Vicious Cycle - Costs And Benefits
Formulation is a key component in talking therapies, and vicious cycles have long been recognized in psychotherapy as key mechanisms that perpetuate psychopathology. Identifying and mapping out vicious cycles can serve many therapeutic functions including: simplifying complex difficulties, making them more manageable; illustrating how problems manifest in different ways; normalizing ways of coping with difficulties; identifying maladaptive responses that perpetuate problems; identifying adaptive responses that can be strengthened or shaped into more helpful strategies; helping clients to gain distance from their difficulties; pinpointing ways to intervene. This Vicious Cycle - Costs And Benefits worksheet provides a client-friendly framework for exploring how certain coping strategies maintain or exacerbate problems. It helps clients examine the advantages and disadvantages of responses that might be contributing to their difficulties.
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Introduction & Theoretical Background
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 (DCP, 2010; 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, p. 4) 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.
Formulation is a fundamental part of most (if not all) therapeutic orientations and serves several common
Therapist Guidance
"I’d like to explore with you what might keep this issue going. One way we can do that is by drawing a diagram. Can we give it a try?"
Step 1: Explore the client’s experience
Problem
Ask the client to describe the problem they are struggling with. Problems can be defined as a diagnosis, or in other ways, such as in terms of troubling beliefs, behaviors, feelings, physical sensations, or patterns of interaction. While diagnoses are clear and succinct, other descriptions are more personalized and capture clients’ subjective experiences of the problem. Encourage the client to describe the problem in the most meaningful way possible, for example:
"Let’s start by describing the problem you are experiencing. How would you put it in your own words?"
Response
Ask the client to describe the typical ways they respond to the problem or try to cope with it. These responses might include ways of:
- Behaving – such as escaping from
References And Further Reading
- Arntz, A., Rauner, M., & Van den Hout, M. (1995). “If I feel anxious, there must be danger”: Ex-consequentia reasoning in inferring danger in anxiety disorders. Behaviour Research and Therapy, 33, 917-925. DOI: 10.1016/0005-7967(95)00032-S.
- Bakker, G. M. (2008). Problem‐maintaining circles: Case illustrations of formulations that truly guide therapy. Clinical Psychologist, 12, 30-39. DOI: 10.1080/13284200802069050.
- Barry, T. J., Vervliet, B., & Hermans, D. (2015). An integrative review of attention biases and their contribution to treatment for anxiety disorders. Frontiers in Psychology, 6, 968. DOI: 10.3389/fpsyg.2015.00968.
- Beck, A. T., Rush, J. A., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Guilford Press.
- Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford.
- Brewin, C. R. (2011). The nature and significance of memory disturbance in posttraumatic stress disorder. Annual review of clinical psychology, 7(1), 203-227.
- Burns, D. D., & Good, M. F. (1980). The new mood therapy. New York, William Morrow.
- Butler, G., Fennell,