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Making sense of mental health problems
Making sense of mental health problems

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3.2 A psychologist’s perspective

In the activities that follow, you will be encouraged to read about psychological formulation and will also be asked to think about what a clinical psychologist had to say about the case study of Mandy.

Activity 7 A psychological perspective

Timing: Allow about 45 minutes

How the principles of psychological formulation work in practice is illustrated in this short online article by Lucy Johnstone (2012) ‘Formulation – The psychological alternative to diagnosis’ [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] .

Read the article and think about how the approach described compares with the medical perspective to investigating mental health problems that you considered in Section 2. Make notes on how formulation differs from diagnosis.

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Johnstone says: ‘Formulation is the process of making sense of a person’s difficulties in the context of their relationships, social circumstances, life events, and the sense that they have made of them. It is a bit like a personal story or narrative that a psychologist or other professional draws up with an individual and, in some cases, their family and carers.’.

Many medical practitioners are likely to use a similar approach to formulation but some may place less emphasis on the importance of the narrative and to be more concerned with detecting clusters of symptoms that have been categorised as typical of certain disorders.

In the article Johnstone suggests that in the case of formulation: ‘Unlike diagnosis, it is not about making an expert judgement, but about working closely with the client to develop a shared understanding which is likely to evolve over the course of the therapeutic work. And, again unlike diagnosis, it is not based on deficits, but draws attention to talents and strengths in surviving what are nearly always very challenging life situations.’.

Johnstone gives an example formulation for Jane, who, like Mandy, has started to hear voices. You may have noticed that the formulation resists labelling Jane as ‘schizophrenic’ or ‘psychotic’ but rather describes what she is experiencing and takes note of some of the difficulties she has experienced in her life.

If the process of psychological formulation were to be applied to Mandy, it would require someone to spend time talking to her about her situation and her perceptions of it. In the next activity you will hear from a psychological practitioner (specifically a clinical psychologist) about how they would work with Mandy in order to understand what her problems are and what can be done to address them. 

Activity 8 A clinical psychologist’s approach

Timing: Allow about 40 minutes

In the group discussion in Activity 2, you heard the clinical psychologist speak about her views. In this activity you will read more about her views. 

The clinical psychologist’s view: Dr Marion Bates

Figure 6 Dr Marion Bates

Pay attention to Dr Bates’s analysis of Mandy’s problem. Again keep in mind what you have written about Mandy in Activity 1 and view this not as a passive learning exercise but as an active experience in which someone else in the room is giving their view on a situation for which you have already formed some opinions. As you read what they have to say, think about and note down ideas covering the following points:

  1. Where does the practitioner’s approach agree with yours?
  2. What has she introduced that had not occurred to you?
  3. What aspects of her approach would you like to challenge?
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In the next section you will explore how a social worker might approach Mandy’s situation, from a social need perspective.