Formulation

Question 1

What is formulation

Answer 1

Unlike diagnosis, formulation is not about making an expert judgement, nor is it based on deficits. Instead, a best-practice formulation draws attention to the service user’s resources and strengths in surviving what are nearly always very challenging life situations

formulation can have many other uses and benefits, including: clarifying hypotheses and questions, providing an overall picture or map, noticing what is missing, prioritising issues and problems, thinking about lack of progress, ensuring that a cultural perspective in incorporated, helping the service user to feel understood and contained, and strengthening the therapeutic alliance.

no guarantee that a formulation will avoid some of the same traps as diagnosis, i.e being individualising, excluding social contexts, or perhaps simply imposing a view with which the service user disagrees

Question 2

Cognitive behavioural

Answer 2

Presenting issues. Statement of the client’s presenting problems in terms of emotions, thoughts and behaviours.
Precipitating factors. The proximal external and internal factors that triggered the current presenting issues.
Perpetuating factors. The internal and external factors that maintain the current problems.
Predisposing factors. The distal external and internal factors that increased the person’s vulnerability to their current problems.
Protective factors. The person’s resiliency and strengths that help maintain emotional health.

Question 3

Characteristics of a CB model

Answer 3

Based on the cognitive model.
• Utilises core concepts of schemas/beliefs, conditional assumptions and
rules, and maintenance cycles to explain onset and maintenance of
emotional difficulties.
• Formulation developed in levels from presenting issues to more
predisposing factors.
• Client and therapist work as a partnership or team to co-create a
formulation.
• Strong emphasis on evidence-base for the effectiveness of the intervention.
• Strong emphasis on empiricism in session so that appraisals are treated as
ideas to be tested and alternatives considered.
• CBT is closely associated with diagnostic frameworks in that RCTs are
usually based on diagnostic categories. CBT formulation is complementary to psychiatric diagnosis. Diagnosis may be a reason to consider a hypothesis or intervention strategy, but the diagnosis will probably only have marginal bearing on the process of formulation.

Question 4

systemic

Answer 4

Exploration of the problem
• Deconstruction of the problem – how do family members define the problem, when did it start, who first noticed, what was first noticed?
• Linking the problem to ordinary difficulties.
• Exploration of what was attempted in order to solve the difficulties.
• Beliefs about the difficulties and what to do about them.
• Discussion/evaluation of what worked and what did not work.
• What decisions were made about whether to persist with the attempted
solutions and which solutions to pursu