Forensic Case Formulation E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Geisteswissenschaft
• Serie: Wiley Series in Forensic Clinical Psychology
• Sprache: Englisch

Seitenzahl: 696

Veröffentlichungsjahr: 2011

Beschreibung

Forensic Case Formulation is the first text that describes the principles and application of case formulation specifically to forensic clinical practice.

• Addresses risk assessment and its implications for case formulation and treatment
• Covers a range of serious forensic problems such as violence, sexual offending, personality disorder, and substance misuse
• Offers guidance in training clinicians on ways to create useful formulations

Leseprobe

CONTENTS

Cover

Wiley Series in Forensic Clinical Psychology

Title Page

Copyright

About the Editors

About the Contributors

Series Editors’ Preface

ABOUT THE SERIES

ABOUT THIS BOOK

REFERENCES

Preface

PART I: GENERAL ISSUES

Chapter 1: Theoretical and Evidence-Based Approaches to Case Formulation

WHAT IS A CASE FORMULATION?

WHY FORMULATE?

THE GOALS OF FORMULATION

THEORY AS A GUIDE TO FORMULATION

EVIDENCE AS A GUIDE FOR FORMULATION

STRUCTURED SYSTEMATIC CASE FORMULATION MODELS

A GENERAL FRAMEWORK FOR FORMULATION

PRACTICAL TIPS FOR CASE FORMULATION

REFERENCES

Chapter 2: Current Issues in Case Formulation

CHAPTER GOALS

SCIENTIFIC BASES I: CF COMPONENTS AND CONTENT VALIDITY

SCIENTIFIC BASES II: RELIABILITY

SCIENTIFIC BASES III: VALIDITY OF CF AND ITS COMPONENTS

SCIENTIFIC BASES IV: THE CASE FORMULATION AND TREATMENT

TRAINING AND COMPETENCY ISSUES

SUMMARY AND CONCLUSIONS

REFERENCES

Chapter 3: Does Case Formulation make a Difference to Treatment Outcome?

CASE FORMULATION: NOT A SINGLE APPROACH

DIFFICULTIES AND BARRIERS IN RESEARCH ON CASE FORMULATION

RESEARCH ON CASE FORMULATION: EMPIRICAL FINDINGS

CONCLUSIONS FROM EMPIRICAL RESEARCH AND IMPLICATIONS FOR PRACTICE

FUTURE RESEARCH

REFERENCES

PART II: VIOLENCE

Chapter 4: Formulation of Violence Risk Using Evidence-Based Assessments: The Structured Professional Judgment Approach

PART 1: THE PRACTICE OF VIOLENCE RISK ASSESSMENT

PART 2: FORMULATION OF VIOLENCE RISK

PART 3: AN ILLUSTRATIVE CASE FORMULATION

CONCLUSION

REFERENCES

Chapter 5: Cognitive Behavioral Approaches to Formulating Aggression and Violence

DEFINITIONAL PROBLEMS

A PROBLEM FOR WHOM?

WHY FORMULATE THE INDIVIDUAL CASE?

WHAT TYPES OF ANTECEDENT MIGHT FEATURE IN A COGNITIVE-BEHAVIORAL FORMULATION OF AGGRESSION?

ANGRY AFFECT IN THE FORMULATION OF AGGRESSION

HETEROGENEITY

MENTAL DISORDER AND AGGRESSION

PERSONALITY DISORDER AS AN ANTECEDENT

PERSONALITY AS AN ANTECEDENT

INDIVIDUAL AND POPULATION FUNCTIONAL ASSESSMENTS

FURTHER ASSESSMENT ISSUES

FUNCTION ASSESSMENTS OF AGGRESSION AND VIOLENCE

IMPLEMENTATION OF THE CLINICAL FORMULATION OF AGGRESSION IN PRACTICE: SOME AWKWARD QUESTIONS

TWO CONTRASTING CASE FORMULATIONS

SUMMARY

REFERENCES

Chapter 6: Formulation of Serious Violent Offending Using Multiple Sequential Functional Analysis

