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Determining What is Important in a Good Formulation

Published online by Cambridge University Press:  04 January 2007

Alyson Flitcroft
Affiliation:
University of Newcastle upon Tyne, UK
Ian Andrew James
Affiliation:
University of Newcastle upon Tyne, UK
Mark Freeston
Affiliation:
University of Newcastle upon Tyne, UK
Amy Wood-Mitchell
Affiliation:
Northumberland, Tyne and Wear NHS Trust, UK

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.

Type
Research Article
Copyright
© 2007 British Association for Behavioural and Cognitive Psychotherapies

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