Clinical Formulation: How does it work?

Formulation is a key skill of psychologists. It is used instead of diagnosis, or to complement diagnosis. It gives more information than diagnosis as it tells the ‘story’ of the problem and the person’s situation. This can help identify areas to work on in intervention.

Formulation definition;

  1. Formulation aims to describe a person’s presenting problems, and provide a clinically useful descriptive framework.
  2. Formulation enables psychologists and clients to make explanations about what caused and maintains the presenting issues. This can be useful for the client to help them understand their problem.
  3. Formulation explicitly and centrally informs intervention. This will be different depending on the person, the explanation and their situation.  It is more individual to the client than diagnosis.

The parts of formulation are;

  • Predisposing factors – the historical or genetic elements that contribute to the current problem.
  • Precipitating factors – the triggers i.e. what set off this problem or behaviours.
  • Maintaining factors – the internal and external thoughts and behaviours that keep the problem going.
  • Protective factors – the strengths, social supports and positive patterns of behaviour. These are important as can be helpful in intervention.

In more simple terms: Formulation asks the question – What’s going on and what are we going to do about it?

Our psychologists develop a formulation of the child or adult’s problem and then design an intervention that may involve working individually with the person, or it may be wider and include other members of the team (such as speech therapy) or other important people in the individual’s life (such as family members or school). This is designed in collaboration with the person to ensure they are happy with the plan.

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