INTRODUCTION

CASE STUDIES: BOB AND LEON

DISCUSSION

CONCLUSION

REFERENCES

Chapter 7: Forensic Case Formulation, Substance Abuse Disorders, and Anger

INTRODUCTION

CASE FORMULATION

CONCLUDING REMARKS

REFERENCES

PART III: SEXUAL OFFENDING

Chapter 8: Sexual Offenses Against Children

RISK ASSESSMENT WITH SEX OFFENDERS

A CLINICAL EXAMPLE: THE CASE OF JOHN DOE

ASSESSMENTS

ASSESSMENT FOR CASE FORMULATION

SUMMARY AND CONCLUSIONS

REFERENCES

Chapter 9: Sexual Offenses Against Adults

INTRODUCTION

LITERATURE REVIEW

ASSESSMENTS

CASE FORMULATION

FORMULATION

CONCLUSIONS

REFERENCES

PART IV: SPECIFIC POPULATIONS

Chapter 10: Forensic Case Formulation with Children and Adolescents

INTRODUCTION AND LITERATURE REVIEW

ASSESSMENT

CASE STUDY

CASE FORMULATION AND TREATMENT PLANNING

CONCLUSION

REFERENCES

Chapter 11: Formulating Offending Behavior with People with Mild Learning Disabilities

BIOLOGICAL RESEARCH AND SOCIOLOGICAL THEORIES

THEORIES OF SEX OFFENDING

A THEORETICAL CONTEXT FOR TREATMENT IN SEX OFFENDERS WITH INTELLECTUAL DISABILITIES

CASE STUDY

REFERENCES

Chapter 12: Case Formulation for Individuals with Personality Disorder

INTRODUCTION

PERSONALITY AND OFFENDING

ASSESSMENT

SUMMARY AND CONCLUSIONS

REFERENCES

PART V: CONCLUSION

Chapter 13: Forensic Case Formulation: Emerging Issues

THE CURRENT STATUS OF CASE FORMULATION

SOMETHING NEW

FUTURE DIRECTIONS

CONCLUSION

REFERENCES

Index

WILEY SERIES IN FORENSIC CLINICAL PSYCHOLOGY

Edited by

Clive R. HollinSchool of Psychology, University of Leicester, UK

and

Mary McMurranInstitute of Mental Health, University of Nottingham, UK

For other titles in this series please visit http://www.wiley.com/go/fcp

This edition first published 2011

© 2011 John Wiley & Sons, Ltd.

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Library of Congress Cataloging-in-Publication Data

Forensic case formulation / edited by Peter Sturmey and Mary McMurran. p. cm. Includes index. ISBN 978-0-470-68395-8 (cloth) – ISBN 978-0-470-68394-1 (pbk.) 1. Correctional psychology. 2. Criminal psychology. 3. Criminals–Rehabilitation. I. Sturmey, Peter. II. McMurran, Mary. HV9276.F67 2011 614′.15–dc22 2011009359

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDFs 9781119977025; Wiley Online Library 9781119977018; ePub 9781119976899

ABOUT THE EDITORS

Peter Sturmey is Professor of Psychology at Queens College and The Graduate Center, City University New York and a member of the Learning Processes and Behavior Analysis and Neuropsychology doctoral programs at City University of New York. He has published over 150 articles and 15 books on developmental disabilities. His current research focuses on applied behavior analysis and staff and parents training.

Mary McMurran is Professor of Personality Disorder Research at the University of Nottingham's Institute of Mental Health, United Kingdom. Her research interests include: social problem solving as a model of understanding and treating people with personality disorders; the assessment and treatment of alcohol-related aggression and violence; and understanding and enhancing offenders’ motivation to engage in therapy. She is a Fellow of the British Psychological Society, and recipient of the Division of Forensic Psychology's Lifetime Achievement Award in 2005.

