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Introduction & Theoretical Background
Some problems look complicated from the outside but start to make sense when we see the inner workings. A case formulation is a good way of understanding complicated problems by creating testable hypotheses about the factors which might be maintaining an individual’s difficulties.
“[The purpose of a case formulation] is both to provide an accurate overview and explanation of the patient’s problems that is open to verification through hypothesis testing, and to arrive collaboratively with the patient at a useful understanding of their problem that is meaningful to them … The case formulation is then used to inform treatment or intervention by identifying key targets for change.” (Tarrier and Calam, 2002).
A cross-sectional formulation takes a ‘snapshot’ of what is going on during a single moment in time. The Exploring Problems Using A Cross-Sectional Model worksheet identifies the key aspects of the cognitive behavioral therapy (CBT) model. It can be a helpful way of introducing the CBT model to clients in session, and is also suitable as a self-guided exercise. It is useful framework for:
- Exploring the connections between our thoughts, feelings, and behavior in a stressful situation
- Gathering data about specific problems so that patterns can be highlighted and discussed
- Discussing potential maintenance cycles and providing a space for collaborative reflection
“One helpful way to explore the problems that you are describing is to take a ‘snapshot’ of what was going on at a time when you were upset. Can you think of a recent time when you felt a sudden change in emotion? What was going on for you then?”
Therapists should encourage clients to elaborate on:
- The triggering situation
- What went through their mind
- What body sensations they were aware of
- How they felt emotionally
- How they reacted to feeling that way.
During the elaboration of this formulation the therapist can help the client to notice how each of the nodes can be influenced by the others. Clients can be encouraged to reflect upon the impact of their behavior upon later reactions (intended and unintended consequences).
References And Further Reading
- Padesky, C. A., Mooney, K. A. (1990). Presenting the cognitive model to clients. International Cognitive Therapy Newsletter, 6, 13-14.
- Tarrier, N. and Calam, R. (2002) ‘New developments in cognitive-behavioural case formulation’, Behavioural and Cognitive Psychotherapy, 30, 311–328.