Constructivist · 2022
Evolutionary Case Formulation
The case is understood once the distress is reconstructed as a sequence of meaning that organises feeling, explaining and coping.
Evolutionary Case Formulation is a constructivist, integrative model of clinical formulation proposed by Álvaro T. Quiñones Bergeret in order to offer a common language in psychotherapy capable of organising the information of a case, explaining psychological suffering and guiding the strategic design of treatment. The model starts from the idea that the human mind is a biological, social, narrative and temporal expression of the evolution of the species, and that distress appears when the person processes their experience through sequences of meaning that generate discontinuity in the sense of self, non-adaptive self-deception, difficulties of emotional regulation, deficient coping and problems of interpersonal coordination. Its central tool is the reconstruction of psychological distress through domains of information — especially the non-adaptive theme of meaning, the sense of self and the temporal attribution of the problem — so that therapist and patient can identify how the problem is organised, what information is omitted or distorted, what emotions and explanations sustain it, what coping strategies perpetuate it and where a strategic perturbation should be introduced. The intervention is defined not by a single technique but by a clinical logic: constructing an explanatory diagnosis, generating guided self-observation, increasing novel information and encouraging a cognitive-affective-behavioural reorganisation that produces narrative coherence, emotional ownership and a greater capacity to solve the problems of existence.
Theory of change
The person changes when they reconstruct the sequences of meaning that organise their distress and generate novel information integrating emotion, cognition, identity and coping.
Core ideas
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Case formulation is the bridge between understanding and treating
Evolutionary Case Formulation starts from a clear position: descriptive diagnosis helps to communicate symptoms, but it is not enough for doing psychotherapy. The therapist needs an explanation of how the problem works that connects request, history, emotion, cognition, identity, coping and context; only then can they decide which goals to prioritise, which tasks to propose, which technique to use and how to assess whether change is taking place. Reference: Quiñones Bergeret, 2022, Formulación de caso evolucionista; Aveline, 1999, The advantages of formulation over categorical diagnosis.
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Psychological distress is organised into themes of meaning
The model holds that symptoms do not appear as isolated phenomena but as expressions of non-adaptive themes of meaning that recur across scenes, relationships and biographical moments. These themes condense existential dilemmas and matrices of schemas that cause particular situations to activate pain, threat, shame or identity disorganisation. The clinical task consists in recognising the theme, formulating it precisely and modifying the sequence of information that maintains it. Reference: Quiñones Bergeret, 2008, Comprensión clínica y perturbación estratégica gradual; Quiñones Bergeret, 2022, Formulación de caso evolucionista.
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The self is expressed as a temporal narrative identity
The continuity of the self is built narratively in the relationship between past, present and future. When distress disturbs that continuity, the person may experience the problem as an old wound, a present state with no way out, a destiny or a future threat. The formulation therefore asks not only what is happening but when it is happening subjectively and what effect it has on the personal theory of who I am. Reference: Quiñones, Ceric, Ugarte and De Pascale, 2017, Psychotherapy and psychological time; Bruner and Kalmar, 1998, Narrative and metanarrative in the construction of self.
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The RMPS makes it possible to reconstruct the concrete sequence of suffering
The RMPS turns distress into a multidimensional sequence of information. Instead of asking only about thought or emotion, it analyses theme, sense of self, temporality, images, inner dialogues, tacit processes, affect, agency, cognition, coping, social consequences, sensoriality and self-care. This reconstruction shows where the dysfunctional coherence lies and where a strategic perturbation may be introduced. Reference: Quiñones Bergeret, 2008, Comprensión clínica y perturbación estratégica gradual; Quiñones Bergeret, 2013, Indicadores de procesos en psicoterapia asociado a éxito.
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Change requires integrated novel information
Novel information appears when the patient recognises something relevant that was previously omitted, distorted or unintegrated: an emotion, a need, an interpersonal pattern, a temporal attribution, an inner image or a form of coping. That novelty produces change only if it can be incorporated into a more viable narrative and connected with action, regulation and the sense of self. Reference: Quiñones Bergeret, Melipillán and Ugarte, 2012, Indicadores de procesos de éxito en psicoterapia cognitiva; Quiñones Bergeret, 2013, Indicadores de procesos en psicoterapia asociado a éxito.
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Strategic perturbation must be gradual and focused
The therapist does not perturb any element of the discourse at random or introduce techniques arbitrarily. The intervention is directed at the domain that organises the distress and is calibrated according to alliance, emotional tolerance, identity risk and the viability of change. A perturbation that is too weak generates no novelty; one that is too intense may increase resistance or disorganisation. Reference: Quiñones Bergeret, 2008, Comprensión clínica y perturbación estratégica gradual; Quiñones Bergeret, 2022, Formulación de caso evolucionista.
