It is at this point in therapy that you may like to introduce case formulation to the client. Whilst you may have already made your own formulation, it is suggested that you work with your client and establish a collaborative formulation for your client's record (Exercise 3). This will help empower the client, allowing him/her to be an active part of his/her intervention.

The following guidelines for case formulation (Persons, 2001), if used, will add to the initial assessment, and are consistent with the cognitive behavioural approach of this intervention.

The formulation assists in the development of working hypotheses or clinical assumptions about how the client's beliefs (underlying mechanisms) shape their thoughts, mood and behaviour (overt level).

Environmental factors play a key role in eliciting and triggering beliefs and thoughts, feelings and behaviours. One important area of consideration is the link between beliefs about mental illness (psychotic symptoms, paranoia, depression) and amphetamine use (behaviour).

A formulation therefore is a summary of the client's presentation, gained from the thorough assessment, which draws together important features to facilitate the development of a treatment plan. Information gained from the initial assessment recommended above is utilised in the formulation. The main areas a formulation should cover are:

  1. Summary of the presenting problem/s (might include a problem list).

  2. Main concern

  3. Predisposing factors:
    • These are the factors that increase a client's vulnerability to drug use such as having parents who used drugs, having a mental health disorder, and holding certain core beliefs about themselves.

  4. Precipitating factors:
    • These are the factors that are immediate triggers for drug use, such as feelings of anger or depression, being exposed to drugs, and experiencing withdrawal symptoms.

  5. Maintaining factors:
    • These are the factors that maintain use, such as having a circle of drug-using friends, reasons for using (drug expectancies), having a partner who uses, previous failed attempts to stop, not contemplating change, and alleviation of withdrawal symptoms with drug use.

  6. Relationship between mental health problems and drug use:
    • What is the relationship between the client's substance use and mental health problem?
    • What are the links in the beliefs the person holds about their drug use and mental health problems?
    • What possible interactions are there between the client's substance use, prescribed medication and compliance with the medication regimen?

  7. A treatment plan that addresses each of the above areas.
Top of pageUse the following worksheet to guide your case formulation with the client (Exercise 3).

The case formulation should be constantly revisited and revised throughout the intervention to monitor the client's progress and evaluate the effectiveness of the intervention.

Explain rationale for formulation
Agree on the elements of the formulation
Make a joint treatment plan

Explain rationale for formulation

Explain to the client that the development of a formulation provides the foundation for a mutually agreed treatment plan, and allows the key areas that require emphasis during the intervention to emerge.

Agree on the elements of the formulation

  • predisposing factors (increase a client's vulnerability to drug use);
  • precipitating factors (triggers for drug use as determined previously);
  • maintaining factors (maintain use such as drug-using friends etc);
  • relationship between mental health problems and drug use.

Make a joint treatment plan

Based on the information gained from the assessment and the formulation, jointly develop an individualised treatment plan that emphasises the relevant aspects of the intervention as appropriate for the person's readiness to change drug use, level of motivation, level of commitment, skills, and goals for treatment.

Exercise 3: The case formulation

  • Presenting problem/s:
  • Problem list (1 to 5):
  • Main problem of concern:
  • How did these problems develop (predisposing factors)?
  • What are the identified triggers (precipitating factors)?
  • What factors maintain drug use?
  • What is the relationship between speed use and mental health problems (if present)?
  • Treatment plan: