Disorder specific and trans-diagnostic case conceptualisation

Case conceptualisation is the process of integrating the unique experience of the individual with psychological theory and is often described as a central process in effective therapy. Hence, a key question facing a clinician working from a cognitive behavioural perspective is which theory should be chosen as the basis of the conceptualisation with a particular client? We address this question by first considering the strengths and limitations of the disorder specific and trans-diagnostic approaches. From this, the differences between the approaches are framed as a conundrum or puzzle that is solved through a principle based approach to case conceptualisation that allows clinicians to individualise therapy by selecting and incorporating the most appropriate theory and research. Furthermore, by considering how to achieve lasting improvement for the client we emphasise incorporating client strengths and resilience into both disorder specific and trans-diagnostic approaches. To achieve this we necessarily extend beyond consideration of models of disorders, and draw on models of wellbeing, and resilience, and by doing so require theoretical accounts not only of disorders but also of resilience. ► Case conceptualisation is seen as a central process in Cognitive Behavioural Therapy and is based on the selection of an appropriate disorder specific model. ► Trans-diagnostic approaches are increasingly demonstrating value in helping understand the development and persistence of emotional disorders, and may well serve as the basis of conceptualisations. ► Research on the value of case conceptualisation and the merits of using disorder specific or trans-diagnostic approaches is vital.