Three Functions of Using Psychoanalytic and Systemically Informed Perspectives in Case Formulation: Ways of Thinking About Distress in Others, Our Own Reflexive Contribution and Collaborative Formulation

This chapter will consider some psychological, psychoanalytical and psychodynamic perspectives of formulation. The words are essentially interchangeable depending upon your theoretical frame of reference. In this chapter the focus is upon theories of identity and emotional development; systemic and relational influences; and the act of doing formulation as a reflexive group process. Formulation is a framework to invite evidence-based hypothesis and thinking that can challenge assumptions and invite new ideas and knowledge and focus our conversations, assessments and interventions. The utility of group formulation and discussion affords our thinking and about the person’s experience of distress. The chapter asserts that one perspective is not enough to understand the whole story. The focus is on developing knowledge and use of case formulation as a means of collaboratively understanding a person’s experience of mental and or physical distress and illness, whether in crisis or longer-term situations: from cognitive behavioural, medical, psychological and social perspectives. Some authors may differ in the way they name the different domains of formulation as CBT, Psychodynamic, Systemic and Integrative (Johnson & Dallos, 2014) and as a consequence favour different influences; but the process, i.e. the act of doing formulation is what is foregrounded; the process of exploration is the same regardless of your theoretical or professional position. I have used this approach in my own clinical practice, in the teaching of undergraduate and postgraduate students and continued professional development of clinicians in practice to frame discussions in group supervision for many years. I never fail to be impressed and captivated by the level of critical thinking and compassionate willingness of students and clinicians to be self-effacing about the theoretical models we feel wedded to, and a readiness to consider assumptions we all hold about personhood, illness and expected outcomes. This chapter may be of use to new and experienced clinicians. It may not offer new theoretical knowledge to experienced clinicians but prompt each to consider ways of working—using formulation as a structure to think together, assess and work with individuals and families referred with mental and physical health difficulties. I have been inspired by, and learnt from, those with whom I have had the privilege to work with: colleagues, students and people with lived and living experience. I could not have done my job without involving the thinking of others. There is a case example of a family’s story which is shared to illustrate the ideas offered in this chapter.