APPIC Essay 2 (Psychology Doctoral Internship)
Essay 2: Please describe your theoretical orientation and how this influences your approach to case conceptualization and intervention. You may use de-identified case material to illustrate your points if you choose.
I see Essay 2 as a persuasive essay – you are persuading the reader that you really believe in the theoretical orientation you use in your clinical work and you have a clear understanding of why it is effective.
- Declare your theoretical orientation in the first paragraph – don’t make your reader guess what you’re talking about. Say a little about why you believe in this orientation – e.g., it’s very effective for the range of issues you treat; human connection is the foundation to change; etc.
- Theoretical orientation includes both conceptualization and intervention. Too often students focus only on intervention techniques. What is the theory and understanding of the problem that is driving your intervention approach? E.g., Attachment theory informs how you pay attention to the client-therapist relationship and use interpersonal interventions.
- I recommend reviewing texts and articles on theoretical orientation – at this point in your training, you have probably noticed a pattern of how you think about cases and how you work with clients, but perhaps you don’t regularly talk about your work using theoretical orientation terminology. Refresh your memory by reviewing resources and realize there’s probably a theoretical orientation (or two) that best represents how you work.
- You should assume your audience is familiar with psychological jargon, so it’s fine to mention “behavioral activation”, “avoidant attachment style”, “transference”, etc. as long as the context makes it clear that you know what those terms mean.
- “Eclecticism” vs. “Integrative” –
- Eclecticism most often reflects a “toolbox” approach – however, this is more focused on intervention techniques and leaves the reader to wonder how you decided to use a particular approach.
- Integrative approach – often times if you identify with more than one theoretical orientation (I suggest no more than 2-3), you may say you’re “integrative.” However, this means the way you write about them needs to reflect how you use them in an integrated fashion. I particularly like Boswell, et al.’s (2010) article on integrative psychotherapy (full citation below).
- “Evidence-based” psychotherapy – remember that this is not synonymous with “empirically supported treatment (EST)”. Read more here about the difference.
- While theoretical orientation and diversity issues are compartmentalized into two separate AAPI essays, you may consider writing about how you integrate diversity considerations into your theoretical orientation and how it is applied in your clinical work. After all, diversity considerations are not isolated from the person (client/patient).
- Case studies – essay 2 does not require a case study discussion, but if you do, the purpose is to illustrate how you apply your theoretical orientation. If you would like to include case studies, you may choose a couple approaches:
- Include one case study – be careful that you are not just describing the client situation. Describe how you conceptualize the client according to your chosen theoretical orientation. That should then lead into how you chose the intervention(s) you used (i.e., your conceptualization informed which intervention techniques you used). Don’t forget to comment on the effectiveness/outcome of your approach (remember: beginning, middle, and end). It’s totally fine to describe when something didn’t work and why you think that was the case (perhaps you adjusted your approach once you realized you needed to re-conceptualize the case).
- Reference a couple of cases briefly as you discuss conceptualization and intervention. You may consider this approach if you wanted to compare and contrast how you work differently with clients based on your conceptualization.
- One of the big challenges is not to get bogged down in the details of a case study! If you want to discuss a more complex case, you may consider focusing on a more narrow aspect of your work with the client to illustrate your point. (Reminder – what is the purpose of you sharing this information with the reader?)
- If you discuss a case, the format should parallel your previous paragraph that describes your conceptualization and how that ties into your intervention approach. This makes it much easier for the reader to follow your case example.
- Remember to write a brief summary paragraph (2-3 sentences) – it’s perfectly acceptable to mention what else you are interested in learning during internship year (e.g., cognitive processing therapy for PTSD).
A note about “biopsychosocial” model and Bronfenbrenner‘s ecological perspective – these are useful overarching frameworks for conceptualization. However, it is important to drill down and focus on the “psycho” (psychological) part of the models when talking about theoretical orientation in terms of how you conceptualize and facilitate change (think foundational theories – humanistic, psychodynamic, cognitive-behavioral, behavioral, existential). If you are going to conceptualize biological and social environmental factors as part of your understanding of your client/patient, then do also include how you address these issues in your interventions (e.g., consultation, integrated health approach, family systems therapy, advocacy, etc.).
Resources for psychotherapy theoretical orientation
Many of these articles and books are available in university libraries (remember to check inter-library loan options).
Boswell, J. F., Nelson, D. L., Nordberg, S. S., McAleavey, A. A., & Castonguay, L. G. (2010). Competency in integrative psychotherapy: perspectives on training and supervision. Psychotherapy: Theory, Research, Practice, and Training, 47, 3-11.
Planned Short-Term Psychotherapy: A Clinical Handbook (2nd Edition) by Bernard Bloom, 1997 (check used book options)
• Includes a range of theoretical orientations (CBT approaches, psychodynamic approaches, solution-focused, etc.)
Systems of Psychotherapy Systems of psychotherapy : a transtheoretical analysis.
By James O Prochaska; John C Norcross, 2009
• Includes various theoretical orientations
• Readiness for change (Prochaska)
Theory and Practice of Counseling and Psychotherapy (any edition) by Gerald Corey
• Includes various theoretical orientations (easy to read)
• Includes the same case example presented from each of the theoretical orientations covered in the book
Case conceptualization : mastering this competency with ease and confidence
Len Sperry; Jonathan J Sperry, 2012.