1. Formulation and Clinical Psychology

2. Scientific study mind behaviour Psychology Clinical Populations E.g. mental health, cancer, learning disability, children with problems, dementia

3. Cognitive-Behaviour Therapy ThinkingWhat we do

4. Situation Thoughts Feelings

5. Therapy in Clinical Psychology Problems Development History Formulation Treatment Plan Contract Change

6. Problems Current T houghts A ction B ody What? When? Where? Who? How? Anything else?

7. Development When did it start? – What was happening at the time? When has it become worse since then? – What was happening? When has it become better? – What was happening?

8. Situation Home Family Work Finance Leisure

9. History Parents Brothers Sisters Upbringing Education Adult history Social

10. Formulation Provisional explanation….. …..of the problems Uses a frameworke.g. CBT Collaborative Meaningful to client

11. CBT Formulation – the 5 P’s What are the presenting issues? What precipitated the problems? – set them off What is perpetuating them? – Keeping them going What predisposed the person to them – historical What protective factors does the person have – Strengths and resources

12. Treatment Plan Based on Formulation Cognitive – Automatic thoughts – Challenging thoughts – Rational response Behaviour change – E.g. avoidance Contract

13. Borderline Personality Disorder (BPD) Intense and unstable emotions Impulsive behaviour Viewing others as uncaring and rejecting Intense relationships – Idealisation/devaluation Negative self-concept

14. BPD – Formulation Issues Parenting – Inconsistent/unsupportive Biological vulnerability – Including genetics Attachment style – disorganised Negative thoughts & attitudes – World is hostile – Others are uncaring – I am unlovable – “if I can keep a close relationship with someone, then I can feel secure in my life”

15. Dialectical Behaviour Therapy (DBT) Capability – Mindfulness, interpersonal skills, distress tolerance Weekly CBT – Including problem solving Generalisation – phone consultations Therapist motivation – team consultation Structuring environment – E.g. family work

16. Bulimia – Automatic Thoughts Judge myself by what I eat and look like Focus of attention is taken up with food and eating What I should or shouldn't eat – rigid rules Self-critical thoughts when don't keep to rules – I'm a failure, I'm useless and weak, I'm worthless I'm unattractive and unlovable If I start eating, I won't be able to stop – I'm out of control If I'm not perfect, then I'm a complete failure If I eat, I'll feel better

17. Bulimia - Formulation

18. CBT for Bulimia 20 sessions of therapy. Three stages of therapy: 1.educating about the disorder 2.replace dietary restraint with a more normal eating routine. 3.change cognitive distortions that the patient might have…. …..and the behaviours that may result due to these Maintenance of change – and relapse prevention strategies Progress highlighted by: – discussion in therapy sessions – continuous assessments e.g. Eating Disorder Examination ……and the client’s self monitoring journals

19. Solution Focused Brief Therapy What are the client’s strengths? What are the client’s goals? How can the client use the strengths to get towards the goals?