Case Conceptualization Frameworks for working with highly self-critical and shame prone clients

This case conceptualization framework is the product of several years of work, including piloting with clients.  Parts of it have been posted previously on this website, but the complete case conceptualization framework (including handouts) can be downloaded below.

Our case conceptualization process is informed primarily by two scientific traditions: 1. Contextual behavioral science (e.g., Acceptance and Commitment Therapy or ACT) and 2. Affective science (e.g.,  basic research on emotions such as shame and compassion). Our goal is to bring research findings from affective science more thoroughly into clinical practice and integrate these with the functional contextual viewpoint found in therapies such as ACT.  As such, this case conceptualization framework  should be useful to therapists in helping therapists work with highly shame prone and self-critical clients using principles they already know from other evidence-based therapies, such as exposure therapy, behavior therapy, CBT, compassion-focused therapy, dialectical behavior therapy, or ACT.  We hope you find it useful and would love any feedback you have when you use it. You can download the full case conceptualization outline using the button below or by clicking on this link.

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Case conceptualization forms for assessing critical and compassionate relationship histories

 These forms are included in the document above, but here they are separately if you only want one of the other:

  • Shame History: This is a handout for clients to assess their history with relationships characterized by criticism and lack of warmth. Read the blog post about this assessment here. More information about how to use this assessment can be found here. This is also included in the comprehensive case conceptualization above.

  • Warmth History: This is a handout for clients to assess their history with relationships characterized by compassion and warmth. Read the blog post about this assessment here. More information about how to use this assessment can be found here. This is also included in the comprehensive case conceptualization above.

  • Criticism vs Responsivity Handout: This handout is meant to help clients understand how a relative lack of warmth in their early relationships may have impacted their tendency toward self-criticism and current approach to relationships. Read the blog post about this handout here.

 

You may also find this post on using and debriefing self-report measures of shame, self-criticism, and self-compassion with clients. We share a number of standardized assessments that may be useful in working with highly self-critical and shame prone clients, such as the Internalized Shame Scale, the Self-Compassion Scale, and the Early Memories of Warmth Scale.


We’d love your feedback as you try to use these frameworks. Let us know on Facebook, Twitter, or via the website about any reactions or questions you may have or just like us to let us know you appreciate what we’re doing.


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