Psychological formulation in residential teams working with people with dementia: An exploration of multidisciplinary views using Q-methodology.

Psychologists are encouraged to integrate their practice more closely within
multidisciplinary mental health teams, whilst maintaining their professional identity
(Onyett, 2007). The Team Formulation approach is one solution; this aims to
provide a protected thinking space for a group staff to construct a shared
understanding of a service user’s difficulties which guides intervention planning
(Johnstone, 2014). However, it requires some initial investment from services.
Chapter one investigated the evidence relating to the use and effects of team
formulation in secondary mental healthcare. Eleven papers were systematically
critiqued. A synthesis of findings revealed that whilst team formulations had no
direct impact on clinical outcomes, they helped promote psychological thinking and
facilitated better working alliances with service users. Several quantitative studies
minimised bias through control groups and randomised designs, although practicebased
evidence may have overstated effects due to a lack of methodological
rigour. To address the identified gaps and limitations of the literature, chapter two
describes a Q methodology study exploring multidisciplinary views on formulating
with teams in dementia care settings. Participants ranked the relative importance
of various aspects of sessions, and elaborated on their views through a semistructured
interview. Results indicated three shared viewpoints regarding what
was most valued about a team formulation approach, namely: Working together to
identify residents’ unmet needs; Prioritising the needs of the resident versus those
of the team; and Being heard – Valuing the relationship between the facilitating
clinician and team. Viewpoints were explored in terms of their implications for
clinical practice, including supporting residential teams to process the emotional
impact of their work in addition to maintaining a focus on residents’ individual
needs. Finally, chapter three provides a first person reflective account of the
process of completing this thesis, and it’s impact on the personal and professional
development of the author.