---

name: case-formulation
description: "Build a collaborative case formulation that maps the maintaining loop, gives the client a usable map, and makes session work translate to real-world behavior change."

/case-formulation

Insight doesn't shift behavior — maps do. A client can understand, intellectually, that they avoid conflict because conflict felt unsafe in childhood, and still avoid every difficult conversation at work. The gap between insight and change is usually that no one has drawn the maintaining loop: the precise cycle of trigger → belief → behavior → consequence → reinforcement that keeps the problem in place. Without that map, sessions become interesting conversations that don't generalize. With it, the client can catch themselves in the loop in real time, name what's happening, and choose a different response. This skill builds the formulation collaboratively — not as a clinical document, but as a tool the client can actually use.

Presenting Problem

• State the problem as the client named it: "I keep procrastinating on important projects until the deadline is so close I have to stay up all night."
• Then state it in behavioral terms — what an observer would see: "Client delays starting high-stakes tasks for weeks, then produces work in a concentrated burst under severe time pressure, consistently."
• Note: the behavioral description removes judgment and makes the pattern observable. Clients who feel observed rather than judged are more willing to investigate.

Originating Circumstance

• What early experience taught the client this pattern made sense? This isn't about blame — it's about origin. The pattern was learned because at some point it worked.
• Write a hypothesis, collaboratively: "It sounds like early experiences where your effort was criticized before it was finished may have taught you that starting = risk of criticism. Waiting until the last minute removed that window."
• The hypothesis must be checked with the client. A formulation the client doesn't recognize is a theory about someone else.

Core Belief Formed

• What belief about themselves, others, or the world was formed in that circumstance?
• Write it in first person: "If I show unfinished work, I'll be judged as incompetent." Or: "My worth depends on delivering perfect outputs."
• The core belief is not a personality trait — it's a cognitive schema that the client operates from automatically, especially under stress.

Current Triggers

• What specific situations activate the core belief and start the cycle? Be precise.
• "When a manager asks for an update on a project that isn't done" is a trigger. "High-pressure situations" is not.
• Name 3-5 triggers. The more precisely named, the more catchable they are in real life.

The Coping Strategy That Now Causes Problems

• What does the client do to manage the anxiety triggered by the core belief? This was adaptive once — name why.
• "Procrastination delays the moment of judgment indefinitely — which reduces anxiety in the short term and creates crisis in the long term."
• The coping strategy is not the enemy. It was the solution. It has just outlived the problem it was solving.

The Maintaining Loop

• Draw the loop in explicit steps: Trigger → Core Belief Activated → Anxiety → Coping Behavior → Short-term Relief → Long-term Consequence → Reinforcement of Core Belief.
• Example: "Deadline approaches → 'I'll be judged if it's not perfect' → anxiety → avoid starting → relief from not facing judgment → eventually panic-produces → gets it done under pressure → confirms belief that the approach works, even though the cost is enormous."
• The loop is the most powerful element of the formulation. When the client can name where they are in the loop in real time, they can interrupt it.

The Intervention That Disrupts the Loop

• Where is the loop weakest — where is there the smallest intervention for the largest disruption?
• Usually: the coping behavior, because it's observable and can be changed behaviorally before the belief fully shifts.
• Name the behavioral experiment: "Commit to showing one paragraph of an unfinished document to a trusted colleague and notice what actually happens." The experiment tests the core belief in real conditions.

How to Share This With the Client

• Formulations are collaborative, not delivered as diagnoses. The framing: "I want to share a map I've been building of how this pattern works. Tell me where it fits and where it doesn't."
• Use the client's own language wherever possible. Their metaphors are more resonant than clinical terms.
• End by asking the client what would feel different about their life if the loop changed. That answer becomes the goal.

Rules

1. The formulation uses the client's language, not clinical jargon.
2. Every element is checked collaboratively — the therapist proposes, the client confirms or corrects.
3. The maintaining loop is drawn with specific steps, not described in general terms.
4. The intervention targets the most accessible link in the loop, not the most theoretically interesting.
5. The core belief is stated as a belief, not a personality trait. Beliefs can be tested; traits imply permanence.
6. The behavioral experiment is small, real, and proximal — something the client can attempt before the next session.

The output is a formulation document — loop diagram, belief statement, triggers, behavioral experiment — that the therapist and client review together and that the client takes away as a working map for the week.