The 15 Minute Case Conceptualization by Sperry Len;Sperry Jonathan;

Author:Sperry, Len;Sperry, Jonathan;
Language: eng
Format: epub
Publisher: Oxford University Press, Incorporated
Published: 2021-10-15T00:00:00+00:00

Step 3: Specify the Predisposition and indicate the Perpetuants

In Step 3, we specify the most likely predisposing factors that help explain the presenting symptoms and the client’s pattern. The extent that your clinical formulation is compelling and clearly reflects the predisposing factors is explanatory power. The predisposition answers the “Why did it happen?” question and offers a hypothesis for and explanation of the influences of the presenting issues in Step 1 and pattern dynamics in Step 2. Ultimately, the predisposition statement is developed by piecing together dynamics that foster adaptive or maladaptive functioning. We employ a biopsychosocial formulation in the provided case examples, but readers can import their desired theoretical orientation in this step.

Perpetuants are factors that maintain and reinforce the problematic pattern and presenting symptoms. Perpetuants are the metaphorical fuel that gets thrown on the fire; these factors maintain a problematic presentation or make it worse. For example, you have a sprained ankle, and a doctor asks you, “What makes the pain worse?” You report that walking makes it worse; therefore, the doctor will encourage you to use crutches and avoid putting pressure on your ankle for a short period of time. In this step, we are examining what maintains the client’s issues in their environment, relationships, and intrapersonal dynamics. For example, anxiety often can be perpetuated by caffeine consumption, and depressive symptoms are often maintained by interpersonal or experiential avoidance.

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