Good practice guidelines on the use of psychological formulation



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Research into formulation
Clinical psychologists, like other health professionals, are committed to practice that is based on the best evidence. Evidence-based practice can be understood in two different ways in relation to formulation. Firstly, there is the research into the theoretical content and psychological principles on which formulation is based. This is extensive, particularly in areas such as CBT, attachment theory, developmental psychology, and the therapeutic relationship. In addition, there is substantial evidence about the psychological effects of trauma, bereavement, poverty, discrimination, domestic abuse, head injury, physical disability, stroke, alcohol, illicit drugs, and soon. Secondly, there is the question of whether there is evidence to support formulation as a specific intervention. Currently, most of this evidence, that is for reliability, usefulness, effect on outcomes, positive impact on the service user/family/carers and on teams and soon, is lacking. This is despite the fact that formulation is considered to be a central component of the psychological therapies that are most commonly practised within NHS settings, and a starting point for the process of intervention. The lack of a service user perspective is a major gap in the literature, as is an understanding of the process by which clinicians draw up formulations (although some attempts have been made to fill this gap, Corrie & Lane, 2010; Kuyken et al., Further research is needed in order to develop formulations in away that is respectful of service users and carers experiences, and that maximises benefits while minimising potential negative effects. We also need to know much more about whether and how formulation enhances interventions and care packages, facilitates recovery, improves outcomes, and fulfils the many other purposes claimed for it. Margison et al. (2000) have recommended that evidence for the effectiveness of psychological therapy, including formulation, should come from practice-based evidence as well as evidence-based practice.
(See Appendix 2 fora fuller summary of existing research on formulation.)


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