Review - Formulation in Psychology and Psychotherapy
Making Sense of Peoples Problems
by Lucy Johnstone and Rudi Dallos
Routledge, 2006
Review by Marieke Geoghegan
Sep 23rd 2008 (Volume 12, Issue 39)

Formulation in therapeutic work forms part of the assessment of the client, informs the subsequent intervention and makes sense of the client's story. It "provides a hypothesis about a person's difficulties, which draws from psychological theory" (p.4). This book provides an interesting exploration of the process of formulation within five different therapeutic approaches.

Chapter 1 attempts to arrive at a unified definition of the concept of formulation as well as considering the differing understanding or meanings given to formulation between the five modalities. The editors consider the purpose of formulation and quote several relevant sources across the treatment modalities. In this chapter the reader is introduced to Jack, a 25 year old recently hospitalised with paranoid delusions, and Janet, a 9 year girl with a variety of behavioural and emotional difficulties. Jack and Janet's stories are considered through the lens of the five treatment modalities included in the book.

Chapters 2, 3, 4, 5 and 6 cover the Cognitive Behavioural approach, Psychodynamic, Systemic, Social Constructionist, and interestingly, Social Inequalities Formulation. Each chapter begins with a clear and concise description of the core assumptions and features of the approach, issues such as developing the therapeutic relationship are explored, the formulation of Jack and Janet's stories are presented followed by reflections on difficulties and considerations of formulation within each approach.

For example, the Cognitive Behavioral formulation presents Jack's Predisposing Factors, including his early experiences, core beliefs ("I'm not good enough"), his rules and assumptions maintaining the core belief, his compensatory strategies, and triggering events in his life. Perpetuating factors, such as unhelpful thinking patterns, Presenting Issues such as feeling lonely, not answering the phone and avoiding people and Protective Factors, such as social networks, provide the clues to the best intervention techniques. This can be contrasted with the systemic formulation involving genograms and other visual depictions of problem maintaining patterns, feedback loops and the influence of contextual factors. The theoretical assumptions and formulations for all approaches are accompanied by detailed diagrams and tables.

Chapter 7 discusses the integrated approach to formulation, strategies including Weerasekera's (1996) model of integrative formulation, and the advantages of disadvantages of the integrated approach.  We are shown an example of such an approach applied to Jack's presentation. The final chapter presents two further integrated approaches to formulation: the "off the shelf" framework of Cognitive Analytic Theory and the more "idiosyncratic" Attachment Narrative Therapy. Again, Jack's story is formulated within these frameworks.

The text is an extremely thorough, well referenced and attractively presented introduction to formulation likely to be useful to training therapists and beginning therapists. It would also be useful for more experienced therapists wishing to refine their formulation skills.

© 2008 Marieke Geoghegan

Marieke Geoghegan is a Registered Psychologist from Western Australia.