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An Abductive Perspective on Clinical Reasoning and Case Formulation

  • Brian D. Haig
Chapter
Part of the Studies in Applied Philosophy, Epistemology and Rational Ethics book series (SAPERE, volume 45)

Abstract

This chapter presents a framework for clinical reasoning and case formulation that is largely based on the abductive theory of scientific method presented in chapter three. Clinical reasoning has traditionally been understood in terms of the hypothetico-deductive method. Occasionally, Bayesian methods have been used as a resource. However, it is suggested that clinical psychology requires an organizing framework that goes beyond the strictures of these two methods and characterizes the full range of reasoning processes involved in the description, understanding, and formulation of the difficulties presented by clients. In the abductive theory of method, the processes of phenomena detection and theory construction are articulated and combined. Both of these processes are applied to clinical reasoning and case formulation, and a running case example is provided to illustrate the application.

References

  1. Abrantes, P. (1999). Analogical reasoning and modeling in the sciences. Foundations of Science, 4, 237–270.CrossRefGoogle Scholar
  2. Allport, G. W. (1937). Personality: A psychological interpretation. New York, NY: Holt.Google Scholar
  3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  4. Borleffs, J. C. C., Custers, E. J., van Gijn, J., & ten Cate, O. T. (2003). Clinical reasoning theatre: A new approach to clinical reasoning education. Academic Medicine, 78, 322–325.CrossRefGoogle Scholar
  5. Bruch, M. (1998a). The development of case formulation approaches. In M. Bruch & F. W. Bond (Eds.), Beyond diagnosis: Case formulation approaches in CBT (pp. 1–17). New York, NY: Wiley.Google Scholar
  6. Bruch, M. (1998b). The UCL case formulation model: Clinical applications and procedures. In M. Bruch & F. W. Bond (Eds.), Beyond diagnosis: Case formulation approaches in CBT (pp. 103–140). New York, NY: Wiley.Google Scholar
  7. Butler, G. (1998). Clinical formulation. In P. Salkovskis (Ed.), Comprehensive clinical psychology. Vol. 6, Adults: Clinical formulation and treatment (pp. 1–24). Oxford, England: Elsevier.Google Scholar
  8. Carruthers, P. (2002). The roots of scientific reasoning: Infancy, modularity, and the art of tracking. In P. Carruthers, S. Stich, & M. Siegal (Eds.), The cognitive basis of science (pp. 73–95). Cambridge, England: Cambridge University Press.CrossRefGoogle Scholar
  9. Clarke, L., Ungerer, J., Chahoud, K., Johnson, S., & Stiefel, I. (2002). Attention deficit hyperactivity disorder is associated with attachment insecurity. Clinical Child Psychology and Psychiatry, 7, 179–198.CrossRefGoogle Scholar
  10. Coderre, S., Mandin, H., Harasym, P. H., & Fick, G. H. (2003). Diagnostic reasoning strategies and diagnostic success. Medical Education, 37, 695–703.CrossRefGoogle Scholar
  11. Collins, N. L., Cooper, M. L., Albino, A., & Allard, L. (2002). Psychosocial vulnerability from adolescence to adulthood: A prospective study of attachment style differences in relationship functioning and partner choice. Journal of Personality, 70, 965–1008.CrossRefGoogle Scholar
  12. Cozzarelli, C., Karafa, J., Collins, N., & Tagler, M. J. (2003). Stability and change in adult attachment styles: Associations with personal vulnerabilities, life events, and global construals of self and others. Journal of Social and Clinical Psychology, 22, 315–346.CrossRefGoogle Scholar
  13. Crabtree, M. (1998). Images of reasoning: A literature review. Australian Occupational Therapy Journal, 45, 113–123.CrossRefGoogle Scholar
  14. Dawes, R. M., Faust, D., & Meehl, P. E. (1989). Clinical versus actuarial judgment. Science, 243, 1668–1674.CrossRefGoogle Scholar
  15. De Bilt, A., Serra, M., Luteijn, E., Kraijer, D., Sytema, S., & Minderaa, R. (2005). Social skills in children with intellectual disabilities with and without autism. Journal of Intellectual Disability Research, 49, 317–328.CrossRefGoogle Scholar
  16. Eells, T. D. (1997). Handbook of psychotherapy case formulation. New York, NY: Guilford Press.Google Scholar
  17. Elstein, A. S. (1994). What goes around comes around: Return of the hypothetico-deductive strategy. Teaching and Learning in Medicine, 6, 121–123.CrossRefGoogle Scholar
  18. Elstein, A. S. (1999). Heuristics and biases: Selected errors in clinical reasoning. Academic Medicine, 74, 791–794.CrossRefGoogle Scholar
  19. Elstein, A. S., Shulman, L. S., & Sprafka, S. A. (1978). Medical problem solving: An analysis of clinical reasoning. Cambridge, MA: Harvard University Press.CrossRefGoogle Scholar