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Techniques are subordinate to the formulation
The model allows cognitive, emotional, experiential or coping techniques to be used, but it requires their selection to derive from the explanatory diagnosis. The Moviola, Focusing, the Empty Chair, EMDR or cognitive restructuring make sense only if they facilitate self-observation, information processing and the reconstruction of meaning in the appropriate domain of the case. Reference: Quiñones Bergeret, 2008, Comprensión clínica y perturbación estratégica gradual; Quiñones Bergeret, 2022, Formulación de caso evolucionista.
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The therapeutic alliance functions as a research team
The therapeutic relationship is not merely a supportive climate but an active device of clinical investigation. Patient and therapist observe the problem together, formulate hypotheses, review the usefulness of tasks and detect new information. Cognitive and emotional attunement makes it possible to introduce strategic perturbations without the patient experiencing them as judgement or as a threat to their identity. Reference: Quiñones Bergeret, 2008, Comprensión clínica y perturbación estratégica gradual; Quiñones Bergeret, Melipillán and Ugarte, 2012, Indicadores de procesos de éxito en psicoterapia cognitiva.
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Therapeutic success is observed in narrative, metacognition, coping and interpersonal life
Change is not reduced to a decrease in symptoms, important though that decrease may be. The model evaluates thematic resolution, narrative coherence, emotional and cognitive ownership, increased self-reflective awareness, flexibility, self-efficacy, the capacity to plan, to enjoy, to cope with problems and to generalise the regulation achieved in therapy to the interpersonal world. Reference: Quiñones Bergeret, 2008, Comprensión clínica y perturbación estratégica gradual; Quiñones, Ceric and Ugarte, 2015, Flujos de información en zonas de tiempo subjetivo.
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Effective psychotherapy turns suffering into viable personal knowledge
The model's evolutionary orientation understands psychological health as a form of personal knowledge that makes it possible to sustain a viable self-esteem, to negotiate with others and to solve the problems of existence. Therapy helps the patient to transform opaque distress into information about themselves, their bonds, their emotions and their ways of coping, generating a more habitable and workable narrative. Reference: Quiñones Bergeret, 2008, Comprensión clínica y perturbación estratégica gradual; Quiñones Bergeret, 2022, Formulación de caso evolucionista.
Influences
- Constructivism
- Post-rationalist cognitive psychotherapy
- Cognitive psychology
- Constructivist cognitive psychotherapy
- Process and outcome research in psychotherapy
- Narrative psychology
- Theory of the narrative self
- The assimilation model of problematic experiences
- Attachment theory
- Experiential therapies
- Evolutionary psychology
- Clinical case formulation
Key references
- Quiñones Bergeret, Á. T. (2022). Formulación de caso evolucionista: Un lenguaje común en psicoterapia. RIL Editores.
- Quiñones Bergeret, Á. T. (2008). Comprensión clínica y perturbación estratégica gradual. Revista Argentina de Clínica Psicológica, 17(1), 37-47.
- Quiñones Bergeret, Á., Melipillán, R., & Ugarte, C. (2012). Indicadores de procesos de éxito en psicoterapia cognitiva. Revista Argentina de Clínica Psicológica, 21(3), 247-254.
- Quiñones Bergeret, Á. T. (2013). Indicadores de procesos en psicoterapia asociado a éxito. Tesis doctoral, Universitat Autònoma de Barcelona.
- Quiñones, Á., Ceric, F., & Ugarte, C. (2015). Flujos de información en zonas de tiempo subjetivo: estudio de un proceso psicoterapéutico exitoso. Revista Argentina de Clínica Psicológica, 24(3), 255-266.
- Quiñones, Á., Ceric, F., Ugarte, C., & De Pascale, A. (2017). Psychotherapy and psychological time: a case study. Rivista di Psichiatria, 52(3), 109-116.
- Aveline, M. (1999). The advantages of formulation over categorical diagnosis in explorative psychotherapy and psychodynamic management. European Journal of Psychotherapy, Counselling and Health, 2(2), 199-216.
- Guidano, V. F., & Quiñones, Á. T. (2001). El modelo cognitivo postracionalista: hacia una reconceptualización teórica y clínica. Desclée De Brouwer.
- Bruner, J., & Kalmar, D. (1998). Narrative and metanarrative in the construction of self. En M. Ferrari & R. Sternberg (Eds.), Self-awareness. Guilford Press.
- Safran, J. D., & Segal, Z. V. (1991). Interpersonal Process in Cognitive Therapy. Basic Books.