The implicit Contract by Therapist and Patient in Psychotherapy
Idea for an experiment:
I proposed to prime therapists with the case of a patient that could easily be identified as one disorder (for example depression or dementia) and then present another case in which the information is ambiguous and thus allowing the possibility for both disorders to be present. Having read the articles by Chadwick, Williams and Mackenzie (2003) I wonder if disorder specific information is the “big thing” about case formulation. Rather it could be seen as a contract between the therapist and the client in which the therapist can prove his knowledge and skill to the client by structuring the clients’ life history, behaviour and cognitions in a meaningful way. A case formulation is like the therapist saying: “I know what is wrong with you, I have decided to help you and that is how were are going to do it!”. For the patient this might raise hope and contribute to remoralization. For the therapist the case formulation might be an important step-by-step guideline on what to concentrate on in therapy and how to do it. I stick with my experiment, but I would like to include another sub experiment. The case formulations by the novice and the expert are shown to the patient and he or she rates them in on their affective impact. As a control condition the patient could receive either personal case formulations that structure behaviour, life story and cognition in parsimonious ways, but do not reference to specific disorders. As an alternative, standard case formulations could be used.