Formulations in Clinical Psychology

Introduction

• Presenter: Ian, Clinical Psychologist in the UK
• Topic: How clinical psychologists use formulation to understand and help clients better.
• Purpose: Provide a more comprehensive understanding of clients' problems than just diagnosis.

Understanding Diagnosis and Its Limitations

• Diagnosis: Often sought for comfort and explanation (e.g., depression).
• Example: Saying “I have depression” is easier to understand than describing all the symptoms.
• Limitations: Does not provide a complete picture of why someone is experiencing problems.
  • Example of different symptoms under same diagnosis (Depression):
    • Mr. Red: Depressed mood, physical/mental tiredness, reduced concentration, disturbed sleep.
    • Mrs. Blue: Depressed mood, loss of interest, low self-esteem, suicidal thoughts.

Formulation: A Comprehensive Approach

Definition

• Formulation: An approach to understand all factors contributing to a client’s problems; offers a roadmap for improvement.

Benefits

• Individual Differences: Tailors understanding to individual circumstances.
• Collaborative: Jointly agreed upon by therapist and client for accuracy and relevance.
• Dynamic: Can be updated with new information; reviewed regularly.
• Personalized: Specific to the individual; varies from one person to another.

Elements of Formulation

• Predisposing Factors: History and past events making the problem more likely.
• Precipitating Factors: Triggers that caused the problem to emerge.
• Presenting Factors: The current problem being faced.
• Maintaining Factors: Elements that keep the problem ongoing (e.g., relationships, work stress).
• Protective Factors: Elements that prevent the problem from worsening (e.g., resilience, support network).

Example Formulations

CBT (Cognitive Behavioral Therapy)

• Situation: Leads to a thought → emotional change → physical reaction → behavior/action.
• Example: Anxiety about attending a party leads to avoidance behavior, reinforcing the initial negative thought.

CAT (Cognitive Analytic Therapy)

• Cycle of Rejection:
  1. Feeling rejected → low self-worth → negative thoughts.
  2. Push others away → feel isolated and vulnerable.
  3. Let others in → susceptible to being hurt again → feel rejected.

Longitudinal Formulation

• Example:
  1. Forgot to lock door, house gets burgled → feelings of guilt and unsafe.
  2. Developing checking behaviors (e.g., door, switches) to feel safe.
  3. Increased routines and rituals for safety → cycle of needing control.

Conclusion

• Purpose of Formulation: Shared understanding of the problem; helps decide interventions and empowers clients.
• Interaction: Viewers encouraged to leave comments, send emails, or follow on social media.