A worksheet that places clients’ emotions at the centre of the psychological formulation, to support clinicians to explore distress and behaviour through the lens of emotional experience.
Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.
A copy of the worksheet in PDF format.
An editable Microsoft PowerPoint version of the resource.
Developed by Isabel Clarke in the context of acute mental health settings, the Emotion Focused Formulation integrates the client’s emotional experience with their behavioural responses and significant past history. It helps clinicians and clients to understand and map cycles of behaviour that stem from an “intolerable internal state” - typically involving intense emotions such as fear, sadness, or anger.
This approach uses functional and behavioural analysis to clarify how emotional states drive coping behaviours. It places emphasis on using the client’s own language to create shared understanding and connection between past experiences, recent triggers, and current distress.
The Emotion Focused Formulation supports psychological work by:
Understanding how past events influence current anxious or depressive states and patterns.
Mapping responses to overwhelming or unresolved emotional experiences from the past (e.g. abuse).
Formulating emotional states that may drive unshared beliefs or experiences.
Supporting understanding of impulsivity, self-harm, or other coping behaviours.
Begin with the client’s own language to describe their emotional difficulties.
Use past events and recent stressors to understand triggers.
Link the central emotional state to behaviours and consequences.
Identify maintenance cycles driven by short-term relief or avoidance.
Frame psychological terms in a way that aligns with the client’s perspective.
Use the insights to guide therapy goals and inform treatment planning.
The Emotion Focused Formulation is rooted in behavioural theory and functional analysis, with a strong emphasis on emotion regulation and client collaboration. Developed by Isabel Clarke (2015), it was designed for acute mental health settings but has since been adapted for broader use.
At its core is the concept of an “intolerable internal state” - a powerful emotional experience that the client may struggle to process or tolerate. These states often stem from early adverse experiences or traumatic events and are triggered by current stressors. The client’s behavioural responses, such as withdrawal, aggression, or self-harm, are seen as attempts to manage these overwhelming feelings. Although these behaviours may bring short-term relief, they often maintain or exacerbate distress in the long term.
The formulation aims to make this cycle visible to both client and therapist. By focusing on what the client feels, how they cope, and the outcomes of those coping strategies, it provides a shared map for understanding distress and planning change. Clarke (2008, 2015) emphasises using the client’s own words wherever possible, allowing the formulation to reflect their reality and foster therapeutic engagement. This approach provides a flexible and collaborative framework that can inform assessment, formulation, and intervention.
