Free Therapist Training›Psychodynamic Therapy Toolkit›Psychodynamic Case Formulation
Last updated: November 11, 2026
A psychodynamic case formulation, also called a case conceptualization, is a short written account of how a client's difficulties developed and what keeps them going. It names the defenses and feelings at work, the relational pattern the client repeats, and the beliefs that hold the pattern in place, and it turns that understanding into a focus for treatment. The template below has eighteen parts, and a completed example for an invented client follows it. Both are free to copy, print and adapt.
The template comes from the Sentio MFT program's free psychodynamic therapy toolkit, which also holds a cyclical maladaptive pattern worksheet, a treatment plan and progress notes built on the same case.
This is an optional aid from the Sentio MFT program's psychodynamic therapy toolkit. It is not an official form of any agency or payer.
Download the PDFMake an editable copy
| Part | What to write |
|---|---|
| 1. Client and context | Age range, the identities the client has shared that matter to the work, the setting, the referral source and who else is involved in care. |
| 2. Presenting problem | The problem in the client's own words, why help is being sought now and what the client hopes will change. |
| 3. Symptoms, functioning and diagnosis | Mood, anxiety, sleep, work and relationships; scores on any measures you use; a diagnosis if your setting requires one. |
| 4. Risk and safety | Suicide and self-harm, harm to others and substance use, with the safety plan if one is in place. |
| 5. History that bears on the problem | Family and developmental history, losses, trauma, medical history and earlier treatment, limited to what helps explain the present problem. |
| 6. What cannot be changed | Temperament, constitution, illness and life circumstances outside the client's control that shape the problem and the work. |
| 7. Developmental themes | Developmental tasks or conflicts that still seem alive, such as closeness and separateness, autonomy, competition or identity. |
| 8. Defenses | How the client protects against painful feelings, with one example from a session, and how flexible or rigid those protections are. |
| 9. Affect | Which feelings the client can feel and name, which ones are avoided or dreaded, and how distress gets managed. |
| 10. Identifications and self-esteem | Whom the client resembles or works hard not to resemble, how the client sees the self, and what raises or lowers self-esteem. |
| 11. Relational pattern | The recurring pattern with other people, summarized in the four parts of the cyclical maladaptive pattern from time-limited dynamic psychotherapy: what the client does, what the client expects of others, what others do, and how the client then treats the self. |
| 12. Core beliefs | The beliefs about self and others that keep the pattern going, written in the client's idiom, for example "If I need something, I become a burden." |
| 13. Transference and countertransference | How the pattern has shown up with you so far, and what you find yourself feeling or doing with this client. |
| 14. Strengths | Capacities that will help the work: curiosity about the self, relationships, humor, persistence, work, faith or community. |
| 15. Culture and context | Identity, culture, community and social conditions that shape the problem, the pattern and the client's view of therapy. |
| 16. Formulation summary | Three to five sentences that tie the history, the pattern and the defenses to the current problem and explain what keeps it going. |
| 17. Implications for treatment | The focus, goals, length and frequency of treatment, what the alliance may need, the transference to expect and the measures you will track. |
| 18. Open questions | What you do not know yet, and the hypotheses you want to test over the next few sessions. |
Keep the formulation to one or two pages. Write it as a working hypothesis, date it, and revise it when the client tells or shows you something that does not fit.
What Does a Completed Psychodynamic Case Formulation Look Like?
The example below is a formulation written after the third session with Elena, an invented client seen weekly in a group practice. The same client appears in most of the other completed examples in the toolkit, so you can follow one case from formulation to treatment plan, progress note and process note.
