Linking assessment to treatment: case formulation

Abstract

Case formulation is a, … hypothesis about the causes, precipitants, and maintaining influences of a person's psychological, interpersonal, and behavioural problems. A case formulation helps organize often complex and contradictory information about a person. It should serve as a blueprint guiding treatment, as a marker for change, as a structure for enabling the therapist to understand the patient better. A case formulation should also help the therapist anticipate therapy-interfering behaviours and experience greater empathy for the patient … broadly, a psychotherapy case formulation also includes descriptive information on which the hypothesis is based and prescriptive recommendations that flow from the hypothesis (Eells, 1997a; p. 2; italics in original). The above quote by Eells highlights that a case formulation links the client and his or her problems with the treatment. It captures both the strengths and the weaknesses of the client, thereby placing the problem and the potential resolution in the context of the whole person. To use a metaphor, if the treatment is the locomotive and the client's problems are the carriages, then the case formulation is the coupling that holds the two together. Without the coupling, a treatment might chug along nicely but it will fail to bring about any movement in the problems. Clients present to a professional psychologist with a large quantity of information. There is information specific to the presenting problem, but there is also historical, familial, demographic, cultural, medical, educational and social information.