1. Running head: CASE CONCEPTUALIZATION Bennett 1
Case Conceptualization Paper
Ethan D. Bennett
Western Kentucky University

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Theoretical Perspective on Diagnosis and Treatment Planning
Model of Counseling
The Adlerian theoretical perspective, also known as Individual Psychology, is a holistic
view of psychopathology (Sperry, L., Carlson, Duba Sauerheber, & Sperry, J., 2014, p. 3). As
opposed to a reductionistic view, Individual Psychology attempts to integrate the entire person
using a bio-psycho-social view (Sperry et al., 2014, p. 3). A key theme for the Adlerian
approach is inferiority vs superiority (Sperry et al., 2014, p. 2). For Adler, psychopathology can
be the result of a person’s perceived inferiority and their striving toward personal superiority
(Sperry et al., 2014, p. 2). Also, a person’s lifestyle, faulty conceptions, and discouragement
stem from early childhood experiences (Sperry et al., 2014, p. 2). Another basic tenant of
Individual Psychology is the desire of all human beings to belong or to have an invested social
interest (Sperry et al., 2014, p. 18). Adler believed that social interest was key for a non-
pathological, healthy person (Sperry et al., 2014, p. 1). Social interest entails the ability to
overcome daily life tasks with courage and common sense (Sperry et al., 2014, p. 1).
The Adlerian approach is also concerned with forming a family constellation to
understand the family dynamics and relationships between family members (Sperry et al., 2014,
p. 18). Birth order is also important to understand sibling influences on lifestyle convictions and
private logic about an individual’s world view and self view (Sperry et al., 2014, p. 18). Lastly,
the Adlerian approach is a positive psychology that focuses on an individual’s strengths and
protective factors, as opposed to pathology, faulty behavior and faulty cognitions (Sperry et al.,
2014, p. 18). Truly, Adlerian Psychology is holistic and multidimensional to reflect the
indivisibility and unity of the person (Sperry et al., 2014, p. 1).

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Use of Assessments
Counselors using the Adlerian approach would likely use assessments to perform a
lifestyle analysis to understand the client’s current situation and predisposing factors to develop
psychopathology (Sperry et al., 2014, p. 18). An Adlerian may use a family constellation, early
recollections, or lifestyle convictions to assess a client (Sperry et al., 2014, p. 19). A family
constellation attempts to understand the client’s relationships with family members and family
dynamics that could affect how the client understands him or herself, others, and the world
(Sperry et al., 2014, p. 19). Birth order is also important to gather for examining predispositions
to certain behaviors and convictions. The family is understood to be where individuals learn or
fail to learn social skills, as well as, form an identity and sense of self-worth. According to
Adler, individuals seek love, friendship, and work which are all topics wrestled with from an
early age in the family system (Sperry et al., 2014, p. 19).
Early recollections help the counselor and client to gain insight into what life-style
convictions were formed from an early age and how were they formed (Sperry et al., 2014, p.
19). An Adlerian views behavior as purposeful and early recollections give insight to the
intention or purpose behind a client’s presenting behavior (Sperry et al., 2014, p. 19). Also, early
collections are telling of a client’s social interest and acclimation to daily tasks (Sperry et al.,
2014, p. 19). To collect the early recollection the counselor will ask the client to describe their
earliest memory in as much detail as possible. The counselor may further prompt the client to
help them recount the feelings and thoughts that accompany the memory. Life-style convictions
are identified to represent patterns in the client’s life (Sperry et al., 2014, p. 20). For instance, a
life-style conviction can cause a person’s life strategy to overcompensate so that a client who
was raped by her father refuses to trust a man to love her. They tell an individual that “I am…,”