| Part | Example entry |
|---|---|
| 1. Client and context | Elena, 38, high school chemistry teacher, married, one son aged 9. Referred by her primary care physician. Weekly individual outpatient therapy in a group practice. |
| 2. Presenting problem | "I'm tired all the time and I don't enjoy anything. I don't know why I can't just be grateful." Low mood for six months, since she was passed over for department chair and her husband started a demanding new job. She hopes to "feel like myself again." |
| 3. Symptoms, functioning and diagnosis | Low mood most days, early waking, fatigue, poor concentration, loss of interest in running and choir. Still working, with effort. PHQ-9 of 14 at intake. Major depressive disorder, single episode, moderate (F32.1). |
| 4. Risk and safety | Denies suicidal ideation, intent or plan, now and in the past. No self-harm or harm to others. Two or three glasses of wine a week. Risk screened at each session. |
| 5. History that bears on the problem | Elder of two children. Parents divorced when she was 10; her mother was depressed afterward and often in bed. Elena cooked for her younger brother and kept the house quiet. Her father remarried and was warm but rarely available. Praised as "mature" and "no trouble." First in her family to finish college. No earlier therapy. |
| 6. What cannot be changed | A quiet, conscientious temperament by her own and her family's account. Her mother's illness and the divorce shaped her role in the family long before she could choose it. |
| 7. Developmental themes | Closeness and separateness: closeness came through looking after others, and having needs of her own felt like a threat to it. Competition is uncomfortable; she wanted the chair position and feels ashamed of wanting it. |
| 8. Defenses | Minimizing ("it's fine"), turning her attention to others' needs, and an even, orderly way of telling painful events. In session 3 she laughed and changed the subject as her eyes filled. These soften when she feels unhurried and not judged. |
| 9. Affect | Sadness reaches her as fatigue. Anger is the most dreaded feeling: she calls it "being petty." She manages distress by working harder and going quiet. |
| 10. Identifications and self-esteem | Identifies with her mother's struggle and works hard not to be "needy" like her. Self-esteem rests on being useful and drops when she is overlooked, which she then reads as proof that she wanted too much. |
| 11. Relational pattern | She hides what she wants and gives more (acts of the self), expecting that asking would make others annoyed and withdraw (expectations of others' reactions). Others lean on her and hand her more (acts of others). She then calls herself greedy for wanting anything (act of the self toward the self). |
| 12. Core beliefs | "My needs are a burden." "I am valued for what I do, not for who I am." |
| 13. Transference and countertransference | Apologizes for arriving early and asks whether she is "doing therapy right." The therapist feels pulled to reassure her and fill silences with suggestions, and at times feels a flat, drifting attention during her even accounts. |
| 14. Strengths | Reflective, reliable, warm with students, a long marriage she values, and a sense of humor that comes through once she relaxes. |
| 15. Culture and context | Describes a family rule of not complaining and worries that therapy is "self-indulgent." As the first in her family to finish college, she carries a strong sense of obligation to the family. |
| 16. Formulation summary | Elena learned early that her needs added to her mother's burden and that she earned closeness by looking after others. She still hides her wishes and gives more, expecting that asking would drive people away. When others take what she gives and pass her over, she turns on herself for wanting anything, and the low mood deepens. Being passed over at work, while carrying more at home, brought the pattern to a head. |
| 17. Implications for treatment | Time-limited dynamic psychotherapy, weekly for about 20 sessions, reviewed at session 10. Focus on the pattern as it appears in her week and with the therapist. New experience: voicing wishes and disagreement with the therapist and finding them welcome. New understanding: recognizing the cycle as it happens and its origins. Expect deference and reluctance to bring "small" problems. PHQ-9 every four sessions. |
| 18. Open questions | How much anger sits under the fatigue? What happens in her marriage when she does state a need? Is there a medical contribution to the fatigue? (Her physician is following this.) |
What Is a Psychodynamic Case Formulation?
A case formulation is the clinician's explanation of a client's problems: how they arose, what maintains them, and what treatment should aim to change. In a psychodynamic formulation the explanation draws on processes the client is not fully aware of. Defenses keep painful feelings out of awareness, early relationships leave expectations of how others will respond, and the client repeats a pattern that once made sense and now causes harm.
McWilliams (1999) organizes psychoanalytic case formulation as an assessment of several areas: what cannot be changed, developmental issues, defenses, affects, identifications, relational patterns, self-esteem and pathogenic beliefs. Time-limited dynamic psychotherapy (TLDP), developed by Hans Strupp and Jeffrey Binder at Vanderbilt University and extended by Hanna Levenson, organizes the relational part of that picture as a cyclical maladaptive pattern (CMP). The template uses both: the broad survey of the person and a relational summary specific enough to guide each session.
Is a Psychodynamic Case Conceptualization the Same Thing?
