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Case Formulation in Psychotherapy: Revitalizing Its Usefulness as a Clinical Tool

Received August 1, 2004; revised October 3, 2004; accepted October 19, 2004. Dr. Sim is with McLean Hospital/Harvard Medical School, Belmont, Massachusetts. Dr. Gwee is with the Institute of Mental Health/Woodbridge Hospital, Singapore, Singapore. Dr. Bateman is with St. Ann's Hospital, Halliwick Unit, London, United Kingdom. Address correspondence to Dr. Sim, McLean Hospital/Harvard Medical School, 115 Mill St., Belmont, MA 02467; kang_sim{at}imh.com.sg (E-mail). Copyright © 2005 Academic Psychiatry.

OBJECTIVE: Case formulation has been recognized to be a useful conceptual and clinical tool in psychotherapy as diagnosis itself does not focus on the underlying causes of a patient’s problems. Case formulation can fill the gap between diagnosis and treatment, with the potential to provide insights into the integrative, explanatory, prescriptive, predictive, and therapist aspects of a case. Despite the acknowledgment that case formulation is a basic, necessary, and key clinical skill, it is still largely undertaught and underlearned. Some of the issues faced in the development of a case formulation include that of immediacy versus comprehensiveness, complexity versus simplicity, observation versus organization, and the need for cultural sensitivity toward each individual patient. METHODS: The authors propose five aspects of case formulation beneficial to therapists and residents in training. CONCLUSIONS: The authors argue that case formulation remains an important and indispensable integrative tool for therapists and residents in training who are involved in psychotherapeutic interventions.

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