Topic 9: CBT Case Formulation & Treatment Plan {by 11/16}

There are multiple readings on CBT Case Formulation due this week (J. Beck – 2 Chapters & Appendix A; Wright et al. – 1 Chapter; Persons & Tompkins [2006]; Academy of Cognitive Therapy: Candidate Handbook – Appendix D & E).  For this discussion, share at least two main thoughts: (1) Why is a CBT case formulation important for effective therapy (i.e., how does it help clients get “better”)? (2) Why is it necessary to have specific, concrete, and measurable treatment goals whenever possible?  Your original post should be posted by the beginning of class 11/16.  Have your two replies no later than 11/18.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

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42 Comments (+add yours?)

  1. Stephanie Welch
    Nov 13, 2017 @ 04:57:55

    1) A CBT case formulation is important for effective therapy because it allows for the therapist to collect information regarding the patient. Information such as medical problems, family history, and previous psychological history can be useful to the therapist in order to determine treatment for the client. If the client has a family history of mental disorders, it would allow the therapist to educate the client about the biological influence of mental disorder through genes. If the client had previous history of symptoms, then the therapist could inquire about how the client handled the symptoms in the past. This would be useful in determining what treatment methods will work for the client and what might have failed in the past.
    Beck points out that the case formulation guides the therapy. The ideas and conceptualization of the client’s problems start the therapy process. Although the case formulation serves as a starting guide, Beck also points out that it is a dynamic process that changes with the therapy sessions. The client’s problems could change or the client may face a crisis that can cause the reevaluation of the case formulation. However, the care formulation is beneficial to creating a hypothesis about the client’s problems and determining the factors that are maintaining the client’s problems.
    A CBT case formulation helps the client to get “better” by determining the necessary treatment for the client. The information taken in the case formulation allows for the therapist to make a diagnosis about the client. For example, the patient may come for depression but it is determined that he or she should be diagnosed with bipolar disorder. The determination of bipolar disorder affects the treatment plan. The therapist would use a different treatment plan than a treatment plan for major depressive disorder. The client would benefit from a treatment plan that is appropriate and effective for his or her diagnosis.
    For the therapist, case formulation can be a scale on whether the therapist thinks that he or she has the necessary skills for treating the patient. The client could be diagnosed with bipolar disorder but the therapist has no experience in treating bipolar disorder. The therapist can then refer the client to a therapist who specializes in the treatment of bipolar disorder. This helps the client get “better” by being treated by a therapist with the knowledge and expertise involved in his or her diagnosis.
    The case formulation also allows for the client to give input about treatment in regards to what he or she thinks may help his or her problems. Collaborating with the therapist in the initial intake session allows for collaboration of the therapist and client throughout the treatment process. If the client perceives that the therapeutic relationship is collaborative, the client is more likely to have a better treatment outcome and prevent any relapse. By taking an interest in the client, it allows for the start of a strong therapeutic alliance. The first impression of the client determines whether or not the client will continue with the treatment. The initial intake session allows for the therapist and client to determine whether CBT will work for the client or whether the client should be referred out to someone else. The case formulation process also allows the client and therapist to talk about their expectations for therapy.
    2) It is necessary to have specific, concrete, and measurable treatment goals whenever possible because the treatment goals direct therapy. The treatment goals are the ones that the therapist and client focus the most on. There may be other goals that the client has but therapy needs specific goals in order to reach termination. Specific goals are important because CBT treatment is time limited. Focusing on too many goals will overwhelm the client. It is better to have a few specific goals to tackle instead of trying to do too much or too little.
    Concrete goals allows for the the therapist and client to define the goals. If the client and therapist know what the goals are, then the therapy can go smoother. The strong therapeutic alliance necessary for successful therapy can never be forged if the client keeps personal goals to himself or herself. Measurable treatment goals allows for the therapist and client to determine the progression of the therapy. CBT is based on empiricism and gathering data plays an important role in determining whether or not treatment is working for the client. Research has determined that certain treatment is effective for certain mental disorders. For example, behavioral activation for depression and exposure therapy for anxiety.

    Reply

    • Luke Gustavson
      Nov 16, 2017 @ 12:34:13

      Hello Stephanie,

      I’ve found that case formulations seem to be less about choosing the correct therapeutic intervention and more about ensuring the choices made with regard to the client are accurate and in accord with the way in which a client experiences a certain problem. For instance, two different clients are experiencing depression. This is note on their case formulation. However, the mechanisms and precipitants (and even the individual problems, despite the presence of any common themes) these two clients are experiencing can be glaringly different and require different techniques, questions, and rapport-building strategies. Without a strong case formulation for either of these individuals the treatment could look quite similar and be entirely inappropriate for one (or both) of the clients.

      Your characterization of Beck’s comments appear to hold what I believe to be the bulk of the truth regarding case formulations: they guide psychotherapy. The client gets better because not only is the correct treatment chosen but because there is a framework ensuring the correct treatment is matched to the appropriate problem or mechanism. They also guide psychotherapy through a slightly more holistic approach, allowing a psychotherapist to apply the diasthesis-stress model to a number of problems in order to better understand where these problems come from and why.

      Reply

      • Lindsey
        Nov 18, 2017 @ 08:57:30

        Hi Luke, I agree that case formulations are less about being rigid and right but more so a tool therapists use to condense multifaceted factors regarding a client. Organizing and structuring this information in a way that cross-communicates to the client and to potentially other therapists helps facilitate insight regarding overlapping effects pertaining to problem-specific environments, medical histories, symptoms, etc., etc. It is important to keep in mind that the case formulation must have clinical utility…. yes it helps narrow the scope of intervention methods… but it offers guidance in a number of other areas for the client as well. For instance, a CBT therapist won’t aim to get the client out of poverty but having this situational awareness might prompt the therapist to provide the client with additional resources to enhance this aspect of life.

        Reply

    • Chiara Nottie
      Nov 17, 2017 @ 12:32:25

      Hey Stephanie,
      I think an important factor to a case formulation, that you mentioned, is the chance it gives the client to offer feedback. I can see how creating a case formulation, and treatment plan can shift power to the therapist. However, the allowance a client has to comment on the case formulation and treatment plan can restore the power balance between the therapist and client. After all, each party has their strength, the therapist has their professional knowledge, while the client has personal knowledge about themselves, and their environment. If a therapist thinks a certain approach towards treatment would be beneficial but the client believes it is impossible to achieve, it would be meaningful to know this.

