From the very earliest stages of development, each person’s individual experiences (i.e., their relationships, social and cultural norms, life events, etc) begin to shape the way they view themselves, other people, and the world around them. Psychological formulation is a term used to define the process of making sense of a person’s difficulties/ distress within the context of these unique experiences.
A formulation is essentially a ‘working hypothesis’, rationale or summary/narrative about the factors underpinning the development and maintenance of a problem being faced by an individual, family or team. Gaining a shared understanding of the broader context allows for individualised care/intervention planning, that is flexible, evidence-based, needs-led, and responsive.
At Meadows Psychology Service, we recognise the vast body of evidence which indicates that psychological formulation is most effective when carried out as a sensitive, collaborative process, which accounts for key strengths of the individual, family, or team. Our specialist team are highly experienced and trained in undertaking in-depth and detailed psychological assessments to inform formulation and care planning. To do this, we draw on key pieces of evidence, including:
- Our clinical experience and specialist knowledge of psychological theory and research.
- The client/child’s expert knowledge of their own unique experiences and the sense they have made of these, and;
- Where possible, information about the child’s family, care team, or other systemic factors which may be important to consider.
The 5Ps Model of Formulation
There are a number of different models that our clinicians can draw upon when developing a formulation, though key themes are evident throughout the literature. One of the most commonly utilised approaches to formulation is known as the ‘5P’s’ models:
- Presenting problem(s): The difficulty, behaviour or symptoms that are clinically important for the young person. For example, low mood or aggression.
- Predisposing factors: Factors in the young person’s background/early life that are likely to have made them susceptible to presenting with the given problem(s). For example, witnessing domestic violence.
- Precipitating factors: External or internal triggers that cause the young person to present with or experience the problems or symptoms.
- Perpetuating factors: Factors that are likely to be maintaining the young person’s symptoms/problems worse. For example, conflict within the family home, a lack of support, or unhelping coping skills.
- Protective factors: Individual strengths/resources or external factors that serve to improve the young person’s situation or symptoms. For example, helpful emotional regulation strategies, or positive social relationships.
Why Use Psychological Formulation?
There is a vast evidence base which highlights several benefits to this approach. For example, there is evidence to indicate that psychological formulation can:
- Help to reduce shame and self-blame by normalising problems.
- Help young people to feel understood, heard, valued and seen.
- Increases feelings of hope.
- Help a young person to better understand their thoughts, feelings, and behaviours.
- Help guide effective care/intervention planning, leading to improved therapeutic outcomes for the young person.
- Support collaborative working and increase staff team moral.
- Encourage teams to adopt a psychological informed approach to overcoming difficulties or complex challenges.
- Provide a shared understanding and increase empathy for a young person’s difficulties.
- Help to ensure teams value and draw upon the expertise and knowledge of all.
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