4 May 2022


What is formulation, as used in clinical psychology practice, and how does it differ from diagnosis?

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In the present world, formulation has gained considerable use in the field of mental health. Conventionally, diagnosis has been the commonly used concept when establishing the type of treatment that people with a mental health condition ought to be given. However, studies have indicated that diagnosis has its own limitations, particularly when dealing with patients with mental problems. In that respect, various researchers have suggested that psychiatrists need to use diagnosis and formulation in tandem (Macneil, Hasty, Conus & Berk, 2012). Therefore, this paper will provide insight into to the meaning of formulation and diagnosis from a clinical psychology point of view. It will also discuss the major principles of these two models and the differences they exhibit. 

Definition and description of formulation

Formulation is defined as the process whereby clinicians strive to understand the difficulties that a person faces in the context of life events, relationships, self-esteem and social circumstances. Therefore, formulation appears to be more like a process in which a psychologist or other medical professional seeks to gain insight into a personal narrative of a patient, their kin or even careers (Macneil, Hasty, Conus & Berk, 2012). Formulation has gained increasing use since it ensures that psychiatrists work collaboratively with their patients to identify the underlying causes to their conditions. In doing so, they can select to an intervention that will address the contributing factors to their client's conditions. Besides, clinicians may have a good understanding of their clients, and this may enable them to develop a more personalized treatment hence bettering the outcome of the process.

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Definition and description of diagnosis

Traditionally, clinical practice entailed three main segments namely diagnosis, prediction (prognosis) and treatment (Croft et al., 2015). In most cases, diagnosis involves classifying or rather establishing whether a patient has a particular disease or not. Since time in memorial, diagnosis has been considered as the first step before initiating a treatment regime and predicting the future outcomes (Croft et al., 2015). To date, diagnosis is still viewed as an essential component in the field of medicine. However, the modern world has become competitive in all spheres. For example, in the medical field, health professionals are now required to deliver quality services to gain a comparative advantage (Croft et al., 2015). The outcomes determine quality service which on the other hand is justified by the efficiency and safety of the treatment plan. Therefore, the usefulness of a diagnostic method will be measured on whether a patient that was diagnosed with a particular disease is doing better and those that were not diagnosed with the disease are not harmed (Croft et al., 2015).

Comparison between Formulation and Diagnosis

Individuals who in one way or another have sought psychiatric services have experienced a traumatic event that has led them there. In most instances, they are diagnosed with depression, schizophrenia, bipolar I, or II depending on the diagnosis that a clinician will find to be appropriate. However, such diagnostic results provide little information regarding the context and the effects the difficulties have on the patient (Macneil et al. 2012). On the other hand, formulation ensures that such information is clearly understood. 

Diagnosis does not seek to establish a personal relationship that would help a clinician to understand the life story of a patient. On the contrary, formulation aims at ensuring that a psychiatrist gains insight into such information before initiating a treatment plan. August, (2013) indicated that formulation is a process that is ongoing and involves collaborative sense-making activities that will help in summing up a patient's core problems from a psychological perspective. It utilizes both the psychological theories and evidence to come up with a sound recovery plan for the patient (Green, 2013). 

Diagnosis relies on the psychiatrist ability to make an expert judgment about a client's mental status. However, formulation entails a clinician working closely with a patient to establish a shared understanding that is likely to change during the therapeutic process. Furthermore, diagnosis is a deficit-oriented process whereby much of the treatment is based on new traits that client needs to learn in order to recover. However, formulation maximizes on the talents and the strength of the client to cope up with challenging life situations (August, 2013). 

Critical Evaluation of Formulation

Formulation is the best tool that clinicians need to embrace to improve the outcome of their partaking. According to Macneil, Hasty, Conus & Berk, (2012), formulation is guided by 5P’s namely presenting problem, predisposing factors, precipitating factors, perpetuating factors and protective factors. Macneil, Hasty, Conus & Berk, (2012), indicated that the first element of formulation is problem presentation. This is where the clinician and the client identify difficulties collaboratively. This process helps in understanding how a particular issue affects an individual and when an intervention plan needs to be initiated.

