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The Power of Understanding Psychological Formulation: A Guide for Mental Health Professionals

Updated: Feb 28

A formulation is a joint effort between you and the psychologist to summarise your difficulties, to explain why they may be happening and to make sense of them. It allows for a structured conceptualisation of an individual’s presenting problems!

Person sat with psychologist using psychological formulation

What is a Psychological Formulation?

A psychological case formulation is a working hypothesis (proposed explanation) about the factors that have contributed to or caused; and also maintained the client’s presenting problems. This hypothesis is held lightly and is adjusted as more assessments and sessions with the client yield more information.

Formulations have been recognised to be a useful conceptual and clinical tool in psychotherapy as diagnosis itself does not focus on the underlying causes of a client’s problems. Psychological formulation has been defined by various practitioners but commonly, formulation is a structured approach to understanding factors underlying the client’s issues and contributes to intervention plans. Typically, psychological formulations will follow an assessment period, which then allows for intervention and evaluation.

One of the most commonly used formulations in clinical psychology is the ‘5 Ps’ which focuses on Predisposing Factors, Protective Factors, Precipitating Factors, Presenting Issues and Perpetuating Factors. The ‘5 Ps’ formulation can help provide a framework and has the freedom to draw on a range of different factors, including a variety of psychological theories and principles, e.g. attachment theory or systemic approaches.

What are the 5 P’s?

Predisposing Factors: These are internal or external historical factors which are likely to have increased someone’s vulnerability to developing their current problems, e.g. early life trauma, genetic conditions

Protective Factors: Both internal and external resiliency and strengths which help to maintain an individuals emotional health, e.g. engaging in hobbies such as physical exercise.

Precipitating Factors: The triggers of the current presenting issues, which can be internal or external, e.g. loss of a close family member

Presenting Issues: A description of the individual’s presenting difficulties, including thoughts, feelings, and behaviours, e.g. feeling anxious in crowds, and avoiding social gatherings

Perpetuating Factors: Internal and external factors which maintain the presenting issues, e.g. unhelpful coping strategies which feed into maintenance cycles, such as substance misuse

Interested in learning more about psychological formulations? Then please visit the following sites below:

Why do we use them?

They can fill the gap between diagnosis and treatment. It helps provide both client and therapist with a clear direction in which to travel in order to achieve set goals. It allows the client to better understand themselves by working closely with a trained professional, who then outlines and details, usually in a visual representation, the factors contributing to their difficulties, as well as their resilience, all of which can help provide clarity and focus for intervention.

Who will use it?

There is no hard and fast rule on who benefits most from a psychological formulation. In general, if a person is struggling with their mental health then a formulation can be beneficial. It will help provide a better understanding of the presenting issues, and the factors contributing to them and is an integral tool for the individual themselves (when supported to understand the content), their families, carers, teachers and pastoral support.

What are the benefits?

One of the key benefits of a formulation is being able to summarise diverse information about a client in a brief, coherent manner for the purpose of better understanding and treating of the client. Furthermore, some additional benefits include:

  • An agreement of a treatment plan

  • Guiding of the work and facilitation of the client’s process of change

  • Increased self-awareness of the client through developing an understanding of self

Where can you find out more?

For more information about the support we provide in developing psychological formulations and establishing appropriate interventions and strategies for therapeutic care approaches, please contact us on 0161 510 0111.

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