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Case formulation—A vehicle for change? Exploring the impact of cognitive behavioural therapy formulation in first episode psychosis: A reflexive thematic analysis

Lookup NU author(s): Helen Spencer, Dr Rob DudleyORCiD, Professor Mark FreestonORCiD, Professor Douglas Turkington



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2022 The Authors. Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of The British Psychological Society. Objectives: Formulation is considered a fundamental process of cognitive behavioural therapy for psychosis (CBTp). However, an exploration into the personal impact of different levels of case formulation (CF) from a service user perspective (SU) is lacking, particularly for those experiencing a first episode of psychosis. Design: This Big Q qualitative design used semi-structured interviews. Methods: Reflexive thematic analysis (TA) was used to analyse 10 participant interviews. NVivo 12 computer-assisted qualitative data analysis software aided data organisation and analysis. Results: One overarching theme ‘CF – A vehicle for change?’ was developed as a pattern of shared meaning across the data set. Three main themes related to the overarching theme: (1) Vicious cycles: ‘I never really thought about it being me maintaining the problems’ (including one subtheme – Self-empowerment: ‘Only you can make the changes for yourself’); (2) Early life experiences: ‘My experiences have shaped the person that I am, therefore, it's not my fault’ (including one subtheme – Disempowerment: ‘[My] core beliefs have been damaged’); and (3) Keep it simple: ‘Don't push it too far over the top in case it becomes like spaghetti’. Conclusions: Maintenance formulations may be experienced as self-blaming, but also self-empowering, which may help to facilitate change. Longitudinal formulations may be experienced as non-blaming, but also disempowering, which may inhibit change. Simple CF diagrams may also facilitate change, whereas overly complex CFs may inhibit change. How CBTp therapists might look to improve the impact of different levels of CF for service users (SUs) in first episode psychosis (FEP) are described.

Publication metadata

Author(s): Spencer HM, Dudley R, Johnston L, Freeston MH, Turkington D, Tully S

Publication type: Article

Publication status: Published

Journal: Psychology and Psychotherapy: Theory, Research and Practice

Year: 2023

Volume: 96

Issue: 2

Pages: 328-346

Print publication date: 01/06/2023

Online publication date: 08/12/2022

Acceptance date: 22/11/2022

Date deposited: 06/01/2023

ISSN (print): 1476-0835

ISSN (electronic): 2044-8341

Publisher: John Wiley and Sons Inc.


DOI: 10.1111/papt.12442


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Funder referenceFunder name
British Federation of Women Graduates. Grant Number: 17136