Diagnosis vs formulation: Which do psychologists prefer?

Many of us are familiar with the process of a diagnosis. The doctor will ask “what is wrong with you?” and after describing the problem briefly, they will have identified a physiological cause. More often than not, they will prescribe medication to fix the issue. Psychiatrists following this line of thinking too. But as Psychologists, we see a big issue with this.

We don’t exist in vacuums! We are shaped by our experiences, environments and relationships, all of which have a significant effect on our emotions and behaviour. So at Pocket, we think more holistically when you come to see us. We prefer to ask “what has happened to you?”.

This question allows us to work alongside our clients to create their personal narrative. We don’t want to a label a problem to solve it, we want to contextualise it. We call this process case formulation.

Case formulation

A client and psychologist work together to understand the difficulty and any significant events, relationships or environments which could have contributed to its development and maintenance. In short, it’s a hypothesis based on psychological theories with consideration of the client’s personal interpretation of their experiences.

Further questions we might think about when creating a personal narrative

  • What happened to me?

Is there a key experience which made you feel an intense emotion? This could be anything from bullying in younger years to family arguments or to losing a loved one.

  • What am I scared of?

Are you trying to avoid fear or pain? Perhaps you’re scared of rejection or you feel as if your emotions are becoming too hot to handle.

  • What are my survival strategies?

How am I dealing with the above? An example may be overeating to make yourself feel better or not allowing others space of their own.

  • What are my strengths?

What skills and qualities do you already possess which could help you to cope in hard times? Maybe you love baking and it calms you down or you maintain a close relationship with your parents.

If you would like to think about some of these questions with us, we offer adult and family consultations.

As always,

Take care

Pocket Family Psychologist

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