Integrating shared and unique approaches in personality assessment: A case formulation of Emma

Abstract

Even though the shift to a dimensional perspective on personality and psychopathology is increasingly substantiated by scientific evidence, clinicians may still struggle to apply this transition in clinical practice on an individual level. The question may not be if but how we adopt this ‘new’ perspective. In this paper we guide clinicians along McAdam's three-layered theoretical model of personality as a suitable approach for making this transition in clinical assessment. McAdam's model provides a dimensional and developmental framework that integrates nomothetic and idiographic approaches by assessing dispositional traits, characteristic adaptations and the narrative identity. As such, it may structure the process of assessment, case formulation and treatment planning. The developmental perspective makes it useful to gain a nuanced understanding of the personality of individuals of all ages, and may be particularly suitable for youth. In addition, with identity formation as a key developmental milestone, the inclusion of narrative identity is informative for this phase. The use of this framework is illustrated with a case formulation of Emma, an 18 year old women who is referred to specialized mental health care in the Netherlands. We draft a theoretically driven case-formulation and treatment plan. The picture of Emma, that is obtained by mapping her development along dispositional traits, characteristic adaptations and narrative identity, facilitates communication and treatment planning. As such, the case of Emma presents an example of clinical assessment that integrates unique individual and more standardized information to personality and simultaneously illustrates how clinicians may apply a dimensional, developmental theoretical framework of personality and psychopathology in clinical practice.