The importance of Case formulation in psychotherapy

The Misconceptions and Misunderstandings of the Public about Psychological Therapy

I often receive inquiries and consultations from patients and colleagues. They ask me questions like:

• "Do you provide CBT (Cognitive Behavioral Therapy) for my X problem?"
• "I have depression, can hypnosis be used to treat it?"
• "I have borderline personality disorder, do you provide DBT (Dialectical Behavior Therapy)?"

These questions are incorrect because they are based on a flawed assumption. I want to clarify the misconceptions and misunderstandings of the public about psychological therapy and help those who want to seek psychological counseling to determine whether they are suitable for therapy.

A clinical psychologist's professional ability is not just to provide therapy, but to formulate a case.

The First Misconception: Same Diagnosis, Same Treatment

The first misconception is that people with the same diagnosis can be treated with the same method. Diagnosis can only tell us what symptoms a person has, but it cannot tell us who the person is, what happened to them, or their story.

We psychologists do not decide on treatment plans based on symptoms and diagnoses, but rather on the case formulation. This is the biggest difference between us and psychiatrists. Psychiatrists urgently need to know the symptoms and control them with medication.

We, on the other hand, need to understand the person behind the symptoms. Who are you? What happen to you? What is your story? Otherwise, therapy cannot begin.

The Second Misconception: One-Size-Fits-All Treatment

The second misconception is that all CBT is the same, and we don't need to consider the therapist's approach. The therapist is just a technician, with a bag of psychological techniques. If you want to learn more about me please go to my website here.

Examples

Let's take two examples:

• A person who is depressed because of poor exam results and a person who is depressed because of midlife crisis. They may have the same diagnosis, but their treatment plans should not be the same. Can we use the same CBT techniques for both of them?
• A person who is depressed after losing a loved one and a person who is depressed because failing an exam. They may have the same diagnosis and same symptoms, but their treatment plans shoud not be the same. Can we use the same technique for both of them?

The African Violet: A case from Dr. Milton Erickson

Let me share another example. Dr. Milton Erickson, a hypnosis master, had a case of an elderly woman who was depressed due to loneliness. The family doctor was worried and asked Dr. Erickson to visit her. During the visit, Dr. Erickson discovered that the woman's room was dark and filled with a sense of sadness. He also learned that she was a Christian and loved to grow violets. He then told her, "You are not a good Christian, but you are good at growing flowers. Why don't you share your talent with others?"

He then instructed her to send flowers to her neighbors and friends whenever there was a local event. As a result, her depression disappeared because she had more social relationships and no longer felt lonely.

The "Send Flowers" Method

Can we name this method as the "Sending Flowers" method and ask all depressed patients to follow this method? Will this cure depression? Of course not, each patient is an individual and each patient should be treated differently. I hated it when the system required or dictate what I should do in therapy. To me that is how therapy lost its way, become dead and robotic. If you want to learn more about my approaches, please visit my website.