Young People's Experiences and Views of Formulation, and Its Clinical Implications for Mental Health Professionals

Abstract

The experiences and opinions of adult clients, professionals and teams regarding clinical formulation have been researched, with mixed findings. Formulation helps some clients understand their problems, and feel accepted (Redhead, Johnstone & Nightingale, 2015; Burchardt, 2004). However, some can find it upsetting and worrying (Chadwick, Williams & Mackenzie, 2003). Professionals reported that formulation increases understanding of clients and gives direction (Pain, Chadwick & Abba, 2008), but can limit care plans (Summers, 2006). A systematic literature review with a critical analysis is presented in this research. The review found no published research regarding young people’s (< 18 years) experiences of formulation. Thus, the current study aimed to explore young people’s views, opinions and experiences of formulation in Child and Adolescent Mental Health Services (CAMHS). A qualitative study is outlined, in which semi-structured interviews were conducted with nine 13-17-year olds currently accessing therapy in CAMHS across one county in the UK. The data were analysed using Thematic Analysis. Findings included three key themes: Shared Sense Making; Formulation Process as a Therapeutic Intervention; and The Purposes and Uses of Formulation. These findings were shared with 13 Multi-disciplinary professionals within the CAMHS’ teams which the young people were recruited from. Two focus groups were conducted, again analysed using Thematic Analysis, and aimed to explore clinicians’ reactions to the findings, and what impact the findings might have on clinical practice. Findings included three key themes: The impact of young people’s experiences of formulation on clinical practice; clinician’s reflections on their role and their reactions to the young people’s findings; and wider network and societies’ expectations of CAMHS and knowledge of formulation. Clinical implications are discussed which include a need for clinicians to check understanding with clients; increasing familiarity of formulation outside of mental health services; ensuring inclusion of client’s strengths in formulations; and ensuring collaboration.