Evaluating Case Conceptualizations in Psychotherapy Reports: Links to Therapy Outcome and the Alliance

Abstract

Case conceptualizations are a key component of cognitive behavioural therapy (Beck, 1995; Persons, 2005; Needleman, 1999). Despite the theoretical importance of case conceptualizations, the question of whether they actually improve therapy outcomes is relatively unexplored (Bieling & Kuyken, 2003). Additionally, case conceptualizations may have other important effects on therapy, such as by increasing client engagement and improving the therapeutic alliance (Nattrass, Kellett, Hardy, & Ricketts, 2014). Utilizing two approaches (Collaborative Case Conceptualization Rating Scale; Padesky, Kuyken, & Dudley, 2011; Case Formulation Content Coding Method; Eells, Kendjelic, & Lucas, 1998) for evaluating case conceptualization quality, this project examines these possible inter-relations. The project involved a trained team of coders rating case conceptualizations found within psychotherapy reports generated at two stages of therapy. The first reports coded were written following the completion of the assessment phase of therapy, and the later reports were written upon client discharge from therapy. In Study 1 the comparative reliabilities in coding achieved across the two methods utilized is discussed, as are the strengths and weaknesses in coding and their possible causes. Study 2 reports the results obtained upon examining the relationship between case conceptualization quality, the therapeutic alliance, and treatment outcome. Results of Study 2 suggest that for more complicated or impaired client cases, therapists produce higher quality conceptualizations at assessment but these generally do not predict therapy outcome or the overall alliance between therapist and client. It was found that the quality of conceptualizations within discharge reports were associated with more positive therapy outcomes. Case conceptualization quality at discharge was also positively associated with the therapeutic alliance.