Out of all the topics within clinical psychology, formulation remains my favourite topic of all time. Since this is where mental health should be going as it individualises psychological treatment for mental health conditions. As well as with formulation becoming more important in clinical psychology and formulation content is always popular, I want to use this podcast episode to explore what are the key elements of a clinical formulation report. By the end of this podcast episode, you’ll be familiar with the key elements so hopefully you’ll feel a little more confident if you ever need to write one up. Which if you work in clinical psychology, chances are you probably will need to in the future. If you enjoy learning about mental health, psychotherapy and working in clinical psychology then you’re in for a treat with this episode.
Today’s psychology podcast episode has been sponsored by Formulation In Psychotherapy. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.
What Are The Key Elements Of A Clinical Formulation Report In Psychotherapy?
What is Clinical Formulation?
Below is an extract from my Formulation In Psychotherapy book that sums up the answer to this question really well.
“In essence, formulation can be understood as a hypothesis to be tested because Butler (1998) states that formulation is ‘the tool used by clinicians to relate theory to practice’
Nonetheless, that isn’t the only definition of formulation due to other notable figures in Clinical Psychology have made their own definitions as well.
· “A psychotherapy case formulation is essentially a hypothesis about the causes, precipitants and maintaining influences of a persons psychological, interpersonal and behavioural problems” (Eells, 1997, p.4).
· “A process of ongoing collaborative sense-making” (Harper and Moss, 2003, p. 8).
I must mention that in the topic of Formulation there is one very important figure called: Lucy Johnstone and she is a massive figure and a great author on the topic of formulation.
Therefore, her definition needs to be highlighted:
“Formulation can be defined as the process of co-constructing a hypothesis or ‘best guess’ about the origins of a person’s difficulties in the context of their relationships, social circumstances, life events, and the sense that they have made of them. It provides a structure for thinking together with the client or service user about how to understand their experiences and how to move forward. Formulation draws on two equally important sources of evidence: the clinician brings knowledge derived from theory, research, and clinical experience, while the service user brings expertise about their own life and the meaning and impact of their relationships and circumstances”. (Johnstone, 2018)”
Personally, I flat out love formulation because I’m really excited that there is another option away from diagnosis that allows us to tailor a course of psychological therapy to a specific client and their needs. Since it really is all well and good us just giving someone Cognitive Behavioural Therapy because they have depression. Yet unless we tailor the CBT and we make sure it addresses what the client actually needs, then it’s effectiveness will be limited.
And I also want to take a moment to address the so-called “criticisms” of formulation. Since the major criticism (that I have little time for to be honest) is the idea that the hypothesising that formulation relies on isn’t empirical in nature or something along those lines. My issue with this rather silly criticism is if we follow that logic then absolutely no experiment in any science is empirical, because all studies and all experiments start off with a hypothesis, then an experiment is tested out and the results are assessed then next steps are determined.
That is exactly what formulation seems to do because a therapist working alongside a client comes up with a hypothesis based on sound psychological theory. Then they both test it out in therapy, see what the results are and then they tweak the formulation/ plan and they go again.
This is no different from any other type of empirical hypothesis testing. That is what formulation is.
And I would talk about how formulation is different from diagnosis but I have spoken about that in other places and on other podcast episodes.
Formulation Questions
In addition, there are three main questions that a therapist seeks to answer when they write up their formulation about a client:
· What is causing the mental health difficulties?
· What factors are maintaining these difficulties?
· What might facilitate therapeutic change?
What Should A Formulation Report Cover In Clinical Psychology?
A formulation report should cover four areas of a client.
Firstly, a therapist should summarise the client’s mental health difficulties so that they provide an overview of the difficulties the client is currently facing and identify which difficulties should be targeted in the therapy.
Secondly, a formulation report should provide an evidence-based rationale for the proposed therapeutic approach. For instance, if a therapist wanted to offer a client Internal Family Therapy then the therapist would need to outline the theoretical basis for this therapy explaining why it would be suitable for the client and the difficulties that they’re experiencing.
Thirdly, a formulation report should discuss a recommended treatment plan for the client including their treatment measurements and goals.
Finally, the report should highlight issues that might come up in treatment. Since the report should explore the challenges that might pop up for the client in therapy. For example, any concerns about a client might deal with some painful memories or feelings or even the structure of the therapy itself. This is important to think about now because it allows the therapist to come up with potential solutions ahead of time before the issues pop up.
Overall, this helps to improve the therapy experience for the client.
Therapy Measurements And Goals For Success
As you can probably guess, an effective treatment plan for a client should include meaningful goals and measurements. Now I know in clinical psychology, we use a lot of psychometric tests and measures, but as I talk about in Clinical Psychology Reflections Volume 4, this isn’t useful to our clients. It doesn’t exactly give them much motivation or goalposts because it is just a weird number to them.
Instead, working with a client to create meaningful goals helps them to make progress and actually see that progress for themselves. Hence, why it’s important to regularly review these goals with our clients.
In addition, any goals should be SMART goals, so they need to be Specific, Measurable, Achievable, Realistic and Time-Bound. Larger goals can and should be broken down into smaller steps or goals so the client is less overwhelmed.
For example, your client might have a goal to build their emotional regulation and coping skills. Then the measurement for this might be identifying the negative thoughts and feelings when they pop up and then rate their strength. Afterwards, the client can review this goal by keeping a thought diary and the therapist can review this diary with them each week in the session. As well as a rating scale of 1= still not able to identify the negative feeling to 5= confident in recognising negative feelings, can be used to help the client see that they’re progressing.
Clinical Psychology Conclusion
Personally, I still flat out love formulation because I hope I’ve shown you that a comprehensive formulation can be a very powerful and a great tool for providing a therapist and client with a solid basis for any psychological intervention. One that is based on psychological theory, evidence and the client’s expertise in their lived experiences.
Due to by grounding any therapeutic recommendations in evidence-based theory and considering the client’s unique experience, we can build a flexible framework for therapy that is tailored to the client’s needs. So their goals and therapy outcomes can reflect their specific needs and their hopes for the future.
I really hope you enjoyed today’s clinical psychology podcast episode.
If you want to learn more, please check out:
Formulation In Psychotherapy. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.
Have a great day.
Clinical Psychology References
BPS ‘Understanding formulation’ guide [Online] Available at https://www.bps.org.uk/sites/www.bps.org.uk/files/Member%20Networks/Divisions/DCP/Forumlation%20WEB%20ID3412.pdf
Goldfried, M. (2013), ‘What should we expect from psychotherapy?’ in Clinical Psychology Review 33 (2013) p. 862–869
Johnstone, L. (2018). Psychological Formulation as an Alternative to Psychiatric Diagnosis. Journal of Humanistic Psychology, 58(1), 30–46
Johnstone, L., & Dallos, R. (2013). Introduction to formulation. In Formulation in psychology and psychotherapy (pp. 1-17). Routledge.
Whiteley, C. (2020) Formulation In Psychotherapy. CGD Publishing. England.
Whiteley, C. (2024) Clinical Psychology Second Edition. CGD Publishing. England.
I truly hope that you’ve enjoyed this blog post and if you feel like supporting the blog on an ongoing basis and get lots of rewards, then please head to my Patreon page.
However, if want to show one-time support and appreciation, the place to do that is PayPal. If you do that, please include your email address in the notes section, so I can say thank you.
Which I am going to say right now. Thank you!
Click https://www.buymeacoffee.com/connorwhiteley for a one-time bit of support.