ABSTRACT
When examining patients, we are accustomed to thinking in terms of diagnosis. However, there are many types of diagnosis many ways to 'examine the problem' and are more relevant to planning therapy. A different form of diagnosis is case formulation. With case formulation, the goal is to go beyond identifying the behavioral symptoms to generating hypotheses, in the form of a narrative, about the predisposing, precipitating, and perpetuating influences on the patient's current distress. This model has its roots in the medical case history, dating back to Hippocratic and Galenic medicine in the fourth and fifth centuries BC Menninger's approach is at the core of most case formulation methods that followed, be they psychodynamic, cognitive-behavioral or integrative. A rigid demarcation between diagnosis and therapy is artificial because active collaboration in designing a therapy plan is always therapeutic, and therapy, when conducted with a mind open to discontinuities and the need constantly to refine our hypotheses, is always diagnostic.
