.007.
    1. Eells TD, Kendjelic EM, Lucas CP. What’s in a case formulation? Development and use of a content coding manual. J Psychother Pract Res. 1998;7:144–153.
    1. McClain T, O’Sullivan PS, Clardy JA. Biopsychosocial formulation: recognizing educational shortcomings. Acad Psychiatry. 2004. 10.1176/appi.ap.28.2.88.
    1. Meehl PE. Psychodiagnosis: selected papers. 1973. pp. 225–302.
    1. Popper KR. The logic of scientific discovery. London: Hutchinson; 1959.
    1. Seitz PFD. The consensus problem in psychoanalytic research. In: Gottschalk L, Auerbach L, editors. Methods of research in psychotherapy. New York: Appleton-Century-Crofts; 1966.
    1. Malan DH. Individual psychotherapy and the science of psychodynamics. New York: Butterworth; 1979.
    1. Barber JP, Crits-Christoph P. Advances in measures of psychodynamic formulations. J Consult Clin Psychol. 1993. 10.1037/0022-006X.61.4.574.
    1. Garb HN. Studying the clinician: judgment research and psychological assessment. Washington. DC: American Psychological Association; 1998.
    1. Crits-Christoph P, Cooper A, Luborsky L. The accuracy of therapists’ interpretations and the outcome of dynamic psychotherapy. J Consult Clin Psychol. 1988;56:490–495.
    1. Høglend P, Amlo S, Marble A, Bøgwald KP, Sørbye Ø, Sjaastad MC, Heyerdahl O. Analysis of the patient-therapist relationship in dynamic psychotherapy: an experimental study of transference interpretations. Am J Psychiatr. 2006;163:1739–1746.
    1. Høglend P, Bøgwald K-P, Amlo S, Marble A, Ulberg R, Sjaastad MC, Sørbye Ø, Oscar H, Johansson P. Transference interpretations in dynamic psychotherapy: Do they really yield sustained effects? Am J Psychiatr. 2008. 10.1176/appi.ajp.2008.07061028.
    1. Freud S. The dynamics of transference. In: Strachey J, editor. The standard edition of the complete psychological works of Sigmund Freud. London: Hogarth Press; 1912. pp. 97–108.
    1. Ulberg R, Amlo S, Critchfield KL, Marble A, Høglend P. Transference interventions and the process between therapist and patient. Psychother. 2014. 10.1037/a0034708.
    1. Sifneos PE. Short-term psychotherapy anxiety-provoking therapy: a treatment manual. New York: Basic Books; 1992. p. 2008.
    1. Malan DH, Osimo F. Psychodynamics, training, and outcome in brief psychotherapy. Oxford: Taylor & Francis; 1992.
    1. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979. 10.1037/0033-2909.86.2.420.
    1. Caspar F. What goes on in the psychotherapist’s mind? Psychother Res. 1997;7:105–125.
    1. DeWitt KN, Kaltreider NB, Weiss DS, Horowitz MJ. Judging change in psychotherapy. Reliability of clinical formulations. Arch Gen Psychiatry. 1983;40:1121–1128.
    1. Perry JC, Augusto F, Cooper SH. Assessing psychodynamic conflicts: reliability of the ideographic conflict formulation method. Psychiatry. 1989;52:289–301.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe