ABSTRACT
In Chapter 6 we illustrated a framework for risk formulation based on the contemporary risk literature and models of risk. However, this framework is primarily aimed at high-risk behaviours (e.g. suicide or violence) and as we noted in Chapter 1, problematic behaviours in psychosis may take a variety of forms that may more broadly act as significant barriers to participation, preventing the person from engaging in ordinary age-appropriate activities or achieving their life goals. A broader formulation framework is required to encompass information relating to these different types of problematic behaviours and to guide the clinician in selecting an appropriate level of intervention. Our Cognitive Approach to Risk Management (CARM) model provides such an integrative framework. CARM may be viewed as a formulation at the level of the problem behaviour. As such, it builds on the earlier levels of formulation, which essentially help to define which problem behaviours are the main barriers to participation. The CARM model provides a means of focusing more clearly on the factors that drive and maintain the behaviours in question and their interrelationships, allowing clear avenues for intervention. The model is a functional analytic one. By understanding more fully the function that a particular behaviour serves, an intervention plan can be devised that aims to meet those functions in a more appropriate and less damaging way. In this chapter we begin by outlining the development of the various components of the CARM model and their rationale. We subsequently illustrate the process of using the model with two main case studies to show its application to different behaviours.
