Case Formulation

The progressive hypothesis and co-construction

Case formulation in couples therapy differs from traditional medical diagnosis.

Rather than applying a static pathological label (such as "depression"), we seek a dynamic meta-description of what is occurring.

This formulation is not a verdict that the therapist imposes, but a working hypothesis to be co-constructed and shared with the couple.

It is not about keeping professional secrets, but about offering an explanatory narrative that helps clients make sense of their chaos. This hypothesis is "progressive," meaning it is not written in stone.

It is constantly updated as new information emerges during treatment.

The therapist poses tentative ideas about why conflicts occur and observes how they resonate with the couple, adjusting the formulation based on their feedback.

Deconstructing the problem and contextual factors

A robust formulation should break down the presenting problem into its components.

This includes analyzing why the couple perceives a certain situation as problematic at this specific time.

Broad contextual factors such as family of origin history, cultural pressures, religious values, and socioeconomic circumstances surrounding the relationship should be integrated.

Also included are the beliefs and explanations that the members themselves have for their difficulties.

For example, if they believe that their problems are due to "character incompatibility," the formulation should address and perhaps challenge that belief, proposing alternative explanations based on interaction patterns or deficiencies in negotiation skills.

In addition, any secondary gains or functional value that the current symptoms may be contributing to the precarious balance of the system should be made explicit.

Explanation of rationality and clinical utility.

The ultimate goal of formulation is not to find a scientific "absolute truth," but to construct a map that is useful for change.

A good formulation must meet the criterion of utility: does this explanation help the couple to understand each other better and unlock their resources? By verbalizing these hypotheses, we make the implicit explicit.

Feelings, unspoken rules or unconscious patterns are put on the table, becoming more concrete and manageable.

Providing a logical justification (rationality) for the couple's difficulties is, in itself, a therapeutic factor.

It reduces anxiety by transforming a confusing suffering into an understandable problem with identifiable causes and solutions, which increases hope and motivation for treatment.

Abstract

The formulation seeks a dynamic description of what happened rather than static pathological labels. It is a working hypothesis shared and continuously co-constructed with the partner.

It must break down the problem by integrating contextual factors such as family of origin, cultural pressures, and socioeconomic circumstances. It also addresses individual beliefs about supposed character incompatibility.

Providing a logical and rational framework for the difficulties functions as a key therapeutic factor. It reduces anxiety by transforming confusing suffering into problems with identifiable solutions.