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Introduction
The role of a clinical psychologist in the NHS involves working as therapist, supervisor, trainer and consultant within a multidisciplinary team (MDT) to offer specialist knowledge and skills effectively (Lavender and Paxton, 2004). Psychological case formulation is described as a defining skill of clinical psychologists (Kinderman, 2001). It is an attempt to make sense of an individual’s difficulties through a set of hypotheses linking the cognitions, life experiences and behaviours of that individual (Summers, 2006).
There is no set definition of case formulation; however, in the literature various authors have provided their own definitions which fundamentally reach a shared consensus (Sim et al., 2005). Wolpe and Turkat (1985) define it as; “A hypothesis that relates all of the presenting complaints to one another, explains why these difficulties have developed and provides predictions about the patient’s condition”. Denman (1994) extended this definition by describing a good case formulation as being embedded in theory, sensitive to the patient, and that the “essence” of the case should be captured. The hypotheses are drawn from psychological theory (Johnstone and Dallos, 2006), and its roots lie within the behavioural approach (Brunch, 1998).
Traditionally formulations are done in collaboration with the client within an individual therapy setting; however, there is growing evidence for the use of formulations within the MDT (the Division of Clinical Psychology (DCP), 2011; Johnstone, 2014). The Department of Health (1999) suggests a team formulation to guide the care of a patient would help to address communication breakdown within the MDT. However, Kuyken et al. (2005) assessed the reliability of formulations and concluded that because formulation is a provisional working hypothesis it can be difficult to distinguish from other aspects of therapy that may promote change such as the therapeutic relationship. It is possible that difficulties measuring and quantifying formulations has meant that they are not routinely considered “interventions” in their own right but added extras to traditional forms of treatment; this may be one reason why they are under researched in clinical practice.
Based on the available research, the benefits of team formulation include increased empathy to the patient and enhanced therapeutic alliance (Waugh et al., 2010), and assist staff teams with care plans (Craven-Staines et al., 2010). Team formulations that are collaborative...