Working with a psychologist

Understandingformulation

Clinical psychologists can help you tounderstand why you feel the way you do.Working together with a psychologist canhelp you make sense of your experiences.This can help you to make changes thatcan lead to a more meaningful life.

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Other things that you mayneed to think aboutYou may find it helpful to find a quiet space afteryour sessions with the psychologist to think aboutwhat was discussed and agreed.

It could be that friends and family have noticedchanges in you and feel worried. You may want toexplain to them that you will talk to them whenyou’re ready. This will reassure them you are okay.It may also take pressure off you.

If you are not happy with the way things aregoing with the psychologist, try to talk to themabout it. If you need to complain you could: talkto your GP; follow your local NHS guidelines; orgo direct to the Health and Care ProfessionsCouncil with whom the psychologist will beregistered (www.hcpc-uk.org). You may also wantto contact a local advocacy group who are there tohelp you express your views and concerns, andaccess information and services.

‘I think if you know the reason something’shappening, it automatically becomes morecontrollable. I could take control of them

(the problems)’. (A service user)

The British Psychological SocietySt Andrews House, 48 Princess Road East, Leicester LE1 7DR, UKt: 0116 254 9568 e: mail@bps.org.uk w: www.bps.org.uk

An exampleMs A described to the psychologist how she wasfeeling low and weepy and was arguing more withher partner. The psychologist asked Ms A about herlife just now, about aspects of her past and abouther views of herself. Together they worked out thatthese problems began a few weeks after Ms A’snew boss started work. This boss had been verycritical of Ms A whereas her previous boss hadthought highly of her. Ms A’s mother was ill forlong periods during her childhood and at thesetimes she was cared for by her grandmother whowas strict and could be very critical of her. This andthe fact she was bullied at school had left Ms Afeeling that she was ‘never good enough’. Her boss’sbehaviour had re-awakened these feelings. Basedon psychological knowledge, the psychologist spokeabout how and why Ms A would have beenaffected by her experiences. She also noted Ms A’sstrengths. Ms A and the psychologist then agreed aformulation of why she was feeling as she was.They were then able to identify things that werelikely to be helpful to her.

If psychological therapy seems right for you, theformulation provides a starting point to addressyour difficulties. You and the psychologist willreturn to the formulation and review it over time.This means it can be updated to respond to newinformation or changing circumstances. This waya formulation is never static – it will keepevolving throughout your work with a psychologistas you find out more about yourself.

Drawing up a formulation is a joint process andthe psychologist will do their best to ensure thatit makes sense to you. It is important that you tellthem if there is anything that doesn’t seemaccurate. The more you are able to contribute tothe formulation, the better. Only you can judgewhether it fits, because you are the expert onyour life and experiences.

Sometimes just having a formulation can be all the help you need. This is because understandingyour difficulties helps you change how you dealwith them.

Working with a psychologist Finding a solution to problems may take time. Itmay be hard for you to look at some of your lifeexperiences and make changes to achieve yourgoals. In the short term, therapy and counsellingcan be upsetting and they can also be emotionallychallenging. Psychologists are trained to recognisethis and to support you. Working with apsychologist is built on mutual trust. It requiresopenness from you and for you to be prepared totake part in the process. You also need to feel ableto tell the psychologist if you disagree withanything or feel something needs to changeabout your work together.

IntroductionA formulation is a joint effort between you and thepsychologist to summarise your difficulties, toexplain why they may be happening and to makesense of them. It may include past difficulties andexperiences if these are relevant to the present. Itacknowledges your strengths and resources. It alsohelps the psychologist work out what needs to bedone in order for you to feel better and recover.There is quite a bit of evidence that developing thiskind of account of your problems can be helpful.Often a formulation is used alongside a diagnosisgiven by a medical doctor, but sometimes it is usedinstead of a diagnosis.

The formulation process Working on a formulation is like two people puttingtogether a jigsaw. The pieces of the ‘jigsaw’ arepieces of information such as:� How you feel at the moment; � What’s going on in your life now;� When the difficulties or distress started;� Key experiences and relationships in your life;� What these experiences and relationships mean

to you.

The formulation process begins during an ‘assessment’appointment. How long it takes to complete theformulation process or ‘jigsaw’ depends on howcomplex the ‘picture’ is – it may not be started andfinished in one session. However, there are usuallyenough pieces put together in a first session to givean idea of what the picture may look like. Whathelps the psychologist do this is their knowledge andexperience of psychological theory and practice. Thisneeds to be combined with your knowledge aboutyour own life and experiences, in order to find ashared understanding and way forward.