Formulation Workshop

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Formulation Workshop

• Tim Atkin
• Caroline Kinney
• 19th November 2004

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Simple Model of Clinical Psychology Practice
Assessment
Formulation
Intervention
Evaluation
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Complex Model of Clinical Psychology Practice !!
InitialAssessment
Critical Review
Outcome
Hypothesising
Action Plan
Intervention Goals, Methods etc.
Hypothesis testing
FORMULATION REFORMULATION
Reflexive Evaluation
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Formulations

• Offer coherent psychological explanations of the
  presenting difficulties
• Place these difficulties in multiple contexts
• Draw upon psychological theory and evidence
• Are designed to be used to plan appropriate
  interventions
• Should be developed and shared with clients where
  possible

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Formulations are not.

• Simply lists of different factors involved.
• Meant to apportion blame to any family, person or
  set of people.
• Final
• Pronouncements to be hidden from the client(s)
• Diagnoses (see next 2 slides)

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Diagnosis (vs Formulation) 1

• Current systems ICD 10 DSM IV
• Multiaxial classification
• Axis 1 Clinical Psychiatric Syndrome
• Axis 2 Specific Delays in Development
• Axis 3 Intellectual Level
• Axis 4 Medical Conditions
• Axis 5 Abnormal Social Situations

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Diagnosis (vs Formulation) 2

• Useful communication but diagnosis conveys
  limited understanding of individual complexities
• Diagnoses can often be powerful in accessing
  further services/ support
• Not take into account heterogeneous nature of
  problems
• Once made, can be difficult to question/ adapt/
  review
• Individual case formulation can supplement
  diagnosis

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Formulations A Framework
Precipitating Factors
Predisposing Factors
The problem as explained by these factors
Suggested Action Plan
Maintaining factors
Protective Factors
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Formulations A Systemic Framework (see Carr,
2000)
Influential Contexts
Belief systems associated with the problem
Behaviour Patterns associated with the problem
A Shared Understanding of the Problem
Untapped Resources, Exceptions Subjugated
Stories
A Shared Understanding of a Way forward
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Engagement Collaboration

• Clinical Experience
• Ethics
• Evidence
• Influential Ideas

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Possible Pitfalls

• Oversimplification of a complex problem
• May be unintentionally perceived as blaming
• May be presented as the truth
• Clinician perceived as the expert with all the
  answers
• Increase hopelessness

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Formulation Feedback

• simple jargon-free language (e.g. the clients)
• present as ideas rather than the truth
• respectful non-blaming
• encourage feedback
• draw it / write it down
• focus on key areas of change
• think about timing