Formulation in Psychology and Psychotherapy : Making Sense of People's Problems

by Johnstone; Lucy

• ISBN13: 9781583917008
• ISBN10: 1583917004
• Edition: 1st
• Format: Nonspecific Binding
• Copyright: 2006-04-28
• Publisher: Routledge

Summary

Formulation is attracting an increasing amount of interest in the fields of psychology, psychiatry, psychotherapy and counseling. Drawing on psychological theory, it attempts to examine a client or family problems in terms of how they arose and what may currently be holding these in place. It synthesizes this information and explanatory ideas into working hypotheses, which are then used to suggest appropriate and effective ways of working to relieve the problems. It can also be described as the key way of relating theory to practice in clinical work. Formulation in Psychology and Psychotherapy places this growing interest in formulation in a clinical and historical context. It introduces the reader to the theory and practice of formulation through the discussion of two clients (one adult and one child focused problem), whose problems are formulated from the perspective of 5 different therapeutic traditions: systemic, psychodynamic, community, cognitive behavioral and socialconstructionist/narrative. It looks at the growing trend for formulations that draw on two or more therapeutic models and includes two chapters dealing with integrative formulation. It offers some creative suggestions for how this can be carried out in a way that is theoretically coherent and clinically effective. The authors also explore the important issue of formulation as a collaborative activity, and consider the ethics of formulation. The final chapter takes a critical overview of the main research, controversies and debates in the area, and gives a guide for using, developing, and researching formulation in a way that maximizes its strengths while being aware of its limitations. The book is unique in including newer therapeutic approaches such as narrative therapy and social inequalities; it critiques and takes forward recent work on integration, and provides a lively and challenging critical evaluation of the area as a whole. It guides readers through a complex field in a clear, accessible andengaging way. Both experienced and novice clinicians will be able to enhance their clinical skills and theoretical knowledge.

