Formulation in psychology: a review exploring collaborative formulation and a consensus study on the key components of a formulation.

Abstract

The aim of this thesis was to further the understanding of psychological formulation. It is presented as three papers: (i) a thematic synthesis of qualitative studies exploring experiences of clients and clinicians when creating formulations to understand barriers and facilitators to a collaborative formulation; (ii) a Delphi study to develop consensus on the key components of a psychological formulation; (iii) a critical appraisal of the research process. The systematic review identified 19 relevant studies, which varied in their appraised quality. A thematic synthesis was conducted with results suggesting that clients' ability to tolerate the formulation process and engage in a collaborative formulation is dependent on how well they are prepared and the emotional impact of the formulation process. The development of the therapeutic relationship supports a collaborative formulation and is influenced by the therapists' skills in containment, empathy and trust, and ensuring the formulation is accessible. Countertransference and therapist's own biases regarding clients also impacted collaborative formulations, as well as unsupportive colleagues, a lack of resources including time and training, and external pressures to prescribe and diagnose. The Delphi study included a list of statements initially generated through literature review and consultations with experts in formulation, which was then rated by clinical psychologists in two further stages. Consensus was reached on eighteen statements relating to key components of a formulation and twelve statements regarding the process of formulation. These statements emphasised the importance of integrating sociocultural factors, strengths and personal meaning alongside well-established frameworks in formulation training. Interestingly, participants did not agree formulations should be simple. Paper three is a critical reflection on how this research was conducted, and provides further detail on the methodology and decision-making processes, alongside research strengths, limitations and recommendations. It includes personal reflections and a plan for dissemination.

Date of Award	31 Dec 2023
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Katherine Berry (Supervisor) & Lydia Morris (Supervisor)