Schema Maintenance – Vicious Cycles

Formulation in talking therapies

Formulations (also known as case formulations, case conceptualizations, and working hypotheses) are a central component of most talking therapies and a key skill for mental health professionals (Division of Clinical Psychology [DCP], 2010; Royal College of Psychiatrists [RCP], 2017; Sperry & Sperry, 2012). In essence, a formulation is a way to make sense of an individual’s difficulties. It is a provisional account or hypothesis, informed by psychological theory, about what an individual is struggling with and why (Johnstone & Dallos, 2014). A formulation is also a tool that therapists use to relate theory to practice (Butler, 1998). Sperry and Sperry (2012) describe formulations as:

A method and clinical strategy for obtaining and organizing information about a client, understanding and explaining the client’s situation and maladaptive patterns, guiding and focusing treatment, anticipating challenges and roadblocks, and preparing for successful termination.

(Sperry and Sperry, 2012, p.4)

Formulation is a fundamental part of

"Schemas are an understandable response to our early experiences. They help us make sense of what happened to us when we were young. But as our lives change, these old patterns might not be accurate or fit our current reality. Because of this, schemas often lead to unhelpful patterns in our adult lives that keep them going. I’d like to explore what might be maintaining one of your schemas. One way that we can do this is by creating a diagram. Can we give it a try?"

Step 1: Explore the client’s experience

Schema

Ask the client to choose an EMS they would like to focus on and describe it in their own words. Since clients’ primary or ‘core’ EMS are usually the starting point for schema-focused treatment, these schemas are ideal to begin with. Primary EMS can be identified using three criteria (Young, 1999):

1. They trigger the strongest emotional reactions.
2. They relate to the

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