Do you find yourself spending a lot of your time thinking about why things are the way they are? Wondering why that certain friend keeps repeating the same behaviours despite apparently negative outcomes, or how someone close to you developed their bad habits in the first place. Then maybe, just maybe, you’re like me and you’re the child who never grew out of asking “why?” – potentially also to the great annoyance of those around you. I certainly feel like that’s what fed my passion for psychology, but in particular formulation. I simply love the process of unpicking and analysing – trying to figure why things came to be that way. This can relate to simple things like “why do I bite my nails?”, or even my slightly unhealthy obsession with reality TV (seriously it’s rife with opportunities to formulate).
I wouldn’t recommend basing your approach to formulation on such examples though – a more structured and evidence-based approach is necessary when we think about the more obvious uses of formulation within justice, such as understanding the factors behind someone’s offending or the relationships between multiple problems within a person’s life. Formulation isn’t just the outcome of producing a narrative explanation (although it absolutely involves that) it is a way of thinking about a problem, an approach to decision-making and a method of identifying relevant solutions. This is captured beautifully in Lucy Johnstone and Rudi Dallos’ book – “Formulation in psychology and psychotherapy: Making sense of people’s problems” – where they refer to formulation as both a process and a product.
Risk assessment has evolved considerably in the past few decades – with many recognising the current generation is focused on the use of a Structured Professional Judgement (SPJ) approach. However some would argue that a ‘fourth generation of risk assessment’ is upon us and that is about a formulation-based approach. This builds upon the application of SPJ tools and guidelines but with an emphasis on formulation as the central element to risk assessment and management (e.g. Sturmey & McMurran, 2011). As such Johnstone and Dallos describe the process as one of suggestion, testing hypotheses, reflection, linking to risk management, feedback and revision. Such a process then leads to the product of a narrative risk formulation (if we focus on offending behaviour that is). This product should organise the risk-relevant information to tell a meaningful story about the individual.
For me the key word here is ‘story’. It’s about telling the person’s narrative – what has contributed to the path they have taken to get here, what affects the choices they make, what might interfere with them making better choices, and what might help them make better choices.
We surely all accept that every person is unique and complex – and therefore each formulation is equally individual. We have to distil everything we know about what can lead to offending into a meaningful picture of what has been relevant to this individual, and really importantly, what can be done to change that picture. In that sense it is also action-oriented. It has to give those working with an individual – and the individual themselves – hope and clarity on what can be done to improve situations. It should identify the things that increase concerns – and how to reduce said concerns – but also indicate positive ways of working with an individual so as to enhance motivation and strengthen pro-social bonds and ties.
I’ve probably fallen foul in this short ramble of using jargon. The truth is it’s incredibly difficult to be succinct and use plain language. We all become used to the language of our profession but we must remember that we work in multi-agency teams. As such formulation should be a collaborative process involving other professionals and the individual themselves. Formulation should be done with an individual not on them. Done in this way it can be a powerful tool that assists someone in understanding themselves – alternatively if done poorly it can be seen as a summary of all the bad things that have happened in their lives. Use of language is therefore crucial to provide meaning and a way forward. A lecturer I once had always said “Don’t utilise when you can use” and this has always stuck with me – prudent advice that I could probably do with following a bit more stringently myself.
One of my biggest motivators behind a career in psychology – other than the quite common but slightly unhealthy self-obsession with having a better understanding of who I am – is the enjoyment I get from bringing psychological theory to practice. In a previous job the psychology department was referred to as “Narnia” and rather than taking this personally I saw this was an opportunity to break down barriers (and let’s face it there are worse things you could get called). Formulation is one of those things that allows for complex ideas to be brought together and conveyed in simple terms – it can help staff work in more effective and efficient ways, which can reduce the stressors so commonly associated with working in difficult environments.
The truth is formulation is not a ‘psychologist-only’ activity it is something that is used across justice (and other sectors).
Many professions and people do it on a daily basis – parents and teachers immediately spring to mind. We may not all give it a formal title or call it the same thing but across psychology, social work and police work there is a pivotal role for the process of explaining something in the context of individual relevance and narrative. What is probably true is that we use it to varying degrees. Caroline Logan talks about this important concept of depth or levels in relation to formulation. It can range from a simple understanding of how factors and behaviour might link within a chain of events, all the way through to comprehensive understanding of a case involving multiple co-occurring behaviours.
I am also keen to acknowledge that there is a need to better understand what is the actual impact of formulation within practice. Understanding what makes a good formulation is a healthy start (see McMurran and Bruford’s 2016 Case Formulation Quality Checklist – Revised) of which I’ve referred to several characteristics within this piece. Wheable and Davies (2020) have also taken it a step further and produced a promising journal that looked at various areas like training staff, the perceived use of formulation and issues within formulation. I would really like to take it further and try to look at the impact of formulation on decision-making, and actual outcomes for the people we work with.