The clinical report and the design of individualized treatment. An overview of the literature on clinical case formulations.

Paola Pagano

Abstract


In this paper we will analyse a part of the international literature, to be specific, that produced in the USA and Germany, taking into consideration the way the clinical case is dealt with both in contexts of certification of the clinical practice in the psychotherapist-patient relationship, and in those of legitimation of this practice in a broader domain which sees the intervention of subjects other than the couple engaged in therapy. 
The works considered, dealing with the function of the clinical case in the domains just mentioned, talk about “formulations or conceptualizations of a clinical case”; in other words, about translating it from ordinary language into a formalized language. What is discussed is therefore the conceptualization of cases, trying to establish methods and strategies. For this reason our analysis will not touch on works that set out to present a case, but will examine those that focus on the way cases are structured.     
The approaches to which the works refer are: Functional, Cognitive, Behavioral,, Cognitive-Behavioral andthat of Descriptive Psychology. In all of them, the writing up of the clinical case serves for the planning and the design of treatment and assumes a clear “diagnostic” function. Through the reporting of the clinical case, it is possible to reorganize and sum up a client’s situation on the basis of a theory, and later, to plan the treatment itself.  
The decision to explore these works arises from a broader interest in reporting, considered as a clinical psychology tool. Underlying our viewpoint there is also the hypothesis that reporting a clinical case is related to the clinician activating the organization of the process shared with the client. Our attention however, unlike what is proposed by the Authors under study, is focused on  the relationship which develops progressively during the work between clinician and client. The formulation of a case is in our opinion the outcome of a process of reflection and reorganization of what emerges from this relationship by means of clinical psychology criteria and categories. 
Reading this psychological literature showed various ways of looking at reporting and different terms used to indicate the practice in which the clinician reports the process shared with the client. These ways seem to be related both to the professional function that clinicians think they are activating when working with their patients and to the goals they pursue in practice, both in the socio-political and organizational contexts within which clinicians operate.
Starting from an initial analysis we see that the terminology used connects directly to the position taken by the clinician in relating to the client, and is the first clue as to the clinician’s way of focusing on the latter. It certainly is not the report on a relationship; it would seem that the relationship is being used to acquire information about the other, and is not being explored in itself. This view of the report finds its place in a mainly psychotherapeutic field and within the services designed for the care of mental health; the professional is identified with the therapist, the client with the patient. These works provide guidelines or propose criteria on how to organize case formulations so as to have a practice that can be assessed; the interlocutors are the academic scientific community, the community of professionals and the various actors designated to the certification of the health services.

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Rivista di Psicologia Clinica. Teoria e metodi dell'intervento

Rivista Telematica a Carattere Scientifico Registrazione presso il Tribunale civile di Roma (n.149/2006 del 17/03/2006)

ISSN 1828-9363