TMA04 - DD310 - Formulation Report

Formulations Offer complex multi-factorial descriptions of psychological processes Inform therapy planning and risk management Consider the social context of a person and is based on personal meaning Based on analogue logic (more or less continuum) Used in psychotherapy / less suitable for healthcare/CJS needs The aim with a formulation is to make sense of a client’s problems by considering multiple contexts, from biological and psychological factors to the social and relationship context and life events. The term is used in varying ways, and there doesn’t seem to be a universally agreed definition. The BPS Division of Clinical Psychology (2011) defines a psychological formulation as ‘a hypothesis about a person’s difficulties, which links theory with practice and guides the intervention’ (p. 2). Formulations draw on the information collected from the client at the assessment and during therapy and consider how they make sense of their difficulties. They offer a theoretically based explanation or conceptualisation of the information that is available to the therapist. Apart from explaining the cause and nature of the problems, the main aim with formulations is to provide a framework and guidance for the next steps and interventions in therapy. In most of the therapeutic approaches introduced in this block, the therapist works together with the client to develop a shared understanding of the problem(s) and shares the resulting formulation with the client. As you will see in the coming weeks, the therapeutic approaches covered in this block differ in the way that they develop and use formulations, as the content and structure of a formulation will depend on the underlying theoretical concept (e.g. a CBT formulation will include content on dysfunctional cognitions and beliefs, whereas a systemic case formulation will provide a conceptualisation of the relational context). · What has caused the problems? · What factors are maintaining the problems? · What might facilitate change? TMA04 NOTES DD310-19J Table 1 Attachment styles in the ‘Strange Situation Test’ (Mary Ainsworth) Security class At play Towards stranger On separation On reunion B: Secure Plays freely; explores room and toys; looks back at mother; shows toys to her Curious; uses mother as safe base; checks with mother if engaging in play with stranger Follows mother to door, calls or cries; may be slightly comforted by stranger Cries; reaches up; clings; stops crying soon; reengages in play A: Anxious/Insecure: Avoidant Physically distant from mothers; seems confident but explores less; does not approach mother Initially wary but may engage in play; may move subtly closer to mother Watches mother go but does not follow or protest; does not cry but play is inhibited and there are physical signs of stress Watches mother return; does not approach or protest; seems occupied with play C: Anxious /Insecure: Ambivalent Stays close to mother; may not play; checks back Wary; anxiety clearly raised; stays close to Follows mother; cries; distressed; not Approaches with angry or distressed cries; clings; not soothed or frequently mother comforted by stranger re-engaged in play D: Disorganised/ Disorientated (classified by Mary Main) May seem distracted or stare into space; may have obsessive quality to play; may appear more stressed in PRESENCE of parent rather than absence May superficially respond to stranger’s entry as one of the categories above, or seem more relaxed and engaged with stranger than parent May appear to relax a little in mother’s absence, or may superficially react as one of the above categories Attachmentseeking behaviour collapses, e.g. may freeze or start to follow then turn back; may rock or display bizarre behaviours; may approach backwards or veer aside or avert gaze Based on and with permission of Linda Cundy (2016). Table 2 is an overview of the AAI classification (including narrative style, qualities as parents and adult relationships). Table 2 also shows how the different narrative styles identified in the AAI can be related back to the main SST attachment styles (Table 13.2, page 195). Table 2 Adult Attachment Interview and attachment styles (Mary Main) SST Classification AAI Classificatio n Narrative style Qualities as parents Adult relationships