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).
An Antecedent-Behavior-Consequence (ABC) diagram is a form of functional analysis, and is a helpful way of conceptualizing a behavior of interest. It explores what happened before and after a target event, and makes explicit the contribution of consequences to further instances of target behavior.
“When we’re trying to understand why we feel ’stuck’ or why the same things seem to happen over and again, it can be helpful to think about what happened before and after. 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 reflect on:
- What happened before the target behavior (What made it more likely? What was the client experiencing internally (thoughts / feelings)? What was happening externally?)
- The behavior itself (observable and non-observable)
- The consequences of the behavior (Intended and unintended; immediate and longer-term)
- The relationship between the consequences of their behavior and the likelihood of future instances of the behavior
- Tarrier, N. and Calam, R. (2002) ‘New developments in cognitive-behavioural case formulation’. Behavioural and Cognitive Psychotherapy, 30, 311–328.