Formulation in Clinical Psychology Practice - Assignment Example

? Formulation in Clinical Psychology Practice What Is Formulation, As Used In Clinical Psychology Practice, And How Does It Differ From Diagnosis? The formulation process is a critical part of psychology both in training and practice as it facilitates psychodynamic understanding of the client and enhances the capacity of psychologists and psychiatrists to engage the clients in empathic and constructive manner (Korner et al, 2010). Generally, formulation refers to the process whereby a professional or a specialist makes sense of the information gathered from assessment of a client with the aim of using the information to help a client in a productive way. Johnstone and Dallos (2006) note, in clinical psychology practice, formulation is the process whereby psychologists and psychiatrists try to make sense of clients’ information by individualizing their understanding of the clients so as to create intervention appropriate to a particular client based on many models and general psychology knowledge. Miriam (2007) argues that the ability of psychologists and psychiatrists to develop an individualized understanding of their clients to provide individualized intervention is what sets their profession apart from other healthcare professions. The original purpose of formulation in clinical psychology is to ensure enhanced therapeutic engagement with the client (Beinart et al, 2009). As such, there is more to formulation than just application of models and theories; formulation entails effective communication and written cases in assessment among other aspects that are essential in engaging clients in formulation process. This is essential on the part of psychology practitioners as they will be able to formulate a hypothesis on the cause and nature of the problems presented by the clients hence creation of appropriate intervention (Thomas, 2005). Lemma (2003) notes that formulation in clinical psychology is often distinguished from diagnosis because even though these two approaches are similar in some ways, they also differ in fundamental way. Mainly, diagnosis is focused on assessment with the aim of offering medical interventions; its assessment is medically- inclined whose main intervention is medical. This approach greatly disregards other factors such as early experiences and genetics hence denying interventions of input of these very factors (Weerasekeera, 1995). Formulation on the other hand seeks to identify all predisposing factors related to the client’s problems such as temperament, genetics, and early experiences among others. Bruce and Ian (2002) explain that clinical psychologists who use formulation approach usually base their assessment, research evidence, and interventions on the following aspects: medical conditions; understanding feeling of behaviors and distressing thoughts; behavioral and emotional difficulties; clients’ age; therapeutic needs of adults and young people with mental health difficulties; and disputes relating to the client’s daily activities such as employment and education. Formulation not only focuses on the problem of the client but seeks to understand the cause(s) and nature of the problem. It seeks to understand what contributed to the emergence of the problem; is the problem environmental, trans-generational, relationship oriented or physical. It also focuses on the belief or stories that the client or his friends or relatives have regarding the problem. After looking at the causes of the problem, formulation model in clinical psychology requires that a trigger to the problem be identified (Kang et al, 2005). Moreover, since a difficulty has to have a maintenance cycle, that is, what keeps the cycle in progress for instance what keeps a client’s depression recurring, formulation seeks to evaluate the factors behind this cycle. Psychiatrist using this approach has to examine the pattern of events relating to the client’s problem and why the problem has not been resolved previously using other means. Eells (1997) says that formulation calls for examination of how the client’s feelings, behavior, and thoughts have contributed to the maintenance of the problem cycle. For example, how a client’s feeling of underachievement has contributed to his/her depressed state of the mind. In addition, formulation requires that psychiatrist ‘should make observation on how the problem is presented; how the client looks at the problem currently? In what circumstances is the problem occurring? What strength does the client have, say in terms of friends and family? Apart from that, psychiatrists are required to share formulation with the client so as to help them understand their difficulties and understand intervention plan, which is critical in increasing insight hence behavior change (Korner et al, 2010). It is important to point out that the main principles of formulation are similar and are applied in the same manner regardless of the cultural or social group of the client (Schneider et al, 2001). That notwithstanding, psychiatrist is required to apply different techniques based on the nature and cause of the problem so as to provide individualized interventions to meet particular client’s needs. Also, even though the principles applied are similar, the techniques used should suit other factors such as the age of the client, cultural background, and socio- economic status of the client. Kinderman and Lobban (2001) notes that this is important so as to provide appropriate interventions that will aim at resolving the client’s problem. The formulation procedures- assessing the causes, trigger, maintenance cycle and presentation of the problem shows that formulation entails integration and summation of client’s information attained through assessment. The approach draws from the biopsychosocial model that provides a framework for problem description, development of problem and how they are maintained (McLaren, 2010). In general, the model stipulates that psychological, social, and biological factors all play a crucial role in the functioning of humans in the context of illness or disease (Pilgrim, 2002). As such, McLaren (1998) argues that mental illness and mental health in general should be understood in terms of the combination of all these; factors rather than from a medical or biological perspective