Good practice guidelines on the use of psychological formulation

Formulation in clinical psychology

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Formulation in clinical psychology
professional documents

Division of Clinical Psychology
Despite the widespread use of the term in key clinical psychology documents, there is no universally agreed definition of formulation, and different professions bring their own characteristic perspectives to the subject (see Corrie & Lane, 2010, pp and
Johnstone & Dallos, 2006, ch. For the purposes of these guidelines, definitions will be drawn from the field of clinical psychology. A recent clinical psychology textbook (Johnstone & Dallos, 2006) lists the essential features of formulations across different therapeutic modalities. All formulations:

summarise the service user’s core problems;

suggest how the service user’s difficulties may relate to one another, by drawing on psychological theories and principles;

aim to explain, on the basis of psychological theory, the development and maintenance of the service user’s difficulties, at this time and in these situations;

indicate a plan of intervention which is based in the psychological processes and principles already identified;

are open to revision and reformulation.
(NB: The term service user in this document may include family/carers, especially in Child and
Adolescent and Learning Disability settings where systemic formulations are commonly used)
Clinical psychologist Gillian Butler (1998, p) puts this succinctly

A formulation is the tool used by clinicians to relate theory to practice It is the lynchpin that holds

theory and practice together Formulations can best be understood as hypotheses to be tested.
The Core Purpose and Philosophy of the Profession (DCP, 2010, pp) states
Psychological formulation is the summation and integration of the knowledge that is acquired by this
assessment process that may involve psychological, biological and systemic factors and procedures. The
formulation will draw on psychological theory and research to provide a framework for describing a
client’s problem or needs, how it developed and is being maintained. Because of their particular
training in the relationship of theory to practice, clinical psychologists will be able to draw on a number
of models (bio-psycho-social) to meet needs or support decision making and so a formulation may
comprise a number of provisional hypotheses. This provides the foundation from which actions may
derive… Psychological intervention, if considered appropriate, is based upon the formulation.
Both Health Professions Council criteria and British Psychological Society criteria for training courses state that clinical psychologists should
Be able to use professional and research
skills in work with clients based on a scientist-practitioner and reflective-practitioner model that
incorporates a cycle of assessment, formulation, intervention and evaluation (HPC, 2009; BPS, 2010).

The influence of our core professional identity as scientist-practitioners can be seen in the emphasis, in these definitions, on applying psychological principles and theory in order to develop hypotheses about service users difficulties. The assumption is that this process will render even the most unusual or disturbing behaviour and experiences understandable:
‘…at some level it all makes sense (Butler, 1998, p.2).

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