Understanding the Factors That Contribute to Creating a Collaborative Psychological Formulation: A Qualitative Systematic Review

Objectives: Creating a formulation is one of the key competencies of a clinical psychologist and is understood to be important for guiding therapeutic input and understanding client distress. However, client experience of formulations can vary, with some reporting it is unhelpful and distressing. This novel review explores the experiences of clinicians and clients when creating a formulation, specifically the barriers and facilitators to collaborating on a formulation. This ultimately aims to improve client experience and engagement in formulation. Methods: A systematic search of PubMed, Web of Science, PsycINFO and EMBASE was conducted using PRISMA guidelines. The protocol was registered on PROSPERO. This search was conducted using terms related to ‘psychological formulation’ and ‘experience’. Nineteen qualitative papers met inclusion criteria and were appraised using the Critical Appraisal Skills Programme. Findings that pertained to formulation were thematically synthesised. Results: Three analytical themes were identified: toleration of the formulation process—‘a necessary evil’, which highlights the potential emotional impact of formulation on the client and indicates the importance of responding to client readiness and expectations of formulation; development of the therapeutic relationship—‘it's like a two way thing, isn't it?’, which suggests that client empowerment, adapting to client needs and clinicians creating a safe and containing environment facilitated the formulation process; systemic factors—‘walking a tightrope’, which highlights the constraints of resources and team dynamics in therapists' ability to engage in collaborative formulation. Conclusion: Facilitators to a collaborative formulation include the following: simple formulations, thorough assessment and preparation for formulation, ‘doing with’ activities such as timelines and diagrams and working environments that include supportive colleagues and time for reflection and training.