Reciprocal CBT Formulation

The Reciprocal CBT Formulation tool aids therapists in addressing clients' relational problems using cognitive behavioral therapy principles through a structured, visual framework.

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Professional version

Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.

Client version

Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.

Editable version (PPT)

An editable Microsoft PowerPoint version of the resource.

Overview

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.

Why Use This Resource?

The Reciprocal CBT Formulation tool helps clients and therapists navigate relational difficulties by:

  • Encouraging alternative perspectives on interpersonal problems.
  • Helping clients understand others' perceptions of their behavior.
  • Increasing awareness of clients' influence over relational situations.
  • Empowering clients to target and change maladaptive beliefs and assumptions through behavioral experiments.

Key Benefits

Perspective

Facilitates understanding of others’ appraisals.

Reflection

Helps clients mentalize and reflect on their interactions.

Empowerment

Encourages clients to identify and alter targets for change.

Testing

Supports the use of behavioral experiments to challenge beliefs.

Who is this for?

Interpersonal Difficulties

Issues with connection and relationship satisfaction.

Avoidance Patterns

Fears surrounding intimacy and vulnerability in relationships.

Defensive Behaviors

Angry or defensive responses that disrupt social interactions.

Relationship Problems

Useful in couples therapy to examine reciprocal patterns and process issues.

Integrating it into your practice

01

Identify

Focus on specific triggering events involving interpersonal interactions.

02

Appraisal

Determine the client's interpretation of these events.

03

Feelings

Connect client appraisals to emotional responses.

04

Behavior

Examine client responses to these feelings.

05

Perception

Consider others' interpretations of the client's behavior.

06

Empathize

Encourage empathic understanding of others' emotional and behavioral responses.

07

Reflect

Observe patterns and explore and test alternative behaviors and interpretations.

Theoretical Background & Therapist Guidance

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.

What's inside

  • Blank case conceptualization diagrams that help you to visually map relational problems.
  • Case examples to illustrate application across different dyads.
  • Therapist guidance to help you use the tool effectively.
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FAQs

It is best utilized by therapists with clients presenting relational problems such as avoidance, anger, or a history of challenging interpersonal dynamics.
It helps clients visualize and understand their interpersonal cycles, encouraging them to test and challenge their beliefs about relationships.
It can be adapted for use in both individual and couples therapy, and is available in multiple formats to suit different clinical contexts.
Yes, it can aid supervisors in exploring process issues within supervisory or therapeutic relationships.

How This Resource Improves Clinical Outcomes

The Reciprocal CBT Formulation tool enhances therapy by:

  • Facilitating clients' self-awareness and insight into relational dynamics.
  • Supporting therapists in delivering targeted, effective interventions.
  • Encouraging adaptive change and behavioral experimentation in clients.

References And Further Reading

  • Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.
  • Flecknoe, P., & Sanders, D. (2004). Interpersonal difficulties. In Bennett-Levy, J., Butler, G., Fennell, M., Hackman, A., Mueller, M., & Westbrook, D. (Eds.), The Oxford guide to behavioural experiments in cognitive therapy, 393-412. New York: Oxford University Press.
  • Grimmer, A.G. (2013). The nine-part model: A tool for sharing dyadic formulations. Retrieved from www.bristolcbt.co.uk/publications/the-nine-part-model-dyadic-formulation
  • Padesky, C.A. & Mooney, K.A. (1990). Presenting the cognitive model to clients. International Cognitive Therapy Newsletter, 6, 13-14. Retrieved from http://padesky.com
  • Persons, J. B. (2008). The case formulation approach to cognitive-behavior therapy (guides to individualized evidence-based treatment). New York: Guilford.
  • Safran, J., & Segal, Z. V. (1996). Interpersonal process in cognitive therapy. Jason Aronson, Inc.
  • Teichman, Y. (1992). Family treatment with an acting-out adolescent. In A. Freeman & F. M. Datillio (Eds.), Comprehensive casebook of cognitive therapy. Springer.