Yes. Training programs and textbooks use both terms for the same task. What changes between models is the content. A cognitive conceptualization centers on beliefs and behaviors that maintain symptoms; a psychodynamic one centers on conflict, defense, affect and the relational pattern, including how that pattern shows up with the therapist. If your program asks for a case conceptualization in a psychodynamic orientation, the template answers it.
How Do You Write One?
- Let the client tell the story. Note the problem in the client's own words and why help is being sought now.
- Collect specific relational episodes. Ask for particular moments with particular people: what the client wanted, did and expected, what the other person did, and how the client felt afterward. Our interventions list describes the kind of therapeutic inquiry that draws these out.
- Watch the room. Note the feelings that appear and disappear, the defenses that follow them, and what happens between you and the client.
- Draft the pattern. Sort what you have into the four parts of the CMP worksheet and write the cycle in one paragraph.
- Write the summary. Three to five sentences that link history, pattern and defenses to the current problem.
- Turn it into a plan, and revise. State the focus and goals in a treatment plan, then revisit the formulation every few sessions.
What Goes Wrong in Psychodynamic Formulations?
A common problem is a history without an explanation: pages of background with no account of why the problem is happening now or what keeps it going. A second is jargon that the clinician cannot translate into the client's words, which usually means the formulation has not yet been tested against what the client says. A third is a formulation that never changes after intake. Others include leaving out culture and context, describing defenses without an example from a session, and saying nothing about how the pattern is likely to appear with the therapist, which is often where the most useful work happens.
Supervision is the natural place to test a formulation. The supervision toolkit's case presentation format gives the formulation a slot, and our recording review form helps a supervisor check it against what happened on a recording.
Keep reading
Cyclical Maladaptive Pattern Worksheet, the relational summary at the center of the formulation, with a completed example
Psychodynamic Treatment Plan Examples, how the formulation becomes goals and measurable objectives, for depression and for anxiety
Case Formulation and Treatment Planning, a free webinar with Alexandre Vaz on moving from formulation to plan
Deliberate Practice in Psychodynamic Psychotherapy, free skill videos that pair with the APA book by Levenson, Gay and Binder
Frequently Asked Questions
What should a psychodynamic case formulation include?
The presenting problem in the client's words, symptoms and risk, the history that bears on the problem, defenses, affect, identifications and self-esteem, the relational pattern, core beliefs, transference and countertransference, strengths, culture and context, a short summary and the implications for treatment.
How long should a psychodynamic case formulation be?
One or two pages is enough for most clinical uses. The summary itself should fit in three to five sentences; if it cannot, the formulation usually needs more thought rather than more history.
Is a psychodynamic case conceptualization different from a case formulation?
No. The two terms name the same task. What differs between therapy models is the content: a psychodynamic formulation centers on conflict, defense, affect and the relational pattern, including how the pattern appears with the therapist.
How often should I revise a case formulation?
Revisit it every few sessions and whenever the client says or does something it does not explain. In time-limited work, a review at the midpoint of treatment is a natural moment to rewrite it.
References
Binder, J. L. (2004). Key competencies in brief dynamic psychotherapy: Clinical practice beyond the manual. Guilford Press. ISBN 978-1-59385-058-6. https://www.guilford.com/books/Key-Competencies-in-Brief-Dynamic-Psychotherapy/Jeffrey-Binder/9781609181680
Levenson, H. (2026). Brief dynamic therapy (3rd ed.). American Psychological Association. ISBN 978-1-4338-4478-2. https://www.apa.org/pubs/books/brief-dynamic-therapy-third-edition
Levenson, H., Gay, V., & Binder, J. L. (2023). Deliberate practice in psychodynamic psychotherapy. American Psychological Association. ISBN 978-1-4338-3673-2. https://doi.org/10.1037/0000351-000
McWilliams, N. (1999). Psychoanalytic case formulation. Guilford Press. ISBN 978-1-57230-462-8. https://www.guilford.com/books/Psychoanalytic-Case-Formulation/Nancy-McWilliams/9781572304628
Strupp, H. H., & Binder, J. L. (1984). Psychotherapy in a new key: A guide to time-limited dynamic psychotherapy. Basic Books. ISBN 978-0-465-06747-3. https://www.hachettebookgroup.com/titles/hans-h-strupp/psychotherapy-in-a-new-key/9780465067473
