Academic journal article Journal of Counseling and Development : JCD

Using Case Documentation to Strengthen Counselor Trainees' Case Conceptualization Skills

Academic journal article Journal of Counseling and Development : JCD

Using Case Documentation to Strengthen Counselor Trainees' Case Conceptualization Skills

Article excerpt

Much attention continues to be paid to the factors that influence the development of case conceptualization skills in counselor trainees (e.g., Kemp & Mallenkrodt, 1996; Nelson & Neufeldt, 1998; Seem & Johnson, 1998). However, a search of professional counseling literature databases indicates that the role of case documentation and record keeping--one of the most common activities that counselor trainees engage in, and an activity that directly reflects trainees' conceptualization of clients' needs and difficulties--has not received the attention it deserves. This oversight is unfortunate in that the documentation of client care through intake assessments, weekly case notes, treatment plans, and other relevant forms of record keeping may be a valuable tool to increase trainees' case conceptualization skills.

Supervision scholars have for some time investigated trainees' cognitive development as it pertains to their conceptualization of clients' mental health difficulties (e.g., Berg & Stone, 1980; Blocher, 1983; Borders, 1989; Borders, Fong, & Cron, 1988; Claiborn & Dixon, 1982; Cummings, Hallberg, Martin, Slemon, & Hiebert, 1990; Hirsch & Stone, 1983; Holloway & Wampold, 1986; Holloway & Wolleat, 1980; Martin, Slemon, Hiebert, Hallberg, & Cummings, 1989). A common approach to understanding the development of trainees' case conceptualization skills has involved using concepts from the area of expert-novice differences in information processing (cf. Hillerbrand & Claiborn, 1990).This approach, based on scholarship in cognitive psychology (e.g., Anderson, 1996), has focused on the idea that complex cognitive and problem-solving processes (such as conceptualizing the diagnosis and treatment of mental health clients) likely evolve in counselor trainees through specific processes. These processes include trainees' acquisition of knowledge and facts from the environment (e.g., through course work, supervision, clinical experience), trainees' creation of cognitive schemata (procedural knowledge) that in turn serves to further organize declarative knowledge units and aid in the acquisition of new facts, and trainees' ongoing process of learning to effectively deploy their knowledge in various problem-solving situations. Chiefly, trainees seem to acquire knowledge and learn by imitating the solutions that they see knowledgeable others implement (e.g., supervisors), by having knowledgeable others show them connections among facts and how these connections can be transformed into useful procedural schemas, and by having knowledgeable others explicitly show them specific steps on how to reason through and solve problems.

According to this cognitive-developmental approach, a key step in building trainees' case conceptualization skills is for supervisors to help trainees to recognize, understand, and integrate discrete facts about their clients, about the nature of their clients' problems, and about the experiences trainees have with their clients during the treatment process. Forming these understandings and cognitive schemata could then help trainees begin to identify what additional facts they need to acquire about clients and also form the building blocks of trainees' ability to plan, implement, and adjust their counseling interventions. Also, according to this cognitive-developmental approach, in order to facilitate the development of trainees' cognitive schemata, supervisors would need to make their own thinking processes on a clinical problem clearly manifest to their trainees (e.g., thinking out loud). Supervisors would need to show trainees how to see relationships among and make connections between seemingly disparate facts in a case, and supervisors would also need to show trainees how this knowledge could be used to determine effective treatment interventions.

It is in this process that case documentation and record keeping could serve as a useful tool for the supervisor in accomplishing these cognitive-developmental goals with trainees. …

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