Development of an Individual Case Formulation Rating Scale

Danelle Pettman

Research output: ThesisDoctoral Thesis

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CBT treatments guided by case formulations have been overshadowed by more standardised methods of therapy in current service delivery models, due to the evidence base for formulations limited reliability, validity and clinical utility. A more unified and explicit approach to formulation and formulation training is required to establish an evidence base for formulation driven approaches. The individual case formulation (ICF) model (Hallam, 2013) offers a functional and systematic approach to case formulation using protocol driven conventions.

This study sought to empirically test Hallam’s (2013) ICF diagramming conventions. As no suitable measure of ICF formulation skills exists the primary focus of the present study was to develop and assess a rating scale of ICF skills. The ICF rating scale was assessed in terms of its reliability and validity. The elements of the ICF model that can be taught declaratively through workshops were assessed and the potential predictive validity of learning ICF skills upon clinical outcome was explored.

Novice cognitive behavioural therapy trainees’ formulation skills were assessed before and after attendance at an ICF training workshop. Evidence was found that there were a significantly higher amount of formulation skills demonstrated from pre to post the workshop. The ICF rating scale demonstrated acceptable inter-rater reliability and internal consistency (Chronbach’s alpha .91). Validity assessed in terms of correlation with therapists’ CBT competence or years of clinical experience was not demonstrated, but tentative evidence of the predictive effects of attending ICF training on clinical outcome were found.

Whilst the conclusions of the study are limited due to the sample size and methods used, the ICF rating scale demonstrated emerging reliability. Further research is needed to establish validity of this measure in different settings, particularly across different experience levels of therapists. The study concluded that further research focused on the ICF model is warranted due to promising findings that ICF skills can be improved with a one-off training session.
Original languageEnglish
Awarding Institution
  • Royal Holloway, University of London
  • Brown, Gary, Supervisor
Award date1 Nov 2017
Publication statusUnpublished - Sept 2017


  • Case Formulation
  • Formulation
  • CBT training

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