Formulation as a Basis for Planning Psychotherapy Treatment

Formulation as a Basis for Planning Psychotherapy
Treatment utilizes a step-by-step structure and copious case
illustrations to teach psychiatrists, residents in psychiatry and
psychology, social workers, and marriage and family counselors how to plan
treatment after the initial diagnosis. This new edition arrives two decades
after the first, with revised content, updated case studies, and new
insights gleaned over the author's noteworthy career. Clinical formulation,
also known as case formulation and problem formulation, is a
theoretically-based explanation or conceptualization of the information
obtained from a clinical assessment. Although formulation systems vary by
different schools of psychotherapy, the author has adopted and here explores
a systematic approach based on an integrative effort. This system of
configurational analysis combines concepts derived from psychodynamic,
interpersonal, cognitive-behavioral, and family system approaches.


After an overview of psychological change processes, each of the five
steps of configurational analysis is covered systematically:


* Step one involves selecting and describing the patient's currently
most important symptoms, signs, problems, and topics of concern. For
example, symptoms may consist of trouble sleeping or feelings of depression;
signs may include discordant verbal and physical expression; problems may
include reluctance to go to work or care for family members; and topics of
concern might be unresolved grief the patient feels helpless to process
without assistance. Since both patient and therapist want to know if these
observable phenomena are changing, this list is modified as treatment
progresses.
* Step two entails describing states in which the patterns
of phenomena do and do not occur, with attention to patterns of shifts in
states, especially maladaptive state cycles. The therapist is taught how to
aggregate and organize this information by describing states of mind-for
example, undermodulated (e.g., unthinking rage) or overmodulated (e.g.,
numbness and lack of affect).
* Step three involves describing the
challenging topics that patients may both approach and avoid because they
are conflicted or unresolved, as well as the obstacles patients may create
to divert attention from those topics. For example, patients may avoid a
topic or shift attention from it by changing the subject and so forth.
*
Step four entails describing the organizing roles, beliefs, and scripts of
expression and action that seem to organize repetitions in each state, with
an effort made to identify dysfunctional attitudes and how these may have
evolved from past attachments and traumas.
* Finally, step five
involves figuring out how to stabilize working states by enhancing the
therapeutic alliance and helping the patient contain and master emotional
attitudes. At this point, the clinician plans how to counteract avoidances
by direction of attention and promotes adaptive social cognitive capacities.


From surface observation to deeper inferences, Formulation as a
Basis for Planning Psychotherapy Treatment transcends DSM diagnoses,
helping clinicians to use information gleaned in the immediacy of the moment
to make sound, sensitive, and effective psychotherapeutic decisions.