  20. Elstein, A. S., Schulman, L. S., & Sprafka, S. A. (1990). Medical problem solving: A ten-year retrospective. Evaluation and the Health Professions, 13, 5–36.CrossRefGoogle Scholar
  21. Falvey, J. E., Bray, T. E., & Hebert, D. J. (2005). Case conceptualisation and treatment planning: Investigation of problem-solving and clinical judgement. Journal of Mental Health Counseling, 27, 348–372.CrossRefGoogle Scholar
  22. Frederisckson, N., & Jacobs, S. (2001). Controllability attributions for academic performance and the perceived scholastic competence, global self-worth and achievement of children with dyslexia. School Psychology International, 22, 401–416.CrossRefGoogle Scholar
  23. Freeman, S., & Alkin, M. C. (2000). Academic and social attainments of children with mental retardation in general education and special education settings. Remedial and Special Education, 21, 3–18.CrossRefGoogle Scholar
  24. Galanter, C. A., & Patel, V. L. (2005). Medical decision-making: A selective review for child psychiatrists and psychologists. Journal of Child Psychology and Psychiatry, 46, 675–689.CrossRefGoogle Scholar
  25. Gambrill, E. (1990). Critical thinking in clinical practice. San Francisco, CA: Jossey-Bass.Google Scholar
  26. Garb, H. N. (1989). Clinical judgement, clinical training, and professional experience. Psychological Bulletin, 105, 387–396.CrossRefGoogle Scholar
  27. Garb, H. N. (1998). Studying the clinician: Judgement research and psychological assessment. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  28. Garb, H. N. (2005). Clinical judgement and decision making. Annual Review of Clinical Psychology, 1, 67–89.CrossRefGoogle Scholar
  29. Garb, H. N., & Boyle, P. A. (2003). Understanding why some clinicians use pseudoscientific methods. In S. O. Lilienfeld, S. J. Lynn, & J. M. Lohr (Eds.), Science and pseudoscience in clinical psychology (pp. 17–38). New York: Guilford Press.Google Scholar
  30. Goldman, A. I. (1986). Epistemology and cognition. Cambridge, MA: Harvard University Press.Google Scholar
  31. Goodheart, C. D. (2006). Evidence, endeavour, and expertise in psychology practice. In C. D. Goodheart, A. Kazdin, & R. J. Sternberg (Eds.), Evidence-based psychotherapy (pp. 37–61). Washington, DC: American Psychological Association.Google Scholar
  32. Harding, S. G. (Ed.). (1976). Can theories be refuted? Dordrecht, The Netherlands: Reidel.Google Scholar
  33. Haig, B. D. (1987). Scientific problems and the conduct of research. Educational Philosophy and Theory, 19, 22–31.CrossRefGoogle Scholar
  34. Haig, B. D. (2005a). Exploratory factor analysis, theory generation, and scientific method. Multivariate Behavioral Research, 40, 303–329.CrossRefGoogle Scholar
  35. Haig, B. D. (2005b). An abductive theory of scientific method. Psychological Methods, 10, 371–388.CrossRefGoogle Scholar
  36. Harré, R., & Madden, E. H. (1975). Causal powers. Oxford, England: Basil Blackwell.Google Scholar
  37. Haynes, S. N., & O’Brien, W. H. (1990). Functional analysis in behaviour therapy. Clinical Psychology Review, 10, 649–668.CrossRefGoogle Scholar
  38. Herbert, M. (1998). Clinical formulation. In T. Ollendick (Ed.), Comprehensive clinical psychology. Vol. 5: Children and adolescents: Clinical formulation and treatment (pp. 25–55). Oxford, England: Pergamon/Elsevier.CrossRefGoogle Scholar
  39. Ingram, R. E., Nelson, T., Steidtmann, D. K., & Bistricky, S. L. (2007). Comparative data on child and adolescent measures associated with depression. Journal of Consulting and Clinical Psychology, 75, 390–403.CrossRefGoogle Scholar
  40. Jacobs, L., & Joseph, S. (1997). Cognitive triad inventory and its association with symptoms of depression and anxiety in adolescents. Personality and Individual Differences, 22, 769–770.CrossRefGoogle Scholar
  41. Josephson, J. R., & Josephson, S. G. (1994). Abductive inference: Computation, philosophy, technology. New York, NY: Cambridge University Press.CrossRefGoogle Scholar
  42. Kendjelic, E. M., & Eells, T. D. (2007). Generic psychotherapy case formulation training improves formulation quality. Psychotherapy, Theory, Research, Practice, 44, 66–77.CrossRefGoogle Scholar
  43. Kim, N. S., & Ahn, W. (2002). Clinical psychologists theory based representations of mental disorders predict their diagnostic reasoning and memory. Journal of Experimental Psychology: General, 131, 451–476.CrossRefGoogle Scholar
  44. Kodituwakku, P. W., Handmaker, N. S., Cutler, S. K., & Weathersby, E. K. (1995). Specific impairments in self-regulation in children exposed to alcohol prenatally. Alcoholism, Clinical and Experimental Research, 19, 1558–1564.CrossRefGoogle Scholar