      Reply

    • Alana Kearney
      Nov 18, 2017 @ 10:40:07

      Hey Stephanie,
      I liked that you emphasized the importance of the collaborative relationship when constructing a case formulation. This relationship is a huge part of therapy that we have discussed in most, if not all, classes we’ve had so far so I believe it is beneficial to remind ourselves of this important feature whenever possible. Although the counselor/therapist creates this case formulation, he/she would not be able to do so without the guidance of the client. The client ultimately determines what he/she wants to accomplish through therapy, so when choosing a path of treatment, it is important to include the opinions of both the therapist and client.

      Reply

  2. Venessa Wiafe
    Nov 14, 2017 @ 16:38:47

    1. A CBT case formulation is essential to a client’s treatment plan because it is able to commence the process towards treatment by collecting vital factors of a client, such as symptoms and diagnoses, which are used to understand the client’s needs. It is an organized procedure and it breaks down all of the vital factors of the client by pinpointing everything that is important to the client’s recovery, which guides the client towards treatment. Once the client and therapist is able to figure out everything that is occurring in the client’s life, which are the driving forces of his symptoms and negative events, the therapist will be able to acknowledge what needs to be taken into consideration about the client. This then leads to establishing interventions that can be utilized for the client’s needs. The client’s needs can be complex, so it is vital to break it all down, so that none of his needs will be shunned.Therapists can alter initial ideas and plans to make sure that they can be tailored to and suitable for the client, which will help him improve and get better. This assists the client by allowing him to not only work collaboratively with the therapist, but also have a sense of autonomy over his needs and his treatment. This enables the client to be capable of improving in the best way possible. The case formulation is based off of the client, moves in his pace, and helps make everything he desires for happens within therapy. most importantly, during treatment.

    2. In order to help a client move towards living a more adaptive and healthier life, a well-organized strategy must be devised based on the client’s needs that were disclosed in therapy during the case formulation process. The treatment plan must be tailored to the client’s needs, so treatment must target all of the negative factors in his life. The goals that the client states he wants to achieve by the end of therapy are vital. They must be used as a foundation for therapy to accomplish all the changes the client wants to see in his life. Goals also allow the client to remain positive and confident in himself and his ability to overcome his challenges. When the goals are set in stone and concrete, it can also motivate the client to improve his performance in therapy. The goals should not be beyond the client’s understanding and ability, so that the client will not feel discouraged and overwhelmed. Treatment also should align with the client by being appropriate and effective enough to help the client recover and not relapse. CBT is a rather short form of therapy, so making sure goals can be achieved by the end of therapy is vital to keep in mind. The client and therapist should move at a moderate pace that allows, so that all plans can be accomplished. Even though the therapist is a guide for the client in therapy, the should be the one stating his own personal goals, which will furthermore guide the therapist in how each session should run, in order to achieve the goals as each week of sessions goes by. All in all, when goals are concrete, specific, and measurable, the client can have something to work towards, knowing that it will have an optimistic impact on his life. Goals, along with the initial case formulation works hand in hand in therapy towards treatment for the client.

    Reply

    • Luke Gustavson
      Nov 16, 2017 @ 12:55:32

      Hello Vanessa,

      You make many good points, but there is one in particular that I want to point out. It looks like you said that case formulations allow the therapist to consider all of the client’s needs so they will all be met. I believe there is an issue here that many other posters have grazed up against, notably that CBT is a time-restricted therapy. Accordingly, I believe case formulations are not to look at every need or problem but to ensure that only the most pressing or significant problems are examined. Thus, case formulations may also function as a form of triage, whereby the worst problems are taken first with the least of them taken last if at all. Prioritizing what to work on is an important facet of utilizing a case formulation within the boundaries of CBT.

      Reply

  3. Olivia Grella
    Nov 15, 2017 @ 07:54:00

    A CBT case formulation is important for multiple reasons. It’s the way to gather a lot of information about the client in multiple different domains. All this information is very important to the treatment process because it helps the therapist get a more holistic view of the client. In this formulation, the therapist finds out about the presenting complaints the client has and why they are choosing (or sometimes being told) to go to therapy. They also formulate a list of problem areas that the client wishes to work on. This makes the process collaborative. While the therapist if picking up on some things that may be issues, the client is able to also communicate these concerns and emphasize which are causing them more distress or which are the ones they really want to work on. Also, a case formulation includes information about any previous therapy a client may have done. Knowing whether a client has entered therapy and how successful that was is very informative for the therapist. For example, if a client started therapy but terminated it short after, understanding why that happened is important for the relationship that the client and their new therapist is forming. This way any difficulties can be addressed to help the client stay in therapy longer this time. A CBT case formulation also includes any medical issues that may be relevant or cause a problem. The book mentioned how it’s possible that some medical illnesses have psychological effects. Therefore, getting a medical exam first and inquiring about any medical issues they may have had in the past is important to having a proper diagnosis. Also, including information about family history and information about their environment/where they live is also important to understanding the client as a person and what other influences may be impacting how they are feeling now. Basically, this whole document comes together as a very informative piece of information that includes a lot of background information that leads to a diagnosis and formulation of a treatment plan. I remember that during my undergrad at Eastern I had to write a case formulation about a fake client and make diagnoses, treatment goals, a treatment plan, and then follow through with other reports about assessment data and how they did in therapy (I just made up the information based on the info I had about them because it wasn’t a real person). I bring this up because I remember that my professor said that by the time you reach the very end of the formulation, everything should flow together and make sense. Therefore, the information presented before the diagnosis and goals needs to make sense so by the time someone gets to the end they are not questioning why you decided what you decided.

    That whole case I did at Eastern also made it easy for me to understand why specific, concrete, and measurable treatment goals are very important. Goals that are described in these ways allows the client to know what behavior is being targeted, if they want to increase or decrease (depending on if it’s a positive behavior they want to see more of or a negative behavior they want to reduce) that behavior, a time frame this will happen in, and a specific way that it will be measured. For example, a treatment goal for a client with an alcohol problem should not just be “I want to drink less” because that’s not objective and it’s not clear what “less” actually means. Instead, it could be that they are going to reduce alcohol use from X times a week to X times week (and define what constitutes a “drink”) with no more than X drinks in one day, for a period of X weeks. Although not the best example, it shows that it’s more specific because the client knows what they are changing, how they are going to do it, and in what amount of time, but also they know and the therapist knows how their progress on the goal will be measured. They would set up a way to record their drinking patterns once this started, but they would still be able to track the progress on the goal. For these reasons, having goals like this are very straightforward to the client and they typically come up with them together, but they also allow a way to know what progress is being made within therapy.

