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Ebook Basics of psychotherapy - A practical guide to improving clinical success: Part 2

(BQ) Part 2 book “Basics of psychotherapy - A practical guide to improving clinical success” has contents: What is a formulation, what is a treatment plan, what is communication, what is collaboration, what is an autodidact, what is the sum and substance, suggested readings. | CHAPTER FIVE What Is a Formulation? Anyone who has ever attempted a pure scientific or philosophical thought knows how one can hold a problem momentarily in one’s mind and apply all one’s powers of concentration to piercing through it, and how it will dissolve and escape and you find that what you are surveying is a blank. John Maynard Keynes It’s tough to make predictions, especially about the future. Yogi Berra Introduction In the final portion of your initial interview, your evaluation should have gathered enough history, and the right kind of history, to formulate the case. A formulation is an explanation of how and why the patient devel­ oped the problems you propose to treat. It usually has three components: 1. A brief case description with the demographic identifiers, the pre­ senting problem, and a formal diagnosis 2. Relevant history: central issues, hypotheses, and cause-and-effect connections 3. A narrative summary The second and third components are sometimes combined. If your initial assessment allows you to construct a complete formulation, you will be in a strong position to 145 146 • • • • • Basics of Psychotherapy Understand the patient. Develop an effective therapeutic alliance. Decide on the best treatment approach. Negotiate a treatment contract with the patient. Begin treatment with a solid foundation and clear objectives. As an example of a complete formulation, consider the following short example: David is a 25-year-old single male graduate student who presents with a three-month history of depressed mood, insomnia, anorexia, and suicidal ideation without a plan. The diagnosis is major depressive disorder. The onset occurred after his fiancée broke their engagement. A previous ro­ mantic breakup when he was 17 was followed by a similar, although milder, episode that resolved without treatment. His father died when he was 11. His mother and maternal grandmother have had recurrent de­ pressions. In summary, this 25-year-old man .