ABSTRACT
Formulating cases on the basis of an idiographic assessment was originally proposed by Victor Meyer (Meyer and Chesser, 1970) when attempting to treat difficult and complex cases in the psychiatric setting. According to Meyer, with such cases standard techniques of behaviour therapy, which became fashionable in the 1960s, were largely ineffective as they were not properly addressing the mechanism of the disorder. He would argue that an individualised understanding of a problem behaviour in learning terms, the ‘problem formulation’, should be attempted mainly for two reasons:
• Even seemingly similar presenting complaints can involve great individual variations regarding development, presentation, and maintenance.
• It proved unsatisfactory if not impossible to understand and conceptualise more severe, complex disorders on the basis of the diagnostic model, particularly when either multiple or unfocused complaints were reported.
In developing this approach, Meyer emphasised two aspects: the direct application of experimental methodology, as well as learning principles (as developed in the field of empirical learning psychology) to clinical problems. This approach was designed to enhance understanding of the more severe and complex cases that were seen in clinical practice, and to facilitate new innovative treatments where other approaches had failed. Obviously, in those pioneering days of behaviour therapy knowledge about disorders and suitable treatment methods was limited. It is hardly surprising that in due course such a case formulation method proved to be far more useful to therapists (and patients) than a superficial ‘symptom-technique’ matching approach. The present format does not allow a full discussion regarding assumptions, foundations and historical development of case formulation approaches, particularly in relation to nosological approaches in psychiatry. This can be found elsewhere (e.g. Bruch and Bond, 1998)
