ABSTRACT
Two of the most common concerns trainees have in working with clients are refl ected in the questions: “What do I say?” and “What do I do?” While logical, these questions can quickly get trainees lost and off track. Getting lost and off track is common when trainees lack an accurate cognitive map to guide them. To develop accurate cognitive maps to guide the treatment process, trainees must fi rst become competent at focusing, which means knowing where to focus one’s attention when listening and observing. One of the most useful questions trainees can ask themselves and their supervisor is: “What should I be noticing and listening for when I talk with this client?” The apparent magic that distinguishes master practitioners from average ones lies in what each attends to and focuses on. The better trainees get at focusing, the better practitioners they will become. Because highly effective practitioners continually develop and refi ne this art and competency over their careers, trainees should not expect to master this competency right away. Case conceptualization is the technical term for the therapeutic art and competency of focusing, including an “assessment focus” which is central to the pattern recognition in the diagnostic formulation, and a “treatment focus” on pattern change which is central to the treatment formulation and treatment process.
