This chapter examines the clinical tool of case conceptualization, a key part of the clinical assessment and appraisal process. Case conceptualization picks up where descriptive diagnosis leaves off and includes an examination of the client’s presenting problem, related problems, root causes, and factors currently keeping the problem going. It gives the clinician a bridge between knowing what the client’s concerns are and deciding what to do about them. It allows the clinician to understand a client’s needs, through his or her unique theoretical perspective, and subsequently apply appropriate counseling skills and treatment strategies. Whereas natural helpers have little understanding of the case conceptualization process, professional counselors use case conceptualization to help focus on client needs and eventual treatment plans.
本章研究了病例概念化的臨床工具，這是臨床評估和評價過程的關鍵部分。案例概念化從描述性診斷結束的地方開始，包括檢查客戶提出的問題、相關問題、根本原因和當前使問題持續的因素。它為臨床醫生在瞭解客戶的問題和決定如何解決它們之間架起了一座橋樑。它使臨床醫生能夠通過他或她獨特的理論視角來理解客戶的需求，並隨後應用適當的諮詢技能和治療策略。雖然天生的説明者對案例概念化過程知之甚少，但專業諮詢師使用案例概念化來幫助關注客戶需求和最終的治療計劃。

In this chapter, we first define and exple
在本章中，我們首先定義和解釋
In conceptualization is. We discuss the purpose of conceptualization and why new counselors sometimes feel overwhenmed when learning conceptual skills. Next, we introduce a specific, step-by-step method that new counselors can use in the conceptualization process. We include case illustrations and practice exercises throughout the chapter to acquaint you with case conceptualization. Finally, we focus on how learning case conceptualization skills is an ongoing developmental process.
在概念化是。我們討論了概念化的目的，以及為什麼新諮詢師在學習概念技能時有時會感到過分。接下來，我們介紹了一種具體的、循序漸進的方法，新諮詢師可以在概念化過程中使用。我們在整個章節中包括案例插圖和練習，以使您熟悉案例概念化。最後，我們關注學習案例概念化技能如何是一個持續的發展過程。

Effective mental health treatment depends on using a valid framework to assess, appraise, and make sense of client needs (Hinkle, 1994; Seligman, 2004). Conceptual skills provide clinicians with a rationale for their approach to treatment (Seligman, 2004). Further, with today’s emphasis on brief counseling ápproaches (Budman & Gurman, 1983, 1988; Gelso & Johnson, 1983) and eclectic models of treatment
有效的心理健康治療取決於使用有效的框架來評估、評估和理解客戶需求（Hinkle，1994 年;Seligman，2004 年）。概念技能為臨床醫生的治療方法提供了基本原理（Seligman，2004 年）。此外，隨著今天的強調簡短的諮詢（Budman & Gurman，1983,1988;Gelso & Johnson，1983）和折衷的治療模式
(Mahalick, 1990; Norcross & Prochanska, 1982; Smith, 1982), quick client assessment, conceptualization, and treatment planning have become essential. In fact, exploring client concerns, developing a conceptualization, specifying goals, and building a treatment plan generally are completed in the first few sessions in most counseling models today (Burlingame & Fuhriman, 1987; Neukrug, 2002). Case conceptualization and related intervention skills are so important that our ethical codes require clinicians to be competent in using them, and learning them has become one key task of clinical training (Eilis & Dell, 1986; Loganbill, Hardy, & Delworth, 1982).
（Mahalick，1990 年;Norcross & Prochanska， 1982;Smith，1982 年），快速的客戶評估、概念化和治療計劃變得至關重要。事實上，在當今大多數諮詢模型中，探索客戶關注的問題、發展概念化、指定目標和制定治療計劃通常在最初的幾次會議中完成（Burlingame & Fuhriman， 1987;Neukrug，2002 年）。案例概念化和相關干預技能非常重要，以至於我們的道德準則要求臨床醫生能夠勝任使用它們，學習它們已成為臨床培訓的一項關鍵任務（Eilis & Dell，1986;Loganbill， Hardy， & Delworth， 1982）。

When we asked novice counselors-new clinicians who had some experience with clients but were just beginning their clinical career-how they defined “case conceptualization,” here is what they said:
當我們詢問新手諮詢師——有一些與客戶打交道經驗但剛剛開始臨床職業生涯的新臨床醫生——他們如何定義“案例概念化”時，他們是這樣說的：

