Testing Case Formulation Hypotheses in Psychotherapy: Two Case Examples

• two case presentations that illustrate and demonstrate the utility of a case formulation-driven approach to psychotherapy
• clinicians collect data in session to test the accuracy of the case formulation and evaluate the adequacy of the treatment
• a case formulation-driven approach to clinical work is effective when the patient shows an initial poor response to treatment

We describe two cases that illustrate and demonstrate the effectiveness of a case formulation–driven approach to psychotherapy in which the therapist, in collaboration with the patient, develops a hypothesis (formulation) about the psychological mechanisms that cause and maintain the patient’s difficulties, uses the formulation to guide intervention, and collects data to test the formulation and evaluate the effectiveness of the intervention plan. As shown by the cases reported here, a key strength of this collaborative empirical process is that it enables the patient and therapist to quickly determine when a treatment is failing and take action to rescue it.