A Dynamic Systems Approach to Clinical Case Formulation

Abstract

Summary: This contribution is based on the evidence that most psychological practitioners are concerned with the facilitation of change processes. They help people to learn, to develop, or to change patterns of cognitions, emotions, and behaviors. Consequently, they need assessment tools that enable them to represent the essential features of the complex systems they are concerned with, i.e., structure of functioning and dynamics. After some introductory remarks on systemic assessment, we focus on two methods of comprehensive data representation: one of them is used in order to represent the structure of functioning of a system, the other to assess its dynamics. The first one is called “idiographic system modeling” and represents the interrelations between the most important variables of a system by graphical means. The other one is based on a continuously produced flow of data about the functioning of a system and on a continuous screening of dynamic features of this time series (critical fluctuations, degree of synchronization, and stability vs. instability). It is called “real-time monitoring.” Perhaps this methodology can help to bridge the gap between research, usually realized in artificial laboratory settings, and the change processes taking place in practice.

Bridging the gap between complexity science and clinical practice by formalizing idiographic theories: a computational model of functional analysis

“…[35]), and second, modeling relations between specific variables directly for and with each patient (bottom-up approach, cf. [36][37][38][39]). An advantage of the former approach is that it allows modeling individual differences between patients regarding the strength of shared relations (e.g., person-specific tendencies to avoid when confronted with fear), which consequently allows for examining for instance tipping points in fear responses following maladaptive coping.…”

“…Sim, Gwee, and Bateman [40] identified five key advantages associated with formulating thorough case conceptualizations in clinical practice: (a) the integration/relation of multiple problems of a patient, (b) the explanatory nature of the resulting model, (c) the prescription of interventions, (d) the prediction of outcomes, and (e) the support for the therapeutic relationship. Schiepek and colleagues [36,37,41] pioneered the integration of case formulation and idiographic system modeling and argued that these key advantages could be strengthened through computational models. Clinicians are required to make more rigorous decisions in specifying relations in the case conceptualization, which makes the formalization of idiographic theories a promising avenue to foster more scientific practices in designing patient-tailored treatment.…”

Real-Time Monitoring of Non-linear Suicidal Dynamics: Methodology and a Demonstrative Case Report

“…These tools must provide continuous and frequent assessments of suicidal processes with equidistant sampling rates (time-sampling) and provide algorithms applicable to short, coarse-grained, and non-stationary time series that enable the identification of typical dynamic properties of non-linear dynamic systems. Time-sampling procedures can be realized using electronic diaries such as the experience sampling method ( Csikszentmihalyi and Larson, 1987 ), ecological momentary assessment ( Shiffman et al, 2008 ), or the Synergetic Navigation System (SNS; Schiepek, 2003 ; Schiepek et al, 2015 ). These methods have already been used in suicidological applications ( Nock et al, 2009 ; Ben-Zeev et al, 2012 ; Palmier-Claus et al, 2012 , 2013 ; Thompson et al, 2014 ), but not from a non-linear dynamic systems background.…”

Nonlinear Dynamics: Theoretical Perspectives and Application to Suicidology

“…In addition, the SNS offers the possibility to create customized questionnaires that cover an individual’s risk and protective factors as well as resources and coping strategies. Individual risk factors as well as protective factors can be identified by the work on idiographic system models (Schiepek, 2003), which visualize the interdependencies of the most important variables (processes) constituting the “problem system” of a patient. The variables included in an individual network can be transferred to the items of an individual questionnaire.…”