Formulation Paper

You will all be independently writing a CBT case formulation and treatment plan of the same case (The
Case of Jen, in Canvas). Your final paper should be two double-spaced pages (treatment plan table
should be a third page) and submitted on Canvas.

Idea: You may use the Eels Model to structure your paper but be sure to apply CBT theory and practice
in the content and include all the areas listed below.

Complete a CBT formulation of the case. This formulation will include:

• A summary of the presenting complaint, with emphasis on the cognitive and/or behavioral
and/or physiological components
• Current precipitating / contributing events
• Patient strengths and resources
• Potential barriers to treatment or adherence to provider recommendations
• Formulation Summary Statement (likely the longest part): Explanation of the causes and
ongoing maintenance of symptoms using one or more of the models we discussed in class (e.g.
operant/classical conditioning, cognitive restructuring, ACT).
• Provide a full DSM-5 Diagnosis
• Problem List (things you believe will be a target for treatment) – A bulleted list will suffice.
• A treatment plan using the Table provided in the assignment description. NOTE: Provide a
reference for each empirical validated intervention. Cite the reference in the table using APA
style, e.g. (King & Ott, 2020). Include all references in APA reference section style at the end of
the table.
• Your treatment plan need not state obvious relational or transtheoretical goals (e.g.
“establish rapport”).
• Please list at least three specific goals with objectives, CBT interventions, and a
proposed outcome measure for each.
• You may choose to list and number your goals in chronological order to demonstrate
awareness that some goals should come before others. However, you do not need to
create a week-to-week plan.

CBT Treatment Plan

Goal(s) Objective Intervention Outcome Measure
(specific, measurable, (with Reference)
achievable, etc)
Reduce intrusive Endorse lower levels Prolonged Exposure PTSD Checklist
memories of trauma. of intrusive memories. therapy (Foa, Year) –
or even better
PE: Imaginal Exposure
 Treatment Plan References List (APA Style):

Case of Jen
Initial Information

Jen is a 28-year-old mother of a one-year-old child.  She is meeting with you today because she
has been feeling down and overwhelmed.  When she called to make the appointment she said, “I
feel like I’m a total failure as a mom.  I just can’t do anything right.”  She says she used to have
a wide circle of friends but hasn’t been in touch with them in a long time and feels she has little
social support.

Results of CBT Assessment

You conduct an initial assessment with Jen. Here are your notes from this assessment, which will
help you to formulate your case conceptualization. You DO NOT need to use all of this
information in your conceptualization (which should be relatively brief)! This comprehensive
information is provided to you to mirror the information you would have if you had completed
an initial assessment.

Demographics: 28-year old mother of one-year-old child. Identifies as White and cisgender.
Married for past 3 years to husband Todd.

Primary complaint: feeling “down,” “depressed,” “discouraged” for the past ~ 9 months
approximately; has difficulty “getting out of bed in the morning” and cries “every day.”

Medical history: no medical history besides an appendectomy at age 17. Has had a check-up with
PCP in past 6 months which included bloodwork (results were normal).

Precipitating events: reports that symptoms have been getting worse since she returned to work
after 3 months of maternity leave; Jen is an administrative assistant at a Fortune 500 company
where she supports the work of three top-level executives who are “very demanding.”
Coping strategies: reports not having time to engage in self-care due to demands of childcare and
her job; has a hard time identifying any current coping techniques. Reports trying not to let her
child see her when she is crying.

Psychiatric history: experienced moderate symptoms of depression during her freshman year of
college due to social isolation and academic stress; benefited from counseling; no significant
symptoms since then.

Family psychiatric history: none that she knows of, but is not sure whether her parents or siblings
would have told her if they had ever experienced similar symptoms.

Religious history/status: raised Catholic; reports that she is not involved in religion right now,
though she used to attend services and sing in church choir before her child was born; reports not
being sure what she believes in anymore.

Substance use history: denies any use of alcohol or substances in past year (and only ever
drinking “socially”).

Developmental history: Jen is the first out of 4 children; reports that her parents were strict and
had high expectations for her and her siblings while growing up, were somewhat “cold,” but
“well-intentioned.” Denied any history of traumatic events, but was deeply affected by the death
of her grandmother a few years ago. Reports that her grandmother was “very affectionate” with
her.

Educational and vocational history: Jen always did well in school and was the first in her family
to earn her bachelors’ degree. After college, she had difficulty finding a job in journalism (what
she hoped to do) and instead settled for a well-paying job as an administrative assistant at a
Fortune 500 company, where she still is now. She always worked extra-diligently and was
promoted quickly to work with some of the top executives in the company.

Social history: Jen describes herself as “usually social but reserved at first.” Made a small group
of close friends in college. She also met her husband in college. She describes him as supportive
but “extremely busy with his work as a financial analyst.” Jen is the primary caregiver for the
child, responsible for everything because he has “too much work right now.” She explains that
he doesn’t seem to understand why she has been so down.

Strengths and values: Jen has difficulty identifying any of her strengths, but reports that her
friends would describe her as loyal, caring, and kind. With some assistance, she identifies that
love, creativity, and generosity are important values in her life.

DSM criteria: Jen meets criteria for Major Depressive Disorder, with peripartum onset (i.e.,
“postpartum depression”). She endorsed most symptoms at moderate to severe levels of the past
9 months. Additional anxiety disorder diagnoses should be ruled out, as Jen appears to have very
high standards for herself as an employee and as a mother.
Functioning and goals: Jen reports that in an ideal world, she would like to “be happy again,” “be
the type of person who calls her friends regularly to catch up,” and “go out on dinner dates with
her husband.” She identifies that engaging in self-care and fun activities is something she really
misses. She also wants to better understand how to balance the demands of parenting with her
work and personal life without thinking that she is “a bad mother.”

Thoughts/beliefs: Jen reported that she cried a lot last Sunday, so we discussed what thoughts
went through her mind at that time. Jen reported the following cognitions: “Parenting is too hard,
I can’t do this anymore;” “Why can’t I get my child to stop crying?”; “I shouldn’t cry in front of
my child;” “I am completely alone;” “No one cares about how I am doing, not even my own
husband or family;” “I am a slob – I haven’t been able to take care of myself since our baby was
born;” “I feel like I am doing everything wrong.” She also reports having fleeting thoughts that
“life may not be worth living,” but denies any intent/plan to harm herself.

Behaviors: Jen reported that even though several of her friends have tried to visit her and offered
to help with the baby, she has postponed their visits indefinitely because she feels “too ashamed”
of the fact that she is not taking care of herself. She also worries that she will feel even worse if
she tells others how badly she is doing. Jen is reporting some emotional eating when she is
feeling down though it is not clear whether this is maladaptive. Otherwise, Jen mostly reports
“not having time” to engage in behaviors she thinks would be useful (exercise, reading/watching
movies, journaling, etc.).