The capacity to formulate a case is at the heart of all psychiatric and psychotherapeutic work and is a core competency in training. So what do we mean by formulation? There is a summary and organisation of a patient’s case into a concise hypothesis that explains, describes and predicts. For any individual case, the formulation evolves with growing experience and understanding of the patient and their situation. The skill and expertise developed over time by the clinician comes into practice. The formulation can be used by the psychiatrist, therapist, treating team and patient, and when constructed, at times it can be similar to a piece of art or poetry – capturing the essence of the patient’s difficulties and providing a deep insight in a condensed form.