ABSTRACT
Formulation and diagnosis share overlapping features, but differ in important ways. Diagnosis addresses the question: What is the nature of a person’s difficulties (Kendell 1975). It seeks to categorise a problem in terms of (say) a disorder (e.g., depression, anxiety or psychosis), a set of basic beliefs/ schema, a problem list or biological dysfunction. Formulation in psychological therapies may address such questions but in addition: (a) considers onset/triggers, maintenance factors and their treatment implications; (b) seeks to develop a functional analysis of symptoms and presentations; and (c) is guided by a therapist’s theories of disorders. Thus, a psychodynamic, systemic, behavioural or cognitive therapist might diagnose a disorder in similar ways (e.g., via a symptom checklist for depression or panic disorders), but would formulate the causes and treatment quite differently. Psychodynamic therapists might seek to identify unconscious motives and conflicts; systemic therapists might try to understand problems in the context of family interactions; behavioural therapists might focus on the functions of certain behaviours; and cognitive therapists might explore automatic thoughts and core beliefs. Although many schools of therapy acknowledge patient-therapist collaboration as key to therapeutic work, generally the patient is expected to collaborate in formulating and working with their difficulties in the way their particular therapist conceptualises difficulties. In a broader sociocultural context the very nature of a disorder, and the relationship between ‘patient’ and ‘healer’, are contextualised in cultural meaning systems that give rise to explanations for disorders (e.g., as soul loss or possession) and to healing rituals and processes (Csordas 2002). While some diagnoses can be relatively culture-free (one either has cancer, diabetes or heart disease or not), formulations, and especially psychological ones, are not.
