Good practice guidelines on the use of psychological formulation


Clinical issues When is a formulation a formulation



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8.

Clinical issues When is a formulation a formulation


In order to decide how full a formulation needs to be, whether or not it should be documented in writing and where its main focus should lie, a psychologist will need to consider factors such as where the most pressing concern or stuck point is the extent to which wider systemic factors seem relevant the stage of the therapy or intervention the amount of information available the likely receptiveness of the service user, family, team or service and the usual constraints of time and resources.
While the principles outlined in this document will be broadly relevant to formulation used in a more partial, informal or evolving way, for obvious reasons it will not always be possible, necessary or appropriate to incorporate them in full. Clinical judgement must be exercised in making these decisions. However, the guidelines can still be seen as a useful reference point and checklist of good practice for all stages and versions of formulation and formulating.
Good Practice Guidelines on the use of psychological formulation
11

Division of Clinical Psychology
For the purposes of these guidelines, psychological formulation will mainly be used in its

‘formulation-as-an-event’ sense (i.e. the written or diagrammatic version which is developed with service users/teams/referrers, and appears in letters/medical notes/electronic records) However, the written formulation necessarily evolves, and continues to evolve, out of ‘formulation-as-a-process.’ For this reason close attention will also be paid to the process of formulating. Thus, best practice in both formulation and formulating will be addressed. (A complete set of criteria is presented in the checklist in

Appendix The following principles of psychological formulation in clinical psychology are widely accepted:

it is grounded in psychological theory and evidence;

it is constructed collaboratively, using accessible language;

it is constructed reflectively;

it is centrally concerned with personal meaning;

it is best understood in terms of usefulness than truth. In addition, it will be argued that best practice clinical psychology formulation and formulating has the following characteristics:

it is person-specific not problem-specific; it draws from a range of models and causal factors;

it integrates, not just lists, the various possible causal factors through an understanding of their personal meaning to the service user;

it is not premised on functional psychiatric diagnoses such as schizophrenia or personality disorder. Rather, the experiences that may have led to a psychiatric diagnosis (e.g. low mood, hearing voices) are themselves formulated;

it includes a cultural perspective and understanding of the service user’s presentation and distress;

it is clear about who is the service user and who are the stakeholders in any given situation;

it starts from a critical awareness of the wider societal context of formulation, even if these factors are not explicitly included in every formulation.
(NB: service user will include carers if a systemic/family formulation is employed.)
These additional principles raise some complex issues that merit discussion in more detail.

The first five items are expanded in the sections below, while the last two are covered in the sections on


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