    Reply

    • Sarah Hine
      Nov 18, 2017 @ 08:07:01

      Olivia,
      You raise the point that therapy should flow and make sense in order to be effective. I think this is an important concept to understand while writing case formulations and is consistent with Beck’s approach to CBT. It suggests that as therapists we need to focus on not only the details, but on creating a bigger picture that connects all the important aspects of a client’s case. While reading and hearing the details of each client, it will be important to keep in mind the relevance of the information and the purpose it may serve in therapy. I think even the process of making sense out of a jumble of information could be beneficial for some clients, creating a helpful map for identifying sources of a problem and the path to potential solutions. When a client can understand the purpose of therapy and how it is related to helping his or her specific situation, he or she will be more likely to feel motivated and become engaged.

      Reply

    • Alana Kearney
      Nov 18, 2017 @ 10:43:14

      Hi Olivia,
      I think it’s great that your undergrad class prepared you well to understand case formulations. What your professor said about the formulations creating a flow for therapy is very comforting. Going into therapy for the clients can be very overwhelming because they may not know what to expect and may see no possible positive outcomes. After getting to know the therapist and understanding that the therapist does in fact have a plan of action, the clients can feel more secure in the benefits of therapy. It also allows them to guide therapy and see evidence of success.

      Reply

    • Matthew Collin
      Nov 18, 2017 @ 13:15:14

      Olivia,
      I also agree that a case formulation is a great way to conduct effective therapy, and how it should all come together to make cohesive sense of the client’s problem. I find that case formulations are the first step therapists can do to at least act like they “have their crap together”. It’s important to have it make sense, and to have an analytical conceptualization of the problem before coming up with arbitrary treatment goals. The goals should be attainable, and sometimes if a therapist does not have a holistic view of what’s going on, then they may be chasing after goals that may not be attainable for that particular client. An example of this would be children who have fairly restrictive environments because they are particularly dependent.

      Reply

  4. shay
    Nov 15, 2017 @ 11:05:47

    Case formulation is important again for reasons of structure, and having goals in mind. It’s a reminder of what needs to be accomplished. Case conceptualization is important because it unifies all components and contributing factors of a problem/ psychopathology and also synthesizes the important information. It is both a cross-sectional and longitudinal analysis. It consists of diagnosis and symptoms, contributions of childhood experiences, situational and interpersonal issues, biological factors, strengths and assets, typical patterns of automatic thoughts, emotions and behaviors and understanding schemas. The case formulation involves creating a working hypothesis blending all treatment information to make therapy more directive. This in itself is helpful to a client. Using CBT skills to formulate or create almost a profile for your client, can help the therapist come to understand the client all the more better, and therefore treat the client more appropriately and effectively. The case formulation is also good for psychoeducation because it’s an entryway into viewing how thoughts, emotions and behaviors interact and perpetuate one another. Again case formulation is also helpful for structure. The client is directly influenced by the therapist. So the therapist being structured, cognizant of the process and having a flow to therapy can only benefit the client. Wright points out that it may be helpful for clients who are already overwhelmed and stressed as is, to become latched on to something purposeful that was deliberately constructed to inflict change. She points out that structuring methods begins with goal formulation and agenda setting. These provide a direction for change. It also helps client to maybe take things in stride, and focus on only a few things at a time. Focusing on the key problems, may help alleviate a lot of other pain. In other words having clients pinpoint a few areas they would like to work on may serve as a way to calm their minds, and establish direction, purpose and hopefulness.
    Apart from that case formulation is a collaborative process. Pedasky calls this the shoulder-to-shoulder conceptualization. This means case formulation is a shared process that client and therapist can do together. We’ve talked in the past that collaborative in therapy and collaborative empiricism produces good therapeutic results. Doing a case formulation together can strengthen that therapeutic alliance, and also set the scene that the client is going to be an active participant in therapy as well. There is also some evidence that doing case formulation together leads to success in therapy (Person).

    It is helpful to have specific goals so that the goals can be measurable. If not specific the therapist and client alike cannot be sure how to measure the goal. Also if the goal is not specific, you really won’t know when you reached it. For example if I had the goal to lose weight I could not stop there. I would have to attach a numeric value to it ( ie 10 pounds, 15 pounds etc). Or else I would not be entirely sure when I reached my goal. If my goal was simply to lose weight, I could technically have accomplished my goal after one pound, though I’m sure that wouldn’t warrant the sense of accomplishment or efficacy desired. Too vague of goals are not going to be easy to determine or measure. These ideas both related to having concrete ideas as well, because non-concrete ideas are also not measurable. I also think that having specific and concrete goals can kind of minimize an overwhelming amount of goals. Having specific, measurable and concrete goals keeps goal-setting realistic. When there are no limitations to goal setting that is when goals can get outlandish ,more implausible and focused on more sub-components to stress (ie money). I think keeping these goals realistic can help the client to focus on the most important issues at hand.

    Reply

    • Lindsey
      Nov 18, 2017 @ 08:50:12

      Hi Shay, I appreciate your commentary regarding ‘shoulder-to-shoulder’ case formulation and time-limited treatment. Without specific measurable goals, the therapist is doing a disservice to the client. CBT prides itself on being an evidence based time-limited therapeutic orientation.I would argue the lack of measurable goals means the therapist is not performing cognitive-behavioral therapy. Specific goals must have clinical utility: to raise awareness and increase accountability for the client. Without those functions, the client is less likely to achieve optimal outcomes.

      Reply

    • Matthew Collin
      Nov 18, 2017 @ 13:21:37

      Hi Shay,
      I totally agree that setting concrete goals can be a great way of formulate and rule out any goals that are unattainable do to the limitations of pragmatism in the world we live in. Sometimes things just can’t happen, and people cannot attain anything they want – even if they work hard. A great example of this is when we discussed alternative automatic thoughts or core beliefs. If a depressed person has a core belief of he/she is worthless, an unattainable and unpragmatic alternative core belief would be “I am valued by everyone”.

      Reply

    • Liisa Biltcliffe
      Nov 18, 2017 @ 15:44:51

      Shay,
      I really liked how you defined goals and used the example of losing weight needing a specific numeric goal, that in therapy clients and therapist need to set up goals together in order to know when a goal has been reached. Really insightful and well put. It’s like something that people know on some level but don’t really articulate very well and you did a great job articulating it.

