Formulations Flashcards
Define what is meant by formulation?
‘Drawing on psychological theory, it attempts to examine a client or family’s problems in terms of how they arose and what may currently be holding these in place. It synthesises this information and explanatory ideas into ‘working hypotheses’, which are then used to suggest appropriate and effective ways of working to relieve the problems’
Formulation is a provisional explanation or hypothesis of how an individual comes to present with a certain disorder or circumstance at a particular-point in time. (Weerasekera, 1996)
What are some of the things a formulation should achieve?
-Summarises the client’s core problems
-Show how the client’s difficulties relate to one another, by drawing on psychological knowledge
-Explains, through a set of working hypotheses (based in psychological theory) why these difficulties have developed, at this time and in this context
-Gives rise to a plan of intervention
-Drawn up collaboratively with the client/system
Based on making meaning
What are some of the benefits of a shared team formulation?
-Increases the likelihood of a consistent team approach
-Generates new ways of thinking
-Supportive of other disciplines, valuing shared expertise
-Challenges myths and reducing negative perceptions
Why is it important to hold in mind a therapeutic position when formulating?
Different paradigms (Cognitive, Psychoanalytic, Existential, Behavioural, Systemic etc.) hold different assumptions about what brings about human distress and suffering and what alleviates it
Why you believe someone is distressed will be rooted in your model of psychopathology (which has its own origins) and will directly influence how you view what needs to be changed (and how), for example, consider the Power threat Meaning Framework.
How is the 5p’s model best used?
Good framework for gathering different information in relevant life areas but limited in it’s understanding of personal meaning and theoretical influence?
How reliable are formulations?
Finn, Braham & das Nair (2015) How Reliable are Case Formulations? A Systemic Review.
18 papers (Mix of CBT, dynamic and integrative orientations. Only 1 study reported test-retest reliability)
Reliability ranged from slight to substantial (.1 to .8)
E.g. Beiling & Kuyken (2003) found high rates of inter-rater reliability for descriptive elements of cognitive formulations but less for inferential and theory driven aspects, i.e. moderate for core beliefs and compensatory strategies and low for dysfunctional assumptions.
Some evidence for greater reliability with higher levels of clinician experience and training
What is the assumption of coherence we should hold when formulating?
There’s always an understandable reason why an individual has developed certain ways of behaving, even if they are objectively maladaptive / subjectively “strange” or illogical
What’s the purpose of a formulation?
-Clarifying hypotheses and questions
-Understanding: providing an overall picture of what has lead to the clients problems (for clinician and client) – “a guiding map”
-Prioritising issues and concerns
-Planning overall & specific strategies for intervention (or recommending no intervention). Formulation may be the intervention itself.
-Predicting responses to strategies (including possible impasses and obstacles)
-Determining criteria for successful outcomes
What are some reflective/critical questions we might want to ask ourselves about our formulation?
-Life events alone do not explain distress - does your formulation go beyond this?
-Does it fit with the person’s view? ——-How might we navigate this?
-Does it set treatment goals?
-Is there anything that disconfirms your view? (You may weigh supportive evidence higher than counter-evidence)
What are some benefits notes by Redhead, Johntone and Nightingale (2015) in terms of client experiences of formulation?
-Formulation helps me to understand my problems
-The diagram facilitates understanding
-The therapist’s guidance facilitates understanding
-Formulation leads to feeling understood and accepted
-Perceived accuracy facilitates feeling understood and accepted
-The therapist’s stance facilitates feeling understood and accepted
-Formulation leads to an emotional shift
-Relief &/or distress
-Formulation enables me to move forwards
-Empowerment
-Help to cope
-Talking more openly/sharing
What are the stages of the formulation cycle that Jarrad gave?
-Generation of clinical hypotheses
-Individual hypothesis testing
-Development of initial formulation
-Ongoing hypothesis testing
-Re-formulation: a new understanding based on feedback & reflection
What are some of the things we can do to test hypothesis that we’ve generated?
-Further information gathering
-Questioning, and discussing with the client
-Questioning others – collateral information
-Behavioural experiments
-Observations
