hi everyone welcome to cleanse I explained my name is Ian and I am a clinical psychologist working in the UK this video is all about formulation so how clinical psychologists might use formulation to help their clients understand their problems a little bit better if you watch some of my videos you know that I just flashed it off this this Glee and referral awhile just about the content of the videos really so I'll give you a little bit time to read over and then we'll get home as clinical psychologists we know that when people arrive at mental health services they might be quite distressed or quite confused by what's happening in their life they might not understand the problem and that they're experiencing and sometimes they might feel quite comforted and want answers like or an explanation like a diagnosis because the diagnosis can get used in everyday life you can sort of say to someone I've got depression and that person will understand them a little bit more rather than saying well I wake up in the morning and I don't feel motivated to do anything and I feel like crying most of the time that that's hard at first maybe someone to understand while saying depression everyone knows what depression is and it's much easier to understand em but sometimes even though people are after these diagnostic labels and sometimes the the labels don't really tell the whole story and so you know why is someone depressed what was kind of going on that led up to that what when when are they most depressed when do they feel better I'm formulation is a way of understanding problems a little bit better understanding all the factors that make up the problem for someone and it maybe helps them have a road map as to see how to improve things so I'm just going to I'm sure you know maybe some of the difficulties with just labeling people with a diagnosis since have already talked about depression let's look at that one for a little bit of time so to meet a diagnosis of depression according to icd-10 sorry icd-10 is a catalog of mental health problems that psychiatrists and other medical professionals can diagnose from and so to meet criteria for a mild depression you need to have at least two of the following depressed mood loss of interest or enjoyment in activities that you previously enjoyed and increased physical and mental tiredness as well you also need to have at least two of these other categories so reduce concentration in tension which is self esteem and confidence ideas of guilt or worthiness pessimistic views about the future ideas or acts of self-harm or suicidal ideation disturbed sleep or reduced appetite so quite a range of things and so I'm gonna look night and to show you and some of the difficulties with diagnostic criteria so we're gonna look at this first person column mr. red shall we say and so mr. red meets criteria for depression because he has depressed mood and increased physical and mental tiredness he also has a reduced concentration in tension and disturbed sleep so he meets the criteria and he could be diagnosed with mild depression but then maybe someone also sees mrs. blue mrs. blue has depressed mood just like mr. red and but instead she has a loss of interest or enjoyment and coupled with that she has been reduced self esteem and confidence may be is actually considered self-harm or suicide now I looking at a two they both meet the criteria for mild depression but they're completely different so one of them mr. red maybe is struggling to motivate himself he's feeling quite tired he has per concentration and then we got mrs. blue who maybe is thought about like self-harm and suicide and it's been a really low about herself and doesn't really think much of herself so completely different and yet they have the same diagnosis so a formulation tries to show and these individual differences to paint a picture about that specific person so let's look at that nine another criticism of using a diagnosis is that it's given to you and you maybe sometimes don't have much power or control over whether you receive this diagnosis or not my formulations are a bit different they should be jointly agreed and pieces of work so both the therapist and the client jointly agreed and this makes sense that this is a good understanding of the problem that is faced formulation should also be really easy to understand that should make sense to the person if it doesn't there's no point in having it and they should be specific to that person so one formulation shouldn't really look like another one I the formulation should also be reviewed to check that they're still current and they're still correct the way that I always think about formulations especially if they're written down on pieces of paper is that you can always add to them you can always add you know some extra writing and to when there's more information you can scrub that site darn relevant anymore you can also tear up the thing and start again if you need to like I was saying before the sometimes the problems with a diagnosis are they provide a limited understanding of the problem whilst the 5-piece show the history of the problem and how it came into being and it starts with predisposing factors so what things have happened in the past that have made this problem more likely we then look at precipitating factors so what was maybe the trigger for the problem to emerge 9 so what what changed for the problem to start taking hold of someone then present in factors what what what is the problem that a person is actually encountering and what's maintaining the current problem so what factors like people relationships work stresses are actually keeping the problem going and of course let's not forget protective factors so what stops the problem from getting even worse so is it someone's resilience is it that they've got a good support network water the protective factors that that help them I'm going to cover CBT in a bit more detail in another video but this is to show just a basic formulation that can be used so the CBT there's a situation it leads to a thought which can lead on to a philan change in your body and a behavior or an action and the best way to think about this is to fit it into an example so maybe for a person there's not common partly they might think well if I go I won't know anyone so it's quite a negative thoughts they're quite apprehensive there may be anxious worried and stressed about the potential have gone there and not knowing anyone this might lead them to maybe have some panic attack so feel breathless their heart rates and they feel shaky they feel hot they feel sweaty that might make them even more stressed and it might maybe reinforce the thought that they're having and what you might see is eventually they'll probably avoid the party they won't go and that actually doesn't disprove the thought so the next time a party might emerge or might be happening they mock again think well what if I don't know anyone I was here for last time whenever I didn't go I'll just do the same and you can see how something like this can get hold of someone and the cycle keeps on going let's look at a cat formulation though I'm a cat stands for a cognitive therapy and in this one you start in the the bottom half of it so where it says rejected so maybe the first person feels rejected that might lead them to feel quite low maybe quite worthless they might have thoughts that they're not good to be around or that it's my fault that maybe someone has rejected them and their reaction might be to push other people away and be quite aggressive so quite a rejecting in their behavior but that actually pushing people away and saying I don't want be around you you can be left movie theater than quite isolated and vulnerable and so because we're humans because we were social animals because we want to be around people then we maybe let other people kind of get close again because we don't want to be alone but that leads us maybe to be vulnerable to be let down again and hurt by others and because maybe that person doesn't meet your expectations of being a good friend or being supportive whenever you want them to be and again you sort of feel rejected and sometimes people get caught in this loop of not knowing how to interact with people because they feel that either they're pushing people away and being quite rejecting or they are leaving themselves vulnerable to rejection themselves and this is a basic formulation or a movie some people would call it a long de jouvenel formulation so it just tracks the history of the problem a little bit more so you start off at the top with maybe someone forgot to lock their front door at night and by chance their house was burgled but that obviously leads to maybe quite quite a lot of guilty feelings that it was their fault and also some feelings of not feeling safe in their own house so then might lead then might lead them to offer check a little bit more to you know check the front door two or three times before going to bed that yes it's definitely shot I feel safe and that might develop rituals and routines to make sure that they they always do this thing every night and keep to order and control and you might see that creeping into other aspects of their life as well they might start to maybe watch the hands a little bit more or to make sure they turn off switches whenever they leave the room little things like this because all these things make them feel safe but because the world is always unpredictable then then it's kind of keep on happening that threatened this safe feeling and that might lead someone maybe to actually run up the number of routines that they do to get even further control to get that feeling of safety back and as you can see as with the other formulations of just showing you you get caught in a bit of a trap and that tends to be whatever people need help and that's it for formulations they are a shared understanding of what the problem is and they can be used with clients to help decide how to intervene how to help them and highly someone can I suppose get control over that problem and help themselves a little bit more and if you'd like to make a comment about this video then please do so on the youtube comment section you can send me an email on the details at the end or you can follow me on twitter at what is clinton sign and so that's it for me so hopefully see you in one of the other videos you