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  5. Luke Dery
    Nov 15, 2017 @ 22:11:41

    1) A Case Formulation is important for effective therapy because it serves as a roadmap for treatment of the client. It also provides a summary of information that depicts the client and can give the therapist a better understanding of who the client is and what he or she needs. Since clients often present with multiple needs or problems, the CBT case formulation is essential to help gather the information gathered about the client, and to organize and prioritize treatment. All of the information collected in a case formulation is an essential part of setting up the collaborative work of CBT therapy. A CBT case formulation captures a breadth of topics, such as the client’s symptoms and eventual diagnosis, formative influences and childhood experiences that may play a role in their current distress, situational and interpersonal issues, genetic and medical factors, strengths and assets, patterns of thought, emotions, and behaviors, and underlying schemas. All of this information is used to create a working hypothesis that will direct treatment during the length of therapy. It is important to understand that this hypothesis will be tested and possibly modified throughout treatment. The therapist’s theories about the client may be proven wrong and roadblocks may appear in treatment, both of which will call for modifications to be made to the plan of treatment. The case formulation at the start of therapy will most likely be very sparse in information compared to later in therapy due to the fact that new information and approaches may present themselves. The case formulation later in therapy will typically be more detailed regarding each intervention used and roadblocks encountered. The case formulation is essential to helping clients get “better” because it allows the therapist to have a recorded, organized method to plan and track therapy, and to make adjustments throughout the process.

    2) Since CBT therapy is a collaborative experiment, the qualities of being specific, concrete, and measurable apply to the treatment goals that are set. Goals must be specific, meaning that they are clearly defined with great detail. It is not enough for a therapist and client to work to “reduce anxiety.” Instead they have to clearly define what level of anxiety is considered the completion point, possibly using assessments as a means of putting thoughts/feelings into numbers. Interventions must also be specific. Simply stating “exposure” as an intervention says nothing about the level, intensity, and nature of the task. Detail must be given to describe interventions that are being planned, especially for the sake of the client’s safety. Goals must be concrete in that they are able to be physically planned and attained. Behavioral interventions especially should be trackable and doable. Often much of therapy can be abstract, but interventions and activities should be involved and visible, whether this is through actual behaviors or recording on worksheets. Finally, goals should be measurable in that progress can be observed and tracked over the course of therapy. Seeing their progress from session to session can be motivating and empowering to clients. It also gives them hope in the therapy itself by giving them indication that their work is paying dividends. Measurable goals also allow the therapist to notice roadblocks or stagnancy in therapy so that modifications can be made. Interventions should aim to be recordable so that they can be measured to one another as the client progresses. If progress on a goal cannot be measured, the therapist and client will never know if they’ve reached it, which can lead to therapy that becomes potentially harmful or non-beneficial to the client.

    Reply

    • Venessa Wiafe
      Nov 16, 2017 @ 18:38:14

      Hey Luke,

      I really like how you described the case formulation process as being a roadmap for treatment. Upon the initial intake, so much is disclosed from the client, and it can include everything from symptoms to even goals that they want to accomplish by the end of therapy. The case formalization adds organization to all the important factors that need to be covered and focused on. It also keeps both the therapist and client on the same page, allowing some time for modification as the case formulation does spread over a few weeks. Without this process, I believe this short term form of therapy would be all over the place and the therapist may run out of time to make sure all important elements, such as treatment for the client, are covered.

      Reply

  6. Noella Teylan-Cashman
    Nov 16, 2017 @ 01:13:36

    Proper case formulation is a key component in effective therapy because it 1) enables clinicians to gain a comprehensive understanding of their clients, 2) allows clients to actively and collaboratively participate in treatment, and 3) helps to prioritize areas of concern. It is important to note that the process of case formulation is continuous; it typically spans the entire length of therapy. At the beginning of therapy, the case formulation should be detailed enough to provide direction for treatment, but should never be considered as “absolute.” As the therapeutic process advances, more details about the client and the factors that contribute to his/her distress are revealed. Because of this, clinicians and clients are constantly adding new information into the case formulation and adjusting the treatment plan accordingly. In sum, case formulations allow clinicians to combine the important information from a client’s past and present to pinpoint areas that are intensifying the distress experienced by the client. By doing this, clinicians can also help clients take preventative measures to avoid any future problems.

    It is necessary for treatment goals to be specific and measurable so that the clinician and client are able to tell if a certain intervention is effective or ineffective. The specificity of the goal helps the clinician and client both understand the area of concern and the desired outcome; it ensures that they are on the same page with a mutual understanding of the goal. The measurability of the goal allows clinicians to track client progress towards the goal—they are able to see if the interventions being implemented in treatment are effective towards reaching the desired result. If the current interventions are seen to be ineffective, it signals to the clinician that a different approach is needed and allows them to adjust treatment modalities. Setting specific and measurable goals provides the best chance for treatment success.

    Reply

    • Venessa Wiafe
      Nov 16, 2017 @ 18:54:49

      Hi Noella,

      I like how you stated that the case formulation helps develop a specific treatment plan, but aren’t actually “absolute”. It is salient to consider the fact that case formulations can alter as sessions go by. Just one factor stated by the client can be the reason why modifications have to occur in a case formulation. The client may also reveal new information that is pertinent in regards to treatment and that may have to navigate goals and interventions in a new and different direction. It is vital to realize that the case formulation is not exactly set in stone and that omitting and adding specific, vital information is not prohibited, as it is going to work in the client’s best interest.

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    • Olivia Grella
      Nov 17, 2017 @ 07:55:14

      Hi Noella, I like how when describing treatment goals, you included how this is something that the therapist and client work on together. A part of having effective treatment goals is that the therapist and client both agree on these goals and that the client knows why these goals are being pursued over others maybe. Also, if these goals are not working like they originally thought (something you also mentioned in your post), the therapist and client will revise them together. This way now both of them can see progress towards the goals being made, in a way that works better for the client.

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    • Chiara Nottie
      Nov 17, 2017 @ 12:37:46

      Hey Noella,
      Your understanding of why measurable goals are important, is perfect! Subjective descriptions cannot help a client and therapist reach desired goals. Subjectivity cannot even establish goals well. An objective measurable goal allows the client and therapist to have desired accomplishments set in place, with ways to reach them. Objective measurable goals, as you said also helps with evaluation of progress. A client can alert a therapist about challenges they experience when trying to perform a set goal. A client can also make a therapist aware if a goal is no longer relevant, or mastered. Likewise, a therapist has a way of measuring progress concretely, which makes for clear explanations to a client about troubled areas.

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    • shay
      Nov 18, 2017 @ 12:55:32

      Hey Noella,

      I liked that you pointed out that case formulation isn’t to be considered completely finished the first time it’s drafted. You’re right it should never be considered absolute. Case formulations are to subject to editing as the client and therapist see fit. If the therapist notices something different about the client maybe including a new insight, a change in affect, or a new contributing factors that are revealed at a later date the therapist may decide to make a edit to the case formulation. Truth be told within the first one or two meetings with the client, there is no way possible to be in total and complete understanding of a client or to have every essential piece of information. A case formulation is as dynamic as the client itself. it may be rewritten and revised many times, and that is okay. Of course it is important that it reflects what is best and most productive for the client’s treatment plan and goals.

