The situation is typically more complicated when the three lines of evidence are divergent.

would suggest to you that our patients must experience some anxiety, as this provides an impetus for therapeutic change to take place.

Addressing the most superficial level is typically the least anxiety provoking for most patients. This can be seen as similar to a supportive style of psychotherapy. By contrast, continuously focusing only on the fourth level can be quite an intense and overwhelming experience for many patients,

Patients with more complicated difficulties may require additional elements in the treatment contract.

she is generally ‘‘safe and contained’’ prior to beginning therapy.

of what the ‘‘journey’’ of therapy may look like

synthesize an understanding of the patient’s difficulties with regard to the potential biological, psychological, social, cultural, and spiritual factors

Therapy can help patients to see themselves and others more realistically. This can free our patients to have relationships with others as they really are, rather than as they imagine them to be.

Synthesizing an understanding/formulation of your patient and her difficulties involves putting together all of the information communicated through what you have heard, what you have observed, and your emotional reaction to what has transpired so far.