Good practice guidelines on the use of psychological formulation

Person-centred and problem-specific formulation

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Person-centred and problem-specific formulation

This refers to the difference between a standardised
formulation of a problem
as opposed to a
formulation of a particular person’s problematic experiences
. As examples of the former,
CBT protocols have been developed for typical cognitive processes in anxiety, depression,
personality disorders, PTSD, psychosis and soon (e.g. Ehlers et al., 2004; Wells, 2004).
Problem-specific formulation has its place, especially with less complex difficulties for example, in the Increasing Access to Psychological Therapies programme for anxiety and depression. It has strong links to the evidence base, and can serve as a starting point fora more broadly-based formulation. However, as it stands it does not fulfil all of the principles of psychological formulation as outlined in this document because it allows for only a limited range of causal and process factors. For example, it may overlook or downplay the significance of transference, cultural, service/organisational and social/societal factors. In addition, it does not allow for debate about who is the service user and who are the stakeholders and it is based on problematic diagnostic categories.
(All these aspects of psychological formulation are discussed further below) Problem- specific formulation thus typifies Level 2 skills (MAS, 1989) rather than the Level 3 skills that are said to be the defining feature of the profession.

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