      ,

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  7. Sarah Hine
    Nov 16, 2017 @ 07:39:18

    1. Having a case formulation is important for effective therapy because it addresses clients’ individual needs and provides a helpful guide for treatment planning. A case formulation in CBT provides information about clients’ history, symptoms, their thoughts, behaviors, emotions, and strengths. A developed, complete understanding of clients’ individual symptoms and problems can help a therapist form a “hypothesis” for the driving force behind behaviors and can help form effective strategies for reducing symptoms and addressing problems. Therapists who are aware of their clients’ individual needs will develop better therapeutic relationships and will be more likely to address relevant problems in therapy, which will be more likely to lead to better outcomes for clients. Therapists can use case formulations to create effective treatment planning based on their clients’ needs. A treatment plan will help therapists plan sessions and determine the general course of therapy. A treatment plan can give therapists a general outline for therapy with individual clients, noting what to address and when to address it. Number of sessions needed, goals, and effective techniques can be determined based on the assessment of the client. Therapists will have difficulty staying on track within sessions if they have limited knowledge of the case or choose to focus on problems irrelevant to their clients’ main concerns. Through case formulation, therapists determine what problems are appropriate and helpful, and what will be most beneficial to the overall treatment of their client. Certain areas may need to be addressed before the client can make progress in other areas, so therapists must keep this in mind when planning therapy. Therapists who prioritize and who are focused during sessions will have a better chance of providing effective therapy to their clients and addressing concerns in a way that makes sense for the client. Treatment plans can be modified as sessions progress, ensuring that therapy is effective. Reevaluation and revision of treatment plans and goals ensures that therapy is continuing to address the clients’ needs.
    2. Treatment goals that are specific, concrete, and measurable are helpful for therapists and their clients in ensuring effective therapy. Specific goals will allow clients and therapists to strategize practical ways to meet these goals outside of therapy. Therapists who clearly define goals for clients ensure that their clients are involved in the therapeutic process and ensure that they are both on the same page. If goals are specific and concrete, clients will understand what they are working toward and when they achieve a certain goal. Clients will feel motivated and invested in therapy if they feel they understand their goals and know when they have achieved them. Goals that are measurable also give therapists and clients specific data to observe and discuss during therapy. Measurable goals allow for progress in specific areas to be observed over time. If this measured progress shows that clients are not meeting goals, therapists can alter therapy in order to ensure therapy is effective. When a client is able to see the progress of their goals, they may feel motivated or encouraged to continue or to set new goals.

    Reply

    • Noella Teylan-Cashman
      Nov 18, 2017 @ 15:14:06

      Sarah,

      Your mention of therapists forming a “hypothesis” from case formulations sparked a few thoughts for me. What came to mind was something mentioned in Dr. Weagraff’s ethics class on Thursday—about a “fact witness” vs. an “expert witness.” In my mind, it seems like the case formulation itself could be considered as a “fact witness” in the case of a client because it simply states objective facts, without making any inferences. On the other hand, the therapist could be considered the “expert witness” because he/she uses his/her professional expertise to draw hypotheses about the client’s distress, based off the facts presented in the case formulation. With that being said, it becomes obvious that there is some subjectivity that follows the case formulation; therapists need to use their “professional judgement” about how to proceed with therapy. The case formulation may lay out the important facts, but it does not tell you what those facts mean in relation to client functioning, and does not tell you what to do next.

      (Side note: not sure if that comparison of the fact witness vs. expert witness was a little too abstract, but it made sense in my head!)

      Reply

    • Liisa Biltcliffe
      Nov 18, 2017 @ 15:50:57

      Sarah,
      It was great how you emphasized the malleability of the case formulation even before we talked about it in class, and the need to be flexible for clients so that as clients progress, if something changes, the therapist can also adjust the case formulation and goals as well. I think that oftentimes people think that once something has been written up, that’s it and it cannot or does not get adjusted. This isn’t the case here.

      Reply

  8. Matthew Collin
    Nov 16, 2017 @ 10:37:04

    1. CBT case formulation helps a client get “better”, because it is the very carefully thought out hypothesis that becomes the basis for a patient’s intervention – it allows for the clinician to have the best possible guess at what the client’s actual problem is, therefore, becomes the best information to base treatment on. It also allows for them to get a full picture of who the client is and the information that’s relevant to his/her current problem. The case formulation should be a conjunction of the client’s presenting problem, reliable, valid, assessments, and other details that are relevant to what may be causing the client’s distress. This is in order to provide supporting evidence for the therapist’s formulation. The formulation provides an effective and holistic framework in order to find the best intervention to attack some of the problems the client is experiencing.
    The case formulation process happens as soon as you come in first contact with a client – not the first session. Although a lot of information is collected in the first session, a therapist should start thinking and conceptualizing a client before he/she meets the client for the first time. This could provide the therapist with better ways to interact with a client. The case formulation is also a great way to start the therapeutic process of creating a collaborative relationship between therapist and client. Since the therapist needs to gather as much information as he/she feels relevant to the client’s case, it allows for the validation of the client’s feelings, and making them feel like he/she is heard. It can create a collaborative experience for the client, because for the most part, he/she should be providing all of the information needed for the case formulation.
    2. it’s important to have measurable treatment goals because they become an objective measure of progress. If a client has a goal of “feeling better” it provides no measure of how a clinician is supposed to know if a client is really feeling better, or if the therapist’s treatment is actually working. Measurable goals also create effective therapy because if a therapist can measure progress, it’s easy to assess with the client what is working about therapy, and what isn’t. If therapy isn’t working towards the measureable goal the client put out for themselves, something needs to change in therapy. Why continue to do the same thing that isn’t working towards his/her goals? The treatment plan is not a set-in-stone document, but an open letter that should be reassessed and evaluated if a client is not responding to the current treatment.
    Measureable goals also may give the client some sort of motivation. If clients’ see their depression scores go down by 2 to 3 points (assuming Beck Depression Inventory), if may give them even more motivation to do the things they learned in therapy to continue to lower those scores. There is something tactile, and motivational about seeing progress, rather than just feeling it. Having measureable goals can get people more involved in their therapy.