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“Others are…,” “The world is…” and maladaptive patterns are formed in response to these
convictions (Sperry et al., 2014, p. 20).
Use of Goals and Interventions
The primary goals of an Adlerian are to create social interest and to develop constructive
action (Sperry et al., 2014, p. 20). Again, social interest does not necessarily mean an outgoing
personality. Rather, social interest is the courage to move through life’s tasks and challenges
(Sperry et al, 2014, p. 1). Constructive action is action that forms a healthy individual by
building on the person’s strengths and protective factors. Lastly, Adlerian theory aims to educate
the client (Maniacci & Carlson, 1991, p. 237). The education is based around building skills,
information, and strategies to replace misconceptions, misguided behavior and faulty strategies
(Maniacci & Carlson, 1991, p. 239).
Due to Individual Psychology’s positive approach, counselors would likely use
encouragement to help the client overcome the discouragement of his past or the life-style
convictions that he has placed upon himself (Maniacci & Carlson, 1991, p. 239).
Encouragement defeats the inferiority complex by replacing negative, self-defeating attitudes
and convictions with beneficial, self-improving attitudes and convictions (Maniacci & Carlson,
1991, p. 239). Also, interventions would be based around changing the maladaptive patterns.
Adlerians will use a variety of techniques ranging from cognitive-behavioral modification to
narrative therapy to the expressive arts. However, the interventions will be based upon the
information gathered during the previously mentioned assessments. An Adlerian will change the
maladaptive pattern by addressing the purpose that drives the symptoms. Interventions are

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aimed at creating social interest and integrating all aspects of the individual. Ultimately,
interventions create insight that changes the person’s internalized convictions.
Case Conceptualization
Client Characteristics
The client for the purpose of this case conceptualization will be named John. John is a 24
year old Caucasian male. He is single, but has a long-distance relationship with a girl and he
travels to visit her every weekend. John is Roman Catholic. John recently graduated from
college and displays above-average intelligence.
Problem Statement
John is concerned that his obsessions are preventing him from having successful
relationships with his girlfriend and friends. Also, he is worried that he is not good enough for
his girlfriend.
Bio-psycho-social Evaluation and Assessment
Symptoms and behaviors. John exhibits a tic by sniffing repeatedly as if to clear nasal
passages. The tic is not illness related or due to seasonal allergies, etc. Also, John has
compulsive behavior such as intense hand washing after every meal. John describes needing to
wash his hands multiple times with scalding hot water to get the dirt and germs off of his hands.
In addition, John stops and checks himself each time he passes a full-body mirror in his
apartment. His life revolves around routines and schedules and deviating from his schedule
causes him anxiety. John lifts weights at the same time every day for several hours and cannot
deviate even when prompted by his friends to hang out.

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Within his relationship, John finds himself preoccupied with his girlfriend’s flaws and
constantly reevaluates whether they love each other. However, John mentions that there is no
apparent reason for believing that their love for each other has changed. The same thoughts have
haunted John’s previous relationships. John is aware that his obsessions may not be true and
becomes distressed when the obsessions occupy his thoughts. He says that the obsessions and
compulsions began around 6 or 7 years of age, shortly after an early childhood memory event.
During the memory, his father hit his mother and she was crouched crying in the corner. John
remembers walking to his mother and his brother walked to his father. He remembers that the
behavior gradually got worse after the divorce and after his father’s death.
Health, life cycle stage, and systemic and social variables. John is overall a very
healthy individual, likely due to his obsession with exercise. John is very muscular and strong
and has been running to prepare himself for a police department physical examination. There are
no presenting physical issues. John does drink alcohol; however, he described it as very
infrequent. He is not currently taking any medication. He is also struggling to find his career
path and deciding whether he wants to move to a new location. John works for a local
elementary school as a special education aide, where he enjoys his job but does not find it
fulfilling. In addition, John is witnessing his close friend’s marriages and desires to have a
serious and lasting relationship. John is a caring and empathetic person as evidenced by his
description of his close friends as “brothers.” Also, his demeanor by way of his gentle eyes,
forward posture, listening ears, and body language that matches others moods indicates empathy.
Another strength is his likable personality as evidenced by his multitude of friends and past
girlfriends. John also has the resources of his friend’s families as many of them have “adopted”
him. Despite their quirks, John’s family is also supportive of John and want the best for him.

