Clinical formulation
Encyclopedia
A clinical formulation is a theoretically-based explanation or conceptualisation of the information obtained from a clinical assessment. It offers a hypothesis about the cause and nature of the presenting problems and is considered an alternative approach to the more categorical approach of psychiatric diagnosis
.. In clinical practice, formulations are used to communicate a hypothesis
and provide framework to developing the most suitable treatment approach. It is most commonly used by clinical psychologists and psychiatrists and is deemed to be a core component of these professions. Mental health nurses also use formulations.
. The structure and content of a clinical formulation is determined by the psychological model. Most systems of formulation contain the following broad categories of information: symptoms and problems; precipitating stressors or events; predisposing life events or stressors; and an explanatory mechanism that links the preceding categories together and offers a description of the precipitants and maintaining influences of the person's problems.
Behavioral case formulations used in applied behavior analysis
and behavior therapy are built on a rank list of problem behaviors. from which a Functional analysis (psychology)
is conducted (e.g. ]]) and sometimes B.F. Skinner's account of Verbal behavior or the account from Relational Frame Theory
. This holds true even for what is sometimes called third generation behavior therapy or clinical behavior analysis
such as acceptance and commitment therapy
and functional analytic psychotherapy
Functional analysis looks at setting events (ecoloical variables, history effects, and motivating operations), antecedents, behavior chains, the problem behavior, and the consequences short and long term for the behavior.)
A model of formulation that is more specific to CBT is described by Persons. This has seven components: problem list, core beliefs, precipitants and activating situations, origins, working hypothesis, treatment plan, and predicted obstacles to treatment.
A psychodynamic formulation would consist of a summarizing statement, a description of nondynamic factors, description of core psychodynamics using a specific model (such as ego psychology
, object relations or self psychology
), and a prognostic assessment which identifies the potential areas of resistance
in therapy.
One school of psychotherapy which relies heavily on the formulation is Cognitive Analytic Therapy (CAT)
. CAT is a fixed term therapy, typically of around 16 sessions. At around session four, a formal written reformulation letter is offered to the patient which forms the basis for the rest of the treatment. This is usually followed by a diagrammatic reformulation to amplify and reinforce the letter.
Diagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
.. In clinical practice, formulations are used to communicate a hypothesis
Hypothesis
A hypothesis is a proposed explanation for a phenomenon. The term derives from the Greek, ὑποτιθέναι – hypotithenai meaning "to put under" or "to suppose". For a hypothesis to be put forward as a scientific hypothesis, the scientific method requires that one can test it...
and provide framework to developing the most suitable treatment approach. It is most commonly used by clinical psychologists and psychiatrists and is deemed to be a core component of these professions. Mental health nurses also use formulations.
Types of formulation
Different psychological schools or models utilize clinical formulations, including cognitive behavioral therapy (CBT) and its related therapies, systematic, psychodynamic and applied behavior analysisApplied Behavior Analysis
Applied behavior analysis is a science that involves using modern behavioral learning theory to modify behaviors. Behavior analysts reject the use of hypothetical constructs and focus on the observable relationship of behavior to the environment...
. The structure and content of a clinical formulation is determined by the psychological model. Most systems of formulation contain the following broad categories of information: symptoms and problems; precipitating stressors or events; predisposing life events or stressors; and an explanatory mechanism that links the preceding categories together and offers a description of the precipitants and maintaining influences of the person's problems.
Behavioral case formulations used in applied behavior analysis
Applied Behavior Analysis
Applied behavior analysis is a science that involves using modern behavioral learning theory to modify behaviors. Behavior analysts reject the use of hypothetical constructs and focus on the observable relationship of behavior to the environment...
and behavior therapy are built on a rank list of problem behaviors. from which a Functional analysis (psychology)
Functional analysis (psychology)
Functional analysis in behavioral psychology is the application of the laws of operant conditioning to establish the relationships between stimuli and responses...
is conducted (e.g. ]]) and sometimes B.F. Skinner's account of Verbal behavior or the account from Relational Frame Theory
Relational frame theory
Relational frame theory, or RFT, is a psychological theory of human language and cognition. It was developed largely through the efforts of Steven C...
. This holds true even for what is sometimes called third generation behavior therapy or clinical behavior analysis
Clinical behavior analysis
Clinical behavior analysis has its origins in applied behavior analysis and behavior therapy. It is sometimes referred to as third-generation behavior therapy.-Current models in clinical behavior analysis:...
such as acceptance and commitment therapy
Acceptance and Commitment Therapy
Acceptance and commitment therapy or ACT is a cognitive–behavioral model of psychotherapy. It is an empirically-based psychological intervention that uses acceptance and mindfulness strategies mixed in different ways with commitment and behavior-change strategies, to increase psychological...
and functional analytic psychotherapy
Functional Analytic Psychotherapy
Functional analytic psychotherapy is an approach to clinical psychotherapy that uses a radical behaviorist position informed by B.F. Skinner's analysis of verbal behavior....
Functional analysis looks at setting events (ecoloical variables, history effects, and motivating operations), antecedents, behavior chains, the problem behavior, and the consequences short and long term for the behavior.)
A model of formulation that is more specific to CBT is described by Persons. This has seven components: problem list, core beliefs, precipitants and activating situations, origins, working hypothesis, treatment plan, and predicted obstacles to treatment.
A psychodynamic formulation would consist of a summarizing statement, a description of nondynamic factors, description of core psychodynamics using a specific model (such as ego psychology
Ego psychology
Ego psychology is a school of psychoanalysis rooted in Sigmund Freud's structural id-ego-superego model of the mind.An individual interacts with the external world as well as responds to internal forces. Many psychoanalysts use a theoretical construct called the ego to explain how that is done...
, object relations or self psychology
Self psychology
Self Psychology is a school of psychoanalytic theory and therapy created by Heinz Kohut and developed in the United States at the Chicago Institute for Psychoanalysis. Self psychology explains psychopathology as being the result of disrupted or unmet developmental needs...
), and a prognostic assessment which identifies the potential areas of resistance
Psychological resistance
Psychological resistance is the phenomenon often encountered in clinical practice in which patients either directly or indirectly oppose changing their behavior or refuse to discuss, remember, or think about presumably clinically relevant experiences....
in therapy.
One school of psychotherapy which relies heavily on the formulation is Cognitive Analytic Therapy (CAT)
Cognitive analytic therapy
Cognitive Analytic Therapy is a form of psychological therapy initially developed in the United Kingdom by Anthony Ryle. This time-limited therapy was developed in the context of the UK's National Health Service with the aim of providing effective and affordable psychological treatment which could...
. CAT is a fixed term therapy, typically of around 16 sessions. At around session four, a formal written reformulation letter is offered to the patient which forms the basis for the rest of the treatment. This is usually followed by a diagrammatic reformulation to amplify and reinforce the letter.