formulations While the inclusion of causal factors from a number of different dimensions and models is desirable, this does not necessarily result in integration. Some well-known approaches to formulation advocate the use of templates for filling in lists of relevant factors from biological, social, interpersonal and other domains (e.g. Weerasekera, 1996). Psychologists sometimes use a similar template known as PPPP (predisposing, precipitating, perpetuating and protective) This format is also used in psychiatric training (Royal College of Psychiatrists, 2010) in order to integrate information from multiple sources to formulate the case into which relevant predisposing, precipitating, perpetuating and protective factors are highlighted (p. While these kinds of templates maybe a useful starting point, they have two limitations: firstly, they do not require the various factors to be synthesised into a coherent narrative, as opposed to simply being listed in an additive fashion (X happened, then Y happened, in the context of Z) In other words, these formulations are not necessarily integrated, although they are sometimes described as such. Secondly, the templates do not necessarily include the personal meaning of the factors and life events , as opposed to a list of external triggers (abused by stepfather diagnosed with cancer bullied at school etc. Psychological theory suggests that the impact of difficult circumstances or events is mediated through the meaning they hold for the individual (Kinderman et al., 2008). As noted in Section 9, personal meaning
is the integrating factor in a psychological formulation as defined in this document.
(NB: In some client groups, for example, people with a severe learning disability or older adults with advanced dementia, personal meaning may need to be inferred by the clinician and/or a Best Interest procedure.) Good Practice Guidelines on the use of psychological formulation 15
One of the risks of the list-of-factors approach is the conjoining of incompatible theoretical models. This is true of some versions of the widely-used diathesis-stress or biopsychosocial model, as discussed below.