Process Focused Case Formulation

Some clients present with clearly identifiable symptoms of a specific disorder, in which case it is often appropriate to use evidence-based manualized treatments. However, many clients present with comorbid difficulties, or problems where no clear evidence-based treatment exists. In these circumstances it is essential that clinicians be able to formulate client difficulties using a theory-driven approach. 

The Process-Focused Case Formulation encourages clinicians to make hypotheses regarding mechanisms or processes which they believe may be maintaining the client’s presenting difficulties. These mechanisms can be informed by multiple treatment approaches. For example, a behavioral approach to a problem would focus on antecedents and consequences, a cognitive approach might focus beliefs / assumptions / thoughts associated which contribute to the difficulty, and a systemic approach might focus on factors external to the individual. This worksheet guides the clinician’s thinking through a number of the most important steps of an individualised case formulation. The goal is not

This case formulation worksheet has sections to guide the therapist in developing an individualized case formulation.

• Problem list – this can include client-identified problems, or problems that a therapist identifies but where the client does not necessarily agree (e.g. issues related to self-harm)
• Triggers / precipitants for the current problem - Identify anything which may have acted as a relatively recent trigger for the identified problem
• Hypothesised mechanism(s) – Brainstorm potential mechanisms by which the problems may be being maintained. This section is theory-agnostic and can include behavioral, cognitive, psychodynamic, or acceptance/mindfulness mechanisms. As examples, a behavioural approach might focus on the antecedents and consequences of a problem to look for possible maintaining factors. An ACT approach might focus on client behaviors which indicate cognitive inflexibility.
• Origins of mechanisms – Consider factors which may have predisposed this individual to develop this problem
• Client’s understanding of the relationship between problems and mechanisms – Once a shared