These new counselors agreed that conceprualization involves “picking apart the important details of a case” to gain a “comprehensive understanding of a client and his or her needs.” They felt that case conceptualization was part of the whole clinical assessment process-that conceptualizing the client’s needs is based on “a broad view of a client’s case, including diagnosis, history, test results, goals, etc.” They also believed that although case conceptualization takes into account “the client’s perspective of his or her needs and desires for assistance,” ultimately it is $\therefore$$\therefore$:.\therefore “the clinician’s understanding of the client’s needs and the clinician’s ideas of
這些新的諮詢師一致認為，構思涉及 「挑選出案件的重要細節 」 ，以獲得 「對客戶及其需求的全面瞭解」。他們認為病例概念化是整個臨床評估過程的一部分——概念化客戶的需求是基於“對客戶案例的廣泛看法，包括診斷、病史、測試結果、目標等”。他們還認為，儘管案例概念化考慮了“客戶對他或她的需求和説明願望的看法”，但歸根結底是 $\therefore$$\therefore$:.\therefore “臨床醫生對客戶需求的理解和臨床醫生對
how to serve the client” that drive case conceptualization. Those are good definitions that are in line with how we define case conceptualization. We see case conceptualization as a clinical chought process that includes the following three theoretical or conceptual elements:
如何服務客戶“，推動案例概念化。這些都是很好的定義，與我們定義案例概念化的方式一致。我們將病例概念化視為一個臨床過程，包括以下三個理論或概念要素：

Ultimately, the case conceptualization process is used to address, reduce, manage, or resolve the client’s unwanted problems by developing a plan to tackle the problems directly or by working on the etiological and sustaining factors that are keeping the problems going. (The treatment planning aspect of case conceptualization will be discussed in Chapter 10.)
最終，案例概念化過程用於通過制定直接解決問題的計劃或通過解決使問題持續下去的病因和維持因素來解決、減少、管理或解決客戶不想要的問題。（病例概念化的治療計劃方面將在第 10 章中討論。

To give you a better picture of what case conceptualization is all about, it might be helpful to see a couple of examples. For our first illustration, let’s return to our client, Sienna, who was introduced in Chapter 2. After reviewing the information presented in Chapter 2, page 16, take a look at Case Illustration 9.1. As you read this illustration, consider the “clinical thinking” process that is taking place.
為了讓您更好地瞭解大小寫概念化的全部內容，查看幾個示例可能會有所説明。對於我們的第一個例子，讓我們回到我們的客戶 Sienna，他在第 2 章中介紹過。在查看了第 2 章第 16 頁中提供的資訊后，請看一下案例插圖 9.1。當您閱讀此插圖時，請考慮正在進行的 「臨床思考」 過程。

What follows is an explanation of Sienna’s difficulties using a case conceptualization model that includes the elements just noted. A mention of treatment planning, which will be covered in Chapter 10, concludes this illustration. As you will remember from Chapter 2, Sienna is a 23 -year-old college student who came to the counseling center presenting moderate, persistent depression.
以下是使用案例概念化模型對 Sienna 的困難的解釋，該模型包括剛才提到的要素。第 10 章中提到了治療計劃，這張圖總結了這個例子。正如您在第 2 章中會記得的那樣，Sienna 是一名 23 歲的大學生，她來到諮詢中心時患有中度、持續的抑鬱症。
Element 1: Observe, assess, and measure client behaviors, thoughts, feelings, and physiological features:
要素 1：觀察、評估和測量客戶的行為、想法、感受和生理特徵：
When the counselor more fully explored all of Sienna’s areas of difficulty, a number of important problems emerged: symptoms of depression, including low mood, troubles with sleep, appetite, concentration, and energy level; difficulties in relationships with several important people in her life, including feeling dependent on her boyfriend, having conflict with her mother, and feeling powerless with her roommate; and young adult independence and identity problems, including unclear academic goals, career indecision, multicultural adjustment questions, and concerns about being independent.
當輔導員更全面地探索 Sienna 的所有困難領域時，出現了許多重要問題：抑鬱癥狀，包括情緒低落、睡眠、食慾、注意力和能量水平問題;與她生命中幾個重要的人交往困難，包括對男朋友的依賴感、與母親發生衝突、與室友無能為力;以及年輕人的獨立性和身份問題，包括學術目標不明確、職業優柔寡斷、多元文化適應問題以及對獨立的擔憂。
Element 2: Find patterns and themes by using observations, assessments, and measurements:
元素 2：使用觀察、評估和測量來查找模式和主題：
First, the counselor grouped together all of Sienna’s moderate depression symptoms-depressed mood, melancholic rumination, sleep disruption, poor concentration, low motivation, and so on. Second, Sienna’s dependent relationship issues, conflictual family ties, passive romantic role, and powerlessness with her roommate were dependence issues." Third, a her unclear academic goals, career is and anxiety about life planning.
首先，輔導員將 Sienna 的所有中度抑鬱癥狀——抑鬱情緒、憂鬱反芻、睡眠中斷、注意力不集中、動力低下等歸為一組。其次，Sienna 的依賴關係問題、衝突的家庭關係、被動的浪漫角色以及與室友的無能為力都是依賴問題。第三，她的學術目標、職業和對人生規劃的焦慮不明確。

