The impact of case formulation in cognitive therapy

Abstract

Case formation is deemed paramount in most psychotherapeutic approaches and defines the profession of clinical psychology. It is used to illustrate how clinical psychology embraces the scientist-practitioner paradigm, the distinguishing characteristic of the profession. Case formulation is currently considered to be the first principle in cognitive therapy. Yet considering its stature, there is negligible evidence that supports case formulation as a scientific concept or that proves its clinical value. The literature review presents a conceptual analysis of case formulation in cognitive therapy and concludes that there is insufficient evidence to accredit the process as reliable or valid in the scientific sense. Furthermore, there is a dearth of studies investigating its clinical value. The present study examines the impact of formulation upon two possible variables: the therapeutic alliance and levels of emotional distress. It evaluates these variables in the context of cognitive therapy for psychosis. The results indicate that there was no significant improvement in either variable for clients although therapists perceive the alliance more positively following formulation. Subjective feedback suggests formulation may impact upon clients' understanding and therapists' adherence to the cognitive therapy model. However, a number of clients reported negative emotional responses to formulation. Further evaluations of the impact of formulation are necessary.

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