Hello and welcome to another great article by PsychAssist. Recently we have had many Psych Students and Grads ask us about this “scary thing” called Formulation and more specifically how to use it. This is a topic we grappled with for many years until it was broken down by a Clinical Psychologist once we had entered the working world. This apparent scary and “very professional” topic was actually not as daunting it seemed and this is exactly why we at PsychAssist would like to show you (in basic terms)what Formulation is and how you already Use it every day.
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What is formulation?
Now before we start to get into how you can use formulation, you must first have a brief understanding of what it is. There are many definitions for what formulation is, however we thought we would use one that is very well known. Clinical Psychologist Gillian Butler defined formulation as:
“A formulation is the tool used by clinicians to relate theory to practice… It is the lynchpin that holds theory and practice together… Formulations can best be understood as hypotheses to be tested.”
This definition gives you everything you need to know about formulation. Many PsychGrads feel they are unable to “do” formulation and therefore leave everything to the qualified psychologist. This often leads to the PsychGrad not really understanding what is going on and why the qualified psychologist got to the end decision of treatment. Now that you know that Formulation is merely connecting theory to practice we hope you feel more empowered to contribute to formulation and ultimately treatment.
PsychAssist Tip: Now this goes without saying but you can’t have one side of formulation without the other. It’s very difficult when you sit and listen to a client but have no idea what the best treatment route is for them. I have been in this situation many times throughout my career and it was because I didn’t know what was out there for the client. This is why we recommend that you firstly gain an understanding of different psychological models and practices as this will help you so much in the future. Also, don’t forget to utilise supervision as this will save loads of time (check out: How to Best Utilise Supervision, Pre-Qualified!)
So How Can I Use Formulation
So, you’re probably thinking “ok I kind of know what Formulation is; however how do I do it?” and the answer to that is, there are many models and ways you can use formulation. Nevertheless, to give you a nudge in the right direction we will briefly go through 2 well known models of formulation you can use when you’re with a client.
This is one model of formulation that is widely used and taught within universities. Everyone knows about the 5 Ps. Predisposing factors (any significant life events that could be a catalyst?), Precipitating Factors (any recent events such as a death or break up?), Presenting Factors (what’s the issue?), Protective Factors (What is it about them that’s stopping the issue from getting worse?) and Perpetuating Factors (What’s maintaining the issue?). This is a simple tool to use when formulating the needs and treatments of the client. Now when I finished university, the 5 Ps seemed like the scariest things ever because it used language that I wouldn’t normally use. However, once it was explained to me in a way I understood (similarly to the way we have just done), it suddenly became clear and easy to use.
Systemic formulation is a very powerful and effective way to formulate when dealing with very complex clients. This is where you not only think of the needs of the person, you also think how their network and environment effects their behaviour. Often, when we are working with a client, we only focus on their needs and how we can help them. We may give them some strategies on things that may help; however, when they go back into their environment, everything goes out the window. This is because we aren’t Formulating systemically.What is going on around that person that is making our intervention difficult and what can we do about it? A Clinical Psychologist once told us that whenever she meets a client for the first time, she asks them questions not only about themselves but others within their circle. She said that this is to gather a “picture” in her head of who is around this person to help inform her decision making.
Thanks for reading this week’s article by PsychAssist on “What Is Formulation and How Do Psychologists Use It?” Hopefully this has given you a brief overview of what Formulation is and how you can apply it to your practice. Now remember, Formulation is complex and requires further reading so I would highly recommend the following book in the link.
Formulation in Psychology and Psychotherapy: Making Sense of People’s Problems
By Lucy Johnstone