Refining Formulations Over Time · Capstone Exercise

Revise the Formulation

A session-one formulation, and then what has emerged by session six. Your job is to revise it, which is a different task from writing one. Four of the eight original entries do not survive, and two of those four are entries clinicians almost never revisit.

What this exercise practises

Keeping what holds, removing what has been falsified, adding what is new, and writing a revision somebody else could read against the original and see what changed. Then naming what would falsify an entry in your own revised version.

Two entries in this case were tested by events rather than by design. Sleep improved and the medication changed, and desire followed neither.

Estimated time to complete this exercise: 40 minutes

1The two formulations
2The ledger
3Your revision
4What would falsify it
5Close

Before you begin

How this one works

You are given a session-one formulation and then the information that has emerged by session six. Your job is to revise it, which is a different task from writing one.
Part 2 is a ledger. For each entry in the original formulation, decide whether it still holds as written. Four of the eight do not.
Parts 3 and 4 require writing. You cannot continue past either of them, and nothing you write leaves your browser.
The question organising all of it is not what was wrong with the first formulation. It is what is the most useful explanation right now.
Nothing is graded. The writing is for you and you can copy it at the end.

Formulations are not fixed documents. New information, including what emerges in the treatment process itself, routinely revises a working formulation. The clinician who treats a formulation as final rather than as a working hypothesis is less responsive to clinical information than one who maintains deliberate openness to revision.

References

  1. Eells, T. D. (Ed.). (2007). Handbook of psychotherapy case formulation (2nd ed.). Guilford Press.
  2. Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136. https://doi.org/10.1126/science.847460
  3. Persons, J. B. (2008). The case formulation approach to cognitive-behavior therapy. Guilford Press.
  4. Weerasekera, P. (1996). Multiperspective case conceptualization: A step towards treatment integration. Krieger Publishing.