New Developments in Cognitive-Behavioural Case Formulation. Epidemiological, Systemic and Social Context: An Integrative Approach

Abstract

The historical origins of the case formulation approach to assessment and treatment are described and its role in clinical practice and research discussed. It is argued that treatment based on individual case formulations should not be precluded from clinical trials. The empirical evidence for the reliability and efficacy of case formulation is reviewed. The evidence that an idiosyncratic case formulation approach to treatment has any advantage over a standard protocol is equivocal; however, the studies that have been carried out are under powered and potentially suffer from a Type II error. The standard procedure for case formulation is briefly described and the argument advanced that this method of clinical assessment should be soundly based upon empirical evidence and hypothesis testing and not on speculation. Three modifications are suggested to the current practice of case formulation. These are: 1) the conceptualization of dysfunctional systems in the maintenance of clinical problems; 2) the historical background of a clinical problem should be described in terms of vulnerabilities and epidemiological evidence-base; and 3) the pivotal role of social behaviour and context should be emphasized and accommodated in a formulation. The advantages of a case formulation, in providing an understanding of the maintenance of clinical problems, in providing an integrated approach to intervention are outlined.

Cognitive Behaviour Therapy for Schizophrenia – A Review of Development, Evidence and Implementation

“…Lastly, central to the coping approach, although not unique to it, was the process of a detailed individual idiosyncratic assessment or case formulation to understand the individuals experience of psychosis. (For a detailed account of case formulation in CBT generally see Tarrier and Calam [19], and for a clinical heuristic in psychosis see Haddock and Tarrier [20] and Tarrier [21]. ) This allowed a treatment strategy to be formulated based upon the clinician’s assessment of the determinants of the individual’s psychotic symptoms.…”

Psychology services in psychiatric rehabilitation: Service user needs and staff perceptions

“…Formulation is one of the clinical psychologist's key skills, so they are ideally placed to assist staff in understanding psychological needs in this way (Division of Clinical Psychology, 2001). Case formulations can then be used to guide support planning and staff interventions (Tarrier & Calam, 2002). Staff identified the need for further training in psychosocial interventions.…”

The decisive moment : makiing diagnostic decisions and designing treatments

“…Furthermore, it helps to establish the therapeutic relationship by creating a shared understanding with the client (Eells, 2007;Tarrier & Calam, 2002). Together, classification and case formulation determine treatment decisions by identifying client problems and underlying causal factors and mechanisms of change which can be matched to therapeutic methods and techniques (Haynes, 1993).…”

“…when client problems are complex and an empirically supported treatment is unavailable. Case formulation is supposed to be an essential part of the diagnostic process (Eells, 2007;Haynes, 1993;Tarrier & Calam, 2002). It can help psychologists decide on a treatment when there are different treatments available for the same disorder and classification alone is insufficient to make a choice, the first choice treatment fails or client problems are complex (Haynes & Williams, 2003;Persons, 2006;Persons & Mikami, 2002).…”

“…In this process, psychologists should work as applied scientists to achieve a thorough analysis of the problem. They systematically gather information about the client, integrate this information with existing psychological, scientific knowledge into a coherent mental model of the client and test this model or parts of it (Nezu & Nezu, 1995;Tarrier & Calam, 2002;Van Aarle & Van den Bercken, 1992). The central idea is that diagnostic decision making is "a special case of the activity involved in the establishment of scientific explanations of human behaviour in general."…”