ABOUT THE CONTRIBUTORS

Bruce A. Arrigo Professor of Criminology, Law, and Society in the Department of Criminal Justice and Criminology at the University of North Carolina – Charlotte. He holds affiliated appointments in the Departments of Psychology and Public Health Sciences, and in the Public Policy Program and the Center for Professional and Applied Ethics. He is a Fellow of the American Psychological Association and the Academy of Criminal Justice Sciences. Dr Arrigo's numerous recognitions include the American Society of Criminology's Critical Criminologist of the Year Award (2000), the Society for the Study of Social Problem's Book of the Year Award in Crime and Delinquency (2005), the Academy of Criminal Justice Sciences’ Bruce Smith Sr. Distinguished Research Award (2007), and the First Citizens Bank Scholars Medal (2008). Dr Arrigo's latest book is The Ethics of Total Confinement: A Critique of Madness, Citizenship and Social Justice (2011) Oxford University Press.

Louise G. Braham Acting Lead Psychologist and Consultant Clinical and Forensic Psychologist, Mental Health Service, Rampton Hospital, Nottinghamshire Healthcare NHS Trust and Senior Clinical Tutor for the Trent Clinical Psychology Training Programme, University of Nottingham, UK. Louise has worked in Forensic Mental Health Services for over 15 years. She is a practising clinician, has published and is interested in violence, forensic case formulation, neuropsychological functioning and the experience and symptoms of psychosis related to risk.

Tracy D. Eells Clinical Psychologist and Professor in the Department of Psychiatry and Behavioral Sciences at the University of Louisville in Louisville, Kentucky, USA. He earned a Ph.D. from the University of North Carolina, Chapel Hill. His primary area of scholarship is psychotherapy research, particularly expertise in case formulation. He is editor of the Handbook of Psychotherapy Case Formulation and is advisory editor for the journals Psychotherapy Research and Pragmatic Case Studies in Psychotherapy.

Paul M.G. Emmelkamp Full professor of clinical psychology at the University of Amsterdam and senior consultant at the forensic psychiatry centre, De Waag. Over the years he has published widely on the etiology and treatment of anxiety disorders. He is involved in therapy-outcome studies on adults with work-related distress, substance abuse disorders, personality disorders, domestic violence, depression, and anxiety disorders, and on youth with ADHD, conduct disorder and anxiety disorders. He has written and co-edited many books, and over 450 publications in peer reviewed journals or books. He is Editor of Clinical Psychology & Psychotherapy and of BMC-Psychiatry: Forensic Psychiatry. He has received a number of honors and awards, including a distinguished professorship (“Academy Professor”) by the Royal Academy of Arts and Sciences.

Ata Ghaderi Clinical Psychologist, Licensed Psychotherapist, and Professor of Psychology at the Department of Psychology, Uppsala University, Sweden. His main field of research is prevention and treatment of eating disorders. His interests include philosophy of science in psychology in relation to assessment and diagnosis, psychotherapy research focusing on treatment matching and individualization, dissemination of evidence-based treatment, and basic research on perception and cognition. He is currently running several projects on the intensive treatment of obsessive-compulsive disorder, preventive parent training, treatment of chronic anorexia nervosa, obesity and body dismorphic disorder.

David M. Gresswell Co-Director of the Trent Clinical Psychology Training Programme and works part-time as a Consultant Clinical Psychologist in NHS forensic services in Lincolnshire. Mark has worked in forensic mental health services for over 25 years in high and low security settings and in the community. He has a special interest in behavioral approaches and functional analysis.

Aidan J.P. Hart Clinical Forensic Psychologist and Senior Lecturer in Clinical Psychology, University of Lincoln, UK. Aidan has worked in hospital and community settings with physically and sexually violent offenders. He has also worked in both inpatient and outpatient settings in the assessment and treatment of both early episode and severe and enduring mental health problems. He has an interest in behavioral analysis and in particular third wave behavioral approaches, such as Relation Frame Theory, and their application to understanding and furthering assessment and treatment processes.

