Clients' experience of case formulation in cognitive behaviour therapy for psychosis

Abstract

Case formulation is central to most schools of psychotherapy and involves the integration of information gained from the assessment process with psychological theory in order to understand the causes, development and maintenance of a clinical problem.  In cognitive therapy, the practice of case formulation is central to therapy and has become to be viewed as increasingly essential when working with complex cases.  As such, the practice is considered crucial in cognitive therapy for people with psychosis.  On the other hand, the reliability and validity of cognitive case formulation, its ‘clinical usefulness’, and the impact case formulations has on clients is largely unknown.

In the review paper the current cognitive models of positive symptoms of psychosis, which form the basis for individualised cognitive case formulations, are outlined and critiqued.  The scientific status and clinical usefulness of the cognitive case formulation are also explored, which shows a paucity of research examining the impact of cognitive case formulation on clients and therapy.

The empirical study utilises a qualitative methodology to explore how clients undertaking cognitive-behavioural therapy for psychosis experience the cognitive case formulation.  It was found that case formulation evoked multiple cognitive, emotional and behavioural reactions in each client;  that clients’ reactions were complex;  and that certain reactions changed with time.  The clinical and research implications of these findings are discussed.

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