Working collaboratively with service users (and where relevant, families and carers, using everyday language, emphasising strengths as well as needs, and making good use of supervision will help to minimise formulation’s potentially unhelpful aspects. Special care is needed with children and people with learning disabilities for whom the use of clear language, pictures or tapes/CDs will increase accessibility. These groups maybe particularly vulnerable to being formulated without their knowledge or consent. A formulation that is not understood by, or acceptable to, the service user is not a useful formulation, and implies, at the very least, the need for further collaborative discussion in order to develop a shared perspective. Complete agreement may not be achieved, or maybe the subject of negotiation throughout the intervention (see May’s 2011 discussion about ‘Relating to alternative realities. However, it is essential to try and identify some common ground, and to respect the service user/team’s right to differ in other areas. Reflectiveness is seen by many clinical psychologists as an essential aspect of formulating, enhancing collaboration, sensitivity, flexibility, and awareness of one’s own assumptions,
and avoiding the danger of a diagnostic style of formulation which is just a list of problems…an inflexible and concrete bunch of ideas (Ray, As discussed above, awareness of the service/organisational and social/societal contexts of formulation will help to guard against meta-messages of blame and individual deficiency. It will also alert clinicians to be prepared to question assumptions about who has the problem To avoid the risk of objectifying the service user, the phrase Formulation for/with X’
rather than of Xis recommended. This makes it clear that the formulation is collaboratively constructed and at the service of the person. 22 Division of Clinical Psychology
Good Practice Guidelines on the use of psychological formulation 23 Formulation is a developing field. Three areas that need more work are research, inclusion in electronic records, and formulation-based alternatives to psychiatric diagnosis. These are discussed briefly below.