Element 3: Use the patterns and themes that are found to interpret, explain, or make clinical judgments about the person’s concerns: Here the counselor uses his or her own theoretical perspective to come up with theoretical explanations of Sienna’s concerns to decide on the best focus for their counseling work together and the best strategy for treatment.
要素 3：使用發現的模式和主題來解釋、解釋或對人的擔憂做出臨床判斷：在這裡，諮詢師使用他或她自己的理論觀點對 Sienna 的擔憂做出理論解釋，以決定他們共同諮詢工作的最佳重點和最佳治療策略。

For example, using a humanistic (or person-centered) perspective, Sienna’s (a) depression, (b) relationship dependence, and © general anxiety about life choices might come together to lead to theoretical inferences of low self-esteem or poorly developed self-empowerment. Further, according to the humanistic perspective, it might be inferred that her poor self-esteem was rooted more deeply in feelings of having a “flaw”-the sense that “something is terribly wrong with me”-that come from experiences during her development.
例如，使用人本主義（或以人為中心）的觀點，Sienna 的 （a） 抑鬱、（b） 關係依賴和©對生活選擇的普遍焦慮可能會結合在一起，導致低自尊或自我賦權發展不佳的理論推論。此外，根據人本主義的觀點，可以推斷她糟糕的自尊心更深地植根於她成長過程中的經歷中具有“缺陷”的感覺——即“我有什麼大問題”的感覺。

Alternatively, for a clinician using a psychodynamic perspective, Sienna’s three symptom groups might be conceptually related to “autonomy” difficulties (fears of becoming a fully functioning adult independent who is emotionally independent of her family). Further, according to the psychodynamic perspective, it might be inferred that her autonomy difficulties are tied to fears of “disintegration” (“I will be overwhelmed by my own inclependence”) or fears of “abandonment” (“I will lose my family relationships if I am successful”).
或者，對於使用心理動力學視角的臨床醫生來說，Sienna 的三個癥狀組可能在概念上與 “自主 ”困難有關（害怕成為一個功能齊全的獨立成年人，在情感上獨立於她的家庭）。此外，根據心理動力學的觀點，可以推斷她的自主困難與對“瓦解”的恐懼（“我會被自己的情緒壓倒”）或對“被拋棄”的恐懼（“如果我成功了，我將失去我的家庭關係”）有關。

And using a cognitive-behavioral perspective, Sienna’s passivity in relationships and her avoidance of making important life decisions might be explained theoretically by “negative self-talk” (undermining, catastrophic self-statements) and having learned ineffective interpersonal behaviors.
從認知行為的角度來看，Sienna 在人際關係中的被動和她迴避做出重要的人生決定，理論上可以用 「消極的自我對話」（破壞、災難性的自我陳述）和學會了無效的人際行為來解釋。
Treatment Planning: Determine a treatment plan to address, reduce, manage, or resolve the client’s unwanted problems:
治療計劃：確定治療計劃以解決、減少、管理或解決客戶不需要的問題：
As we will see in the next chapter, the clinician’s theoretical perspective and the way the client’s case is conceptualized will lead to a decision about the goals to be accomplished in counseling and a conceptually driven plan for treatment to reach those goals.
正如我們將在下一章中看到的那樣，臨床醫生的理論觀點和客戶案例的概念化方式將導致關於諮詢中要實現的目標的決定，以及為實現這些目標而制定的概念驅動的治療計劃。

Notice that when implementing the first element of observing, assessing, and measuring, the counselor goes beyond Sienna’s presenting problem of low mood to explore other signs of depression and to find out if additional client concerns and symptoms were present. That is how the clinician discovers that Sienna also is having troubles with her morher boyfriend, and roommate and some problems making key life decisions. When (Element 2), the counselor organizes Sien depression applyion, relationship problems, and young adult identity probing. Then, by applying the patterns and themes to the clinician’s theory of counseling (Element 3), the clinician comes to understand and explain what is causing Sienna’s difficultues. In our example, we give alternative theoretical interpretations based on three possible orientations: humanistic, psychodynamic, and cognitive-behavioral. All of these elements lead toward a treatment plan specifically designed for the client.
請注意，在實施觀察、評估和測量的第一個要素時，諮詢師超越了 Sienna 目前出現的情緒低落問題，探索了抑鬱症的其他跡象，並找出是否存在其他客戶的問題和癥狀。這就是臨床醫生發現 Sienna 也與她的 morher 男朋友和室友有問題以及做出關鍵人生決定的一些問題的原因。當（元素 2）諮詢師組織 Sien 抑鬱申請、人際關係問題和年輕人身份探索時。然後，通過將模式和主題應用於臨床醫生的諮詢理論（要素 3），臨床醫生開始理解和解釋導致 Sienna 困難的原因。在我們的例子中，我們根據三種可能的方向給出了替代的理論解釋：人本主義、心理動力學和認知行為。所有這些要素都導致了專門為客戶設計的治療計劃。

