Case Formulation as an Outcome and Not an Opening Move in Relational and Psychodynamic Models

Case formulation in psychodynamic models is influenced by the conflictual and unconscious conception of mind functioning. This conception suggests that in psychodynamic models, case formulation is the final fruit of the demanding task of exploring unconscious drives, resistances and transferal patterns ands not an initial setting of the rules as in the cognitive behavioral approach. This hypothesis is partially applicable, albeit with a number of limitations, to modern psychodynamic models such as Control Mastery Therapy (Weiss et al., The psychoanalytic process: Theory, clinical observations, and empirical research. Guilford Press, New York, NY, 1986), Mentalization Based Therapy (Bateman and Fonagy, Mentalization based treatment: A practical guide. Oxford University Press, Oxford, 2006) and the Ruptures and Repairs model (Safran and Muran, Negotiating the therapeutic alliance: A relational treatment guide. Guilford Press, New York, NY, 2000), which include a case formulation procedure that is clearly present but not fully shared with the patient from the beginning.