In many ways the UK is the home of the formulation based approach to CBT. In other countries protocol based, modular forms of therapy prevail. In the British Isles the work of David Clark, Paul Salkosvskis in anxiety and therapists working with other conditions has led to a range of conceptual models that explain the maintenance of disorders through attentional focus, cognitive bias and safety behaviours. The formulation, based on the framework for the specific disorder, guides the interventions chosen. There are some fundamental principles underlying all these different models and considering them can help therapists formulate more effectively. As with all CBT, conceptualising cases is a collaborative exercise and this is where it is important not to be excessively rule bound in applying a model which is useful as a template but may need to be adapted for the individual. This particularly applies to complex cases where consideration of the longitudinal formulation can be helpful. This workshop will focus on the basics of good formulation and their application to complex cases.
The event will be equivalent to 2.3/4hrs of CPD.
This workshop will briefly review the literature on formulation in CBT and the importance of a good formulation as a principle for establishing a therapeutic alliance, guiding therapy, and predicting and managing difficulties. We will look at some of the basic principles underlying all CBT formulations and consider how these are adapted in the various models used to understand and treat different disorders. The formulation can be seen as part of an iterative process: it is informed by the client’s problems and goals but in turn helps to clarify them and at the same time works to socialise the client into the cognitive model. Many clients’ problems can be understood within a standard disorder based conceptualisation, but for complex cases it can be helpful to broaden the perspective to contextualise the problems using a more comprehensive conceptualisation. We will discuss how the formulation can be developed collaboratively and practice this skill. The diagrammatic formulation gives a helpful overview of the origin and maintenance of the client’s difficulties. We will consider how this conceptualisation can be ‘warmed up’ by creating a compassionate therapeutic narrative that tells the story of how the person is doing their best within their experience and world view, and give hope for how new perspectives and behaviours might emerge. The workshop will also introduce some ways in which a formulation using modes or self-states can be shared with clients to help them make sense of chaotic experiences and behaviour. Participants are encouraged to bring a case that they can formulate during the workshop.
1. To understand the basic principles underlying all CBT formulations and how they are adapted for different clinical groups.
2. To feel free to go beyond the maintenance formulation to use a comprehensive conceptualisation to make sense of complex cases.
3. To learn how to develop and share a compassionate conceptualisation in narrative as well as diagrammatic form.
The workshop will include presentation of theoretical, research and clinical material together with questions and answers throughout. These will be a mixture of questions via Q&A and use of the chat for sharing experiences. There will be experiential exercises, opportunities to formulate a case vignette and participants’ own cases, and a live formulation of a case.
Beck, A. T., & Haigh, E. A. (2014). Advances in cognitive theory and therapy: The generic cognitive model. Annual review of clinical psychology, 10, 1-24.
Kuyken, W., Padesky, C. A., & Dudley, R. (2011). Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. Guilford Press.
Tarrier, N., & Johnson, J. (Eds.). (2015). Case formulation in cognitive behaviour therapy: The treatment of challenging and complex cases. Routledge.
About the presenter
Stirling Moorey has over 40 years experience of practising and teaching CBT. He was co-founder of the Institute of Psychiatry CBT course in 1987 and has taught psychiatrists, psychologists and other mental health professionals. He worked as a consultant psychiatrist specialising in CBT in East London and then for 20 years at the South London and Maudsley. His main research interest has been the application of CBT to relive distress in people living with cancer. While maintaining a fundamentally cognitive approach Stirling has also trained in mindfulness based cognitive therapy (MBCT), mindfulness based compassionate living (MBCL), schema therapy and Cognitive Analytic Therapy. He brings insights from some of these different models into formulation and clinical practice.
Who should attend
This workshop is primarily aimed at high intensity therapists but may also be of interest to PWPs. The cases discussed will be adult cases, but may also be of interest to those working with adolescents. The general principles of formulation apply across all disorders and one of the main foci will be on conceptualising complexity, particularly the impact of Axis II symptomatology on Axis I disorders.