    Reply

    • Sarah Hine
      Nov 18, 2017 @ 08:19:16

      Matt,
      You bring up two good points that I think are important for therapists to keep in mind. The first is using the process of case formulation as a means for building a collaborative relationship between the client and the therapist. Because this happens in the beginning of therapy, therapists set a collaborative tone for the rest of therapy and convey to their clients that their input is valid and important. Clients may also feel more engaged from the start of therapy if they understand that their feelings and thoughts are heard and necessary. The second point you make is the importance of having tangible goals to increase clients’ motivation. When clients are able to see clear progress they have made, they will be encouraged to continue in working in therapy. If goals are unclear or unidentified, a client may be left wondering whether or not therapy is working and will have difficulty feeling motivated to continue.

      Reply

    • shay
      Nov 18, 2017 @ 13:02:52

      Matt,

      I liked your comments about having measurable goals. I think if you can measure a goal, not does it provide a means to know when you’ve accomplished it, but it can also indicate a level of realism and feasibility. Obviously when making goals with a client, a therapist should be hopeful, but realistic. It is possible that goals can be too hopeful or too far-fetched. I think tracking progress and looking at the journey to accomplish a goal can be indicative of possible changes that need to be made along the way. If a client is really trying hard to accomplish a goal, but for whatever reason they cant accomplish it, it may be appropriate to have a conversation about modifying the goal so that they can be successful. This will involve some clinical judgement of course, and having a good relationship with the client. That’s why when making goals it is also important to look at potential obstacles as well to kind of prepare for that.

      Reply

  9. Luke Gustavson
    Nov 16, 2017 @ 11:23:46

    1.
    Boiled down to its most basic function, a CB case formulation exists to guide therapy according to a set of hypotheses about the client and their problems. The psychotherapist utilizes the case formulation to plan interventions and chart the overall course of both individual sessions and therapy as a whole. Through descriptions of the problems, the mechanisms of the problem, and the precipitants of the problem, the therapist is able to choose what area to focus on. Not only does case formulation allow them to change the focus of therapy, it allows the psychotherapist to see the reciprocally determinant and interconnected nature of the client’s problems, mechanisms, and precipitants.

    I view CB case formulations as blueprints or an architect’s sketch. A blueprint does not, typically, dictate the color of the walls, or the materials used for wainscotting, or the choices of lighting. Rather, a blueprint dictates the overall framing and layout of the house. Smaller details are typically added later, and the entire thing can be scrapped and sketched again if needed. The case formulation operates in a similar manner: it simply creates a framework to build upon with psychotherapy. It is (or ought to be) regularly revisited and revised throughout the process of therapy, ideally as new information is uncovered or goals are met.

    It is certainly possible to build a house without it being sketched out and planned. It might even turn out well, though this is more likely a function of chance and experience than anything else. It is most likely that the house is crooked, or there is a space unaccounted for, a wall where it should not be, and a chimney in the bathroom. Case formulations are the same way: it is possible to conduct psychotherapy without a case formulation, only it is likely to be chaotic, incomplete, require reconstruction at a later date.

    A case formulation ensures that therapy is being built to the specifications laid out in the hypotheses generated by the psychotherapist. These hypotheses are constructed with the problems a client has, the mechanisms driving these problems, and the precipitating events that may have led to the problem or the mechanism. This ensures psychotherapy is not a guessing game of “where do I put this wall?” Instead, the client and their problem is laid out in a diagram or paragraph format to ensure that the psychotherapist is tackling the correct problems in an expedient and accurate manner. A client will not “get better” simply because a case formulation exists, but it will increase the chances of the psychotherapist being right the first time through, decreasing the amount of time in therapy and increasing the client’s chances of success in treatment.

    2.
    I just want to be happy. I don’t want to feel bad anymore. I don’t want to be anxious or depressed anymore. These sound like great goals, yes? Very few people want the opposite of these things, but how does a psychotherapist help a person “be happy”? The issue is that these goals are vague and complex. Get a group of people to define “happiness” and it is likely they will generate many different answers. Which one is right? How do you measure “happy”? With a ruler, perhaps? Maybe with a “Total Happiness Index.”

    The biggest problem with vague goals is that they are difficult for psychotherapists to target and typically too complex for successes to be eked out of them. Being “happy” is a tall order, and one that is likely to decrease a client’s self-efficacy if it is not reached – and given how vague it is this is all too likely to occur. A depressed client may then become more depressed as they have been unsuccessful at reaching their goal.

    However, “happy” can be altered to be useful. For instance, it can become a number of more specific, concrete, measurable goals, like “spend more time with my friends,” “go hiking more often,” and “go on regular dates with my partner.” These goals may seem obvious to a clinician-in-training, but that is the point of them: they are obvious, or concrete. They are specific: hiking instead of “pleasurable activities.” Finally, they are measurable: how much time has the client spent with their friends this week and how does that compare to last week? How has the client’s BDI score changed since last week and the week before that?

    Specific, concrete goals are more easily attainable, meaning a client experiences more successes in therapy, raising their self-efficacy and, ideally, mood. These goals are also easier to work toward as they set the groundwork for what is to be done and how, removing the guesswork. This also hearkens back to the importance of case formulations, as the goals are likely informed by the material contained within the formulation.

    Overall, this ties in nicely with the blueprint analogy. As goals are related to an individual’s problems, they can be considered the “finishing touches” of the plans. Goals are the details of the rooms: the color of the paint, the type of floor, the location of the door. Once a room is complete, there is a sense of completion and success that brings the homeowner to the next room. Eventually, the house is complete – or is it? There may be something that was missed or needs adjustment: perhaps a light fixture needs to be added or maybe a room is too big and could function better as two separate rooms. This translates to therapy well: completing a client’s goals brings the psychotherapist and client closer to termination of therapy and ideally better functioning, but this does not mean their time in therapy is completely over. They might need to return to fix a room they thought looked good at first.

    Reply

    • Luke Dery
      Nov 17, 2017 @ 21:06:26

      Luke,

      I liked your point about the holistic view presented by the case formulation allowing the therapist to see the connections between different aspects of the client’s presenting factors. In my own experience, important points often come to light when I gather information together and analyze it in front of me. People’s life are so complex and disorganized, it is important for a therapist to find ways to efficiently collect and decipher the most important information. Especially when treatment is time-sensitive, there is extra pressure to quickly discover the main problem and begin to work on it. A case formulation is a tool that allows therapists to do this in as timely a manner as possible.

