How Clinicians Conceptualize Symptoms Influences Their Therapy

This post is part 3 of a series.

As with addressing or interpreting dreams in therapy—a phenomenon many psychotherapists today sadly dismiss as meaningless—part of the clinician's role and responsibility is to consider, along with the patient, what, if anything, their symptoms might mean.

What Is Clinical Case Conceptualization?

Most mainstream psychotherapists these days are clinically, legally, and ethically expected to construct, from the inception of the psychotherapy process, some sort of case formulation or conceptualization upon which to base their tentative treatment plan. This has become what is called a "standard of care" and "core clinical competency" in the mental health field, and it refers to a comprehensive and integrative overview of the client or patient's clinical presentation and circumstance.

We could say that such a formal case conceptualization consists of at least 10 clinical considerations, which can be called the 10 P's: presentation, predisposition, precipitating, perpetuating and protective factors, preexisting patterns, provisional psychodiagnosis, plan of treatment, and prognosis.

The basic idea is to formulate and tailor a unique and specific treatment plan for each patient or client by preliminarily assessing and identifying their presenting symptoms, biopsychosocial history, behavioral and emotional traits and tendencies, psychosocial stressors, strengths and weaknesses, social support system, etc., in order to arrive at a relevant psychiatric diagnosis, treatment plan, and prognosis—preferably, all in the initial consultation.

Assuming therapy proceeds beyond this initial consultation, which at times does not, and sometimes should not always happen, the case conceptualization can, and frequently will, be modified as more information becomes available or arises during the course of treatment. Such conceptual flexibility on the part of the clinician is, in my view, essential to successful psychotherapy, though it may not always be practiced as preached. In general, however, there is some encouraging consensus among mental health professionals that case conceptualization or formulation should ideally always be tailored to the specific patient, collaboratively agreed upon, and “resonate with the client’s experience, avoid stigmatization, and restore agency, meaning, and hope” (Eells, 2025). This clearly comports with some core principles of existential psychotherapy. (See my prior post.)

Moreover, according to clinical psychologist Eells (2025), “Research comparing outcomes between formulation‐driven and manual‐based therapy shows either no difference or a slight advantage for the former.” (See also Eells, 2015.) In other words, psychotherapy should be person-driven and situation-driven, rather than rote, one-size-fits-all, manualized, or recipe-driven. Again, this study appears to at least mildly affirm, support, corroborate, and encourage a more existential, phenomenological, individualistic, or humanistic treatment approach.

How Your Therapist Conceptualizes Your Symptoms Matters

An essential aspect of case formulation has to do with how the clinician views, understands, or interprets the patient's presenting signs and symptoms. (See Part 2.) Some, if not all, of this is determined by the particular theoretical orientation taken by the therapist.

In most cases, it can be quite helpful for the clinician to share their own perspective on the person's symptoms and to encourage them to do the same, focusing together on considering their possible significance—or lack thereof. And, in any case, it is crucial for the client or patient to be aware of and informed about how the clinician conceptualizes their problem and symptoms and how best to treat them, so as to be able to decide whether or not to proceed with this particular therapist or not.

Might, as some psychotherapists surmise, the person's presenting signs or symptoms have no hidden, symbolic, or underlying meaning or significance other than indicating the presence of some mental disorder or current life crisis? Perhaps. For example, French existential philosopher Jean-Paul Sartre insisted that life is inherently absurd and meaningless other than the significance with which we imbue it. So, "deeper" or hidden meaning can be arbitrarily imposed on psychiatric signs and symptoms by the clinician or the client themselves.

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On the other hand, another existential philosopher, Soren Kierkegaard, believed that life is intrinsically meaningful and that it is our task to seek out and discover that meaning. It is equally possible, and commonplace, for patients or therapists to casually dismiss certain psychiatric symptoms or signs as being psychologically insignificant. Thus, symptoms and signs might be intrinsically meaningless or meaningful, depending upon one's philosophical, spiritual, and clinical point of view. This question, of course, is ultimately for the psychotherapy patient or client to answer for themselves.

If our signs and symptoms, or dreams for that matter, are merely meaningless, aberrant, random neurological phenomena, then it might make perfect sense to dispatch and dispel them post-haste. But if the clinician concedes the possibility that symptoms may be meaningful messages worth paying attention to and perhaps heeding, the question remains as to what that meaning might be and how to comprehend and make clinical use of it.

To find a therapist, visit the Psychology Today Therapy Directory.