Clinical formulation

A clinical formulation, also known as case formulation, case conceptualisation, and problem formulation, is a theoretically based explanation or conceptualisation of the information obtained from a clinical assessment. It offers a hypothesis about the cause and nature of the presenting problems and is considered an adjunct or alternative approach to the more categorical approach of psychiatric diagnosis. In clinical practice, formulations are used to communicate a hypothesis and provide a framework for developing the most suitable treatment approach. It is most commonly used by mental health professionals and is deemed to be a core component of that profession. Clinical psychologists, mental health nurses, social workers, and some psychiatrists use this formulation based on specific psychological frameworks.

Types of formulation

Different psychological schools or models utilize clinical formulations, including cognitive behavioral therapy (CBT) and related therapies: systemic therapy, psychodynamic therapy, and applied behavior analysis. The structure and content of a clinical formulation is determined by the psychological model. Most systems of formulation contain the following broad categories of information: symptoms and problems; precipitating stressors or events; predisposing life events or stressors; and an explanatory mechanism that links the preceding categories together and offers a description of the precipitants and maintaining influences of the person's problems.

Behavioral case formulations used in applied behavior analysis and behavior therapy are built on a rank list of problem behaviors, from which a functional analysis is conducted, sometimes based on relational frame theory. Such functional analysis is also used in third-generation behavior therapy or clinical behavior analysis such as acceptance and commitment therapy and functional analytic psychotherapy.