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Case Formulation and Disorder-Specific Models

“[Formulation is] The lynch pin that holds theory and practice together” (Butler, 1998).

Cognitive behavioral therapists use individually tailored formulations as a framework with which to understand their patients’ difficulties and to plan effective treatment. A case formulation helps therapists and patients to understand the origin, current status, and maintenance of a problem. Formulations are developed collaboratively between therapists and patients during the assessment phase of therapy and are revised as new information is gathered during the course of treatment. Jacqueline Persons wrote an influential account of individualized case formulation (1989). Her current case formulation approach (2008) describes how a complete CBT case formulation ties together all of the following parts:

all of a patient’s symptoms, disorders, and problems;
hypotheses about the mechanisms causing the disorders and the problems;
proposes the recent precipitants of the current problems and disorders;
describes the origins of the mechanisms.

Types of Case Formulation

Case formulations can vary according to their purpose, and according to the information they attempt to convey. A number of types of formulation have been described:

A cross-sectional formulation presents information relevant to a short time period, as though an event were sliced open at a particular moment in time to reveal the triggering event, thoughts (interpretations/appraisals), emotions, body feelings, and behaviors or reactions. One of the most popular formats for a cross-sectional formulation is Padesky and Mooney’s ‘hot cross bun’ (1990).
A longitudinal formulation presents information relevant to the origin and maintenance of a problem. Weerasekera’s “Multiperspective model” popularized the use of the “5 Ps” approach (presenting, predisposing, precipitating, perpetuating, and protective) to case formulation (Weerasekera, 1993). Judith Beck’s cognitive conceptualization (1995) links longitudinal factors (including relevant childhood data, core beliefs, conditional assumptions, coping strategies) to cross-sectional breakdowns (situation, automatic thought and appraisal, emotion, behavior).
Micro-formulations have been described as a helpful way of understanding the origin and effects of troubling imagery (Hackmann, Bennett-Levy, & Holmes, 2011). In this approach problematic images are explored along with their origin, associated appraisals, current impact, maintenance factors, and cognitive consequences.
Disorder-specific models describe the critical presenting, predisposing, precipitating, and perpetuating factors relevant to a condition. Disorder-specific cognitive behavioral conceptualizations have been published for most conditions including low self-esteem, panic, obsessive-compulsive disorder, psychosis, post-traumatic stress disorder.

References

Beck, J. S. (1995). Cognitive behavior therapy: Basics and beyond. New York: Guilford Press.

Butler, G. (1998). Clinical formulation. In A. S. Bellack and M. Hersen (eds) Comprehensive clinical psychology. New York: Pergamon Press

Hackmann, A., Bennett-Levy, J., & Holmes, E. A. (2011). Oxford guide to imagery in cognitive therapy. New York: Oxford University Press.

Padesky, C. A., & Mooney, K. A. (1990). Presenting the cognitive model to clients. International Cognitive Therapy Newsletter, 6, 13–14.

Persons, J. B. (1989). Cognitive therapy in practice: A case formulation approach. New York: WW Norton.

Persons, J. (2008). The case formulation approach to cognitive-behavior therapy (guides to individualized evidence-based treatment).

Weerasekera, P. (1993). Formulation: A multiperspective model. Canadian Journal of Psychiatry, 38(5), 351–358.

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Assessment

Collaborative Case Conceptualization Rating Scale (CCC-RS) | Kuyken, Padesky, Dudley | 2009
- Rating scale & coding manual download archived copy
- Score sheet & feedback form download archived copy
- Kuyken, W., Beshai, S., Dudley, R., Abel, A., Görg, N., Gower, P., … & Padesky, C. A. (2016). Assessing competence in collaborative case conceptualization: Development and preliminary psychometric properties of the Collaborative Case Conceptualization Rating Scale (CCC-RS). Behavioural and Cognitive Psychotherapy, 44(2), 179-192. download archived copy

Information

CBT

The “Blobby” formulation | Helen Kennerley | 2015 download archived copy
Understanding formulation (client handout) ~~download~~ archived copy
BPS DCP Good Practice Guidelines on the use of psychological formulation ~~download~~ archive.org
Working with Schemas, Core Beliefs, and Assumptions download archived copy
Cognitive behavioral case formulation and treatment plan example download archive.org
What is the case formulation approach to cognitive-behavior therapy? download archived copy

ACT

A quick guide to ACT case conceptualization ~~download~~ archived copy
ACT assessment / case formulation process download archived copy
ACT simple case formulation download archived copy

Intervention

DBT case formulation format ~~download~~ archived copy
Case formulation template ~~download~~ archive.org

Presentations

The case formulation approach to cognitive behavior therapy| Jacqueline Persons | 2014 download archived copy
A case formulation approach to cognitive-behavior therapy | Jacqueline Persons | 2015 download archived copy
The role of a case conceptualization model and core tasks of intervention | Donald Miechenbaum download archived copy
Cafe formulation in cognitive-behavioral therapy | Caleb Lack download archived copy

Case Formulation and Disorder-Specific Models

Types of Case Formulation

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