Formulation in Psychology and Psychotherapy: Making Sense of People's Problems

by Lucy Johnstone, Rudi Dallos

Formulation is attracting an increasing amount of interest in the fields of psychology, psychiatry, psychotherapy and counselling. Drawing on psychological theory, it attempts to examine a client or family's problems in terms of how they arose and what may currently be holding these in place. It synthesises this information and explanatory ideas into 'working hypotheses', which are then used to suggest appropriate and effective ways of working to relieve the problems. It can also be described as the key way of relating theory to practice in clinical work. Formulation in Psychology and Psychotherapy places this growing interest in formulation in a clinical and historical context. It introduces the reader to the theory and practice of formulation through the discussion of two clients (one adult and one child focused problem), whose problems are formulated from the perspective of 5 different therapeutic systemic, psychodynamic, community, cognitive - behavioural and social constructionist/narrative. It looks at the growing trend for formulations that draw on two or more therapeutic models and includes two chapters dealing with integrative formulation. It offers some creative suggestions for how this can be carried out in a way that is theoretically coherent and clinically effective. The authors also explore the important issue of formulation as a collaborative activity, and consider the ethics of formulation. The final chapter takes a critical overview of the main research, controversies and debates in the area, and gives a guide for using, developing, and researching formulation in a way that maximises its strengths while being aware of its limitations. The book is unique in including newer therapeutic approaches such as narrative therapy and social inequalities; it critiques and takes forward recent work on integration, and provides a lively and challenging critical evaluation of the area as a whole. It guides readers through a complex field in a clear, accessible and engaging way. Both experienced and novice clinicians will be able to enhance their clinical skills and theoretical knowledge.

Genres: Psychology, Nonfiction

Paperback

First published January 1, 2006

Reviews

[Ioana Filipaş · Rating 5 out of 5]

A 'must read' book for psychology students - and why not - for anyone interested in different frameworks around constructing meaning. This idea of 'making sense' is not limited to being interested in clinical psychology, but is central to being human, as creatures driven by the ability of making sense of our experiences.

Overall a really got summary and critical analysis of formulation in the light of different therapeutic approaches to case studies, while also acknowledging the benefits these can bring in comparison to the medical/diagnosis model.

P.s. would definitely recommend reading this while taking notes and taking some time to digest the content.

[Dafni · Rating 5 out of 5]

This book explores the process of formulation in clinical psychology and psychotherapy from a range of different perspectives including the major schools of thought: psychoanalytic, cognitive-behavioural and systemic. I quite liked the view on integrative formulation combining clues from all therapeutic approaches.

The most thought-provoking chapter was ‘Social Inequalities’ written by Lynn McClelland, highlighting that we should always consider social factors and cultural context in the making of a formulation. Factors such as socio-economic status, race, ethnicity, migration, acculturation, disconnection from cultural heritage, and social cohesion might play a significant role in the mental health difficulties one is facing. Thus, formulation and intervention should be informed by contextual and multi-dimensional view.

Key messages to take home:
- Formulation is a collaborative process, with the individual & team
- As professionals we should always be open to re-formulate
- Reflect and be aware of the harm/distress it might cause to the individual
- Ensure our formulations are culturally sensitive, non-judgmental, take into account wider social/political factors
- Always consider possible role of trauma and abuse

“The potential criticisms and limitations of formulation echo the potential criticisms and limitations of therapy itself.”

[Iona Craig · Rating 5 out of 5]

Great book

[Nickita Love · Rating 5 out of 5]

This book provides an in-depth exploration of formulation within psychological practice. The authors offer a nuanced overview of different theoretical approaches, including cognitive-behavioural, psychodynamic, systemic, and narrative perspectives, allowing readers to appreciate the diversity and flexibility of formulation. One of the book’s key strengths lies in its emphasis on collaboration and the co-construction of meaning between client and practitioner, which reflects the core values of counselling psychology. Johnstone and Dallos also critically examine the limitations of diagnostic models, highlighting the importance of understanding distress within social, cultural, and relational contexts. This critical stance encourages reflective and ethical practice, prompting practitioners to remain aware of issues of power, labelling, and individualisation. While the book is dense in parts, its clear structure and use of case examples make it both accessible and practically relevant. Overall, it is an essential resource for trainee counselling psychologists, offering both theoretical depth and practical guidance for developing formulation skills that are integrative, reflective, and person-centred.

[Rehnuma Choudhury · Rating 3 out of 5]

Read this at the beginning of the year and remember thinking at the time that it was useful for understanding modality-specific formulation processes, but not all too useful as a guidebook for day to day formulation of different presentations in different clinical situations, which is what I was hoping to learn more about.

The psychodynamic chapter, while helpful in illustrating how formulation might work within the discipline, did not do much to help me to understand how to actually formulate problems psychodynamically as the formulations themselves seemed overly dependent on clinician interpretation without a solid framework to use. I get that formulation is mainly a CBT thing - but I was also hoping to gain a general idea of how to conceptualise different presentations.

Maybe what I really needed was a book on formulation frameworks / strategies - but in any case, this book wasn't it.

[Yinxue · Rating 3 out of 5]

Disappointed in how dull and un-informative this is for clinical practice.

[Harriet · Rating 5 out of 5]

Overall, great book on formulation for any psychologist in practice. Reading this has shaped my work. Favourite chapter was the one on team formulation.

[Margo · Rating 4 out of 5]

*Doing work for work outside of work*

To formulate or not to formulate, that is the question.

To me it’s one of those matter-of-fact things that happen naturally without much conscious deliberation. Whether it turns out to be correct and useful is a question for another time, but just like the „therapist nod” the formulation cogs start turning whenever the opportunity arises.

I found it particularly useful that authors used the same 2 scenarios for every formulation rather than different, perhaps more fitting ones. This showed very neatly that any of the approaches can be utilised in any context and it will make SOME, but not necessarily ALL or even A LOT of sense. Making sense, however, sometimes feels like making your way through gorse bushes. And that’s fine. That’s why we have all these tools for.