Critique: J. Persons’ Formulation Approach

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This paper provides a brief critique of Chapters 7 and 8 of the book by Persons (2008) entitled The Case Formulation Approach to Cognitive-Behavior Therapy. The reviewed chapters dwell upon the use of formulation to create a treatment plan and the use of relationship in CBT (cognitive-behavior therapy). In this part of his book, Persons (2008) provides justifications and illustrations of the effectiveness of formulation in the process of treatment development.

The author emphasizes that precision is beneficial for both therapist and patient as the formulation is instrumental in setting clear goals and following the developed plan. The patient’s determination to follow recommendations is also important. Persons (2008) also argues that relationships play an important role in therapy as they help the patient to cope with issues and develop effective behavioral patterns.

The readings include valuable insights into the process of formulation and its impact on treatment development. Persons (2008) emphasizes that it is necessary to use empirically supported therapy whenever it is appropriate. However, the author adds that treatment should be patient-based and consistent with the established goals. One of the weaknesses of the author’s point is the fact that little attention is paid to the way empirical data can be used in obtaining the patient’s informed consent. Patients may be more compliant with the recommendations if they are informed about specific outcomes of certain procedures. The use of such data can be helpful in developing effective relationships with the patient who will see the therapist as a knowledgeable expert capable of helping in certain cases.

Persons (2008) describes the establishment of two types of mechanism change goals and compensatory skills goals. The terms are explained and juxtaposed with similar concepts used in literature. This is a valuable portion as it helps the reader to use prior knowledge and compare the described approach with other frameworks. The author notes that the focus on the goals defines the peculiarities of the treatment recommended to a patient. It is also mentioned that prioritization is essential as the therapist should identify the most urgent issues to address and the goals that may receive less attention or be treated later.

However, the author leaves a serious gap unmet, which leads to a certain confusion. Persons (2008) describes the cases when formulation resulted in the identification of different goals. It is mentioned that the establishment of different goals is quite common. However, it remains unclear which goals should be prioritized and what type of goal, should be addressed. The identified problems should be outlined and discussed with the patient. It is acknowledged that the therapist has the expertise to prioritize goals and develop a treatment plan. It is essential to discuss the patient’s preferences and values, as well as prior experiences, when identifying the goals and developing a plan to address them. Although the author mentioned the need to take into account patients’ previous experiences regarding therapy and seeking assistance, this is not mentioned in relation to the identification of the goals.

Persons (2008) also provides a detailed description of the process of obtaining informed consent. It is stated that informed consent is essential as it facilitates patients’ adherence to the recommended treatment. The major elements of obtaining informed consent include the provision of the data regarding formulation and diagnosis and a brief description of the recommended treatment plan and its rationale, as well as existing treatment options. The author notes that patients may be reluctant to agree to some elements of treatment, so effective strategies to obtain patients’ consent are given. As mentioned above, the discussion of empirical data can be helpful at this stage as well. The author also pays attention to the cases when the therapist may decide not to continue treatment, as well as some strategies to do this effectively.

One of the relevant points made is linked to the benefits of following the plan without excessive compromising. Persons (2008) states that patients may try to change some elements of treatment, and the therapists’ unwillingness to agree to this can make the patient address another professional. For new therapists, patients’ attempts to use the services of other professionals may seem inappropriate and insulting. However, on second thoughts, this scenario is beneficial for both the therapist and the patient. The patient may find the professional whose approach will be more effective, or the patient will understand that the recommended plan is the most effective model. In the latter case, the patient will adhere to the plan, which is fruitful for addressing the established goals.

Chapter 8 deals with the role relationships play in cognitive-behavior therapy. One of the most significant points made is that relationships are often an illustration and manifestation of the patient’s issue. Therefore, the therapist should pay specific attention to the matter to be able to adjust treatment accordingly. Persons (2008) also claims that relationships can be used as a part of therapy as patients can adopt the therapist’s behavioral patterns and use them in diverse situations. The description of the therapists’ feelings and attitudes towards patients’ non-compliance or other undesirable behaviors is invaluable. Persons (2008) displays specific techniques that can be used to address the therapist’s feelings and attitudes and make them an important instrument in therapy. These attitudes can be used to identify the patient’s major issue or some behavioral patterns. Self-disclosure is also mentioned as an effective tool in various cases.

Overall, the reading in question is well-written and informative. The author provides detailed explanations and real-life examples that are instrumental in understanding the exact outcomes of certain practices and models. However, the chapters could be improved through the provision of more real-life examples and cases. The cases mentioned in the text should also be described in more detail. Clearly, no irrelevant or sensitive information should be given, but the data concerning specific techniques used or particular patients’ behaviors could be more detailed. The text would also benefit from the use of some references and empirical data as the author values empirically supported treatment. Irrespective of these gaps, the readings are helpful and provide insights into the peculiarities of formulation-oriented treatment.

In conclusion, it is necessary to note that Persons (2008) provides valuable insights into the benefits of the use of formulation in cognitive-behavior therapy. The descriptions of the establishment of goals, possible obstacles to effective treatment, and the value of relationships are particularly useful. The author includes real-life examples that can assist new therapists in their attempts to use this approach. Although some gaps are evident, the author manages to develop a concise and effective guide for those who want to utilize formulation in CBT. Pretreatment procedures are described effectively and can equip practitioners with specific knowledge and skills they can use in their practice.


Persons, J. B. (2008). The case formulation approach to cognitive-behavior therapy. New York, NY: Guilford.

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PsychologyWriting. "Critique: J. Persons’ Formulation Approach." July 19, 2022.