CBT Model – Past And Present
Formulation is a key component of cognitive behavioral therapy (CBT) and essential to effective practice. This CBT Model – Past And Present is a descriptive formulation that introduces clients to the cognitive behavioral model, highlighting the interplay between thoughts, feelings, and behavior. It also explains how past life experiences, underlying core beliefs, and dysfunctional assumptions shape cognitive appraisals and contribute to current difficulties. Incorporating core beliefs and dysfunctional assumptions – and the life experiences that have led to their formation – can benefit descriptive formulations in several ways. This information can help clients to make links between the past and the present; contextualize their symptoms and understand their origins; understand why symptoms persist across time and situations; tell a broader story of their lives. Therapists should note that exploring early life experiences is often unnecessary during the early stages of therapy. Kuyken and colleagues (2009) advise exploring negative core beliefs and associated developmental experiences only when it is necessary, after constructing other conceptualizations, and when a strong therapeutic alliance has been developed.
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Introduction & Theoretical Background
Formulation in talking therapies
Formulations (also known as case formulations, case conceptualizations, and working hypotheses) are a central component of most talking therapies and a key skill for mental health professionals (DCP, 2010; RCP, 2017; Sperry & Sperry, 2012). In essence, a formulation is a way to make sense of an individual’s difficulties. It is a provisional account or hypothesis, informed by psychological theory, about what an individual is struggling with and why (Johnstone & Dallos, 2014). A formulation is also a tool that therapists use to relate theory to practice (Butler, 1998). Sperry and Sperry (2012, p. 4) describe formulations as:
A method and clinical strategy for obtaining and organizing information about a client, understanding and explaining the client’s situation and maladaptive patterns, guiding and focusing treatment, anticipating challenges and roadblocks, and preparing for successful termination.
Formulation is a fundamental part of most (if not all) therapeutic
Therapist Guidance
"I’d like to explore how the issues we’ve talked about fit together. One way we can do that is by drawing a diagram. Would that be OK?"
Step 1 – Explore the client’s experience
Event
Ask the client to identify and describe a specific recent event that triggered their difficulty. Note that trigger events can be external (e.g., a difficult interaction) or internal (e.g., an unusual physical sensation). Some individuals find it helpful to close their eyes and visualize the event (Beck, 2011). Consider asking:
"Let’s start by writing down a situation that recently triggered your difficulty. Can you think of an example? What happened?"
Next, explore the client’s cognitive, emotional, and behavioral responses to the trigger event. Therapists are encouraged to add this information to the formulation in whatever order the client shares it (Kuyken et al., 2009).
Thoughts
Examine the client’s cognitive response to the trigger (i.e., their
References And Further Reading
- Arntz, A. (2018). Modifying core beliefs. In: S. C. Hayes & S. G. Hoffman (Eds.), Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy (pp.339-350). Context Press.
- Bakker, G. M. (2008). Problem‐maintaining circles: Case illustrations of formulations that truly guide therapy. Clinical Psychologist, 12, 30-39. DOI: 10.1080/13284200802069050.
- Beck, A. T. (1976). Cognitive therapy and the emotional disorders. International Universities Press.
- Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Guilford Press.
- Beck, A. T., & Beck, J. S. (1991). The Personality Belief Questionnaire. Bala Cynwyd, PA: The Beck Institute for Cognitive Therapy and Research.
- Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford.
- Burns, D. D. (1980). Feeling good: The new mood therapy. Penguin Books.
- Butler, G. (1998). Clinical formulation. In: A. S. Bellack and M. Hersen (Eds.), Comprehensive Clinical Psychology (pp.1-23). Oxford.
- Butler,