Practical Two (Case Formulation)

Question 1

What is a case formulation?

Answer 1

It is a process whereby the psychologist and client
work collaboratively to:
1. Describe the client’s difficulties and
2. Explain the difficulties using cognitive-behavioural
theory.

Question 2

What are the aims of case formulation?

Answer 2

• Bring together the client experience with CBT theory,
and research
• Normalise the client’s difficulties
• Encourage client participation in the therapeutic process
• Help to make complex problems more manageable
• Guide the selection, focus, and sequence of therapy
• Identify client strengths and identify ways to build client
resilience
• Identify problems that might arise in therapy

Question 3

Why should we share the case formulation with the client? 3

Answer 3

1. Obtain feedback of client’s response to the
   formulation
2. Help client see the rationale behind
   treatment plan
3. Arrive at treatment goals collaboratively

Question 4

What are the two approaches to case formulation?

Answer 4

1. Disorder specific models
   - Psychologists use cognitive-behavioural models
   of specific disorders and incorporate client
   specific information
2. Generic models
   - These approaches link the client’s experience
   with a generic cognitive behavioural framework

Question 5

What are the 5 P’s in the generic case formulation?

Answer 5

• Presenting problem
• Predisposing factors (events that set the
foundation of the problem)
• Precipitating factors (events that triggered the
problem)
• Perpetuating factors (events that maintain/keep
the problem going)
• Protective/Positive factors (strengths, resources)

Question 6

What are PRESENTING factors?

Answer 6

• Comprehensive list of the problems the client
has come to therapy for
• This list is based on the client’s description of
them during the intake interview and the
psychologist’s observation during the intake
interview

Question 7

The presenting problem can be divided

into what 3 categories?

Answer 7

1.The client’s feelings
2.The client’s thoughts
3.The client’s behaviours and physiological
responses

Question 8

What are PREDISPOSING factors?

Answer 8

• Genetic predisposition
• Developmental experiences (e.g.,
developmental milestones met)
• Family of origin history (e.g., parenting styles)
• Critical events (e.g., trauma)

Question 9

What are PRECIPITATING factors?

Answer 9

• Any event or experience that triggers the
problem
• Triggers are usually external to the person (e.g., conflict or natural disaster)
• Occasionally triggers are internal events (e.g., illness)
• Triggers can be situational critical event (e.g., changes in work environment)

Question 10

What are PERPETUATING factors?

Answer 10

These are the things that stop the problem from
getting better or make the problem worse

In a CBT model these include thoughts, feelings
and behaviours (including physical responses)
such as:
- Cognitive distortions
- Avoidance
- Safety behaviours (behaviours a person engages in
or precautions they might take to protect themselves from perceived risks.)

Question 11

What are POSITIVE/PROTECTIVE factors?

Answer 11

These are the resources the person has that
may be helping to prevent the problem from
getting worse (known or unknown by client/psych)
- May be internal (eg insight)
- May be external (eg family)

Question 12

What is something every case formulation must do?

Answer 12

Identify the client’s strengths

Question 13

What is the basis of CBT?

Answer 13

On the premise that our thoughts, feelings,
and behaviors are all interconnected, but it is our
thoughts (or reactions to events) that tend to drive our
feelings and behaviors.