only. It is against this background that formulation approach has gained prominence in the clinical psychology field. McLaren (2010) observes that psychologists and indeed psychiatrists have found this approach appropriate as it addresses all the aspects that relate to mental health thus enabling them provide appropriate and effective interventions to the clients. This provides a departure from the diagnosis approach which focuses on mental health majorly from the medical perspective thus limiting psychiatrists’ ability to effectively assess the client’s problem and consequently limiting the interventions provided (Pilgrim, 2002). For many years, clinical psychology practice has been using formulation and diagnosis as means of providing intervention to clients (Schneider et al, 2001). The fact that both approaches are effective in engaging clients cannot be disputed. Both approaches involve assessment that is geared towards medical intervention at the end. Despite them having main similarities especially on some fundamental processes such as assessments and similar objective of providing intervention to the client, these two approaches differ in a fundamental way. Johnstone and Dallos (2006) note, some psychologists and indeed psychiatrists believe that formulation and diagnosis are the same because they involve assessment which informs interventions. In essence, this is not the case because diagnosis is majorly focused on making sense on client’s information from a medical perspective. Clinical psychologists who use diagnosis approach rarely focus on other factors such as social or environmental. As such, their interventions are medically- inclined with little regard to non- medical interventions to the problem facing the client. On the other hand, psychiatrists who use formulation take many factors into account; these factors aid them in creating interventions (Bruce and Ian, 2002). The formulation model mainly identifies the clients’ predisposing factors that may relate to the problem that the client is presenting. These factors include neurology, early experiences, temperament, and genetics among others. Identification of these factors helps the psychiatrist to hypothesize whether some or all of them have led to the thoughts, behavior and feeling cycles, and attitude that the client has and which are maintaining the symptoms of particular problem facing the client. Formulation intends to empower the psychologists, psychiatrists, and even clients through identification of change and development areas, whereas diagnosis in most cases leaves clinical psychologists with limited avenues of understanding clients’ information in addition to leaving the clients to be dependent on professionals (Miriam, 2007). Finally, it is evidently clear from the discussion that formulation has more strength compared to diagnosis as it seeks to understand the difficulties of a person in a more holistic way. As has been noted, unlike diagnosis, formulation creates room for understanding how the client’s difficulties arise and how they are maintained, as well the societal, environmental, and cultural circumstances surrounding them. Johnstone and Dallos (2006) say that this is necessary because even though symptoms of a problem may be similar among clients, they may be having different experiences regarding the same. For instance, two clients suffering from drug addiction occasioned by low self esteem may experience varied outcomes of drug use and hence suffer different psychological problems. Diagnosis does not provide room for understanding the clients’ experiences and psychiatrists using this approach often rely on assumptions regarding underlying issues hence hindering understanding. Even though it is argued that diagnosis is more reliable, psychiatrists argue that it lacks some accuracy and validity that formulation has (Kuyken et al, 2005). However, it should be noted that compared to diagnosis, formulation is much more complex and may result to some mistake especially if the psychiatrist is short of experience. Therefore, to avoid mistakes in formulation, it is advisable that psychiatrists should often refresh ideas and look for ways of making formulation work better through supervision, comparison and where appropriate consultancy is advised (Kuyken et al, 2005). References Beinart, H et al. (2009). Clinical Psychology in Practice. Hoboken, NJ: Wiley- Blackwell. Bruce, C and Ian, G. (2002). Introduction to clinical psychology. New York: McGraw-Hill Higher Education. Johnstone, L and Dallos, R. (2006). Formulation in Psychology and Psychotherapy: Making SENSE OF People’s Problems. London, UK: Routledge. Kang, S et al. (2005). Case Formulation in Psychotherapy: Revitalizing its Usefulness as a Clinical Tool. Acad Psychiatry, Vol. 29: 289-292. Kinderman, P and Lobban, F. (2000). Evolving Formulation: Sharing Complex Information with Clients. Journal of Behavioral and Cognitive Psychotherapy, Vol. 28, Iss. 03, p. 307-310 Eells, T.D. (1997). Handbook of Psychotherapy Case Formulation. New York City, NY: Guildford Press. Korner et al. (2010). Formulation, Conversion and Therapeutic Engagement. Australasian Psychiatry, Vol. 18, No. 3. Kuyken, S et al. (2005). The Reliability and Quality of Cognitive Case Formulation. Behavior Research and Therapy, Vol. 43, p. 1187-1201. Lemma, A. (2003). Assessment and Formulation. In Introductions to the Practice of Psychoanalytic Psychotherapy: A Practical Treatment Handbook. Hoboken, NJ: John Wiley and Sons. McLaren, N. (1998). A Critical Review of the Biopsychosocial Model. The Australian and New Zealand Journal of Psychiatry 32 (1): 86–92 McLaren, N. (2010). Humanizing Psychiatrists. Ann Arbor, MI: Loving Healing Press. pp. 135–154 Miriam, K. (2007). Formulation. Retrieved from http://www.clinpsy.org.uk/forum/viewtopic.php?t=35 Pilgrim, D. (2002). The Biopsychosocial model in Anglo-American psychiatry: Past, present and future. Journal of Mental Health, Volume 11, Issue 6. Schneider, K et al. (2001). The handbook of humanistic psychology: leading edges in theory, research, and practice, 2nd ed. Thousand Oaks, CA: Sage Publications Thomas, P. (2005). Contemporary Clinical Psychology. Hoboken, NJ: Wiley & Sons. Weerasekeera, P. (1995). Multi- perspective Case Formulation: A Step Towards Treatment Integration. Melbourne, FL: Krieger Publishing Company. Read More