Case Formulation in CBT: The Personalised Map to Recovery (part 5 of our Gold Standard series)

Posted on: Apr 11, 2025

Cognitive Behavioural Therapy (CBT) is far more than a set of techniques; it's a personalised approach to understanding and transforming the patterns that maintain anxiety. At the heart of this individualised process is case formulation—a collaborative effort between therapist and client to build a working model of how the problem developed and how it continues.

What Is Case Formulation?

A case formulation is like a psychological roadmap. It takes into account a client’s unique symptoms, life history, thought patterns, emotional responses, and coping behaviours. The goal is to make sense of how all the moving parts fit together.

In CBT, a common format for case formulation includes:

• Triggers: External situations or internal sensations that spark anxiety
• Automatic Thoughts: Immediate mental interpretations (often negative and unexamined)
• Emotions: Feelings that result from these thoughts (e.g., fear, shame)
• Behaviours: Coping strategies (e.g., avoidance, reassurance-seeking)
• Underlying Beliefs/Schemas: Core beliefs developed over time (e.g., "I’m not good enough")

Why It Matters

Rather than treating symptoms in isolation, case formulation helps:

• Tailor the intervention to the individual’s needs
• Increase the client’s insight into their thought-emotion-behaviour cycle
• Prioritise which symptoms or situations to address first
• Track progress and revise the plan as needed

For instance, two people with social anxiety may both avoid public speaking, but for different reasons. One may fear judgment rooted in a belief of inadequacy, while the other might fear physical symptoms of anxiety. These differences call for different therapeutic strategies.

A Collaborative Process

Effective case formulation is not something a therapist hands down from above. Instead, it’s built together. Clients contribute their experiences, insights, and reflections. Therapists guide with structure and psychological theory.

It might look like a diagram on paper, but what it truly represents is a shared understanding—a partnership in pursuit of change.

Flexible and Evolving

Case formulation is not static. As therapy progresses, new insights emerge, and the model can be revised. What begins as a tentative hypothesis becomes a clearer map, guiding both therapist and client through each step of treatment.

Conclusion: Making Therapy Make Sense

In CBT, case formulation transforms therapy from generic to personal. It empowers clients with a deeper understanding of their own mind and gives therapists a clear, focused path to guide healing. It’s not just about identifying what’s wrong—it’s about discovering how things connect and how they can change. That insight becomes the engine for recovery.