A clinical formulation (or case 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 [1]. 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[2] and is deemed to be a core component of these professions [3].
Types of formulation
Different psychological schools or models utilise clinical formulations, including cognitive behavioural therapy and its related therapies, systemetic, psychodynamic [4] and applied behavior analysis. 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[5].
A model of formulation that is more specific to cognitive behaviour therapy (CBT) is described by Persons [6]. 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[7].
References
- ^ Bond, Frank W.; Michael Bruch (1998). Beyond diagnosis: case formulation approaches in CBT. New York: Wiley. ISBN 0-471-98222-9.
- ^ Mace, Chris; Binyon, Sharon (2005). "Teaching psychodynamic formulation to psychiatric trainees. Part 1: Basics of formulation". Advances in Psychiatric Treatment 11: 416-4223.
- ^ Butler, G. (1998). Clinical formulation. In A.S.Bellack & M. E. Hersen (Eds.), Comprehensive Clinical Psychology (pp. 1-23). New York: Pergammon Press
- ^ The Psychodynamic Formulation: Its Purpose, Structure, and Clinical Application Samuel Perry, M.D., Arnold M. Cooper, M.D., and Robert Michels, M.D.American Journal of Psychiatry 1987; 144:543–550
- ^ Eells, Tracy; Kendjelic, Edward and Lucas, Cynthia (1998). "What’s in a Case Formulation? Development and Use of a Content Coding Manual". The Journal of Psychotherapy Practice and Research 7: 144-153.
- ^ Persons, J.B. (1989) Cognitive Therapy in Practice: A Case Formulation Approach. New York: W.W. Norton.
- ^ Perry S, Cooper AM and Michels R (1987) The psychodynamic formulation. American Journal of Psychiatry 144, 543–550
Categories: Clinical psychology | Medical terms | Psychiatry
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