What is a Psychological Formulation?
This word is often used by clinical psychologists like myself, and sometimes I think we need to do a better job at explaining what is is.
Understanding an individual's mental health involves more than just identifying symptoms and diagnosing. A psychological formulation is at it's most basic a 'sense making' process. This process involves creating a coherent narrative that explains a person's difficulties, not just in terms of their symptoms, but in the context of their life story and experiences. It is often described as two people putting a jigsaw together.
Components of Psychological Formulation
A typical psychological formulation encompasses several key components:
Presenting Issues: Detailed description of the current symptoms and problems.
Predisposing Factors: What in the individual’s background might have made them vulnerable to these issues? This could include aspects of their early life, such as family dynamics, previous traumatic experiences, or genetic predispositions.
Precipitating Factors: Specific events or situations that triggered the current difficulties. For example, a relationship breakup, job loss, or a significant life change.
Perpetuating Factors: Elements that maintain the issues. These could be ongoing stresses, unhelpful coping strategies, or patterns of thinking and behavior that exacerbate the problem.
Protective Factors: These are strengths or supports that help the individual cope. They might include personal resilience, supportive relationships, or positive life skills.
Prognosis and Plan: Based on the formulation, what can be predicted about the person’s recovery, and what interventions are recommended?
How does it help?
The main goal of a psychological formulation is to first help someone feel like they understand and can make sense of their difficulties. Secondly, after thoroughly understanding what contributes to a person's distress, therapists can tailor interventions more specifically to each individual.
The reason we use psychological formulations as opposed to a diagnostic label is they are:
Person-Centered: It sees the person as a whole, rather than reducing them to their symptoms. This approach is empowering and validating.
Collaborative: Formulations are often developed collaboratively with the client, which can enhance their engagement in therapy and increase their insight into their difficulties.
Flexibility: Unlike a diagnosis that can be rigid, formulations can evolve as more information becomes available or as your circumstances change.
Integrative: This process allows for integration of information from various sources and theoretical orientations, leading to a richer understanding of the person.
Conclusion
Developing a psychological formulation is the first thing you are likely to do when you meet with a clinical psychologist. This formulation serves as a roadmap for understanding and working through the reason you have sought therapy. It can be written out, drawn as a diagram or be an exchange of conversations between the two of you. Understanding a little more about psychological formulation can demystify what happens in sessions.
