By Emily Hanlon
A couple of weeks ago, I posted a strategy snapshot on case formulations. I mentioned that I typically use the 5 P CBT approach to case formulation. As part of this discussion, I mentioned the use of ‘lifelines’ in therapy, and many people asked for more information. Please note that I am speaking of my own experiences and am attempting to explain this concept in layman’s terms.
A lifeline is a technique used to gather a client’s history in an effective way. It allows you to explore a client’s history and allows for appropriate intervention planning. I guess the lifeline technique is exactly what it sounds like. Together with the client, you work from as far back as they can remember and identify the positive and negative events that have shaped the person your client is today. I’ll often use paper and pens with the client or even blutak them to the wall. If I’m in an office with a particularly large white board or window, I may even write on these.
I start by drawing a line and explain that this line represents the client’s life from the day of their birth, to the present moment. We then go through the client’s life together, noting anything of significance and writing it onto the timeline. It’s also important to remind the client that anything they want to add can be included, there is no right or wrong answer. You want the client to feel accepted and included in the process.
The aim here is to also try and highlight themes. For example, you may notice themes of neglect, themes of feeling like a failure or feeling unworthy, or even positive themes such as security. Interestingly, I find that more often than not, as soon as clients physically see their life events on paper, they realise the impact that these events have had on them!
What is interesting about lifeline’s is that, by looking at these events and themes you stumble across the core beliefs that a client holds about themselves. A core belief is a belief that we hold about ourselves and is the very essence of how we see ourselves, see those around us, and see our world and future. Core beliefs can be triggered or activated by certain situations and are quite rigid in nature. We have a tendency to seek information that supports our belief and ignore information that may contradict it. Examples of core beliefs are: I am not good enough, I am a failure, nobody loves me.
So, as you can see, lifelines are a really effective way to start the therapy process and help shape intervention. Below, I have linked some useful hand outs and articles that you guys may be interested in.
For more information on case formulation and CBT, check out this article: https://pdfs.semanticscholar.org/6dc1/dfbd7ccdad40621c7aaea5ef955261ea054d.pdf
For more information on case formulation, check out this power point I found online from Louisiana State University: http://www.lacounseling.org/images/lca/Conference/DSM-5%20LCA%20Case%20Formulation%20Rev..pdf
For more information on lifelines, check out this article, but please note, you have to purchase this one. It is however worth every cent: https://www.tandfonline.com/doi/pdf/10.1300/J085v10n03_05?needAccess=true
For additional information on lifelines in CBT, check out this article: https://pdfs.semanticscholar.org/1ab4/7cf53f933d66f07cbc0ae9c1543293ef2612.pdf
For an amazing client handout on core beliefs, check out this link: https://www.cci.health.wa.gov.au/~/media/CCI/Mental%20Health%20Professionals/Depression/Depression%20-%20Information%20Sheets/Depression%20Information%20Sheet%20-%2012%20-%20What%20are%20Core%20Beliefs.pdf