Project

Developing an Existential-Humanistic Approach to Case Conceptualization and Treatment Planning

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Louis Hoffman
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We are currently working on a book proposal for this project and hope that the book will be in print by early 2021.
 
Louis Hoffman
added a research item
Existential-Humanistic therapists historically have been resistant to engaging in case conceptualization and treatment planning. This resistance is rooted in a philosophical and practical critique of the purpose and implications of engaging in these processes. While there are good reasons to avoid case conceptualization and treatment planning, there are also practical limitations with avoiding these practices, including challenges in training settings as well as implications for receiving third party reimbursement and practicing in certain contexts. This presentation will begin with a critique of case conceptualization and treatment planning, highlighting risks and problems inherent in this process. Next, the presentation will provide an overview on research conducted to develop an existential-humanistic approach to case conceptualization and treatment planning, including a discussion of the limitations that were previously identified and how they are addressed in the existential-humanistic approach.
Louis Hoffman
added 2 research items
Existential-Humanistic therapists have avoided developing an approach to case conceptualization and treatment planning largely due to concerns regarding how this may negatively impact therapy practice, which is understood as a dynamic, unfolding process. However, it may be possible to develop an approach that considers the existential-humanistic critiques and embraces core existential-humanistic principles. This presentation reviews research conducted with existential-humanistic therapies to identify and clarify what these therapists perceive to be essential content and process for existential-humanistic case conceptualization and treatment planning. First, therapist were asked to identify the most influential authors, books, and journal articles to better clarify what is perceived as the foundations of existential-humanistic therapy. Second, therapists were asked to identify key content to consider pertaining to problem identification, case conceptualization, and treatment planning. Third, they were asked to consider essential aspects of the process of problem identification, case conceptualization, and treatment planning. Finally, the therapists were asked to identify the approaches (techniques, stances, processes) most utilized in existential-humanistic therapy. Drawing from the results of this research, an initial sketch of how to do existential-humanistic case conceptualization and treatment planning was developed. This process emphasizes the importance of seeing problem identification, conceptualization, and treatment planning as a collaborative, ongoing, fluid process that utilizes the client’s language and avoids pathologizing the client. This approach takes into consideration the typical existential-humanistic critiques of other approaches while providing some foundation and structure to approach these aspects of the therapy process. The next steps of the research is to formalize and finalize the approach are also discussed through seeking feedback from leading existential-humanistic therapists. It is maintained that building from this foundation it will be possible to being to conduct outcome research on existential-humanistic therapy.
Existential-Humanistic therapy has struggled in embracing multiculturalism and diversity. While there has been important progress made to address these limitations (Hoffman, 2016; Hoffman, Cleare-Hoffman, & Jackson, 2014; Hoffman, Granger, & Mansilla, 2016; Serlin, 2014), it is vital that this progress be integrated into approaches to case conceptualization and treatment planning. In recent research on key scholars and scholarship influencing the development of existential-humanistic therapy (Cleare-Hoffman & Hoffman, 2017), there were only two women and two people of color who were identified among the most influential. This inevitably has shaped how existential-humanistic therapy has developed over time. If consideration is not given to how the predominance of white male scholarship and leadership has impacted the development of existential-humanistic therapy, then it is likely that values reflective of this group could be imposed upon clients through the case conceptualization and treatment planning process. It is important that a multicultural critique be included in the process of developing approaches to case conceptualization and treatment planning. This critique can be used to strengthen and advance the process developed. For example, existential-humanistic therapy tends to focus on the individual and value the individual over the group in terms of identity and responsibility, including making choices. However, this does not fit with the values of many cultures, including cultures that reflect values that are more collective. It is possible to make sure that flexibility is included in any model of case conceptualization and treatment planning to account for these differences. This presentation utilizes a number of specific examples that reflect important considerations in developing an approach to case conceptualization and treatment planning.
Louis Hoffman
added a research item
