Formulation: An investigation into perspectives of non-psychologists within a Child and Adolescent Mental Health Service

This thesis describes the process of exploring the understanding of non-psychologists around the use of formulation, and alternative approaches to explaining a service user’s mental health difficulties. This includes uncovering perspectives about the role of the clinical psychologist within the team. Formulation is seen as a key concept in mainstream psychotherapeutic approaches, but it is not widely understood whether psychiatry or mental health nurses use this approach in understanding a service user’s difficulties, or whether they use diagnosis and classification as the mainstay methodology. Current literature suggests that the use of formulation in psychiatry is constrained to being a part of an overall medical summary, but that mental health nurses can use an approach similar to formulation, undertaking comprehensive assessments, and identifying difficulties through alternative therapeutic interventions. Clinical psychologists report sharing formulations informally within MDTs, helping increase staff cohesion, improve team dynamics, and improve relationships with service users. However, literature suggests that service users may feel more confident receiving a medical diagnosis as it provides a stronger justification and validation for their difficulties. To better understand the role that formulation takes within mental health working, a study was designed to explore these areas further.
Using a qualitative approach called Template Analysis (TA), which utilises hierarchical coding to extract key themes from the interview transcripts, the researcher was able to find four themes: ‘level of understanding of formulation’, ‘level of benefit of formulation within the team’, ‘limitations of using formulation within the team’, and ‘Role of clinical psychologist’. The researcher used these themes and resultant codes to discuss levels of understanding of non-psychologists working within the teams, around formulation and the role of the clinical psychologist, and areas for development and future research.