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Using a Case Formulation to Guide CBT

Developing and Using a Case Formulation to Guide Cognitive-Behavior Therapy

 

 

Jacqueline BP1* and Lisa ST2

1 Cognitive Behavior Therapy and Science Center, Oakland, CA, USA

2 San Francisco VA Medical Center and University of California at San Francisco, USA

Corresponding Author:
Jacqueline B. Persons
Cognitive Behavior Therapy and Science Center
5625 College Avenue, Suite 215, Oakland, CA 94618, USA
Tel: 510-992-4040
E-mail: 

 

Citation: Jacqueline BP, Lisa ST (2015) Developing and Using a Case Formulation to Guide Cognitive-Behavior Therapy. J Psychol Psychother 5:179. doi:10.4172/2161-0487.1000179

Copyright: © 2015 Jacqueline BP, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

This article describes a case formulation driven approach to cognitive-behavior therapy (CBT) that draws on the formulations and interventions in the ESTs while helping the therapist make many of the clinical decisions that are not directly addressed in the ESTs. We begin the article with an overview of case formulation driven CBT. Then we describe each of the steps of case formulation driven CBT, giving special attention to the step of developing a case formulation. We conclude with a brief discussion of alternate approaches to case formulation in CBT, and a brief review of evidence supporting the use of a case formulation approach to CBT.

Introduction

The development of Empirically-Supported Treatment (EST) protocols has transformed our field and improved the quality of care that cognitive-behavior therapists can provide. However, the EST protocols do not meet all of the clinician’s needs for several reasons. One is that the protocols generally target a single DSM disorder; in contrast, comorbidity is the rule rather than the exception in clinical practice. Clinicians typically treat individuals who have multiple related disorders and problems that can affect one another or the process of treatment.

Another reason EST protocols do not meet all of the clinician’s needs is that many patients receive more than one therapy simultaneously. Often patients receive pharmacotherapy or couples therapy or twelve-step or other group therapy in addition to individual CBT. This fact presents the clinician who is providing the individual therapy with the challenge of determining how the therapies might conflict or potentiate one another. EST protocols do not typically address this clinical decision-making issue.

In addition, patients often have unique needs that are not directly addressed by the disorder-focused protocols [1,2]. For example, the EST protocol for a disorder assumes that the patient’s goal is to treat the disorder to remission. However, many patients who meet criteria for a DSM disorder have treatment goals that do not necessarily entail treating that disorder to remission. For example, Peter met criteria for social phobia. However, his treatment goal was not to recover from social phobia. His goal was to begin to date and develop a relationship that would lead to marriage. A treatment that addresses Peter’s goal will likely include interventions that are not part of the EST for social phobia and exclude some of the interventions in the social phobia EST. Other unique factors can also affect a person’s illness or its treatment. For example, a person may be fearful of surrendering longstanding modes of coping, have family members who are ambivalent about his recovery or play a role in the patient’s problems, or be addicted to medications (e.g., benzodiazepines) that interfere with cognitive behavior therapy (CBT).

This article describes a case formulation-driven approach to cognitive-behavior therapy (CBT) that draws on the formulations and interventions in the ESTs while helping the therapist make many of the clinical decisions that are not directly addressed in the ESTs. We provide an overview of case formulation-driven CBT, and we describe each of the steps of case formulation-driven CBT, giving special attention to the step of developing a case formulation. We conclude with brief reviews of alternate approaches to case formulation in CBT and of evidence supporting the use of a case formulation approach to CBT.

To continue reading this paper please click on case formulation to CBT

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