What is formulation
🔹 What is it?
• Formulation is a collaborative, hypothesis-driven explanation of a person’s difficulties
• It integrates biological, psychological and social factors
• It helps understand how their problems developed and are maintained
• It helps inform intervention so it can be:
• Individualised
• Relevant
• Effective
What are the 5 ps formulation?
🔹 Presenting
• May include diagnosis
• But at a deeper level you are looking at:
• How someone is experiencing difficulties
• Impact on quality of life
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🔹 Predisposing
• Factors that lead to vulnerability to experiencing difficulties
• Things that happened (“little t’s”)
• Also what did not happen:
• Feeling safe
• Freedom to explore identity
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🔹 Precipitating (Trigger)
• Events or things that happen to cause stress
• Could be linked to meaning developed in childhood
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🔹 Perpetuating (Maintaining)
• What keeps the problem going
• e.g. avoidance
• Unhealthy coping strategies
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🔹 Protective
• Strengths / resources
• Buffer stress
• Reduce risk
What are the strengths/weaknesses of formulation?
🌿 Strengths
• Can provide nuance to understanding
• Helps people make sense of what’s going on for them
• Can increase sense of agency for change
• Can highlight systemically how services can alter / change treatment more effectively
• Considers wider context outside of individual’s problems
• Draws on people’s strengths and resilience
• It is collaborative → more likely to resonate and feel meaningful
• Helps inform interventions
• e.g. developing understanding of the function of safety behaviours and how this could be achieved more healthily
• Goes further than diagnosis in explaining distress
• e.g. distress caused by hallucinations vs distress caused by being out of routine / re-traumatisation
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⚖️ Limitations
• Not always achievable to a high standard within services
• e.g. short period of admission
• Difficulty creating shared formulation in teams due to time limitations
• Depends on available information
• Often missing info on NHS notes
• Patient engagement may fluctuate
• It is subjective
• Requires reflexivity
• Requires collaboration
Apply behavouralism to a scenario
- Identify Targeted Behavior:
- Identify reinforcement (positive/negative)
- Identify antecedent/ trigger (emotions/stimuli)
4.Develop consequences (for alternative behaviour) - praise/removal of privileges - Identify and teach replacement behaviours
- Develop behaviour change action plan
- Evaluate and review to based on data, and to inform progress
Applying a psychological model
IMAP
Identify- identify hypothesis
M – Model
Name the psychological model you’re using.
“One way to understand this scenario is through Compassion Focused Therapy.”
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A – Apply
Apply 2–3 key concepts from the model to explain the situation.
Examples:
• threat / drive / soothing (CFT)
• attachment security / avoidance (Attachment)
• autonomy / competence / relatedness (SDT)
• reinforcement / habit loops (Learning theory)
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P – Practice
Explain what this means in practice:
• what intervention might involve
• clinical approach- techniques/strats
• what you would prioritise
✔ naming a model
✔ applying key concepts
✔ linking to behaviour or emotions
✔ considering implications
✔ some reflection on context or power
