Evaluating the Role of Formulation in Counselling Psychology: A Systematic Literature Review

The European Journal of Counselling Psychology, January 1, 2018 | Go to article overview

Evaluating the Role of Formulation in Counselling Psychology: A Systematic Literature Review


Background

Formulation is a skill required of counselling psychologists globally, and forms part of the profession's identity as a branch of applied psychology. In the UK, The Health and Care Professions Council (HCPC, 2015) highlights in its Standards of Proficiency for Practitioner Psychologists, that formulation should be used to assist multidisciplinary working and communication, shared with service users to support an understanding of their experience, revised as necessary in light of new information, used to assess and plan interventions considering client perspectives and form part of a therapeutic cycle adhering to a scientist- and reflective-practitioner model. Specifically, regarding counselling psychologists, the HCPC (2015) standards state that practitioners must “be able to formulate service users’ concerns within the chosen therapeutic models” and to implement therapeutic or alternative interventions based on “psychological formulation... appropriate to the presenting problem and to the psychological and social circumstances of the service user” (p. 24). Furthermore, the Division of Counselling Psychology (DCoP, 2005), the profession’s representative division within the wider body of the British Psychological Society (BPS) in the United Kingdom, discusses formulation as a step within the broader therapeutic processes of assessment and intervention, whilst critically considering the context affecting a client’s experience. Despite these requirements and recommendations, there appears to be a lack of literature and discussion emanating from the profession on the use and practice of formulation.

The concept of formulation is contentious within some therapeutic approaches, for example within person-centred schools of thought. This is explored in Simms’s (2011) proposal for and Gillon’s (2012) counter-argument against a person-centred model of formulation. However, while formulation is a skill required of counselling psychologists, we question whether there should be clearer guidance and considerations for formulating within clinical practice. The aim of this literature review is to, therefore, examine existing views upon and applications of formulation within counselling psychology and the related mental health fields of psychology, psychiatry and psychotherapy, to better understand and evaluate the debates within the subject and, therefore, the role formulation may take in modern counselling psychology practice.

Crellin (1998) describes the term 'formulation' appearing in UK clinical psychology publications in the1950s, emerging alongside the new profession as clinical psychology attempted to position itself as an alternative to psychiatry. As the applied psychological professions have developed, the concept of psychological formulation as a distinctive skill set has been similarly embraced by counselling, health and educational psychologists (Johnstone & Dallos, 2014). Despite its inclusion within the applied psychological professions for over 60 years, no single definition of formulation currently exists; however, we feel that Johnstone and Dallos’s (2014) summary of the common features of psychological formulation reflects a broad description which seems useful and applicable across therapeutic approaches and professions. The authors state that the common features of formulation include:

Summarise the client’s core problems; indicate how the client’s difficulties may relate to one another, by drawing on psychological theories and principles; suggest, on the basis of psychological theory, why the client has developed these difficulties, at this time and in these situations; give rise to a plan of intervention which is based in the psychological processes and principles already identified; are open to revision and re-formulation. (p. 6)

In essence, formulation is the application of psychological theory to an individual’s circumstances, to help explain and understand their current experience and potentially to guide therapeutic intervention. …

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