      Reply

  10. Chiara Nottie
    Nov 16, 2017 @ 11:25:11

    A CBT case formulation is important for effective therapy in several ways. First of all, it helps to establish a treatment plan. A treatment plan is very significant for therapeutic success because it is a plan of action about how to approach a client’s distress (Beck, 2011). A case formulation also importantly provides a diagnosis (Beck, 2011). A diagnosis is necessary for a client to get “better” because it can determine a likely amount of sessions needed for progress. The amount of sessions can assist in creating a treatment plan by determining when to implement certain techniques, and when to expect particular improvements. Typically, CBT sessions are broken into phases from beginning, middle, to end. As a therapist enters each phase they can ask themselves important questions, such as, “how much progress have we made”, “do objective scores match the patient’s subjective description”, or “how did this week go compared to previous weeks” (Beck, 2011). If improvements are not met, by a certain time within the amount of allotted sessions, it can help with reevaluating a client’s prognosis. If a patient is not improving like a therapist predicts, then it is a chance for the therapist to gather more data, review treatment options, change the focus in a session, and modify standard treatment for specific disorders (Beck, 2011). A case formulation is very relevant to that last point mentioned. Every patient is different, no matter their disorder, and a case formulation can help a therapist justify deviating from standard treatments to fit a patient’s individual needs. A diagnosis also welcomes psychoeducation, which is particularly empowering and insightful for a client. Psychoeducation generally helps a client get “better”. If a client understands what they have been diagnosed with, it can help them feel less victimized (more normal), and able to manage their symptoms between sessions. Related to managing oneself between therapy sessions, a case formulation and treatment plan can help determine the best in session therapy techniques as well as out of session homework assignments.
    It is necessary to have specific, concrete, and measurable treatment goals whenever possible. A therapist needs specific measurable treatment goals to provide them with a baseline to compare a patient’s improvement or decline during the therapy process. Concrete goals are necessary because they are objective, and not subjective. This means, no matter what a patient describes as their subjective experience, which can vary in meaning between patient to patient, a therapist has an objective measurement they can use with anyone to gauge progress. Treatment goals also help determine a timeline for a therapist and patient. CBT therapy is not expected to be lifelong in duration, so concrete measurable goals helps a therapist determine how close they are to termination (success). If a therapist and patient feel like they have not made enough progress by a particular time, then more data can be gathered and compared to measurable treatment goals, in order to find where adjustments to treatment can be made. Lastly, CBT uses standardized worksheets to help a patient get “better” (Wright, 2006). In order for worksheets to be standardized, they need to be based on concrete, measurable, data. These worksheets are the means in which a therapist works with a patient during sessions, and between sessions, with specifically selected homework assignments.

    Reply

    • Olivia Grella
      Nov 17, 2017 @ 08:01:54

      Hi Chiara, I like how you touched upon how case formulations are specific to every client and not just general in nature. Although two clients may both come in with the same diagnosis, they have different background factors such as where they live, their relationship with their family, how they perceive this disorder is impacting them, and other differences along these lines. Because of this, it is important to make case formulations that are client specific so that when you read them it doesn’t just sound like you are talking about anyone who may have a certain disorder.

      Reply

  11. Alana Kearney
    Nov 16, 2017 @ 12:04:56

    Case formulation is important for quality therapy because it establishes a structure for intervention in treating problem behaviors and/or symptoms. It provides necessary and relevant information about the client’s psychiatric and medical history that relates to his/her presenting symptoms and/or diagnoses. This information is useful for the therapist to be able to understand the origins of these problematic symptoms and helps in creating a working hypothesis for directing therapy. The therapist considers this personal information when trying to understand the client’s reoccurring themes in thoughts and behaviors that may precipitate any negative symptoms. Case formulations allow therapists to formulate treatment plans in order to properly address certain interventions at the right time in therapy. Through this formulation, therapists can address the client’s strengths that will aid in therapeutic progress. Case formulations allow for a general plan of action in therapy that can help both the therapist and client stay on track in order to get the most out of the limited time the two have together in therapy.
    Throughout therapy, it is necessary to address specific, concrete, and measurable treatment goals that guide the direction of therapy. Since therapy can be limited to a certain amount of sessions, it is important to make every session count. At the beginning of therapy, the client should present the issues that he/she is suffering. The therapist and client should then work together to determine what exactly they want to work on improving in the client’s life. It can be very beneficial for the client to create a checklist of goals so that once they’ve accomplished a goal they can have visible concrete evidence that they are capable of change. Therapy is also a gradual process since a client’s life cannot be changed in just one session. The client should develop measurable goals that can be achieved in steps. Changing thoughts and behaviors will be difficult, but if a client realizes he/she can achieve small goals, then the larger goals will feel more possible. Treatment goals are important to have in order to stay organized and continue striving for change in therapy. As the clients’ behaviors change, so too should their treatment goals.

    Reply

    • Stephanie Welch
      Nov 18, 2017 @ 03:01:31

      Alana,
      I agree with your statement that case formulation provides relevant information for understanding problematic symptoms and creating a working hypothesis for treatment. I think that case formulation can also be useful in understanding the obstacles that the client may face in attempting to change his or her thoughts and behaviors. Also, the section on protective factors for case formulation may be useful in determining what the client already has and can use towards making changes.

      Reply

    • Noella Teylan-Cashman
      Nov 18, 2017 @ 14:54:02

      Alana,
      I like how you briefly mentioned the logistical time frame of treatment interventions in your post; when you said, “case formulations allow therapists to formulate treatment plans in order to properly address certain interventions at the right time in therapy,” it made me think of Dr. V’s lecture on Thursday. In class, Dr. V emphasized the importance of planning out treatment goals in a rational and strategic way, so that they essentially build off each other. In this way, clients are able to build their self-efficacy through the successful completion of smaller tasks/goals (at the beginning of therapy), and can eventually establish enough confidence to attempt some of the more discomforting goals that are integrated into therapy at later stages.

      Reply

  12. Julie Crantz
    Nov 16, 2017 @ 13:11:25

    1) CBT case formulation is a critical component for effective therapy. The case formulation is an important guide the therapist uses for a client’s treatment. It reports a wealth of information, including the precipitants of the client’s problem(s), a cross-sectional view of current cognitions and behaviors, a longitudinal view of cognitions and behaviors, client strengths and assets, and a working hypothesis which is a summary of the conceptualization (Beck, 2011). The therapist uses the case formulation as a road map to develop a client’s treatment plan and to direct interventions used in treatment. The case formulation ties together the facets of a client’s case into a comprehensive account that facilitates a better understanding of the client and how to effectively treat him or her (Persons & Tompkins, 2006). The case formulation emphasizes the client’s problem list and helps to provide clarity for how problems are interconnected and how they are related to the hypothesis. It is important to include the client in the case formulation and gather feedback, which helps to strengthen the therapeutic alliance as well as assists with helping the client adhere to therapy interventions. The case formulation may be modified and expanded as therapy progresses, taking into account new information the therapist has gathered during therapy sessions. The case formulation is an essential element of CBT that a therapist uses to create an effective treatment plan that will help clients feel better and to prevent them from relapsing.

