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Behavioural Science

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Clinical Decision Making

The implicit Contract by Therapist and Patient in Psychotherapy

Martin Metzmacher
· 1 min read

Idea for an experiment:

I proposed to prime therapists with the case of a patient that could easily be identified as one disorder (for example depression or dementia) and then present another case in which the information is ambiguous and thus allowing the possibility for both disorders to be present. Having read the articles by Chadwick, Williams and Mackenzie (2003) I wonder if disorder specific information is the “big thing” about case formulation. Rather it could be seen as a contract between the therapist and the client in which the therapist can prove his knowledge and skill to the client by structuring the clients’ life history, behaviour and cognitions in a meaningful way. A case formulation is like the therapist saying: “I know what is wrong with you, I have decided to help you and that is how were are going to do it!”. For the patient this might raise hope and contribute to remoralization. For the therapist the case formulation might be an important step-by-step guideline on what to concentrate on in therapy and how to do it. I stick with my experiment, but I would like to include another sub experiment. The case formulations by the novice and the expert are shown to the patient and he or she rates them in on their affective impact. As a control condition the patient could receive either personal case formulations that structure behaviour, life story and cognition in parsimonious ways, but do not reference to specific disorders. As an alternative, standard case formulations could be used.

Clinical Decision Making2 min read

More on the Topic of Experience in Psychotherapy

In one of the last posts I summarized three articles that all came to the conclusion that there was no big difference between novice and expert therapists. I came to the conclusion that the tasks used were presenting ready-to-judge material, which was in no way ecological valid. I hypothesised that the true merit of expertise […]

Clinical Decision Making5 min read

Research on classification and case formulation

It has been postulated (for example see Persons & Miakami) that psycho diagnostic evaluation is an important phase in the treatment of psychopathology. However there is a fierce battle going on between those that argue for a stepped-care model in mental health care and those that argue that we should rather look at the specific […]

Clinical Decision Making3 min read

How do biases affect decision making in mental health?

Bias in treatment recommendations is a problem health care in general. The focus on my research looks specifically at the biases in mental health care. In this field we find literature that suggests certain disorders are viewed as more “psychological” in nature and others are viewed as more “biological” in nature, and to some degree, […]