Formulation, Conversation and Therapeutic Engagement
Traditionally formulation has been seen as facilitating psychodynamic understanding of the patient and enhancing the capacity of the clinician to engage in a constructive and empathic way with the patient. Typically trainees will use a particular psychodynamic theory, or theories, as the basis for their formulations.
Given that the written case is part of an assessment process, the formulation also tends to be seen as a test of conceptual knowledge. Often trainees become concerned about whether a particular theoretical orientation will be acceptable to the unseen examiners, or simply whether a given formulation is up to the mark . This may lead to an orientation more focused on the examiner than the patient. This paper looks at several case formulations and makes comparisons based upon differences in the language used with contrasting theoretical bases and situations. The implications for the conduct of the individual psychotherapeutic case are discussed, particularly with respect to the utility of the formulation in terms of communicability.