1. Formulation in Action: An Introduction

Abstract

Every individual experiences a complex array of events, situations, and circum-stances within their lifetime that influence their psychological development and sense of personhood. Previous relationships and attachments, social roles and expectations, formative experiences and contexts, education, gender, culture, and countless other factors influence how we perceive ourselves, the world, and those around us. The nexus between our personal characteristics and experiences is where our individuality and relationality lie, and – from a psychological perspective – our preferences, biases, behaviours, peccadillos, hopes, and fears are forged within this complex milieu. Psychological formulation (and its derivatives: case formulation and case concep-tualisation) is the dynamic framework used by many psychological practitioners, in a range of applied contexts, to manage and understand this complexity. While opera-tional definitions vary subtly between different theoretical approaches, formulation in mental health settings can be broadly understood as the process – and product – of applying psychological theory and concepts to understand the aetiology, meaning, and maintenance of the psychological difficulties we, and others, experience, and to identify ways in which these difficulties may be managed (see Corrie & Lane, 2010; Johnstone & Dallos, 2013, for a comprehensive overview of definitions). When individuals seek psychological support, formulation helps to guide iden-tification of the processes, mechanisms, patterns, and so forth that appear to be con-tributing to the individual's difficulties, assisting the psychological practitioner – and the individuals they are engaged with – to look through the complexity in order to recognise the latent factors and processes that appear key to understanding the dis-tress and its maintenance. In this way, formulation can be thought of as the process of looking past the ripples and waves in order to understand the underlying currents and how best to navigate or harness them. Formulation is therefore considered central to the role of many applied psychological practitioners (e.g., American Psychological Association, 2005; Division of Clinical Psychology, 2010), facilitating the idiographic application of established psychological principles, and thus providing the essential bridge between psychological theory and clinical practice (e.g., Butler, 1998; Division of Clinical Psychology, 2010; Kuyken, Fothergill, Musa, & Chadwick, 2005). Figure 1.1 below depicts how formulation is informed by both inductive (information that is specific to the client) and deductive (broader psychological theory) processes. Impor-tantly, there is a reciprocal influence between client-specific information and how a theoretical framework is applied, enabling idiographic responsivity (Persons, 2008). Brought to you by | NHS Education for Scotland GG&C Authenticated Download Date | 3/17/16 11:37 AM 4 Formulation in Action: An Introduction Figure 1.1: In principle, formulation is constructed, validated, and adjusted through ongoing pro-cesses of deduction (drawing from, and applying, theory) and induction (grounded in data). Dashed lines indicate that theory informs assessment of case-specific information, and case informa-tion informs how theory is applied. Through case-based abstractions, case information also has potential to inform theory-building. While the above represents an idealised model of the reciprocal relationship between theory and practice, idiographic practitioner factors (e.g., experience, biases, etc.) are likely to influence how theory is deduced and applied in practice The theoretical landscape that underpins applied psychology and therapy is con-stantly developing and evolving, informed by advances in basic theory, clinical observation, research, data, politics, and fashion; and individual practitioners are trained and embed their practice within different theoretical schools, traditions, and models. The process of formulating, or 'applying theory to practice' within a disci-pline as diverse, critical, and factional as applied psychology can therefore often seem unclear – particularly to students and trainees who are developing their own competencies in this area and who might be anxious to ensure that they apply the 'right' theory 'correctly'. It is this process of applying psychological theory to clinical practice that is the central interest of the current volume. The current volume has a strong applied focus and aims to demonstrate how a single case presentation ('Molly' – described in Chapter 2) can be formulated from a variety of theoretical perspectives. A single case description cannot capture the com-plexity, diversity, and dynamic processes of real-word clinical practice. However, by conveying multiple conceptualisations of a single client presentation, the salient fea-tures and unique aspects of each particular approach become more apparent – thus facilitating direct comparison and contrast between applied approaches. In this way, we wanted chapter contributors to illustrate how they apply psychological theory to their clinical practice, and to show their 'working out' – highlighting their initial thoughts and hypotheses, the case factors they consider salient and why, and how these issues sit within their approach – demonstrating 'formulation in action'.