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Vicious Flower Formulation

Case conceptualizations (formulations) are designed to help a clients and therapists come to a shared understanding of a problem. The ‘vicious flower’ approach uses petals to represent maintenance cycles. Treatment can be framed as ‘plucking’ these petals.

The Vicious Flower Formulation is a deceptively simple case conceptualization (formulation) tool. By encouraging a focus on the maintenance cycles which (often unintentionally) prolong a difficulty it is a tool which targets the mechanisms serving to prolong an individual’s difficulty. In this graphical representation maintenance cycles form the ‘petals’ of a flower.

As with many formulation tools it is most helpful to complete this as a collaborative exercise with clients.

  1. Start by identifying one of the client’s beliefs and write it in the center of the flower.
  2. Now think about what the client does (behaviors) to prevent the feared belief from coming true, or to protect themselves from the potential consequences of the belief. Write these around the belief.
  3. In many cases client’s actions can inadvertently be serving to reinforce the beliefs. Think with the client about the consequences of their behaviour. If the behavior serves to strengthen the belief then drawing an arrow from the belief to the behaviour, and then back to the belief forms a ‘petal’ of the flower.
  4. Using the vicious flower formulation as the foundation for therapy the tasks of ‘treatment’ can be conceptualized as plucking the petals of the flower to reduce the strength of the unhelpful belief.
  5. Later (or in parallel) a ‘virtuous flower’ can be built up which consists of behaviors designed to reinforce a more adaptive belief.

For example, a client who believes they are unlovable may act possessively in relationships, potentially leading to their breakdown, and confirmation of the belief. Alternatively, they may not even attempt to form relationships, which leads to few opportunities to disconfirm their belief.

  • Moorey, S. (2010). The six cycles maintenance model: Growing a “vicious flower” for depression. Behavioural and cognitive psychotherapy, 38(2), 173.
  • Salkovskis, P. M. (1998). The devil is in the detail: conceptualising and treating obsessional problems. In N. Tarrier, A. Wells, and G. Haddock (eds) Treating Complex Cases: The Cognitive Behaviour Therapy Approach. Chichester: Wiley.

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