& Centre for Sexual Addictions

Case Formulation (or Case Conceptualisation), defined by Persons (1989, p. 37) as ‘…a hypothesis about the nature of the psychological difficulty (or difficulties) underlying the problems on the patient’s problem list’, is central to all counselling and therapy. In Cognitive Behavioural Therapy (CBT) the case formulation is based on the Cognitive Model of emotional disorders, first developed in detail by Aaron T. Beck. At its simplest level it focuses on Negative Automatic Thoughts which are locked into vicious cycles with dysfunctional emotions, behaviours and somatic symptoms. It can also be expanded to include more ongoing dysfunctional underlying cognitions in the form of Assumptions and Core Beliefs. In practice, the case formulation guides and structures the course of treatment by unifying and prioritising symptoms, influencing the choice and timing of interventions, and predicting possible problems. The cognitive case formulation approach is open to disconfirmation, grounded in empirical research, parsimonious, and readily understandable by clients. However, it is also open to therapist bias, does not explicitly include cultural influences, can be over-accepting of the client’s judgement as to its accuracy, and relies on controversial mediating psychological entities. It is nonetheless a powerful theoretical and therapeutic tool