The Reciprocal CBT Formulation tool aids therapists in addressing clients' relational problems using cognitive behavioral therapy principles through a structured, visual framework.
Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.
Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.
An editable Microsoft PowerPoint version of the resource.
The Reciprocal CBT Formulation provides a flexible and structured framework for understanding clients' relational issues within a cognitive-behavioral model. It allows therapists to capture the dynamic nature of interpersonal issues over time. This tool is particularly useful for clients who struggle with mentalizing others' perspectives in relationships, whether due to avoidance, anxiety, or previous relational trauma.
The worksheet is rooted in evidence-based therapeutic models such as the reciprocal model of depression (Teichman, 1992) and cognitive interpersonal model (Safran & Segal, 1996), and uses a visual 'figure of eight' metaphor to represent cyclical relational patterns.
The Reciprocal CBT Formulation tool helps clients and therapists navigate relational difficulties by:
Issues with connection and relationship satisfaction.
Fears surrounding intimacy and vulnerability in relationships.
Angry or defensive responses that disrupt social interactions.
Useful in couples therapy to examine reciprocal patterns and process issues.
Focus on specific triggering events involving interpersonal interactions.
Determine the client's interpretation of these events.
Connect client appraisals to emotional responses.
Examine client responses to these feelings.
Consider others' interpretations of the client's behavior.
Encourage empathic understanding of others' emotional and behavioral responses.
Observe patterns and explore and test alternative behaviors and interpretations.
The Reciprocal CBT Formulation is grounded in established cognitive-behavioral models and adapts them for use with interpersonal problems. While CBT has traditionally focused on intrapersonal experiences — thoughts, feelings, behaviors, and physical sensations — this tool expands the formulation process to explicitly include interpersonal dynamics. It draws on theoretical influences including Teichman’s (1992) reciprocal model of depression, Safran and Segal’s (1996) cognitive-interpersonal model, Beck’s generic cognitive model, and adaptations such as the nine-part dyadic model (Grimmer, 2013).
In many cases, therapists find that familiar CBT approaches feel insufficient when clients present with relational difficulties — such as fear of emotional intimacy, repeated patterns of conflict, or persistent dissatisfaction in relationships. These problems are often shaped and maintained by reciprocal cycles of interaction that unfold over time, where one person’s behavior reinforces the beliefs and responses of another, creating a looping pattern that is difficult to interrupt.
This tool enables therapists and clients to visually map these patterns using a ‘figure of eight’ or ‘infinity’ structure. It highlights how appraisals, emotions, and behaviors not only affect the self, but also elicit responses from others that feed back into the client’s own interpretations. This cyclical structure allows for a more dynamic and relational understanding of problems, particularly when clients struggle to mentalize or recognize how their behavior might be perceived by others.
