Iceberg Chart

What is an Iceberg Chart Template?

The Iceberg Chart Template is a resource that can be used to help individuals and health practitioners understand noticeable issues and the contributing factors below the surface. The chart takes on the iceberg analogy, where, just like icebergs, an issue's mass may often be more than what is visible. This approach allows practitioners and clients to gain insight and identify hidden factors to inform strategies and interventions (Mahr & Cheprasov, 2023). 

The chart promotes an understanding of surface-level and deeper factors. Surface level factors can be observed or presented in a situation, whether these come from observing physical symptoms or are experiences reported by clients. Deeper factors below the surface are those that may be indirectly influencing a client or situation. These may be less observable but contextualize an outcome.

For example, clients experiencing anxiety may report poor sleep or feeling on edge as contributors to their anxiety. Further investigation may demonstrate underlying feelings of hopelessness or detachment that may contribute to poor sleep behaviors and anxiety. 

For individuals and health practitioners, the chart visually demonstrates symptoms or problems on the surface. The area below the surface serves as a reminder that numerous underlying causes or factors influence an outcome. 

In the health sector, this would look at underlying health conditions or symptoms contributing to health and well-being and inform strategies or interventions to address these. 

Our template provides a ready-to-use structure that simplifies the iceberg chart. As a customizable resource, it is broadly applicable, allowing individuals and practitioners to gain a deeper understanding of a range of issues or situations.

How does it work?

The template provides individuals and professionals a structure to create their own or a client’s iceberg chart. This encourages them to look beyond what is visible for a more thorough appraisal of factors influencing a situation, issue, or symptoms. Here are some steps to guide you when using our template:

Step 1: Access the template

Begin by accessing our template here or downloading a printable PDF version by following the link below.

‍Step 2: Interpretation

Before applying the template, it is essential to understand and interpret the various sections of the template. This may be done by completing a practice iceberg chart, using our example as a reference.

Step 3: Consultation

If using it for client appraisal, introduce the chart in your client consultation by presenting an online version or printing out a physical copy. Explain the chart and how it may be beneficial for your client. If your client wishes to use the chart, continue with the following steps.

Step 4: Surface-level factors

Looking at the surface-level area of the chart, list the factors that have been observable as contributing to the situation. These may include visible symptoms, client experiences or previous medical notes.

Step 5: Below the surface

Once you have identified the surface-level factors, consider the factors that may have been contributing to or caused them. For example, a client experiencing consistent heartburn may have underlying gastroesophageal reflux disease (GERD).

Note these below the surface of the chart.

Step 6: Planning

Now that the factors have been identified, you can use these to devise strategies or treatment plans for your client.

Step 7: Ongoing Monitoring

It is essential to continue monitoring and supporting your clients' wellness journeys. This may involve scheduling follow-up consultations, providing guidance, or updating iceberg charts as they progress.

When would you use this Template?

The Iceberg Chart Template can be used as a format to gain a deeper understanding of a specific issue, situation, or illness. These can be used in a range of scenarios by various individuals or health professionals. The following are some practical applications that would benefit from this resource. 

Counseling

In helping clients overcome challenges, counselors may help clients identify underlying issues acting as barriers. These can then be used to develop problem-solving strategies for clients. 

General practitioners

In some instances, patients experiencing poor health symptoms may be exposed to an underlying health condition. For example, individuals experiencing headaches or fatigue may have underlying high blood pressure. This can be used to prescribe treatment or lifestyle changes to alleviate these symptoms. 

Health coaches 

Taking a more holistic approach, these health coaches may use the chart to demonstrate the range of interconnected factors influencing health. The chart may help practitioners map out the factors, providing a visual demonstration to clients.  

Physical therapy

When working with clients experiencing a certain pain or challenge with body movement, physiotherapists may use the chart to demonstrate how underlying injuries or muscle weakness may contribute to the issue. 

For example, a client experiencing back stiffness thought to be due to a muscular strain may result from poor posture. The practitioner can then use this information to explain this to the client and devise exercises to address the issue. 

Psychologists

Registered psychologists may use the chart to understand the underlying factors influencing a client’s mental health. These may then inform strategies addressing these factors that may enhance mental well-being.

What do the results mean?

Using our free Iceberg Chart Template, clients and practitioners are able to gain a deeper understanding of the factors influencing a situation, illness, or symptom. These can then be used to make informed decisions around strategies and treatments. 

Results using our template are multi-faceted and may differ among clients depending on several factors. These include the type of circumstance, the number of factors, personality, and the severity of the situation. Here are some common experiences and what they may mean: 

• Client empowerment: After using the chart, clients may be more aware of certain situations contributing to ill-being and avoid these where possible, enhancing their well-being. With enhanced understanding, clients may also identify factors that are within and out of their control, which can be empowering. 
• Enhanced understanding: As a visual resource, the chart may promote both client and practitioner understanding of an issue. Furthermore, student practitioners may find the chart beneficial during training, as it may help translate theoretical understandings in a more practical way. 
• Problem-solving: By broadening perspectives on factor appraisal, the chart can help practitioners and clients identify all underlying factors, helping develop solutions to overcome these problems. ‍
• Reduced medical error: Because the chart broadens appraisal, there is a reduced risk of misdiagnosis or medical error. Therefore, this may enhance practice and patient experiences.

Research & Evidence

Though the historical groundings of the iceberg chart are not certain, the analogy has been accredited to several historical figures, such as renowned neurologist Sigmund Freud (Mcleoud, 2023). 

Freud used the iceberg analogy to describe his topographical model of the mind, which saw three levels differing in accessibility and depth. The first level begins at the surface, consisting of thoughts at the forefront of the mind, the ‘conscious level’. The second is the preconscious, which is slightly below the surface and involves information from memory. The final is the unconscious level, which is deep below the surface and is theorized to be the major cause of behavior (Mcleod, 2023). 

Although the empirical validity of this theory has been contested to be unfounded, the analogy holds value in its ability to contextualize outcomes. In particular, this approach encourages a more holistic way of critical thinking, encouraging a process of reflective judgment beyond what is immediately presented (Facione et al., 2017). Taking a holistic approach is essential for enhancing a practitioner’s understanding of the client’s situation and provides clients with opportunities to play an active role in their health (Hellstrom, 1993). 

The Iceberg Chart encourages holistic critical thinking, which is essential for diagnostic procedures and subsequently informing effective treatments and strategies.

References

Facione, P. A., Crossetti, M. D. G. O., Riegel, F. (2017). Holistic Critical Thinking in the Nursing Diagnostic Process. Revista Gaúcha de Enfermagem, 38(3). DOI: https://doi.org/10.1590/1983-1447.2017.03.75576 Hellstrom, O. (1993). The importance of a holistic concept of health for healthcare. Examples from the clinic. Theoretical Medicine 14, 325-342. DOI:https://doi.org/10.1007/BF00996340 

Mahr, N., & Cheprasov, A. (2023). Iceberg Model in Systems Thinking, Level & Examples. Study.com. https://study.com/academy/lesson/the-iceberg-model-in-systems-thinking-definition-examples.html#:~:text=The%20iceberg%20model%20can%20also,the%20underlying%20causes%20being%20submerged. 

Mcleod, S. (2023). Freud’s Theory Of The Unconscious Mind. SimplyPsychology. https://www.simplypsychology.org/unconscious-mind.html#:~:text=Freud%20(1900%2C%201905)%20developed,conscious%2C%20preconscious%2C%20and%20unconscious.