Development of an Efficient and Broadly Applicable Measure of Case Conceptualization Quality

Abstract

Case conceptualizations are seen as important to the provision of effective and efficient psychological interventions. In creating a case conceptualization, a clinician summarizes information obtained during a course of psychotherapy into an explanatory model of the causes and maintaining factors for a client's areas of difficulty. In turn, the conceptualization is meant to aid the clinician in better empathizing with their client, it provides a shared framework for understanding the problem, and suggests the most relevant treatment targets to maximize the benefits of the psychotherapeutic work.

Many of these proposed benefits, including positive impacts on treatment outcomes, have not been robustly examined. One factor which may be contributing to this paucity of research is the need for an efficient, psychometrically sound, and broadly applicable method of evaluating case conceptualization quality. Previously developed methods for evaluating case conceptualization quality lack breadth in the types of conceptualizations to which they can be applied (e.g. - only a specific therapeutic orientation or a specific presenting problem), appear somewhat cumbersome to use, require access to very specific resources or materials, and/or have poor or inadequately explored psychometric soundness. These same features may limit how well such measures can be applied to other useful contexts in clinical psychology, such as clinical training and supervision.

To address these issues, a broadly applicable and easily accessible method of evaluating case conceptualization quality was generated and evaluated across a pilot and three subsequent studies. Initial evidence for the scale's high internal consistency, moderate inter-rater reliability, good retest reliability, and construct validity was obtained. The results were also indicative of a need for some modifications to coder training and the coding scheme itself to address areas where inter-rater reliability was somewhat low.

The results from these initial applications of this new measure are discussed in the context of future use by researchers and supervisors in clinical psychology and in the context of how to improve and further validate the measure. Given the purported importance of case conceptualizations to psychotherapy and the unanswered questions about their actual impacts, the results of this research suggest the Broadly Applicable Conceptualizations Quality Scale has the potential to become a useful tool in this field of research and in clinical practice.