Planning the treatment of a depressed patient

Abstract

In this paper we present a study of psychotherapeutic treatment planning. By using a process-tracing approach, we were able to gain insight into the nature and the sequence of the considerations that psychotherapists have when they are asked to propose an intervention method for a depressed patient. The results of our study suggest formal similarities: the therapists all gave an interpretation of the patient and his complaints and they all focused on one treatment option, for which they found support in the case description. But the aspects emphasized in the therapists' interpretations were quite dissimilar as were the eventual decisions. We were unable to find a satisfactory explanation for these dissimilarities in our data, but we discuss some possibilities.

The decisive moment : makiing diagnostic decisions and designing treatments

“…The little research there is has mainly focused on the personal descriptions of psychologists about their diagnostic process, for example through verbal protocols (De Kwaadsteniet, Krol, & Witteman, subm. ;Witteman & Kunst, 1997). A drawback of these studies is that the terms used by the psychologists to describe their diagnostic activities cannot be directly compared.…”

“…Bus & Kruizenga, 1989;Witteman & Koele, 1999;Witteman & Kunst, 1997). In these studies, psychologists seemed to rely on pattern recognition heuristics shaped by a combination of personal experience, theoretical orientation and clients previously seen.…”

“…Psychodiagnosis is a complex decision making situation (Lichtenberg, 1997;Witteman & Kunst, 1997). Its aim is to form a mental model of the client's problems which includes an explanation of those problems, and to use this model to inform treatment decisions (Gough, 1971).…”

“…Different decision steps in psychological assessment have been studied separately, such as classification (Krol et al, 1992), causal analysis (Eells & Lombart, 2003) and treatment decisions (Witteman & Kunst, 1997). However, the sequence in which psychologists perform these decision steps and the place of a causal analysis in the entire assessment process is still unclear.…”

“…A study by Witteman and Koele (1999) showed that clinicians' idiosyncratic explanations offered for client problems accounted for differences in the treatment decisions. Differences in treatment decisions found for the same client (Witteman & Kunst, 1997) might thus be explained by differences in content and quality of case formulations (De Kwaadsteniet, Hagmayer, Krol, & Witteman, 2010). In this paper we investigate two aspects of case formulation: their quality and the relation with treatment decisions, for both simple and complex problems.…”