The Case Formulation Approach To Cognitive-Beha...
Reviews the book, The case formulation approach to cognitive-behavior therapy by Jacqueline B. Persons (see record 2008-13011-000). This book places case formulation as its core organizing principle for cognitive-behavior therapy (CBT). Explicitly framing case formulation in a hypothesis-testing context, Persons helps bridge the gap between those advocating strict adherence to manual-driven, empirically supported therapies (ESTs) and those who find such constraints impractical and less than optimal. Her guiding principle is to use ESTs to the extent that one can but to adapt them idiographically as one must to address the array of problems presented by the specific individual being treated. Persons' case formulation model is deceptively simple. It involves four basic components: (a) symptoms, disorders, and problems; (b) mechanisms; (c) precipitants; and (d) the origins of the mechanisms. Persons provides a fresh outlook on all these familiar components. In addition to providing step-by-step instruction for developing the formulation, Persons includes discussions of goal setting, which is organized in categories focused on mechanism change or learning compensatory strategies; treatment plan development; monitoring progress; decision making in the session; and handling nonadherence and treatment failure. A major strength of the book is the focus on the patient-therapist relationship. Persons repeatedly returns to the importance of establishing a positive working alliance and also discusses the opportunities that arise in efforts to re-establish a positive alliance following a rupture. The book is well organized, clearly written, contains up-to-date research references, and is replete with clinical examples. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
The Case Formulation Approach to Cognitive-Beha...
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Nonsuicidal self-injury (NSSI) is a highly prevalent behavior among clinical and nonclinical samples. Despite the prevalence, maladaptive, and potentially dangerous nature of the behavior, no empirically supported interventions have been identified specifically for NSSI, and clinicians report a lack of knowledge regarding the treatment of NSSI. This article discusses the application of a common component of therapy, the case formulation, to conceptualizing and treating NSSI. This strategy for case formulation incorporates cognitive-behavioral and functional analytic approaches while focusing on factors pertinent to the development, maintenance, and treatment of NSSI. A case example is presented.
This book addresses a critical challenge in evidence-based psychotherapy: how to use empirically supported therapies (ESTs) in real-world clinical contexts. The author explains the basic theories of cognition, learning, and emotion that underlie available ESTs and shows how the theories also guide systematic case formulation. By crafting a sound formulation and continually refining and monitoring it as treatment progresses, the therapist can smoothly shift theoretical gears and weave together elements of different ESTs to meet the needs of individual patients, who typically present with multiple problems. Hands-on tools, reproducibles, and many concrete examples are included.
"Decades of research and clinical experience meet in this seminal book. Persons provides a guide for both the novice and experienced practitioner to deal with even the most complex of cases. This significant work will no doubt become the shining light by which the idiographic approach to CBT will be guided in the future. One of the few books that is worth even more than the purchase price!"--Nicholas Tarrier, PhD, FBPsS, Department of Psychology, Institute of Psychiatry, King's College, London, UK
In conclusion, it is necessary to note that Persons (2008) provides valuable insights into the benefits of the use of formulation in cognitive-behavior therapy. The descriptions of the establishment of goals, possible obstacles to effective treatment, and the value of relationships are particularly useful. The author includes real-life examples that can assist new therapists in their attempts to use this approach. Although some gaps are evident, the author manages to develop a concise and effective guide for those who want to utilize formulation in CBT. Pretreatment procedures are described effectively and can equip practitioners with specific knowledge and skills they can use in their practice.
Similar to developments in medicine, researchers within the field of clinical psychology are calling for advancing precision psychotherapy (Insel and Cuthbert 2015). Optimally matching patients to treatments according to certain baseline characteristics has the potential to enhance treatment outcomes (Cohen and DeRubeis 2018; DeRubeis et al. 2014). The goal is to put the individual in focus and provide the most fitting intervention for this specific person. Individualization is currently realized based on different grounds. Tailored transdiagnostic approaches differ in how they select treatment modules or interventions for the individual patient. One classical example of individualization is the use of clinical case formulation to integrate interventions from different treatment packages. Instead of integrating components across treatments, modular treatment packages have been proposed that allow for a flexible adaptation within one treatment package. Decisions on module selection in modular treatments can be based on (a) clinical judgment, factoring in diagnosis or impression in assessment interviews, (b) data, relying on baseline assessment data or more advanced algorithms, or (c) a combination of clinical judgment and data, with approaches differing in how much weight they put on either data or clinician input and in how flexible intervention selection is handled. In the following, we will present different examples of individualized transdiagnostic interventions, ranging from the idiosyncratic case-formulation approach to purely data driven approaches.
In clinical practice, manualized therapies have been criticized by practitioners. A diagnosis does not inform treatment planning sufficiently, and possibly as a consequence, the majority of treatments delivered in practice are not evidence-based (Layard and Clark 2014). Some of these critics raise valid points with manuals oversimplifying complex problems or ignoring important patient characteristics. Furthermore, most manuals do not fit routine care settings in session spacing and frequency, often either prescribing too many or too few sessions to match mental health care realities. In practice, a frequently used method to tailor therapy to the individual is on the basis of clinical case formulation. While clinical case formulation is not a therapeutic approach per se, it is implemented in many manualized treatment protocols at the beginning of therapy or can be applied as a decision basis for integrating components across different protocols. In the following, we will present two approaches where clinical case formulation is central to the therapeutic approach.
Another example of a transdiagnostic case formulation approach with a focus on interpersonal problems is schema therapy (Young 1999) which can be considered a transdiagnostic treatment for various personality disorders (Jacob and Arntz 2013).
Individualized approaches encompass a wide range of treatments, from modular face-to-face and internet-based interventions to case-formulation approaches of evidence-based treatments. Overall, the results on individually tailored therapy are promising and suggest that tailored treatments are more effective than control (waitlist, moderated discussion forum and attention control) and can be equally effective as standardized treatment. While the question remains of whether tailored treatments are actually more effective than standardized treatments, they may offer a better match between patient and treatment program (Berger et al. 2014), have advantages in treating high symptom burden/comorbidity (Johansson et al. 2012), lower treatment costs (Nordgren et al. 2012), and require fewer sessions (Chorpita et al. 2017). They may also lead to a higher satisfaction with treatment on the therapist side (Grawe et al. 1990). 041b061a72