Clinical Formulation is a process through which Clinical Psychologists explore an individual’s clinical presentation from multiple perspectives, including their biological, psychological and social histories and patterns of vulnerabilities. A Clinical Formulation helps us make sense of the complexities of an individual’s psychological difficulties and the various influences that might be contributing to their psychological distress or condition.
It allows us to comprehensively explore an individual’s psychological difficulties from multiple perspectives and, where necessary, through multiple mediums (including clinical interviews, standardised assessment and psychometric assessments). As Clinical Psychologists, we use this assessment information and integrate it with current evidence based psychological theories and models to provide an opinion and, where necessary, a treatment plan that represents the best fit for each individual.
The key components of a Clinical Formulation typically consider:
1. Our clients Presenting Problems:
This requires exploring the symptoms, concerns or events that have brought the client to us at this time. We explore in depth the nature, severity, and impact of an individual’s symptoms on their daily functioning (including their home and family life, their occupational roles, their educational attainments, their social and recreational pastimes and their sleep) because we appreciate changes to these can impact an our psychological wellbeing and overall quality quality of life.
2. Predisposing Factors:
These are the factors that might have predisposed our clients to developing acute psychological upset.
Clinical Psychologists explore why an individual might be more vulnerable to struggling to cope with difficult emotions, thoughts or behavioral changes that have arisen as a result of a stressful life event(s). We consider factors such as, an individual’s prior life experiences or traumas, personality styles, their coping strategies, any maladaptive patterns of responding to distress, if they have any pre-existing environmental or social stressors, if they have any pre-existing chronic health challenges or neurodevelopmental vulnerabilities and whether or not a person perceives they have access to a meaningful network of support (emotional support or instrumental) support from others. As Clinical psychologists we recognise that it is important to consider these factors in order to help us make sense of the person behind the symptoms.
3. Precipitating Factors:
These are the stressors or events that precipitated the onset of our client’s psychological symptoms. For some individuals the “cause” of their problem is easily identifiable but for others, who unfortunately have more chronic or complex difficulties, this can require much greater consideration.
4. Perpetuating Factors:
These are factors that often serve to maintain or exacerbate an individual’s psychological symptoms and disruptions to their daily function, even after the original “trigger” has passed. As Clinical Psychologists we recognise that in spite of an individual’s best efforts to cope, factors can arise that prevent them from effectively self-managing their psychological distress, and this can cause their difficulties to persist. We explore factors such as an individual’s personal coping resources, including adaptive and maladaptive styles, their access to support and the environmental or social factors that are present in a person’s life.
Summary:
A comprehensive assessment and Clinical Formulation is an essential part of helping Clinical Psychologists understand a client’s psychological difficulties in a holistic way. Psychologists recognise that it is important to take into account the broader picture and context that have led to a client’s symptoms and their persistence, rather than just labelling their list of symptoms. We believe this enables a compassionate approach to the psychological assessment process that ensures our clients and their stories remain at the centre of our clinical practice.
