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Formulation Workshop

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after Carr (1999) Formulations : A Framework. Precipitating Factors. Predisposing Factors ... Formulations : A Systemic Framework (see Carr, 2000) Influential Contexts ... – PowerPoint PPT presentation

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Title: Formulation Workshop


1
Formulation Workshop
  • Tim Atkin
  • Caroline Kinney
  • 19th November 2004

2
Simple Model of Clinical Psychology Practice
Assessment
Formulation
Intervention
Evaluation
3
Complex Model of Clinical Psychology Practice !!
InitialAssessment
Critical Review
Outcome
Hypothesising
Action Plan
Intervention Goals, Methods etc.
Hypothesis testing
FORMULATION REFORMULATION
Reflexive Evaluation
4
Formulations
  • Offer coherent psychological explanations of the
    presenting difficulties
  • Place these difficulties in multiple contexts
  • Draw upon psychological theory and evidence
  • Are designed to be used to plan appropriate
    interventions
  • Should be developed and shared with clients where
    possible

5
Formulations are not.
  • Simply lists of different factors involved.
  • Meant to apportion blame to any family, person or
    set of people.
  • Final
  • Pronouncements to be hidden from the client(s)
  • Diagnoses (see next 2 slides)

6
Diagnosis (vs Formulation) 1
  • Current systems ICD 10 DSM IV
  • Multiaxial classification
  • Axis 1 Clinical Psychiatric Syndrome
  • Axis 2 Specific Delays in Development
  • Axis 3 Intellectual Level
  • Axis 4 Medical Conditions
  • Axis 5 Abnormal Social Situations

7
Diagnosis (vs Formulation) 2
  • Useful communication but diagnosis conveys
    limited understanding of individual complexities
  • Diagnoses can often be powerful in accessing
    further services/ support
  • Not take into account heterogeneous nature of
    problems
  • Once made, can be difficult to question/ adapt/
    review
  • Individual case formulation can supplement
    diagnosis

8
Formulations A Framework
Precipitating Factors
Predisposing Factors
The problem as explained by these factors
Suggested Action Plan
Maintaining factors
Protective Factors
9
Formulations A Systemic Framework (see Carr,
2000)
Influential Contexts
Belief systems associated with the problem
Behaviour Patterns associated with the problem
A Shared Understanding of the Problem
Untapped Resources, Exceptions Subjugated
Stories
A Shared Understanding of a Way forward
10
Engagement Collaboration
  • Clinical Experience
  • Ethics
  • Evidence
  • Influential Ideas

11
Possible Pitfalls
  • Oversimplification of a complex problem
  • May be unintentionally perceived as blaming
  • May be presented as the truth
  • Clinician perceived as the expert with all the
    answers
  • Increase hopelessness

12
Formulation Feedback
  • simple jargon-free language (e.g. the clients)
  • present as ideas rather than the truth
  • respectful non-blaming
  • encourage feedback
  • draw it / write it down
  • focus on key areas of change
  • think about timing
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