Stephen D. Hart Professor in the Department of Psychology at Simon Fraser University and Visiting Professor in the Faculty of Psychology at the University of Bergen. His work focuses on the assessment of violence risk and psychopathic personality disorder. He has co-authored more than 160 articles, chapters, and books, including several violence risk assessment guides. He is a recipient of the Career Achievement Award from the Society of Clinical Psychology (APA Division 12), the Saleem Shah Award for Early Career Research Excellence in Psychology and Law from the American Psychology-Law Society (APA Division 41) and the American Academy of Forensic Psychology, and the Distinguished Achievement Award from the Association of Threat Assessment Professionals.

Kevin Howells Clinical and forensic psychologist. He was until recently Professor of Forensic and Clinical Psychology in the Institute of Mental Health and Division of Psychiatry at Nottingham University. He has worked as a clinician in the United Kingdom, Australia and the USA. He has published widely in the field of forensic clinical psychology and headed a research unit at Rampton Hospital investigating interventions for people with personality disorder and high risk. He has particular interests in cognitive behavioral treatments for offenders, anger and violence, therapeutic climates and readiness for treatment.

Lawrence Jones Lead Psychologist and Consultant Clinical and Forensic Psychologist at the Peaks Unit, Rampton Hospital, Nottinghamshire Healthcare NHS Trust. He is a former chair of the division of forensic psychology in the British Psychological Society. He has worked in community, prison and secure hospital settings with offenders. Has published and is interested in planned environment based interventions, personality disordered offenders, sex offenders, forensic case formulation, motivational interventions and using offence paralleling behavior to inform intervention and risk management.

William R. Lindsay Consultant Psychologist and Clinical Lead (Scotland) in Castlebeck, Darlington and Professor of Learning Disabilities and Forensic Psychology at the University of Abertay, Dundee. He is also Honorary Professor at Bangor University, Wales. He is a practicing clinician who has over 200 academic publications. Current clinical and research interests include sex offenders, pathways through learning disability forensic services, programmes for criminal behaviour, the assessment of personality and personality disorder, risk assessment and cognitive behaviour therapy.

Caroline Logan Consultant Forensic Clinical Psychologist in Greater Manchester West Mental Health NHS Foundation Trust and an Honorary Research Fellow in the Department of Community Based Medicine at the University of Manchester. She has worked in forensic settings for many years, working directly with clients who are at risk to themselves and others and, in a consultancy role, with the multidisciplinary teams and local and national organizations that look after and manage them. Dr Logan has research interests in the areas of personality disorder, psychopathy, and risk, and a special interest in gender issues in offending.

Kenneth G. Lombart Clinical Psychologist and Visiting Assistant Professor in the Department of Psychology at the University of Massachusetts Lowell. His primary research interest is in expertise in psychotherapy case formulation.

Gregory H. Mumma Associate Professor of Psychology in the Clinical Ph.D. Program at Texas Tech University. His interests include behavioral and idiographic assessment, intra-individual construct validation, cognitive-behavioral case formulation, and clinical decision making for formulation-based, tailored treatment of complex and comorbid cases. His research focuses on person-specific quantitative methods to validate and test cognitive-behavioral case formulations using daily ratings and ecological momentary assessment. His research, as well as his part-time clinical practice, focuses on adults with comorbid mood and anxiety disorders.

Phil Rich Former Clinical Director and the current Director of Clinical Program Development of the Stetson School, a 111-bed long-term residential treatment program for sexually reactive children and juvenile sexual offenders in Massachusetts. Phil holds a doctorate in applied behavioral and organizational studies and a master's degree in social work, and is a licensed independent clinical social worker. He presents and trains nationally and internationally, and is the author of Understanding Juvenile Sexual Offenders: Assessment, Treatment, and Rehabilitation; Attachment and Sexual Offending: Understanding and Applying Attachment Theory to the Treatment of Juvenile Sexual Offenders; Juvenile Sexual Offenders: A Comprehensive Guide to Risk Evaluation; and the Stages of Accomplishment Workbooks for Sexually Abusive Youth.

