The style and emphasis of formulation will vary according to the specific purpose or intervention but relevant information for the formulation includes:

Diagnostic formulation, with ICD-10 “F-codes” where applicable. This should include the primary diagnosis and any co-occurring diagnoses.

Clinical formulation including:

Symptoms:

        o Cognitive/perceptual
        o Affective
        o Interpersonal
            - Relationship with self/sense of self
            - Interpersonal relationships
            - Relationship with society
        o Behavioural/impulse control

• • Important personality traits
  • Personal strengths
  • Over- and under-developed behaviours
  • Relevant core beliefs
  • Relevant developmental events such as childhood trauma
    

    Treatment plan:

  • Interventions and approaches by phase of recovery (including self-management approaches)
    Short term and long term goals
  • Risk management plans; crisis plans

A useful method of formulation involves developing an understanding of the following five areas:

• Problems: shared view of the main difficulties which the patient wishes help to address
• Predisposing factors: factors from earlier life which increase vulnerability in adult life
• Precipitating factors: factors currently or recently present in the patients life which can or have contributed to triggering the problems
• Perpetuating factors: factors which contribute to maintaining the problems
• Protective factors: factors which contribute to resilience and the ability to cope with adversity.

It can be useful to think of predisposing, precipitating, perpetuating and protective factors in terms of biological, psychological and social components. While predisposing factors are usually historical and not amenable to change, change may be effected by reducing exposure to (or challenging) precipitating or perpetuating factors. There is also likely to be value in strengthening protective factors.

The draft formulation should be shared with the patient in verbal, written or diagrammatic form as appropriate. The patient should be asked for their views on the formulation and changes made appropriately. The aim is to develop a shared understanding of the difficulties and a commitment to the treatment plan — a formulation which the patient does not recognise or agree with, will not function as a basis for effective treatment. The formulation should be dynamic and should be updated in light of any new information or significant changes to the situation.