Existential-humanistic therapists have traditionally avoided case conceptualization and treatment planning on the basis of practical, philosophical, and epistemological grounds (Hoffman & Cleare-Hoffman, 2017b). For instance, existential-humanistic therapists have voiced concern that case conceptualization and, in particularly, problem identification can lead to unnecessarily pathologizing clients. Similarly, therapists have voiced concern that case conceptualization and treatment planning is often a hierarchical process reflecting something that therapist do to their clients without their participation, and sometimes without their awareness or consent. Concern has also been expressed that case conceptualization and treatment planning may narrow the focus of therapy thereby cutting off important emergent issues and possibilities. However, the lack of a structured approach to case conceptualization and treatment planning also has created limitations in training and supervision contexts while impeding outcome research on the effectiveness of existential-humanistic therapy. This workshop begins with an overview of the purpose and limitations relevant to doing case conceptualization and treatment planning in an existential-humanistic therapy context. Next, we review research conducted to begin developing a model of existential-humanistic case conceptualization and treatment planning (Cleare-Hoffman & Hoffman, 2017; Hoffman & Cleare-Hoffman, 2017a, 2017b), which includes identifying key influences on the development existential-humanistic therapy; identifying key content to including in existential-humanistic problem identification, case conceptualization, and treatment planning; and identifying key process considerations in existential-humanistic problem identification, case conceptualization, and treatment planning. After reviewing the research, we will briefly discuss the next steps in the research process toward finalizing an approach. The last third of the workshop will focus on applying the concepts to one or more cases to illustrate a potential approach to existential-humanistic case conceptualization and treatment planning.
Louis Hoffman
added a research item
This presentation builds upon research conducted to develop an existential-humanistic approach to case conceptualization and treatment planning (Hoffman & Cleare-Hoffman, 2017). First, we critique and discuss the limitations of traditional approaches to case conceptualization and treatment planning from existential-humanistic perspective with consideration given to ethical issues and diverse populations. All approaches to case conceptualization have implicit assumptions about human nature and what is deemed to be healthy or pathological. These assumptions are typically based upon the norms and values of the culture that do not adequately take into consideration cultural variations. Similarly, treatment planning is frequently determined by outcomes that mental health professionals have determined clients ought to seek. Clients, often unaware of alternatives, frequently comply with therapist recommendations, if these are even discussed. Therefore, diagnosis, case conceptualization, and treatment planning risk imposing values upon clients, particularly those from diverse multicultural groups. Following the critique, we provide an overview of a newly developed existential-humanistic approach to case conceptualization and treatment planning. As this approach is discussed and applied, particular consideration will be given to ethical issues and application with diverse groups. Learning Objectives: 1. Participants will be able to critique traditional approaches to case conceptualization and treatment planning from ethical and existential-humanistic perspectives. 2. Participants will be able to identify key factors of existential-humanistic case conceptualization. 3. Participants will be able to describe an existential-humanistic approach to treatment planning. 4. Participants will be able to identify and discuss ways that case conceptualization and treatment planning from an existential-humanistic approach can be adapted to work with diverse populations.
Louis Hoffman
added 2 research items
Although existential-humanistic therapy emerged in the late 1950s and has remained an influential approach since this time, there has been limited attention devoted to developing an approach to case formulation and treatment planning. In part, this is for philosophical reasons. Many existential-humanistic therapists believe, for good reason, that formalizing an approach to case formulation and treatment planning could negatively impact the practice of this approach to therapy, especially given that this approach is rooted in understanding the client's challenges from their own perspective. Despite this, there are limitations with not having an approach to case formulation and treatment planning. This can be a challenge for students who are learning the approach, especially when they are required to give a case presentation as part of their supervision, training, or comprehensive examinations. Additionally, without an approach to case formulation and treatment planning it can be difficult to engage in outcome research. The current research project is the first stage of developing an existential-humanistic approach to case formulation and treatment planning. Therapists who identified as an existential-humanistic therapists were asked what they believe are the most important factors in conceptualizing client's problems, case formulation, and treatment planning from an existential-humanistic perspective. They were also asked about their process or approach to formulating their client's problems, case conceptualization, and treatment planning. Finally, they were asked about the intetrventions, stances, and techniques they most frequently utilize.
Existential-Humanistic Therapy originated in the writings of Rollo May and James F. T. Bugental. It combined the influences of existential philosophy, early European approaches to existential analysis, and the American humanistic psychology movement. While existential-humanistic therapy is a well-established therapy, there is limited information on case formulation and treatment planning. As a first step in developing an existential-humanistic approach to case formulation and treatment planning, the current research project sought to identify key influences upon the development of existential-humanistic theory and therapy. Participants were recruited through social media and existential-humanistic schools and training organizations. Forty-eight individuals completed the survey beyond the demographic questions; however, only 34 of those individuals completed the questions pertaining to the key influences. Participants were asked the most influential writers/scholars, books, articles, novels, and movies. For several questions, participants were asked about the most influential individuals and scholarship since the inception of existential-humanistic psychology and the most influential within the last 10-years. For each question, participants could identify up to five influences. With each question, only authors or scholarship that were identified by at least 3 different individuals were included.