BABCP spring meeting: collaborative case conceptualization - including positive psychology (third post)
Last updated on 27th April 2010
Yesterday - in "BABCP spring meeting, second post" - I described my reactions to the "Collaborative case conceptualization" key principle on levels of conceptualization. In today's post I talk about the other two key principles we were presented with - collaborative empiricism and incorporation of client strengths. Collaborative empiricism fits well with how I already act with clients. I often underline this by saying something like "I think of therapy as a meeting of two experts. I'm the general expert. I've spent many years studying and working to help people with the kinds of issues that you're describing. You're the specific expert. You know more about yourself and your life than anybody else will ever know. By putting our different types of expertise together we can be a really effective team." Observation & body language, checking in verbally, and the reflection sheets that I give clients at the end of nearly every therapy session help to clarify how we're doing with this collaboration. I also often explicitly discuss aspects of Self-determination theory with its emphasis on the importance of autonomy rather than control. See handouts on this website's page "Wellbeing, time management & self-determination" - especially those that look at motivation, like the "Motivation questions" sheet. So yes, I "buy" collaborative empiricism. What about incorporation of client strengths?
Here I have a bit more of a problem - not because I don't think we should be incorporating client strengths, but because I don't think this principle goes far enough. I would expand it to something like incorporate a focus on client flourishing. Positive psychology - the investigation of human flourishing - has much to offer us as therapists working to relieve suffering. See for example Sin & Lyubomirsky's 2009 paper "Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis" or more basically still, Chida & Steptoe's 2008 "Positive psychological well-being and mortality: a quantitative review of prospective observational studies". Yes incorporating client strengths can be of value - see Huta & Horley's "Psychological strengths and cognitive vulnerabilities: are they two ends of the same continuum or do they have independent relationships with well-being and ill-being?" but so too, for example, can working to boost positive emotions more generally, e.g. Wichers et al "Evidence that moment-to-moment variation in positive emotions buffer genetic risk for depression: a momentary assessment twin study". And if one looks at what boosts happiness, one spills pretty inevitably from hedonism to looking too at engagement and meaning - see Peterson et al's "Orientations to happiness and life satisfaction: the full life versus the empty life" and Deci & Ryan's "Hedonia, eudaimonia, and well-being: an introduction". And also into broader notions of "meditation" practice than just mindfulness - see Fredrickson et al's "Open hearts build lives: positive emotions, induced through loving-kindness meditation, build consequential personal resources", the earlier Smith et al's "Meditation as an adjunct to a happiness enhancement program" and the "The four aspects model" blog post.
I tend to open up these broader notions of flourishing and meaning by encouraging clients - when appropriate - to complete exercises like the "Respected figures", "Funeral speeches/80th birthday party" and "Goals for roles", all downloadable from the "Wellbeing, time management & self-determination" page on this website. Clearly this can provide value-directed goals to work on with behavioural activation and problem-solving. At the risk of over-expanding this particular blog post, I would also point out that these personally derived "Goals for roles" focus too on physical health. There is expanding evidence highlighting the importance of these areas in combating psychological difficulties. See for example last month's American Journal of Psychiatry editorial "Nutrition and psychiatry" and the endorsment of physical exercise in the recent "SIGN guidance on non-pharmaceutical managment of depression".
So, am I glad I came to this workshop? Yes. It was good to spend time with the two workshop facilitators and get a sense of their thinking and their work. It has been especially good to make time to chew over my reactions to what they proposed. What will I take away? How will it change my practice? Their three key principles - levels of conceptualization, collaborative empiricism, and incorporating client strengths are good. I definitely buy collaborative empiricism. Levels of conceptualization, with its suggestion to start first with cross-sectional conceptualizations, makes good sense. It's what I do. Paradoxically, thinking about it more deeply, leads me to question whether with more complex, personality disorder involved cases it might sometimes be helpful to start with a longitudinal conceptualization. Incorporating client strengths is good too. Here I probably disagree most. I think the evidence supports a wider incorporation of the rapidly developing research findings from positive psychology and mind-body health. This research includes an understanding of client strengths, but is much broader than this.
Note, versions of this "Collaborative case conceptualization" workshop are viewable/downloadable from the web. See for example Willem Kuyken's talk in June 2009 or co-author Robert Dudley's talk on similar material.