1. Formulation and Case Presentation

2. Formulation
Formulations are very individual; tailored for each person and relevant to their specific problems.
Typically, a formulation will examine what events have happened in a person's life, and how they have interpreted and reacted to these.
This can help the person to see that some of their problems have not just come 'out of the blue' but may be an understandable response to their circumstances.
Even when it is not possible to pinpoint one particular cause, worker and client can explore together what might be maintaining the problem.

3. Formulation time scale
Past or distal factors are important in describing patterns and vulnerability
Distal
Vulnerability
Functional analysis is useful in focusing on the present
Proximal or present factors can be conceptualised using the four systems model.
Mind Maps help integrate proximal and distal events
Precipitating,
Maintaining and
Supportive factors
Proximal

4. 4 Systems Approach
Situation
Thoughts
Feelings
Behaviour
Physical

5. Formulation framework
Vulnerability factors
Precipitating factors
Problem
Offsetting Factors
Maintaining factors

6. Vignette
Growing up Mark had a normal development with no major illnesses. He enjoyed school and made friends, however home life was difficult because of unemployment and hardship.
His mother and father both have depression and his grandmother has been diagnosised with schizophrenia.
He is one of three boys and two girls all living in the same four bedroomed house and in a socially deprived ex-mining village.

7. Vignette cont.
Mark was 18 years old when he was caught for a second time for driving without insurance and tax.
He was sentenced to three months community service, fined £200 and banned from driving for a year.
Mark had been saving for his own car and much of his social life revolved around driving.

8. Vignette cont.
Following the conviction Mark began to withdraw and over the next six months increasingly became suspicious about people he passed on the street.
He noticed that people looked at him when he passed them and on one occasion felt sure that someone said ‘That’s him’.
Mark’s parents became increasingly worried and asked the GP to see Mark who referred him on to the community mental health team.

9. 4 Systems Approach Thoughts Feelings Behaviour Physical Situation
Situation – Going places where likely to meet other people
Thoughts
People are talking about me
I am bad
Feelings
Anxious
Angry
Low
Behaviour
Stay in
Walk away from crowds
Physical
Sweaty
Palpitations

10. Formulation Using Mind Maps