Although my training path for a career in Clinical Psychology is a road well-trodden, something was missing from a large chunk of the early part of my journey through Psychology education. A sort of enigma which I’d heard about but didn’t quite know what it was… Is it a bird? Is it a plane? No, it’s ‘Psychological Formulation’.
What is Psychological Formulation?
Formulation is the cornerstone of psychological therapy. It is defined as a hypothesised explanation of an individual’s difficulties, which is underpinned by psychological theory. It provides an understanding of how an individual’s problems may have developed and how these difficulties are then being maintained. Formulation is often a collaborative process between the therapist and client, to facilitate sense-making for the client. It is also not ‘set in stone’, as it is an ongoing process which can be built upon and changed over time. It is also used to guide treatment and intervention planning.
These definitions are taken from “Formulation in Psychology and Psychotherapy”, by Lucy Johnstone and Rudi Dallos. I found this particular book super helpful in my training and would totally recommend. Worth a mention – Dr Lucy Johnstone is one of the top people to look up if you’re interested in formulation.
Are Formulation and Diagnosis the same thing?
Formulation is often presented as an alternative to medical diagnosis for mental health difficulties. I am of the view that there may be a place for psychiatric diagnosis for some individuals, as some people find it a helpful way of understanding their difficulties. I also think that there are many drawbacks of this dominant diagnostic medical model, which has been used in mental health care for decades. For example, pathologizing normal human responses to abnormal events, attributing the problem to lie “within” the person, as well as diagnoses attracting stigma.
Psychological formulation provides an alternative understanding of mental health problems, with its goal to create a more collaborative, validating, non-blaming and compassionate understanding of a person’s problems. This in turn helps to facilitate change and promote feelings of agency and control in one’s recovery. As Dr Sean Maguire famously said, “It’s not your fault”*.
The aim of formulation is to move away from the question “what’s wrong with you?” towards the question “what’s happened to you?”
*Although ‘Good Will Hunting’ is a most excellent film that everyone needs to watch, we would tend not to endorse Dr Maguires professional conduct around the hugging mid-therapy, visiting patients houses and threatening patients with violence… but Robin Williams is wonderful in it and this quote is great!
“What’s in the blog??!!”
Formulation sounds good, right? I’m a big fan anyway. Almost as much of a fan as I am of top notch movies and TV shows. So I thought I would give a go at combining these two and use this blog to explain different types of psychological formulations, using famous fictional characters as example “cases”.
(This is something I’ve been thinking about doing for the past 3 years, however the current COVID-19 ‘Contagion’-style lockdown situation has facilitated some more free time to finally get started!)
I hope this would give a light-hearted way to learn a bit more about psychological formulation, for those who are early on in their psychology career or those who just have a general interest in this area. Additionally, to raise awareness of the use of formulation as an alternative to the medical narrative, such as symptom lists, diagnoses and an often (in my view) unhelpful trend of labelling mental health difficulties.
Where we’re going, we don’t need labels…
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Disclaimer: Images and reference to original films are used for this blog in the understanding that it falls under ‘fair use’. This is due to the images and reference to the films being used in the context of a commentary/critique of the original material for educational purposes. To my knowledge, the use of images in this post do not deny the owner of income and they are not being used in this context for monetary gain of the user. All images rights owners referenced.