Practically Speaking: Behind the Episode “It's Not What You're Doing. It's Why You're Doing It: Complex Cases and EBPs"
Complex cases… The rule? Or the exception? In this episode of Practical for Your Practice, we sit down with Dr. Aaron Brinen, who argues that complexity is often the norm when it comes to client cases. Dr. Brinen shares valuable insights on how to effectively serve clients with complex issues, emphasizing the importance of a thorough case formulation. We dive deep into how this process can lead to more effective strategies for change.
Listen to the full discussion here: It's Not What You're Doing. It's Why You're Doing It: Complex Cases and EBPs
While it can be easy to sometimes fall into the trap of thinking that one-size-fits-all interventions will suffice, truly effective therapeutic practice demands that we take the time to understand what makes each client unique and how various factors intertwine to contribute to the fabric of their clinical picture. The more we understand the unique and intricate factors that are keeping a client stuck, the better we can serve them.
To illustrate this point, Dr. Brinen uses the metaphor of a perpetual motion machine, “I'm recovery oriented, so I know that can sound very top down. And we need to understand what is the physiology underneath of the mental distress that the person's experiencing. And so then collaboratively we can decide how are we going to address it? The physiology is this perpetual motion machine that is driving the psychopathology. Psychopathology does not isolate itself, so PTSD doesn't hang out over here and then psychosis hangs out over here and then social anxiety disorder hangs over here. And then alcoholism hangs out over here. They all work together. They all interact together in this perpetual motion machine and in this additive effect.”
This metaphor paints a vivid picture of how people are often caught in a complex web of influences, like a machine where one part of the process affects another, and sometimes the whole system is stuck in perpetual motion - going round and round endlessly. Understanding how all these pieces fit together is crucial for breaking the cycle and moving towards meaningful change.
Once we recognize the complexity of the client’s situation, the next step is understanding how to proceed therapeutically. This is where formulation and strategy for change come into play. Rather than jumping straight into interventions, therapists must first ask, “What is going on here, and why is it happening?” As Brinnen points out, “ I so frequently see in supervision and consultation is providers or supervisees, their first words, their first discussion is about what am I going to do to the person or do with the person? And they're not thinking about why am I going to do what I’m doing with the person? What's going on? What needs to change?”
One of the biggest pitfalls in therapy, especially for new clinicians, is the temptation to rush into action. It’s easy to want to “do” something — whether it’s suggesting coping strategies, implementing new treatments, or offering advice. However, as Dr. Brinen stresses, understanding and formulation comes first, otherwise the interventions we offer may miss the mark.
If you're curious to hear more, tune in so you don’t miss Dr. Brinnen’s actionable intel and learn why taking the time to understand a client’s “perpetual motion machine” can enhance your evidence-based practice and lead to better outcomes. A word of advice… get that white board ready… you’re gonna need it! And as always, stay curious and mind your EBP’s.
Until next time…
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Jenna Ermold, Ph.D., is a clinical psychologist working as the Associate Director of Online Training, Technology and Telehealth for the Center for Deployment Psychology at the Uniformed Services University in Bethesda, Maryland.
Complex cases… The rule? Or the exception? In this episode of Practical for Your Practice, we sit down with Dr. Aaron Brinen, who argues that complexity is often the norm when it comes to client cases. Dr. Brinen shares valuable insights on how to effectively serve clients with complex issues, emphasizing the importance of a thorough case formulation. We dive deep into how this process can lead to more effective strategies for change.
Listen to the full discussion here: It's Not What You're Doing. It's Why You're Doing It: Complex Cases and EBPs
While it can be easy to sometimes fall into the trap of thinking that one-size-fits-all interventions will suffice, truly effective therapeutic practice demands that we take the time to understand what makes each client unique and how various factors intertwine to contribute to the fabric of their clinical picture. The more we understand the unique and intricate factors that are keeping a client stuck, the better we can serve them.
To illustrate this point, Dr. Brinen uses the metaphor of a perpetual motion machine, “I'm recovery oriented, so I know that can sound very top down. And we need to understand what is the physiology underneath of the mental distress that the person's experiencing. And so then collaboratively we can decide how are we going to address it? The physiology is this perpetual motion machine that is driving the psychopathology. Psychopathology does not isolate itself, so PTSD doesn't hang out over here and then psychosis hangs out over here and then social anxiety disorder hangs over here. And then alcoholism hangs out over here. They all work together. They all interact together in this perpetual motion machine and in this additive effect.”
This metaphor paints a vivid picture of how people are often caught in a complex web of influences, like a machine where one part of the process affects another, and sometimes the whole system is stuck in perpetual motion - going round and round endlessly. Understanding how all these pieces fit together is crucial for breaking the cycle and moving towards meaningful change.
Once we recognize the complexity of the client’s situation, the next step is understanding how to proceed therapeutically. This is where formulation and strategy for change come into play. Rather than jumping straight into interventions, therapists must first ask, “What is going on here, and why is it happening?” As Brinnen points out, “ I so frequently see in supervision and consultation is providers or supervisees, their first words, their first discussion is about what am I going to do to the person or do with the person? And they're not thinking about why am I going to do what I’m doing with the person? What's going on? What needs to change?”
One of the biggest pitfalls in therapy, especially for new clinicians, is the temptation to rush into action. It’s easy to want to “do” something — whether it’s suggesting coping strategies, implementing new treatments, or offering advice. However, as Dr. Brinen stresses, understanding and formulation comes first, otherwise the interventions we offer may miss the mark.
If you're curious to hear more, tune in so you don’t miss Dr. Brinnen’s actionable intel and learn why taking the time to understand a client’s “perpetual motion machine” can enhance your evidence-based practice and lead to better outcomes. A word of advice… get that white board ready… you’re gonna need it! And as always, stay curious and mind your EBP’s.
Until next time…
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Jenna Ermold, Ph.D., is a clinical psychologist working as the Associate Director of Online Training, Technology and Telehealth for the Center for Deployment Psychology at the Uniformed Services University in Bethesda, Maryland.