What is Formulation in Psychotherapy and Why Is It Important?



In today’s episode of The Psychology World Podcast, we will be looking at the clinical and abnormal psychology topic of Formulation in Psychotherapy.


This episode has been sponsored by my book: Formulation in Psychotherapy.

What is Formulation and Why Is It Important?


Here’s an extract from my Formulation in Psychotherapy Book.

However, this raises the massive question of: what is formulation in psychology?


If you’ve read my Clinical Psychology book then you may already have some idea but this book will built upon this information in a LOT more depth.


So, regardless of whether you have never heard of formulation before, only have a small amount of knowledge about it (like me before writing this book) or you know a lot about formulation. Hopefully, you will get something out of this book.


What is Formulation?

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)


I mean you cannot get a better as well as more comprehensive definition as the one above.


However, in case you’re like me and you tend to skip massive complex paragraphs. I’ve given you a summarised version below.


In short, when a formulation is broken down it summarises the client’s core problems and it shows how the client’s difficulties are related to one another.


In addition, it uses psychological theory to explain why and how the client’s difficulties are happening to help plan an intervention.


Why is Formulation Important to Know About?

In all honesty, if formulation wasn’t important to be aware of then I’m afraid that I wouldn’t have looked into it.


Simply, because I love psychology, like you, but there are simply too many areas to investigate.


Therefore, if you intend to go into clinical psychology as a profession, you need to know about Formulation as this is a major topic, and it’s very important for various reasons. This you’ll discover throughout the later chapters.


Another reason formulation is important is because it’s considered a skill by the Health and Care Professionals Council, as well as according to the Division of Clinical Psychology (2010) formulation can be the defining competency of the profession.


In other words, if you want to do clinical psychology as a job then you NEED to know about

formulation.


If you want to know more information about the subfield then please check out Clinical Psychology for more information.


Building Upon this Further:

In formulation, there are a lot of different approaches that can be taken to create a formulation. Like: negative thoughts in CBT, narrative therapy and psychodynamic. Over the course of the book, we’ll look at roughly 6 approaches.


In addition, a formulation applies the theory to an individual and their own unique difficulties.

Interestingly, the term formulation can be used as an event and a process. You’ll see this in more detail in later chapters but you can give a formulation (event) to someone and you can create a formulation with the client. (process)


Another example is most definitions like the ones above are formed as if formulation are only concrete events. Like: a letter to written assignment and so on.


However, as you’ll see later, this is not always the case.


Personally, I prefer to think about formulations as a creative process because ideally you should be working with the client to create a formulation that best fits them.


Equally, I do understand why formulations are sometimes events.


Anyway, you’ll see this in more detail when we get into the meat of the book.


Basic Make Up of a Formulation:

In a formulation, there are a range of common elements regardless of the therapeutic model used. For example, each type of formulation makes a hypothesis about a person’s difficulties which draws upon psychological theory.


In addition, all formulations summarise the client’s core problems by drawing on psychological principles and theory that allow you to see how a client’s problems are related.


Additionally, they allow the therapist to suggest why these difficulties have developed at this time in this situation.


Finally, all formulations are open to revision or reformulating because they need to be ‘accurate’ and ‘corrected’ if something is ‘wrong’ in the formulation.


With the entire point being the formulation is used to plan or guide an intervention for the client to help them live a better, happier life.


On the other hand, formulation is different from the traditional therapeutic models. In terms of:

· The most important factors

· Emphasis on reflectivity

· Explanatory concepts they draw on.

· Emphasis on expert vs collaborative stance

· And more


Although, a formulation could be described as a double-edged sword as the formulation could reveal no intervention is needed. Or the formulation itself could be therapeutic as it gives the client a greater understanding of their difficulties.


(I thought I would include that piece of debate about formulation to start you thinking critically about formulation. But we have an entire section dedicated to the debates about formulation.


So, personally, I would focus on enjoying the book and think critically later)


Additional Purposes of Formulation:

In addition, to the other purposes we’ve discussed in this chapter, according to DCP (2011:8) formulation could serve other purposes as well. For example:


· Ensuring a cultural understanding has been incorporated into the intervention.

· Strengthening the therapeutic alliance.

· Helping the client to feel understood.

· Normalising the client’s difficulties.

· Increasing sense of agency, hope and meaning.

· And more.


Best practices:

Moving onto the last section of our introductory chapter, like any therapist technique, formulation can be harmful as well as be helpful, of course, depending on how a clinician uses it.


Therefore, this was addressed in the DCP guidelines (2011) which includes an event and process checklist which when combined with Bulter (1998) means a formulation needs to meet the following criteria:

· It needs to be grounded in an appropriate depth and level of breath.

· Culturally sensitive.

· Use accessible language so anyone can understand the formulation.

· Consider the possible role of trauma and abuse.

· Possible that the service could be confounding the problem.

· Informed by social/ societal and service/ organisational factors and more.


We’ll explore these more throughout the book.


Subsequently, the checklist for best practices for formulation as a process are:

· Be clear about who the formulation is for.

· Who has the problem?

· Construct formulation collaboratively.

· Provide a rationale for choices.

· Reflective about their own assumption and values.


So now that you’ve learnt what formulation is, how is formulation used in Cognitive Behavioural Therapy?

I really hope you enjoyed today’s episode. If you want to learn more than please check out the links below:


FREE 8 Psychology Book Boxset


Formulation in Psychotherapy


Have a great day, everyone!

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