How to write a case formulation: template and fictional example

Build a first draft with six headings

Presenting concern: What does the client want to change and what is difficult in daily life? Context: How has the problem developed over time and what circumstances matter? Triggers: In which situations does the difficulty emerge?

Maintaining cycle: How might thoughts, emotions and behavior interact? Resources: What strengths and support are available? Open questions: What information is missing and what could change the hypothesis? Separate knowledge from interpretation throughout.

Fictional example: postponing presentations

Observation: A fictional adult client reports postponing preparation for work presentations and repeatedly asking a friend to check them. You have not yet explored the reasons for postponement.

Working hypothesis: Expecting mistakes may increase distress, while postponement and checking offer brief relief. Alternative: The task may be unclear or the workload unrealistic. This example is not a diagnosis or intervention recommendation.

Turn the hypothesis into a question you can examine

“They postpone because they are perfectionistic” mixes observation and explanation. Instead ask: Which tasks get postponed? Are there exceptions? What changes after someone checks the work?

Record evidence that does not fit. If presentations become manageable when workload decreases, reconsider an explanation focused only on individual patterns. A formulation's value lies in incorporating new information.

A brief working text for supervision

A start you can copy: “Presenting concern: […]. Direct observations: […]. Working hypothesis: […]. Alternative explanation: […]. Unknown areas: […]. Supervision question: What information am I overlooking when evaluating this hypothesis?”

Ask SüpervizAI to identify gaps in a fictional draft. Do not record generated explanations as facts about the client's history. Real-case assessment and approach selection depend on your professional competence.

How can different approaches consider the same case?

Formulation relates to a theoretical framework, but observation and interpretation need to remain distinct in any approach. In CBT, a specific situation’s meaning and behavioral cycle may be the starting point. Schema therapy can examine recurring meaning alongside momentary states and protective responses. ACT may examine behavioral function in context and its relationship to valued directions.

These maps are not simply different names for the same thing. When combining concepts, state which question each addresses. In the fictional presentation example, withdrawal describes behavior; its meaning, function and circumstances are separate questions. Moving between approaches requires a rationale within your training and competence.

Do not lose context inside an individual explanation

Workload, financial circumstances, actual relationship problems or experiences of discrimination do not disappear under a personal-pattern label. Formulation should not begin by assuming which areas require changing the person’s thoughts.

For the fictional client, repeatedly changing task requirements is one possible explanation for postponing presentations. If supported, it should change the initial map. “Which environmental information have I not asked about because it does not fit my explanation?” is a useful question for keeping the formulation open.

Record what changed rather than silently replacing the old account

Instead of rewriting the whole note whenever new information appears, record the change. Earlier hypothesis: […]. New information: […]. Revision: […]. Alternative still open: […]. Next assessment question: […].

This prevents an earlier assumption from being read as a current fact. In supervision, discuss not only the final formulation but which observation changed your thinking. Also check where the client’s own explanation appears in the map.

Frequently asked questions

How does case formulation differ from diagnosis?

Diagnosis provides a classification framework. Formulation is an individual working hypothesis explaining a person's difficulty through context, resources and maintaining patterns.

When should a formulation be updated?

Update when new information, contradictory observations, changing goals or difficulties in the process require reconsidering the explanation.