Clients' experiences of formulation in cognitive behaviour therapy

Abstract

Objectives: To explore clients' experiences of formulation in cognitive behaviour therapy for depression and/or anxiety, as reported after the end of therapy.

Design: A qualitative study using inductive thematic analysis.

Method: Ten clients who had completed a course of cognitive behaviour therapy for depression and/or anxiety participated in semi-structured interviews within a month of finishing therapy.

Results: Four overarching themes were identified: Formulation helps me to understand my problems; formulation leads to feeling understood and accepted; formulation leads to an emotional shift and formulation enables me to move forward.

Conclusions: Formulation is a powerful therapeutic tool that can be highly beneficial to clients, leading to an increased understanding of their difficulties, feeling understood and accepted and a sense of relief. The process of formulation can also result in distress, however, when associated with an increased awareness of the nature of one's difficulties, the implications of the formulation for one's sense of identity and being presented with a formulation that is perceived to be inaccurate. In some cases, this distress decreased during therapy, while for others, distress lasted beyond the end of therapy. Formulation enabled many participants to move forwards from their difficulties, leading them to feel empowered, helping them to cope, enabling them to talk more openly, in contrast to previous therapy which had not focused on formulation. Clinical implications indicate that formulation should be undertaken in a sensitive and collaborative way to maximize its benefits and minimize any possible negative effects.

Practitioner points: Formulation can be highly beneficial for clients enabling them to move forwards from their difficulties. It is important to be mindful of clients' possible adverse reactions to the formulation, so that these can be resolved during therapy. Formulation should be undertaken attentively sensitively and collaboratively to maximize its benefits and minimize negative effects.

Keywords: Cognitive behaviour therapy; case conceptualization; case formulation.