The same person, formulated eight ways
A formulation is a hypothesis about what maintains this person’s difficulties and what would change them. Build one for any teaching case in any tradition, and see what each model notices and what it cannot see.
Start from a case
Maya Ellison
Panic attacks with increasing avoidance of driving, supermarkets and the underground.
Daniel Okonkwo
Longstanding low mood, exhaustion and loss of interest, framed by him as "burnout".
Rosa Delgado
Persistent grief nineteen months after her mother’s death, with insomnia and withdrawal.
Theo Kaminski
Recurrent self-harm, intense mood swings, and a pattern of relationships that begin intensely and end catastrophically.
Aisha Rahman
PTSD following an assault at work fourteen months ago.
Greg Nowak
Alcohol use, referred after a drink-driving conviction; he does not think he has a problem.
Sam Whitfield
Social anxiety and low mood, worse since starting a new job eight months ago.
The Harkness family
Referred over Kit’s school refusal; six weeks of near-total non-attendance.
Formulation templates
4P formulation (predisposing, precipitating, perpetuating, protective)
A theory-neutral scaffold for organising why this person, why this problem, why now, and why it persists.
Psychodynamic formulation (CCRT)
Extract the recurring relational pattern — wish, response of other, response of self — that organises the patient’s difficulties.
PAPDTRPCognitive conceptualisation
Link early experience, core beliefs, rules and strategies to the specific situations that trouble the patient now.
CTREBTSTACT case formulation (hexaflex)
Locate psychological inflexibility across six processes and identify the workable direction.
ACTBehavioural formulation
Specify target behaviours, their controlling variables, and the contingencies that will change them.
BTETPerson-centred process reflection
Track the conditions, the client’s process level, and the therapist’s own congruence — the person-centred alternative to formulating about a client.
PCTEFTSystemic formulation & genogram data
Locate the problem in the relational system rather than in the individual.
structural-familybowen-family-systemsstrategic-therapyIntegrative formulation
Combine the levels of explanation coherently, and state the reasoning for each borrowed element.
INTtranstheoretical