Psychology, Department of


First Advisor

Debra A. Hope

Date of this Version


Document Type



Shulman, G. P. (2018). The development of case conceptualization ability in clinical psychology graduate students (Doctoral dissertation).


A DISSERTATION Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Doctor of Philosophy, Major: Psychology, Under the Supervision of Professor Debra A. Hope. Lincoln, Nebraska: May, 2018

Copyright (c) 2018 Grant P. Shulman


Case conceptualization is a core clinical skill across various schools of psychotherapy. Yet, surprisingly little research has examined how student therapists develop their case formulation abilities. The present study examined 110 conceptualizations written by 27 therapists throughout their graduate training. The majority of conceptualizations were collected during a student’s second or third year of clinical training. Conceptualization quality was measured with the Case Formulation Content Coding Method, and examined five primary aspects: Complexity, Precision of Language, Coherence, Multiculturalism, and Overall Quality. Additionally, the types of hypothesized mechanisms were recorded. Hierarchical linear modeling examined the contributions of time in training, previous clinical experience, GRE scores, and clinical supervisor of the report. It was expected that time in training would uniquely contribute to the improvement in case conceptualization quality after controlling for the aforementioned variables. Exploratory analyses investigated the types of hypothesized causal mechanisms and the average level of case conceptualization ability.

The main hypotheses were not supported. Time was not associated with any of the quality variables. Only supervisors predicted the quality of case conceptualization. However, exploratory analyses revealed that the hypothesized causal mechanisms tended to become more sophisticated with time. Although quality did not robustly improve across time, results demonstrated the importance of clinical supervision on the development of case conceptualization ability. One limitation of the study was that reports were edited by clinical supervisors prior to coding in the present study, and this likely contributed to the robust supervisory effects. Future studies should examine student therapist’s case conceptualizations prior to supervisory edits and monitor the effectiveness of conceptualization teaching methodologies. Overall, this study demonstrated that students write sufficient conceptualizations with the assistance of their clinical supervisor, and that the sophistication of their conceptualizations tends to improve with time.

Adviser: Debra A. Hope

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