Conceptualization begins at the first contact with patients and is refined at every subsequent contact. You make hypotheses about patients, based not just on the cognitive formulation of the case, but also on the specific data patients present. You confirm, disconfirm, or modify your hypotheses as patients present new data. The conceptualization, therefore, is fluid. At strategic points, you will directly check your hypotheses and formulation with patients. Generally, if the conceptualization is on target, patients confirm that it “feels right”—they agree that the picture the therapist presents truly resonates with them.