The work of the cognitive therapist is to effect change in the client through improving the interrelationship between the client’s thoughts and his or her environment. A central tool in our approach is the case conceptualization through which we, together with the client, propose a model of the problem. We endeavor to map out how thoughts, emotions, thinking distortions, and environmental factors come together to work their black magic of misery. This conceptualization provides the basis for our treatment interventions.
What is overlooked in case conceptualization it that draws its philosophical strength from the theorem of the Good Regulator as formulated by professor of computer science, Roger C. Conant and British psychiatrist, Ross Ashby, the founders of the modern study of cybernetics. Conant and Ashby posit that every good regulator of a system must inherently be a model of that system. In colloquial terms, ‘every good key must be a model of the lock it opens’. Therefore, in order for our interventions to alleviate despair, for instance, those interventions must be rooted in a map that accurately reflects the underlying system.
While we may assume that case conceptualization must be exhaustive, from a strictly cybernetics perspective it only needs to be as refined as is required to effect change. Turning a light off and on requires a minimal map of the underlying system; repairing a faulty electrical circuit however requires a bit more understanding. So it is with the manifestations of human suffering that we encounter in our practices. Some problems require a rudimentary understanding; others, especially the complex phenomenon of psychosis, personality disorders, and addictions require much more.
What is however demanded in developing a sound case conceptualization is that it be accurate. The effectiveness of cognitive therapy lies in large part in its rejection of dogmatic psychological models, which trap practitioners and clients in ideologically driven dead-ends. Cognitive case conceptualization must be rooted in the phenomenal reality of the client; his or her thoughts, aspirations, and fears. For us there is only one test for the accuracy of our case conceptualization: does it help the client achieve his or her desired goal.
If it doesn’t help then we’re holding the wrong key.
And what good is that?