Formulation and Clinical Psychology

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

Cognitive-Behaviour Therapy ThinkingWhat we do

Situation Thoughts Feelings

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

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

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?

Situation Home Family Work Finance Leisure

History Parents Brothers Sisters Upbringing Education Adult history Social

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

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

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

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

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”

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

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

Bulimia - Formulation

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

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?