Although you may not have fully formed your own theorecical perspective, as best as you can, compare the humanistic, psychodynamic, and cognitive-behavional perspectives to understanding Sienna’s symptoms by answering the following questions:
儘管您可能還沒有完全形成自己的理論觀點，但請通過回答以下問題，將人本主義、心理動力學和認知行為的觀點與理解 Sienna 的癥狀進行比較：

For our second example, let’s return to our client, Janine, who was introduced in Chapter 8. As you will recall, Janine is a client who came to a mental health center for help with depression. Once again, as you read this second illustration, consider the “clinical thinking” process involved in case conceptualization.
對於我們的第二個示例，讓我們回到我們的客戶 Janine，她在第 8 章中介紹過。你會記得，Janine 是一位來心理健康中心尋求抑鬱症幫助的客戶。再一次，當你閱讀這第二個例子時，考慮一下案例概念化所涉及的 「臨床思考」 過程。

In this example, our client is Janine, a 48 -year-old woman who came to a community mental health center in a rural county. Like Sienna, Janine was experiencing problems with low mood and depression. She reported loss of appetite, loss of interest in seeing other people or taking part in hobbies or other activities, some difficulty concentrating, and some trouble with short-term memory. Janine was unemployed, having been recently laid off from her job of 15 years due to a plant closing. She was also recently diagnosed with adult-onset diaberes. Her family includes her male romantic partner, with whom she is living, her father and brother, who live nearby in the same small town, and an adultion her tather and marriage who lives out of state.
在這個例子中，我們的客戶是 Janine，她是一名 48 歲的女性，她來到一個農村縣的社區心理健康中心。和 Sienna 一樣，Janine 也遇到了情緒低落和抑鬱的問題。她報告說食欲不振，對見別人或參加愛好或其他活動失去興趣，難以集中注意力，以及短期記憶有問題。Janine 失業了，最近由於一家工廠關閉，她從工作了 15 年的工作中被解僱。她最近還被診斷出患有成人發作的糖尿病。她的家人包括與她同住的男性浪漫伴侶、住在同一個小鎮附近的父親和兄弟，以及住在州外的通姦和婚姻。
rriage, who lives out of state.
Rriage，住在州外。
What follows is an explanation of Janine’s difficulties using a case conceptualization model that includes the three elements noted earlier. Trearment planning, which will be covered in Chapter 10, concludes this illustration.
以下是使用案例概念化模型對 Janine 的困難的解釋，該模型包括前面提到的三個要素。第 10 章將介紹的飼養計劃總結了這個例子。

