Determining What is Important in a Good Formulation

Abstract

Research suggests that there is low inter-rater reliability between therapists when asked to formulate the same case and that there may be discrepancies in what is considered an essential part of a formulation. The present study aimed to explore the diversity of therapists' viewpoints regarding the purpose and essential features of a cognitive-behavioural therapy (CBT) case formulation of depression. A Q-sort methodology was used in order to render these beliefs operational. Seven experienced CBT therapists participated in the construction of 86 statements, capturing concepts considered relevant to a CBT formulation of depression. This Q-sort was then administered to 23 therapists, who rated these statements in terms of their importance using a Q-sort procedure. Three factors emerged, suggesting three dominant opinions as to the importance of features of a formulation. A “state” CBT factor, focusing on the “here and now”, accounted for most variance; followed by a second factor emphasizing “function and process” and a third factor emphasizing “trait” components. Whilst there was some agreement between what was considered to be least important in a formulation, the emergence of three distinct viewpoints suggests a lack of complete consensus amongst the therapists.