Revisiting the use of formulation

As experienced clinicians we come to challenging problems with assumptions about why they are presented at a particular point in time, and how societal changes may affect both the presentation of the problems, and the way in which parents and indeed professionals try to make sense of them. As discussed throughout the book this means that we start from the position of creating the widest context for understanding, and do not foreclose on narrow circumscribed definitions of the problem. This brings us back to the question of formulation and how the attention given to the formulation process is essential to the successful practice of time-limited therapy. The Division of Clinical Psychology of the British Psychological Society (2011) in their Guidelines on the use of psychological formulation, emphasise throughout how formulation has personal meaning at its core. This personal meaning is always located within a systemic, organisational and societal context. Whilst the Guidelines describe recommended practice for clinical psychologists, they are equally applicable to all professionals working in the mental health field. As pointed out in the Guidelines, a psychological formulation is concerned with attending to the summarising and integrating of the knowledge and information that has been acquired in the assessment process. As in psychotherapy, the formulation process prioritises the use of reflective practice. Most importantly the Guidelines consider that formulation represents ‘a shared narrative’ that is constructed together with the people we are trying to help. Ultimately, a formulation is not a final statement or a tablet of stone. As such, it allows for new information and understanding to be included as this becomes available. This new information may contradict or amplify what has gone before. Thus the process of formulation, which takes place over a number of steps, may be perceived as a series of hypotheses that are constructed, tested and if required, modified through reflection on clinical experience. The Division of Psychology Guidelines highlight a critical element in the construction of the formulation process, by asserting that best practice in clinical formulation is ‘person-specific not problem-specific’. This immediately opens up a more dynamic and relationship centred form of clinical practice that goes beyond the constraints of the bio-medical models described earlier.

Applying the practice framework to clinical challenges

How can we apply understanding of the uses of formulation, as well as the essential components presented of the practice of time-limited psychotherapy to embedded emotional problems within the child and young person? Additionally, how can we apply these principles in therapeutic practice with parents regarding apparent confusions about parenting tasks and responsibilities? In what follows there is first a description of how this model of time-limited psychotherapy can be applied in working with adolescents who present with what may be identified as an embedded problem, such as obsessive beliefs and behaviour. This is then followed by a description of ways the time- limited model can be employed in working with younger children with physical problems for which no organic cause can be found. Finally, in the following chapter the time-limited practice framework will be discussed in relation to therapeutic work with parents.

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