    2) It is essential to have specific and measurable treatment goals in therapy. When treatment goals are clearly defined, this assists the therapist with forming an effective treatment strategy as well as helps with choosing techniques that will be implemented. Using measurable goals helps to establish a baseline of the issues a client is facing and helps to monitor progress throughout therapy. This keeps therapy focused and proceeding in a positive direction. Measurable treatment goals help to demonstrate the effectiveness of treatment methods. They also help to pinpoint when an intervention is not producing the desired result allowing the therapist to make adjustments. Clients may have doubts that treatment is working. Presenting clear and concise measurements of clients’ progress using assessment tools can help clients feel more confident in the therapeutic process. Another important consideration for using measurable treatment goals is they help a therapist to determine when a client has successfully met the goals of therapy and is ready for termination. Communicating concrete results to clients can help facilitate the termination process.

    Reply

    • Stephanie Welch
      Nov 18, 2017 @ 02:53:59

      Julie,
      I liked how you mentioned that measurable goals help when clients have doubts about the treatment working. I agree that the benefit lies in showing the client that there are measurable differences from one week of therapy to the next. I also liked that you mentioned readiness for termination as measurable. It made me think about the ideal number that we as therapist hope to see when our client is nearing termination. It also gives us confidence that the therapy is effective for the client and the client will (hopefully) not need us in the future.

      Reply

  13. Liisa Biltcliffe
    Nov 16, 2017 @ 13:11:56

    1. A CBT case formulation is important for helping clients get better because it helps therapists see the whole picture. For example, therapists need to know more than just a client’s diagnosis to help him or her get better. If a client suffers from alcohol use disorder, the therapist will benefit from knowing the client’s history and other pertinent facts, such as environmental factors, a client’s personal strengths, etc. The therapist would need to know that this particular client may have trauma in his or her history that contributes to the alcohol use disorder and then environmental factors that perpetuate the disorder. The reason for this is because the therapist cannot “treat” the disorder by itself, without the other factors, and a case formulation helps flesh this out. The case formulation also helps the therapist see from whence possible core beliefs stem, which is needed in order to combat negative automatic thoughts. Case formulation also helps the therapist form a treatment plan, and without a treatment plan, how would the client possibly get better? In addition case formulation takes the parts (precipitants, mechanisms, origins and problems) and ties them all together into a whole picture. This helps the clinician, as already highlighted, to see how these different parts come together and create a picture of the client’s issues and strengths and areas of need. It is important for the clinician to realize how all of the parts are related. I feel that it is very important to ask certain questions when doing the initial interview so that the clinician can get a solid case formulation in order to best help the client. In other words, in the case of multicultural clients, being sensitive is important while at the same time being able to elicit the responses needed for the case formulation that involve acculturation or assimilation, religious beliefs, etc.
    2. It is important to have specific, measurable treatment goals because related to the previous question, the therapist and client need to be able to see and feel progress is being made (especially the client), to instill hope that things will get better. Goals help delineate the treatment process in a more concrete manner, laying out the basic plan for how to help the client get better. It is also important in the goal-setting to have the client setting the goals (mostly) and this will help build a collaborative and healthy therapeutic relationship. There, of course, will be some therapist goals as well.

    Reply

    • Julie Crantz
      Nov 17, 2017 @ 13:01:38

      Hi Liisa,
      I appreciate your comments about case formulations with multicultural clients. I think it is very insightful of you to highlight this, especially noting how important it is to be sensitive to clients who may have had life experiences such as assimilating into a new culture. Also, being mindful of a client’s religious beliefs. All clients are unique individuals and the case formulation pinpoints all of the things that help to make people who they are, as well as helps us understand how they have come to develop problems. Using the case formulation will assist us in providing the best possible treatment plan for each client we see, tailored especially to his or her own distinct needs.

      Reply

  14. Lindsey
    Nov 16, 2017 @ 14:41:14

    (1) Why is a CBT case formulation important for effective therapy (i.e., how does it help clients get “better”)?
    Case formulations are important for effective therapy because they take all facets of a person’s life into consideration. Though therapy may not address all problem areas, case formulations provide the therapist and client with tremendous insight about potential origins of the problem(s), presenting symptoms, hypothesized diagnoses, and even cultural considerations. Client problems often overlap and are interrelated. Case formulations allow the client and therapist to strengthen the therapeutic alliance by thoroughly dissecting the client’s past history, present functioning, and future goals as a team. Case formulations are particularly important for new therapists because it helps them identify and prioritize problem areas of the client and determine appropriate treatment planning. Overall, case formulations prioritize client wellness and offer clients with well thought out treatment plans.

    (2) Why is it necessary to have specific, concrete, and measurable treatment goals whenever possible?
    The goal of CBT is to teach clients how to become their own therapist. Having specific treatment goals help the client conceptualize the problem more accurately and make the problem-solving process feel more manageable. By making treatment goals specific, concrete, and measureable, clients are able to monitor their own progress and (gradually) feel more in control of their cognitions, emotions, and behaviors. Collaborative empiricism encourages the therapist and client to examine the evidence together in a safe and supportive environment. During the middle and late stages of therapy, the client begins to set their own measurable goals with specificity and require less guidance by the therapist.

    Reply

    • Julie Crantz
      Nov 17, 2017 @ 13:10:45

      Hi Lindsey,
      You make some great points, especially regarding how specific treatment goals help to make the problem-solving process feel more manageable to clients. Also, I appreciate your comment about how clients having the opportunity to monitor their own progress will eventually lead to them feeling more in control of their cognitions, emotions, and behaviors. There are many advantages to having concrete and measurable treatment goals and I think they are a necessity. Empowering clients to set their own measurable goals is a skill that will help them not only during treatment but throughout their life.

      Reply

    • Luke Dery
      Nov 17, 2017 @ 21:12:33

      Lindsey,

      Your question 2 comments about a client working to become their own therapist made me think of treatment goals in a different light. Of course a goal aims for measurable improvement, but a good CBT goal should also aim for some level of mastery. Say the client has a goal, for example, as simple as “Make my bed 5 times a week.” Part of the work leading to this goal possibly includes learning how to monitor one’s emotions and thoughts, and how to do an exercise such as behavioral activation. Essentially, achieving the goals we set in therapy is essential, but part of every goal involves helping the client master CBT skills. Mastering these skills can lead to maintenance of success.

      Reply

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Adam M. Volungis, PhD, LMHC

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