Cross Sectional Formulation
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Introduction & Theoretical Background
A formulation, or case conceptualization, is a method for understanding and explaining a person’s problems. Case formulations tie together the difficulties that a person is experiencing and the psychological mechanisms underlying these experiences (Persons, 1989). Formulations have been described as “the lynch pin that holds theory and practice together” (Butler, 1998). Consider a simple example: a young woman experiencing feelings of anxiety about an upcoming work event might hold unhelpful thoughts about her performance, “I’ll humiliate myself in front of everyone”. She might act in ways which prevent her from finding out more about the truth of her belief, such as using avoidance or safety-seeking behaviors. Her unhelpful thoughts and avoidance behavior are mechanisms that maintain her anxiety. Case formulations confer several important benefits:
- They help the client and therapist to understand the problem(s) and how they fit together, instilling feelings of hope.
- They draw the client’s experience together
Therapist Guidance
“This is a model that we use to understand all sorts of problems. We are all affected by what is going on around us or the situations we find ourselves in – that’s represented by the big circle surrounding the others. When we are in a difficult situation it can be helpful to break it down and understand our bodily sensations, our emotions, our thoughts, and our behavior. There are arrows linking all of these aspects to represent how they are all connected to one another: what we think is closely connected to how we feel emotionally and in our bodies, and with how we respond. Would you be willing to explore a recent time when you felt [client’s primary concern - e.g. anxious] using this model?”
Eliciting and elaborating an example
Focus on a specific example. Consider asking the client to close their eyes and using imagery to enhance
References And Further Reading
- Butler, G. (1998). Clinical formulation. In A.S. Bellack & M. Hersen (Eds.), Comprehensive clinical psychology. New York: Pergammon.
- Kuyken, W., Padesky, C. A., & Dudley, R. (2008). Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. Guilford 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). The case formulation approach to cognitive-behavior therapy. Guilford Press.