Cultural-Behavioral Science in a Clinical Case Formulation Model

Abstract

This paper aims to provide a clinical case formulation model (CCF) based on Culturo-Behavioral Science (CBS) and Functional Analytic Psychotherapy (FAP). A clinical case illustration is provided and analyzed in terms of ten assessment points, including: the individual/actor; ADDRESSING; the clinically relevant behaviors, behaviors in daily life, and sociopolitical issues, including those that indicate improvement as well as those that are problematic; circuits between clients and a culturally significant other, which may constitute interlocked contingencies; desirable and undesirable aggregate products or cumulative effects and special verbal environments. Critical elements of the clinical context were preserved, such as suffering, singularity, and the therapeutic relationship. At the same time, we sought to highlight cultural and political aspects inseparable from the client’s and the therapist’s life stories. The clinical context is designed to treat suffering. Thus, the sociocultural and political markers involving the therapist and the client are indispensable starting points for interpreting clinical problems. However, as points of arrival, they may remain incomplete if they do not offer relief or meaning to the suffering. Because people have several characteristics and cultural attributes that interact with each other, it is necessary to consider the intersection of these identity attributes. From a behavior-analytic point of view, there may be conflicting contingencies or even contingencies that cease to apply when someone starts to present new cultural attributes. Neither the therapist nor the client holds just one identity attribute. Furthermore, several attributes can be transient throughout a person’s life, such as age, religion, social class, physical disabilities, or even the roles of the client and the therapist. The dynamics of these aspects can generate both suffering and relief. These conditions indicate the complexity and multidimensionality to be considered in a CCF that includes cultural issues. Therefore, the assessment’s clinically relevant response classes can help reconcile cultural attributes with the client’s idiosyncratic suffering. Culturally significant verbal environments that reinforce competing classes rather than problematic ones can be fostered through interventions inside and outside the session. This paper illustrated a CCF in a hypothetical clinical case regarding two women in a romantic relationship. The case example indicates points of observation and recording regarding the sociopolitical aspects in the client/therapist interactions. Considerations are made considering the contribution of FAP values, which include interpersonal connection, exempting neoliberal outcomes in the clinical context. Limitations of the model are its insipidity and its level of complexity, as it requires skills in both FAP and CBS. Possible advantages of the model are discussed in relation to training therapists and extending research by quantifying units of measurement. Additionally, benefits for the clients and the therapists are considered.