Stacey L. Shipley Dr Shipley has specialized in psychological services at the crossroads of psychology and the law. Her training has focused on both adults and adolescents. She is a licensed psychologist in three states and is the Director of Psychology at North Texas State Hospital, the only maximum-security forensic hospital in Texas. She specializes in forensic evaluation, treating maternal filicide offenders, and evaluation or treatment for individuals adjudicated by the courts as Not Guilty by Reason of Insanity or Incompetent to Stand Trial for violent offenses. She has published articles on psychopathy, wrote chapters on maternal filicide and serial rape and murder typologies, and co-authored Introduction to Forensic Psychology: Issues and Controversies in Crime and Justice (2nd edition) and the upcoming 3rd edition published by Academic Press. She was first author of The Female Homicide Offender: Serial Murder and the Case of Aileen Wuornos (2004) published by Prentice Hall.

Ellen Vedel Cognitive behavior therapist and treatment manager at the Jellinek Addiction Treatment Centre in Amsterdam. As a senior researcher, she is currently involved in clinical trials testing integrated treatment protocols for substance abuse and Post traumatic Stress Disorder and for substance abuse and intimate partner violence. Together with Paul Emmelkamp she is the co-author of Evidence-based Treatments for Alcohol and Drug Abuse: A Practitioner's Guide to Theory, Methods and Practice.

Dr Jim Vess Senior Lecturer at Deakin University in Victoria, Australia and a member of the Clinical Forensic Research group of the Deakin Forensic Psychology Centre. He has over 25 years of clinical and research experience with forensic populations. After receiving his PhD in clinical psychology from Ohio State University in the United States, he then served in a variety of treatment, assessment, and supervisory roles at Atascadero State Hospital, the maximum security forensic psychiatric facility in California. He has been a Senior Lecturer at Victoria University of Wellington, New Zealand, where his research focus was primarily on risk assessment with violent and sexual offenders, as well as public policy dealing with high risk offenders. He has remained active in forensic practice, and has provided expert witness evidence in a variety of High Court and Court of Appeals cases involving high risk sexual offenders.

Tony Ward Head of School and Professor of Clinical Psychology at Victoria University of Wellington, New Zealand. His research interests include cognition in offenders, rehabilitation and reintegration processes, and ethical issues in forensic psychology. He has over 285 academic publications and his most recent book is Desistance from Sex Offending: Alternatives to Throwing away the Keys (with Richard Laws; Guilford, 2011). He will be taking up a research chair in Clinical Forensic Mental health at Deakin University, Melbourne, Australia in June 2011.

SERIES EDITORS’ PREFACE

ABOUT THE SERIES

At the time of writing it is clear that we live in a time, certainly in the UK and other parts of Europe, if perhaps less so in areas of the world, when there is renewed enthusiasm for constructive approaches to working with offenders to prevent crime. What do we mean by this statement and what basis do we have for making it?

First, by “constructive approaches to working with offenders” we mean bringing the use of effective methods and techniques of behaviour change into work with offenders. Indeed, this view might pass as a definition of forensic clinical psychology. Thus, our focus is the application of theory and research in order to develop practice aimed at bringing about a change in the offender's functioning. The word constructive is important and can be set against approaches to behaviour change that seek to operate by destructive means. Such destructive approaches are typically based on the principles of deterrence and punishment, seeking to suppress the offender's actions through fear and intimidation. A constructive approach, on the other hand, seeks to bring about changes in an offender's functioning that will produce, say, enhanced possibilities of employment, greater levels of self-control, better family functioning, or increased awareness of the pain of victims.A constructive approach faces the criticism of being a “soft” response to the damage caused by offenders, neither inflicting pain and punishment nor delivering retribution. This point raises a serious question for those involved in working with offenders. Should advocates of constructive approaches oppose retribution as a goal of the criminal justice system as a process that is incompatible with treatment and rehabilitation? Alternatively, should constructive work with offenders take place within a system given to retribution? We believe that this issue merits serious debate.However, to return to our starting point, history shows that criminal justice systems are littered with many attempts at constructive work with offenders, not all of which have been successful. In raising the spectre of success, the second part of our opening sentence now merits attention: that is, “constructive approaches to working with offenders to prevent crime”. In order to achieve the goal of preventing crime, interventions must focus on the right targets for behaviour change. In addressing this crucial point, Andrews and Bonta (1994) have formulated the need principle:

