The utility of case formulation in treatment decision making; the effect of experience and expertise.
OBJECTIVE
We examined whether case formulation guides the endorsement of appropriate treatment strategies. We also considered whether experience and training led to more effective treatment decisions. To examine these questions two related studies were conducted both of which used a novel paradigm using clinically relevant decision-making tasks with multiple sources of information.


METHODS
Study one examined how clinicians utilised a pre-constructed CBT case formulation to plan treatment. Study two utilised a clinician-generated formulation to further examine the process of formulation development and the impact on treatment planning. Both studies considered the effect of therapist experience.


RESULTS
Both studies indicated that clinicians used the case formulation to select treatment choices that were highly matched to the case as described in the vignette. However, differences between experts and novice clinicians were only demonstrated when clinicians developed their own formulations of case material. When they developed their own formulations the experts' formulations were more parsimonious, internally consistent, and contained fewer errors and the experts were less swayed by irrelevant treatment options.


CONCLUSIONS
The nature of the experimental task, involving ratings of suitability of possible treatment options suggested for the case, limits the interpretation that formulation directs the development or generation of the clinician's treatment plan. In study two the task may still have limited the capacity to demonstrate further differences between expert and novice therapists.


CONCLUSIONS
Formulation helps guide certain aspects of effective treatment decision making. When asked to generate a formulation clinicians with greater experience and expertise do this more effectively.
Doctorate of Clinical Psychology, Newcastle University, UK; Northumberland Tyne and Wear NHS Trust, UK. Electronic address: r.e.j.dudley@ncl.ac.uk.
Robert
R
Dudley
Northumberland Tyne and Wear NHS Trust, UK.
Barry
B
Ingham
Doctorate of Clinical Psychology, Newcastle University, UK.
Katy
K
Sowerby
Northumberland Tyne and Wear NHS Trust, UK; Institute of Neuroscience, Newcastle University, UK.
Mark
M
Freeston
D000328:Adult; D002983:Clinical Competence; D000066491:Clinical Decision-Making / Q000379:methods*; D015928:Cognitive Behavioral Therapy / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
Cognitive therapy; Expertise; Formulation; Treatment