Case Formulation in Standard Cognitive Therapy: A Commentary on Chapter “Case Formulation in Standard Cognitive Therapy”

Abstract

The commentary agrees with the premise that cognitive therapy handles the whole therapeutic process by using case formulation, including both specific cognitive strategies and the nonspecific factors such as the therapeutic alliance and the relationship. Cognitive therapists manage the developing relationship across different clients in a manner that is wholly guided by the cognitive conceptualization. Nonspecific processes are relatively secondary with less complicated clients, whereas with more complicated clients they instantiate the case formulation in terms of the “three-legged stool”: current life events, childhood antecedents, and therapeutic relationship. This instrument was introduced to deal with clients with depressions superimposed on personality disorders. These patients were more interpersonally challenging. With such clients the cognitive therapist touches on each leg of the stool with respect to any item that gets put on the agenda; how best to deal with issues in their current life (current life concerns), when did they first respond in a similar fashion in terms of thoughts, feelings, and behaviors (childhood antecedents), and did the way we worked on the topic stir up any thoughts or feelings that might be of concern (therapeutic relationship).