Table of Contents

List of figures	xiii
List of tables	xv
List of contributors	xvi
Introduction to formulation	1	(16)
Lucy Johnstone
Rudi Dallos
Formulation in psychology and psychotherapy	1	(3)
What do we mean by formulation?	4	(1)
What is the purpose of a formulation?	5	(3)
Cognitive-behavioural	5	(1)
Psychodynamic	5	(1)
Systemic	5	(1)
Integrative	6	(2)
How did the concept of formulation arise?	8	(3)
Cognitive-behavioural approaches	8	(1)
Psychodynamic approaches	9	(1)
Systemic approaches	10	(1)
Other therapeutic traditions	11	(1)
Summary	11	(1)
Jack	12	(1)
Janet	13	(2)
References	15	(2)
Formulation in cognitive-behavioural therapy: `There is nothing either good or bad, but thinking makes it so'	17	(30)
Robert Dudley
Willem Kuyken
What is a cognitive-behavioural approach?	17	(1)
Formulating within a CBT approach	18	(1)
The empirical basis of CBT	19	(1)
The process of CBT formulation: the five Ps	20	(11)
Presenting issues: what are the problems?	21	(1)
Precipitating factors: what triggers the problems?	22	(1)
Perpetuating factors: what keeps the problems going?	23	(3)
Predisposing factors: what led to the problems starting?	26	(2)
Protective factors: what are the person's strengths?	28	(1)
Practical aspects of formulation	28	(2)
Towards intervention	30	(1)
Jack: a cognitive-behavioural formulation	31	(5)
Presenting problems	31	(1)
Precipitating factors	32	(1)
Perpetuating factors	32	(1)
Predisposing factors	33	(3)
Protective factors	36	(1)
Towards intervention	36	(3)
Janet: towards a cognitive-behavioural formulation	39	(3)
Reflections	42	(1)
References	43	(3)
Further reading	46	(1)
Psychodynamic formulation: A prince betrayed and disinherited	47	(25)
Rob Leiper
What is a psychodynamic approach?	47	(14)
Core features of a psychodynamic approach	48	(1)
The dynamic perspective	49	(3)
The developmental perspective	52	(4)
The structural perspective	56	(3)
The adaptive perspective	59	(2)
Jack: a psychodynamic formulation	61	(5)
A prince betrayed and disinherited	61	(3)
Reflection on the formulation	64	(1)
Towards intervention	65	(1)
Janet: a psychodynamic formulation	66	(2)
A girl unheld	66	(2)
Reflections	68	(2)
References	70	(2)
Systemic formulation: Mapping the family dance	72	(26)
Rudi Dallos
Jacqui Stedmon
The systemic approach	72	(5)
Symptoms and family processes	72	(2)
Exploration of the problem	74	(1)
Progressive hypothesising	75	(1)
Family therapy and social constructionism	76	(1)
A proposed model of systemic formulation	77	(1)
Jack: a systemic formulation	78	(7)
Mapping the family dance	78	(1)
Deconstructing the problem	78	(2)
Problem-maintaining patterns and feedback loops	80	(1)
Beliefs and explanations	81	(3)
Contextual factors	84	(1)
Summary	85	(2)
Synthesis and preliminary formulation for Jack	85	(2)
Janet: a systemic formulation	87	(8)
Deconstructing the problem	87	(2)
Problem-maintaining patterns and feedback loops	89	(1)
Beliefs and explanations	90	(1)
Transitions, emotions and attachments	91	(1)
Contextual factors	91	(1)
Synthesis and preliminary formulation for Janet and Mary	92	(2)
Comments	94	(1)
The politics of formulation	95	(2)
References	97	(1)
Social constructionist formulation: Telling a different story	98	(28)
David Harper
David Spellman
Social constructionism	98	(3)
Where did social constructionism come from?	98	(1)
What is social constructionism?	99	(1)
The influence of social constructionism on therapy	100	(1)
Narrative therapy	101	(1)
Social constructionism and formulation	101	(3)
Case examples	102	(2)
Jack: a social constructionist formulation	104	(11)
Telling a different story	104	(1)
Externalising conversations: naming the problem	104	(3)
Tracing the history of the problem	107	(1)
Exploring the effects of the problem	107	(1)
Situating the problem in context: deconstruction	108	(1)
Unique outcomes	109	(2)
Re-membering conversations	111	(1)
Therapeutic documents	111	(1)
Expanding the conversation: leagues and teams	112	(1)
Outsider-witness groups and definitional ceremonies	112	(1)
To formulate or not to formulate?	113	(2)
Janet: a social constructionist formulation	115	(5)
The context of the referral	115	(1)
Collaboration	115	(2)
Externalisation	117	(3)
Reflections	120	(1)
The need for critique and debate	120	(1)
References	121	(5)
Social inequalities formulation: Mad, bad and dangerous to know	126	(28)
Joe Miller
Lynn McClelland
What is a social inequalities approach?	126	(5)
Formulating within a social inequalities model	131	(2)
Formulating power	131	(1)
Theory-practice links	131	(1)
Guidelines on formulation	132	(1)
Jack: a social inequalities formulation	133	(8)
Mad, bad and dangerous to know	133	(4)
Masculinity	137	(2)
Delusions, lies and stereotypes	139	(2)
Janet: a social inequalities formulation	141	(5)
The socio-economic context	144	(2)
Formulation from a social inequalities perspective: some guidelines	146	(1)
Towards intervention	147	(1)
Reflections	148	(1)
References	149	(5)
Integrative formulation	154	(28)
Rudi Dallos
John Wright
Jacqui Stedmon
Lucy Johnstone
Integrative formulations	154	(1)
Approaches to integration	154	(5)
Off the shelf	155	(1)
Aptitude-treatment mix (A--T)	155	(1)
Idiosyncratic formulation	156	(1)
Key differences	156	(1)
Implicit integration	157	(2)
Integration strategies	159	(1)
Making conceptual connections	159	(1)
Making practical connections	159	(1)
Weerasekera's integrative formulation	159	(3)
Jack: an integrative formulation	162	(3)
Predisposing factors	162	(1)
Precipitating factors	163	(1)
Perpetuating factors	163	(1)
Protective factors	164	(1)
Coping styles	165	(1)
Reflections on the model	165	(2)
Advantages	165	(1)
Disadvantages	166	(1)
Extending the integrative model	167	(5)
The therapeutic relationship in `live' formulation	167	(1)
Reflexivity	168	(1)
The choice of models	168	(1)
Certainty and pattern matching	169	(1)
Collaboration	170	(1)
The context in which we practise	171	(1)
Summary	172	(1)
A contextual-dynamic view of integrative formulation	172	(7)
Contexts	172	(2)
Who does the formulating?	174	(1)
Gathering information actively	174	(3)
Feedback	177	(1)
Confirming and disconfirming evidence	177	(2)
Summary	179	(1)
References	179	(3)
Integrative formulation: CAT and ANT	182	(26)
Rudi Dallos
Introduction	182	(1)
CAT formulation	182	(5)
Personal construct theory (PCT)	183	(1)
Procedural sequence model (PSM)	184	(1)
Systemic theory	185	(1)
Object relations theory	185	(1)
Reciprocal role procedures (RRP)	186	(1)
Narrative approaches	186	(1)
Jack: a CAT reformulation	187	(4)
ANT formulation	191	(6)
Integration based on the strengths and limitations of models: complementing and compensating	192	(1)
Systemic therapy	193	(1)
Narrative therapies	194	(1)
Attachment theory	195	(2)
Formulating within ANT	197	(1)
Individual level	197	(1)
Interpersonal level	197	(1)
Socio-cultural level	197	(1)
Jack: an ANT formulation	198	(3)
Attachments and narratives	198	(3)
Attachments and systemic processes	201	(5)
Cultural contexts and narratives	202	(1)
Integration	203	(2)
Implications for intervention	205	(1)
Overview	206	(1)
References	206	(2)
Controversies and debates about formulation	208	(29)
Lucy Johnstone
Jack and Janet: the formulations	208	(1)
Formulations: a central process in the role of the scientific practitioner?	209	(1)
Formulations: truth versus usefulness	210	(2)
Formulations: useful to whom?	212	(8)
Useful to the client?	212	(1)
Harmful to the client?	213	(4)
Useful to the therapist?	217	(1)
Useful to professions?	218	(2)
Formulation versus diagnosis?	220	(6)
Are formulations individualising?	224	(2)
Can anyone make formulations? Do we need them at all?	226	(2)
So what are formulations then?	228	(2)
Summary	230	(1)
Jack and Janet: an update	231	(1)
References	232	(5)
Index	237