Assessment
Deception-Aware Case Formulation Update
Adjust the clinical picture of a client to account for known omissions, false reports, and suspected deception — so the formulation reflects the most accurate picture available.
This worksheet helps therapists revise their clinical formulation when known or suspected deception has affected the information base. Used after a significant deception or omission comes to light, it produces a working formulation that is appropriately uncertain without being paralyzed by that uncertainty.
Complete this worksheet whenever a significant deception or omission is discovered, and review it before the next session. A formulation built on information the therapist knew was unreliable is not clinically useful. But neither is one built entirely on suspicion — the goal is a calibrated picture that accounts for what is known, what is uncertain, and what remains to be learned.
Deception-Aware Case Formulation Update
Client (initials or identifier): _______________ Date of update: _______________ Trigger for update (what was discovered): _______________________________________________
Summary of known deceptions What the therapist now knows was false or incomplete, and when it was discovered:
Summary of known omissions What the client has consistently not reported, deflected around, or left out:
How each affects the current formulation For each deception or omission, note which clinical hypotheses need to be revised:
Deception or omission: _______________________________________________ Effect on formulation: _______________________________________________
Deception or omission: _______________________________________________ Effect on formulation: _______________________________________________
Deception or omission: _______________________________________________ Effect on formulation: _______________________________________________
Adjusted hypotheses about the problem What does the formulation look like when the known deceptions and omissions are factored in?
Original hypothesis: _______________________________________________ Adjusted hypothesis: _______________________________________________
Original hypothesis: _______________________________________________ Adjusted hypothesis: _______________________________________________
The clinical picture with deceptions accounted for The most accurate picture currently available, holding appropriate uncertainty where the information base is unreliable:
Areas of the formulation that remain uncertain What the therapist cannot know yet, pending more reliable information:
How the updated formulation changes the treatment approach What will be done differently based on the revised clinical picture?
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