Case Formulation and Treatment Planning: How to Take Care of Relationship and Symptoms Together

Most patients present with a combination of symptoms and relational problems, but often psychotherapies are not conducted in a way to deal with both. Many therapists take a top-down approach to treatments. That is, the techniques they use are based on their theories of therapy (that suggest how certain diagnoses should be treated) rather than on an understanding of the unique problems and issues of the individual patient. We suggest that what is needed is a bottom-up approach , in which the individual patient’s goals, conflicts, inhibitions, and so forth are identified and therapeutic interventions are designed accordingly on a case-specific basis. The foundation of such an approach is a case-specific clinical formulation. There are a number of formulation methods; we focus on the plan formulation method to illustrate how to evaluate the individual needs and specificities of the therapy patient and then how to tailor a therapy to the individual patient, regardless of the therapist’s theoretical or technical predilections. Finally, we report examples of therapies conducted in this bottom-up approach to demonstrate how symptoms and relational problems can and should be addressed.