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Perhaps his greatest asset is his will to change because he recognizes the obsessions and
compulsions are restricting.
John is facing early adulthood challenges of establishing his own identity, separate from
his family. He is the youngest in his family and has one brother who is 6 years older. His
parents divorced when he was 8 years old and his father died when he was 10 years old. John’s
father physically and verbally abused his mother, usually as a result of drinking. His father was
an alcoholic and it was believed that he may have had Obsessive-Compulsive Disorder. His
mother remarried and John’s relationship with her is close, although his mother is overbearing.
His relationship with his brother is distant, but becoming closer as the two get older.
Diagnosis
Obsessive-Compulsive Disorder 300.3 (F42)
- With good or fair insight
- Tic-related (American Psychiatric Association [APA], 2013, p. 237)
Bio-psycho-social Treatment and Interventions
Goal I. Increase intimate interactions with girlfriend.
Objective I. Decrease hand washing frequency after meals.
Objective II. Increase frequency of positive cognitions regarding girlfriend’s strengths.
Goal II. Increase interactions with friends.
Objective I. Limit time at gym to one hour.

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Objective II. Increase changes to schedule for accommodating time with friends.
Interventions. First, the counselor can use early recollections to connect John’s current
behavior with the memories of his past. If John can work through his memories and experiences
of trauma, then his obsessions and compulsive behavior will have less (if any) control over his
behavior. As previously mentioned, Adler believed that behaviors and symptoms were driven by
intention and purpose (Sperry et al., 2014, p. 19). Removing the purpose for the behavior will
remove the behavior. If the counselor is Eye Movement Desensitization and Reprocessing
trained, then he or she might also use EMDR to process the early trauma. To measure the
intervention, a counselor could use a scale to indicate that the memory has been reprocessed.
Another intervention is to desensitize John to the stimuli that trigger his anxiety through
low-intensity exposure to the stimuli in a supportive and controlled environment (Sperry et al.,
2014, p. 84). For instance, John could be exposed to food on his hands, yet resist the urge to
wash his hands. Success would be determined by the increase in time between exposure and
washing hands to the elimination of hand washing.
Multicultural Competencies
Obsessive-Compulsive Disorder (OCD) presents itself very similarly across cultures
(APA, 2013, p. 240). OCD is slightly more prevalent among women in adulthood, but more
prevalent among males in childhood (APA, 2013, p. 239). Age onset and comorbidity are also
nearly the same across cultures (APA, 2013, p. 240). Also, OCD will still present with similar
symptoms such as the need to clean or bring order (APA, 2013, p. 240). Despite the major
similarities between OCD across cultures, culture may influence the expression of symptoms or
the content of obsessions and compulsions (APA, 2013, p. 240).

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According to Wheaton, Berman, Fabricant, and Abramowitz (2013), African Americans
and Asian Americans are more likely than European Americans to exhibit cleaning symptoms
due to contamination obsessions (p. 17). Asian Americans also show increased levels of
perfectionism and perceived responsibility (Wheaton et al., 2013, p. 17). In addition, Asian
Americans have an elevated need to control thoughts (Wheaton et al., 2013, p. 17). Latino
Americans stress the importance of thoughts, due to the predominate religion of Roman
Catholicism (Wheaton et al., 2013, p. 18). Highly religious Catholics tend to overemphasize
thoughts, which is predictive of obsessive-compulsive symptoms (Wheaton et al., 2013, p. 18).
Lastly, African Americans have an elevated disgust sensitivity resulting in contamination
symptoms (Wheaton et al., 2013, p. 17)

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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.; DSM-V). Washington, DC: Author.
Maniacci, M., & Carlson, J. (1991). A model for adlerian family interventions with the
chronically mentally ill. The American Journal of Family Therapy, 19(3), 237-249.
Sperry, L., Carlson, J., Duba Sauerheber, J., & Sperry, J. (2014). Psychopathology and
psychotherapy: DSM-5 diagnosis, case conceptualization, and treatment (3rd ed.). New
York, NY: Routledge.
Wheaton, M. G., Berman, N. C., Fabricant, L. E., & Abramowitz, J. S. (2013). Differences in
obsessive-compulsive symptoms and obsessive beliefs: A comparison between African
Americans, Asian Americans, Latino Americans, and European Americans. Cognitive
Behaviour Therapy, 42(1), 9-20.