  45. Lane, D. A., & Corrie, S. (2006). The modern scientist-practitioner: A guide to practice in psychology. London, England: Routledge.Google Scholar
  46. Levenson, H., & Strupp, H. H. (1997). Cyclical maladaptive patterns: Case formulation in time-limited dynamic psychotherapy. In T. D. Eells (Ed.), Handbook of psychotherapy case formulation (pp. 84–115). New York, NY: Guilford Press.Google Scholar
  47. Macdonald, E. M., Jackson, H. J., Hayes, R. L., Baglioni, A. J., & Madden, C. (1998). Social skill as a determinant of social networks and perceived social support in schizophrenia. Schizophrenia Research, 29, 275–286.CrossRefGoogle Scholar
  48. Magnani, L. (2001). Abduction, reason, and science: Processes of discovery and explanation. New York, NY: Kluwer/Plenum Press.Google Scholar
  49. Meyer, V., & Turkat, I. D. (1979). Behavioral analysis of clinical cases. Journal of Behavioural Assessment, 1, 259–269.CrossRefGoogle Scholar
  50. Nezu, A. M., & Nezu, C. M. (1993). Identifying and selecting target problems for clinical intervention: A problem-solving model. Psychological Assessment, 5, 254–263.CrossRefGoogle Scholar
  51. Nickles, T. (1981). What is a problem that we might solve it? Synthese, 47, 85–118.CrossRefGoogle Scholar
  52. Norman, G. (2005). Research in clinical reasoning: Past history and current trends. Medical Education, 39, 418–427.CrossRefGoogle Scholar
  53. Norman, G. R., Brooks, L. R., & Allen, S. W. (1989). Recall by expert medical practitioners and novices as a record of processing attention. Journal of Experimental Psychology: Learning, Memory, and Cognition, 13, 1166–1174.Google Scholar
  54. Norman, G. R., Trott, A. D., Brooks, L. R., & Smith, E. K. M. (1994). Cognitive differences in clinical reasoning related to postgraduate training. Teaching and Learning in Medicine, 6, 114–120.CrossRefGoogle Scholar
  55. Nurius, P. S., & Nicoll, A. E. (1992). Capturing clinical expertise: An analysis of knowledge “mining” through expert system development. Clinical Psychology Review, 12, 705–717.CrossRefGoogle Scholar
  56. Patel, V. L., Arocha, J. F., & Zhang, J. (2005). Thinking and reasoning in medicine. In K. J. Holyoak & R. G. Morrison (Eds.), The Cambridge handbook of thinking and reasoning (pp. 727–750). New York, NY: Cambridge University Press.Google Scholar
  57. Patel, V. L., & Groen, G. J. (1986). Knowledge based solution strategies in medical reasoning. Cognitive Science, 10, 91–116.CrossRefGoogle Scholar
  58. Pauli-Pott, U., Haverkock, A., Pott, W., & Beckmann, D. (2007). Negative emotionality, attachment quality, and behavior problems in early childhood. Infant Mental Health Journal, 28, 39–53.CrossRefGoogle Scholar
  59. Persons, J. B. (1989). Cognitive therapy in practice: A case formulation approach. New York, NY: W.W. Norton & Co.Google Scholar
  60. Round, A. P. (1999). Teaching clinical reasoning—A preliminary controlled study. Medical Education, 33, 480–483.CrossRefGoogle Scholar
  61. Schmidt, H. G., Norman, G. R., & Boshuizen, H. P. A. (1990). A cognitive perspective on medical expertise: Theory and implications. Academic Medicine, 65, 611–621.CrossRefGoogle Scholar
  62. Spengler, P. M., Strohmer, D. C., Dixon, D. N., & Shivy, V. A. (1995). A scientist-practitioner model of psychological assessment: Implications for training, practice and research. The Counseling Psychologist, 23, 506–534.CrossRefGoogle Scholar
  63. Swets, J. A., Dawes, R. M., & Monahan, J. (2000). Psychological science can improve diagnostic decisions. Psychological Science in the Public Interest, 1, 1–26.CrossRefGoogle Scholar
  64. Thagard, P. (1992). Conceptual revolutions. Princeton, NJ: Princeton University Press.Google Scholar
  65. Trapolini, T., Ungerer, J. A., & McMahon, C. A. (2007). Maternal depression and children’s attachment representation during the preschool years. British Journal of Developmental Psychology, 25, 247–261.CrossRefGoogle Scholar
  66. Turkat, I. D. (1990). The personality disorders: A psychological approach to clinical management. Psychology practitioner guidebooks. Elmsford, NY: Pergamon Press.Google Scholar
  67. Verschueren, K., & Marcoen, A. (1999). Representation of self and socioemotional competence in kindergartners: Differential and combined effects of attachment to mother and father. Child Development, 70, 183–201.CrossRefGoogle Scholar
  68. Ward, T., Vertue, F. M., & Haig, B. D. (1999). Abductive method and clinical assessment in practice. Behavior Change, 16, 49–63.CrossRefGoogle Scholar
  69. Woodward, J. (1989). Data and phenomena. Synthese, 79, 393–472.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of CanterburyChristchurchNew Zealand

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