Many offenders, especially high-risk offenders, have a variety of needs. They need places to live and work and/or they need to stop taking drugs. Some have poor self-esteem, chronic headaches or cavities in their teeth. These are all “needs”. The need principle draws our attention to the distinction between criminogenic and noncriminogenic needs. Criminogenic needs are a subset of an offender's risk level. They are dynamic attributes of an offender that, when changed, are associated with changes in the probability of recidivism. Non-criminogenic needs are also dynamic and changeable, but these changes are not necessarily associated with the probability of recidivism. (p. 176)

Thus, successful work with offenders can be judged in terms of bringing about change in noncriminogenic need or in terms of bringing about change in criminogenic need. While the former is important and, indeed, may be a necessary precursor to offence-focused work, it is changing criminogenic need that, we argue, should be the touchstone in working with offenders.

While, as noted above, the history of work with offenders is not replete with success, the research base developed since the early 1990s, particularly the meta-analyses (e.g. Lösel, 1995), now strongly supports the position that effective work with offenders to prevent further offending is possible. The parameters of such evidence-based practice have become well established and widely disseminated under the banner of “What Works” (McGuire, 1995, 2008).

It is important to state that we are not advocating that there is only one approach to preventing crime. Clearly there are many approaches, with different theoretical underpinnings, that can be applied. Nonetheless, a tangible momentum has grown in the wake of the “What Works” movement as academics, practitioners, and policy makers seek to capitalise on the possibilities that this research raises for preventing crime. The task that now faces many service agencies lies in turning the research into effective practice.

Our aim in developing this Series in Forensic Clinical Psychology is to produce texts that review research and draw on clinical expertise to advance effective work with offenders. We are both committed to the ideal of evidence-based practice and we will encourage contributors to the Series to follow this approach. Thus, the books published in the Series will not be practice manuals or cook books: They will offer readers authoritative and critical information through which forensic clinical practice can develop. We are both enthusiastic about the contribution to effective practice that this Series can make and look forward to continuing to develop it in the years to come.

ABOUT THIS BOOK

Although the context may be different, when it comes to practitioner skills in working with offenders, the same rules of good practice apply as they would with any other group. One of the bedrocks of practice lies in assessment and case formulation: The process of gathering information and then making sense of it, formulating it, within a given theoretical framework. Of course, formulation is independent of theory, so that meaningful formulations of, say, a given behaviour can be made from different theoretical perspectives. The point of a case formulation is to guide practice based on the available case material, theoretical strictures, and extant empirical knowledge.

In this book an impressive list of authors cover every angle concerning case formulation. The chapters range from discussion of the finer points of the theory and practice of case formulation, to applying these principles to specific offender and groups and to specific types of offences. There is a great deal to be taken at many levels from this book and we are pleased to see it as part of the growing body of work addition the Series represents.

Clive Hollin Mary McMurran

REFERENCES

Andrews, D.A. and Bonta, J. (1994) The Psychology of Criminal Conduct. Anderson, Cincinnati, OH.

Lösel, F. (1995) Increasing consensus in the evaluation of offender rehabilitation? Psychology, Crime, and Law, 2, 19–39.

McGuire, J. (ed.) (1995)What Works: Reducing Reoffending. John Wiley & Sons, Chichester.

McGuire, J. (2008) A review of effective interventions for reducing aggression and violence. Philosophical Transactions of the Royal Society, B, 363, 2577–97.

PREFACE

Clinical case formulation is understood by forensic clinical psychologists and forensic psychiatrists to be key in designing appropriate and so potentially effective treatments for offenders. In forensic work, what is effective in treatment is usually taken to mean that an individual's risk of reoffending is reduced. While treatments to ameliorate other problems are part of the work of forensic mental health professionals, they cannot ignore the expectation that their treatments should aim to reduce risk. This places an unusual burden upon this group of people in that they are to some degree responsible for their clients’ behavior and for any harm to others that this may cause. If case formulation is indeed the key to effective interventions, then it is imperative that it should be done well.

