A number of recent methods of formulating psychodynamic cases have good reliability and validity, according to the journal of Barber and Crits-Christoph21. For example, separate components of Luborsky`s Core Conflictual Relationship Theme (CCRT) method had an average weighted kappa coefficient between 0.61 and 0.70. Similarly, Curtis et al.22 report correlation coefficients in the class between 0.78 and 0.90 for the components of their plan diagnostic method. You`re probably already formulating, but you just don`t know it. Like most things in medicine, there are multifactorial causes of diseases, diseases and disorders. For example, type II diabetes does not develop due to a single pathophysiological cause. The patient may have a strong family history of the disease, sedentary work, environmental stresses and/or poor nutritional diet. These factors cause the person`s diabetes. Understanding how each factor contributes to a disease can better guide treatment decisions.
In psychiatry, the formulation seems more complicated because human behavior and the brain itself are extraordinarily complex. As with everything, the more you practice, the better you improve in the formulation. Inference ratings suggest that the formulations contained mostly descriptive information and little inference. On the scale of 1 (descriptive) to 5 (highly inferential), the average inference scores were 1.80 (SD = 0.77). Of the 56 formulations evaluated, 23 (41.1%) were evaluated by consensus at the most significant end of the scale; 21 (37.5%) received a rating of “2”; and the remaining 12 (21.4%) received a rating of “3”. When designing the CFCCM, we assumed that the primary function of a case formulation is to incorporate descriptive information about the patient, not summarize it. We defined a case formulation in general as a hypothesis about the causes, triggers, and lasting influences of a person`s psychological, interpersonal, and behavioral problems. The approach sees case formulation as a tool that can help organize complex and conflicting information about a person. In addition, it can serve as a treatment model, marker of change, and structure that facilitates the therapist`s understanding and empathy for the patient. This definition is consistent with new formulation models that have been examined before, and it contrasts with the view of some that a formulation is primarily a summary of descriptive information.31,32 Thank you for this article – psychologists seem so much smarter than psychiatrists! I have a diagnosis of schizophrenia that seems valid, even though I haven`t had any symptoms of mental illness for over a decade and I`m not taking any medication.
I find it frustrating – I`m pretty sure I don`t have schizophrenia! However, I was very sick once – I was cut three times. I understood all this while writing my memoirs – it is indeed very clear to me now what led to my problems and what I need to do to stay healthy in the future. Thanks again for this article. One of the reasons why case formulation skills have not been studied in more detail may be the lack of consensus on what a case formulation should contain and on its structure and objectives. For example, Seitz9 discovered in 1966 that a group of psychoanalysts showed little agreement in the structure and content of the formulations they constructed using the same clinical material. However, this explanation is less significant today, as several systematic methods of constructing case formulations have been developed in recent years. These construction methods for case formulations have been developed in several psychotherapeutic orientations, including psychodynamic,10-14 cognitive-behavioral,15 interpersonal,16 behavioral,17,18 and mixtures of orientations.19,20 Most share three characteristics: The quality of specific clinical formulations and the quality of the general theoretical models used in these formulations can be evaluated using the following criteria: [19] A Case formulation (case conceptualization) can be seen as a way to help a client understand what their difficulties are, where they come from and what keeps them alive. CBT case formulations often have 5 ingredients: Table 1 summarizes the number and percentage of case formulations in which each formulation element was judged by both programmers as something present or clearly present.
Descriptive information was presented in 94.6% (n = 53) of the formulations. The most frequently cited descriptive categories were symptoms and problems (67.9%; n = 38), identifying information (64.3%; n = 36) and psychiatric history (41.1%; n = 23). Only 37.5% (n = 21) contained a derived predisposing life event as a contribution to a patient`s problems. Only about one-fifth (21.4%; n = 12) of the formulations contained evidence of events occurring during childhood or adolescence, 17.9% (n = 10) treated past events in adults, and 3.6% (n = 2) were related to recent events in adults. A deficient stressor was only considered in 16.1% (n = 9) of the formulations. A minority completed a mechanism that contributed to the individual`s problems: 42.9% (n = 24) deduced a psychological mechanism, 1.8% (n = 1) a biological mechanism and 1.8% a social or cultural mechanism. In addition, only 21.4% (n = 12) concluded that a positive treatment indicator was positive. In summary, the wording portion of the intake assessments was dominated by descriptive information, with a focus on symptoms and psychiatric history.
A clinical formulation, also known as case formulation and problem formulation, is a theoretically sound explanation or conceptualization of information obtained from a clinical evaluation. It provides a hypothesis about the cause and nature of current problems and is seen as a complement or alternative approach to the more categorical approach to psychiatric diagnosis. [1] In clinical practice, formulations are used to communicate a hypothesis and provide a framework for developing the most appropriate therapeutic approach. It is most often used by clinical psychologists and psychiatrists[2] and is considered an essential component of these professions. [3] Psychiatric nurses and social workers may also use formulations. [4] The views of these respondents are echoed by many authors on psychotherapy. Sperry et al.3 have recently described case formulation as a poorly defined and taught clinical skill. Similarly, Perry et al. 8 complain that among psychotherapy supervisors, “complete psychodynamic formulation is rarely offered and almost never included in the written record” (p. 543). Fifty-six reports of admission to an outpatient psychiatric clinic in the city centre were randomly selected from a pool of approximately 300 people and their contents were analysed with the help of the CFCCM. .