Element 1: Observe, assess, and measure client behaviors, thoughts, feelings, and physiological features:
要素 1：觀察、評估和測量客戶的行為、想法、感受和生理特徵：
As with Sienna, Janine sought counseling for feelings of depression. When the clinician more fully explored Janine’s areas of difficulty, a number of important problems emerged: symptoms of depression, including daily low mood and tearfulness, social isolation, loss of interest in once enjoyable activities, loss of appetite, difficulty with concentration and short-term memory, and lack of energy; a poor relationship with her father, rarely speaking with him, and conflicts in her relationship with her
與 Sienna 一樣，Janine 也尋求抑鬱情緒的諮詢。當臨床醫生更全面地探索 Janine 的困難領域時，出現了許多重要問題：抑鬱癥狀，包括每日情緒低落和流淚、社交孤立、對曾經愉快的活動失去興趣、食欲不振、注意力不集中和短期記憶困難以及精力不足;與父親的關係不佳，很少與他交談，以及她與父親的關係衝突
brother; and alchough she writes and phones her son, she rarely receives any response from him. She also has dealt with the stresses that result from poverty, which she has experienced most of her life.
哥哥;雖然她寫信給兒子打電話，但她很少收到他的任何回復。她還處理了貧困帶來的壓力，這是她一生中大部分時間都經歷過的。
Element 2: Find patterns and themes by using observations, assessments, and measurements:
元素 2：使用觀察、評估和測量來查找模式和主題：
Janine’s clinician grouped all of her presenting problems and symptoms into two logical chemes. First, Janine’s daily feelings of depression and sadness, social isolation, loss of appetire, lack of energy, loss interest in once enjoyable activities, and difficuly with pencentation and short-term mest once enjoyable activides, and difficulty with concentration and short-term memory were grouped together as symptoms of a depressive disorder. Second, a theme of “family conflict” was formed from her three different problematic relationships with her father, brother, and son.
Janine 的臨床醫生將她出現的所有問題和癥狀歸為兩個合乎邏輯的化學。首先，Janine 的日常抑鬱和悲傷、社交孤立、失去興趣、精力不足、對曾經愉快的活動失去興趣、難以懺悔和短期 mest 曾經令人愉快的活動，以及注意力不集中和短期記憶困難被歸為抑鬱症的癥狀。其次，「家庭衝突」的主題是由她與父親、兄弟和兒子的三種不同的問題關係形成的。
Element 3: Use the patterns and themes that are found to interpret, explain, or make clinical judgments about the person’s concerns:
要素 3：使用發現的模式和主題來解釋、解釋或對患者的擔憂做出臨床判斷：
The clinician used a cognitive theoretical perspective to make inferences about Janine’s areas of difficulty. From a cognitive perspective, the counselor linked Janine’s low mood and the nature of her relationship conflicts to a negative view of self, negative interpretations of life experiences, and negative projections about the future. Part of Janine’s belief system is that she will never be able to enjoy her life and do the things she could previously. The counselor believes this “faulty chinking” has led to the current depressive episode and some of her other difficulties.
臨床醫生使用認知理論視角對 Janine 的困難領域進行推斷。從認知的角度來看，諮詢師將 Janine 的低落情緒和她的人際關係衝突的性質與對自我的消極看法、對生活經歷的消極解釋和對未來的消極預測聯繫起來。珍妮信仰體系的一部分是她永遠無法享受自己的生活並做她以前能做的事情。這位諮詢師認為，這種 「錯誤的下巴 」導致了目前的抑鬱發作和她的其他一些困難。
Treatment Planning: Determine a treatment plan to address, reduce, manage, or resolve the client’s unwanted problems:
治療計劃：確定治療計劃以解決、減少、管理或解決客戶不需要的問題：
As we will see in the next chapter, the clinician’s theoretical perspective and the way the client’s case is conceprualized lead to a decision about the goals to be accomplished in counseling and a conceptually driven plan for treatment to reach those goals. Janine’s counselor used a cognitive perspective to set treatment goals and build a rrease the clician sees the of Jane’s lems to her plan. C experiences, and her view of the future. Compondingly, the counselor’s plan is to assist Janine to develop healthy cognitive patterns and beliefs about self and the world chat will lead to alleviation of her depressive symptoms.
正如我們將在下一章中看到的那樣，臨床醫生的理論觀點和客戶案例的構思方式導致關於諮詢中要實現的目標的決定，以及為實現這些目標而制定的概念驅動的治療計劃。Janine 的顧問使用認知視角來設定治療目標，並建立一種 clician 對 Jane 的 lems 對她的計劃的看法。C 的經歷，以及她對未來的看法。總的來說，輔導員的計劃是説明 Janine 發展健康的認知模式和關於自我的信念，世界聊天將導致她的抑鬱癥狀得到緩解。

Notice that when implementing the first element of observing; assessing, and measuring, the counselor goes beyond Janine’s presenting problem of low mood to explore other signs of depression and to find out if additional client concerns and symptoms were present. That is how the clinician discovers Janine’s psychosocial stressors, including recent unemployment and a recent medical diagnosis of adultonset diabetes, and finds out something about her family relationship conflicts. Next, notice how the counselor organizes Janine’s many symptoms into two areas of concerns: a depressive disorder and family relationship conflicts. Then, see how the clinician’s theory of counseling is used to understand the patterns and themes
請注意，在實現 observing;評估和衡量，諮詢師超越了 Janine 目前的情緒低落問題，探索了抑鬱症的其他跡象，並找出是否存在其他客戶的問題和癥狀。這就是臨床醫生發現 Janine 的社會心理壓力源的方式，包括最近的失業和最近的成人糖尿病醫學診斷，並瞭解她的家庭關係衝突。接下來，請注意諮詢師如何將 Janine 的許多癥狀分為兩個關注領域：抑鬱症和家庭關係衝突。然後，看看如何使用臨床醫生的諮詢理論來理解模式和主題