A formulation is a shared explanation of how difficulties developed and what may be maintaining them. In cognitive behavioural therapy, it connects experiences with emotions, beliefs, behaviour and circumstances. It is individual rather than a standard explanation applied to everyone who hears voices or has suspicious thoughts.
Cognitive behavioural therapy for psychosis is a collaborative psychological approach to understanding experiences and reducing their distress or impact. It explores relationships between thoughts, feelings, bodily responses and actions. The aim is not to argue someone out of experiences or demand acceptance of a particular diagnosis before useful work can begin together.
The therapist and person consider examples together and revise the account when it does not fit. A formulation may include sleep disruption, worry, trauma, isolation or responses to voices without claiming that any one factor caused the illness. The person’s own understanding is important. The purpose is practical: identifying a cycle that can be changed or a coping response worth testing. A useful formulation is understandable and linked to goals, not merely a technical diagram. Disagreement can prompt clarification rather than being treated automatically as resistance or lack of insight.
Formulations are hypotheses that can be tested through discussion and observation. If an explanation does not fit the person’s experience, it should be revised. This distinguishes collaborative work from imposing a psychological story. A useful formulation connects a specific difficulty with a possible intervention and provides an understandable reason for trying that approach rather than relying on technique alone.
Further reading: NICE clinical guideline; National Institute of Mental Health; Research record 26360083.
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