The second component of formulation is identifying the predisposing factors. This stage encompasses identifying all the factors that predispose an individual to a particular mental condition. These factors may be biological, genetic, psychological, environmental, or personality oriented (Macneil, Hasty, Conus & Berk, 2012). The third step is precipitating the factors. In this stage, the clinician identifies particular events that led to the development of the disorder. This may include financial constraints, drug abuse, or occupational stressors among others.

The fourth phase of formulation entails identifying perpetuating factors. This stage requires the clinician to identify factors that lead to continuity of the present difficulties (Macneil, Hasty, Conus & Berk, 2012). Such factors may include continued substance abuse, cognitive patterns or biological patterns like insomnia. The final phase of formulation involves identifying protective factors. These factors are also called positive factors (Macneil, Hasty, Conus & Berk, 2012). During this phase, the psychiatrist determines the strengths or rather the talents of the client that can help in mitigating the effects of the mental disorder.

The strengths or rather positive factors, in this case, may include personal characteristics, likes, interests, and skills among others (Macneil, Hasty, Conus & Berk, 2012). Many researchers have come out strongly to indicate that this component is what was missing in most interventions that were used on people with a mental health condition. Macneil, Hasty, Conus & Berk, (2012) reported that identifying positive factors elevates optimism in both the psychiatrist and the client. On the other hand, this will lead to an improved therapeutic relationship. Of essence, Macneil, Hasty, Conus & Berk, suggested that the formulation process ought to be flexible and embrace new information as they emerge (2012).

Critical Evaluation of Diagnosis

As aforementioned, diagnosis seeks to identify whether individuals suffer from a particular disease or not. Notably, clinicians usually collect information from their patients which can then be interpreted to mean symptoms of a particular illness. The information can also be used to conduct tests that will help in the decision-making process. In most cases, diagnosis is vital where there is an available treatment plan that can work against a particular illness. According to Guidetopsychology.com, (2017), diagnosis helped in solving the problems that clinicians faced when trying to categorize individuals with and without illness.

In most cases, diagnosis is used to combine the symptoms and signs that clients show in order to identify persons who are likely to be victims of particular conditions and target them for further tests. Croft et al., (2013) stated that the validity if this strategy is justified through prognosis. This implies that the outcomes will be determined in two ways. The first way is if there is an improvement among those individuals who were subjected to tests. The second way is if there is no harm among people who were at low probability of being victims of the disease. This would imply that the diagnosis was safe and efficient.

In conclusion, formulation provided clinicians with a way of understanding the difficulty that their clients face. By understanding such problems, clinicians can be able to answer questions regarding the condition of their patients. Primarily, formulation provides a platform for the clinician and the patient to have a common agenda. Formulation may have its own drawbacks. However, when a collaborative approach is used, and the strengths of the client are taken into consideration, the outcome of the process would be remarkable when compared to when diagnosis is used alone.


August, L. J. (2013) Alternatives to Psychiatric Diagnosis: Psychological Formulation . Retrieved on 25 January 2017 from http://dxsummit.org/archives/1208. 

Croft, P., Altman, D. G., Deeks, J. J., Dunn, K. M., Hay, A. D., Hemingway, H., … Timmis, A. (2015). The science of clinical practice: disease diagnosis or patient prognosis? Evidence about “what is likely to happen” should shape clinical practice. BMC Medicine , 13 , 20. Doi: http://doi.org/10.1186/s12916-014-0265-4. 

Green, H. (2013). Psychiatric diagnosis vs. Psychological formulation: a plea for synthesis. Clinical Psychology Forum 246 . Retrieved on 25 January 2017 from http://www.academia.edu/3986326/Psychiatric_Diagnosis_vs._Psychological_Formulation_A_Plea_for_Synthesis.

Guidetopsychology.com. (2017). Diagnosis in Clinical Psychology. A Guide to Psychology and its Practice . Retrieved on 25 January 2017 from http://www.guidetopsychology.com/diagnos.htm. 

Macneil, C. A., Hasty, M. K., Conus, P., & Berk, M. (2012). Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice. BMC Medicine , 10 , 111. doi: http://doi.org/10.1186/1741-7015-10-111. 

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StudyBounty. (2023, September 16). What is formulation, as used in clinical psychology practice, and how does it differ from diagnosis?.


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