Research into some of the basic issues in case formulation is lacking in the forensic literature and this lack urgently needs to be addressed. Fortunately there is some evidence about reliability, validity, and utility from clinical work in general, and we present this information here for forensic practitioners to draw upon. Additionally, there are forensic practitioners who have given a great deal of thought to the principles upon which forensic case formulation should rest. These ideas are also presented in this book.

We are indebted to the authors who have made such excellent contributions to this volume. We hope that by drawing together this body of work we might create an impetus for further research in this important area.

Peter Sturmey Mary McMurran December 2010

PART I

GENERAL ISSUES

Chapter 1

THEORETICAL AND EVIDENCE-BASED APPROACHES TO CASE FORMULATION

Tracy D. Eells

University of Louisville, USA

Kenneth G. Lombart

University of Massachusetts Lowell, USA

Our task in this chapter is to introduce the concept of case formulation. We begin by discussing the definition, functions and goals of case formulation, including why formulation is important. We continue by reviewing theoretical and evidentiary sources of information to guide the development of a formulation. Next, we summarize several structured case formulation models that have been developed to increase reliability and validity. Finally, we propose a general framework the therapist can use to structure a formulation and conclude with some practical tips.

WHAT IS A CASE FORMULATION?

Our working definition of case formulation comes from a cross-theoretical perspective: “A psychotherapy case formulation is a hypothesis about the causes, precipitants, and maintaining influences of a person's psychological, interpersonal and behavioral problems” (Eells, 2007, p. 4). A formulation involves inferences about predisposing vulnerabilities, a pathogenic learning history, biological or genetic factors, sociocultural influences, currently operating contingencies of reinforcement, conditioned stimulus–response relationships, or schemas, working models, and beliefs about the self, others, the future or the world. The aim of the formulation is to explain the individual's problems and symptoms. The specifics of the formulation will vary depending on the theoretical orientation of the case formulator. As a hypothesis, a formulation is always subject to empirical test and to revision as new information becomes available.

A case formulation serves multiple functions (Eells, 2007). First, it provides a structure to organize information about a person and his or her problems. Clients produce enormous amounts of information in therapy, including verbal, behavioral, prosodic, gestural, affective, and interactional. Formulation facilitates the management of this information cascade. Second, formulation provides a blueprint guiding treatment. Its primary purpose is to help the therapist develop and implement a treatment plan that will lead to a successful outcome. The formulation therefore enables the therapist to anticipate future events, for example, therapy-interfering events, and to prepare for them. Third, a formulation serves as a gauge for measuring change. Indices to assess change may come from goals included in the formulation, from relief of problems identified in the formulation, or from the revision of an inferred explanatory mechanism that did not seem adequate when tested. Fourth, a formulation helps the therapist understand the patient and thereby exhibit greater empathy for the patient's intrapsychic, interpersonal, cultural, and behavioral world.

Kuyken, Padesky and Dudley (2009) offer another definition of case formulation, emphasizing its collaborative and resilience-building aspects. They define formulation as a “process whereby therapist and client work collaboratively first to describe and then to explain the issues a client presents in therapy. Its primary function is to guide therapy in order to relieve client distress and build client resilience” (p. 3). Using the metaphor of a crucible and focusing on cognitive-behavioral therapy (CBT), these authors emphasize that formulation integrates and synthesizes a client's problems with CBT theory and research. Essential ingredients of a productive conceptualization are empirical collaboration between therapist and client, the development of the formulation over time from the descriptive level to an explanatory level, and the elicitation of both client strengths and problems. These authors also describe functions of a CBT case formulation. These include (1) synthesizing client experiences, relevant CBT theory and research; (2) normalizing and validating clients’ presenting issues; (3) promoting client engagement; (4) making complex and numerous problems more manageable for the client and therapist; (5) guiding the selection, focus, and sequence of interventions; (6) identifying strengths and suggesting ways to build resilience; (7) suggesting cost-efficient interventions; (8) anticipating and addressing problems in therapy; (9) helping the therapist understand nonresponse to therapy; and (10) facilitating high-quality supervision.