How formulation feedback can be therapeutic
Sharing the formulation in a therapeutic way Clinical formulation explains the reasons for the presenting problem(s) and guides treatment. Formulation (e.g., case conceptualisation) also enhances the limited reparenting because it helps us to truly understand the client. However, it’s common to feel a bit overwhelmed by the prospect of communicating it to the client. Here are some of the ways I aim to make formulation feedback constructive and therapeutic:
Before communicating the formulation (e.g., the explanation for the presenting problem) to the client consider the degree of healthy adult they have. The less healthy adult they have, the more I give them information in stages/pieces. Even when they have a strong healthy adult I don’t tend to give them a full summary of every one of their schemas and modes in one sitting as this can be more educational than it is therapeutic. Instead, I offer my hypotheses on which schemas and modes are perpetuating/linked to the presenting problem. For example, I know you've come to see me due to a difficult relationship with your mum. "I'm wondering if the conflict with your mum is due to sacrificing your needs due to guilt and then feeling a bit resentful (e.g. angry child mode) and cross with her?"
Seek feedback as you go throughout the assessment process regarding your initial formulation/hypotheses. For example, "when you become close to someone do you start fearing they might leave you, even though you know logically that's not true?"
Explore if a link exists between the present and the past (i.e., their schemas and modes). Questions such as, I’m wondering if these feelings of distrust have shown up in previous relationships? How far back has this been there?
Consider using a mode map when conveying the information.
Instead of having a schema and mode questionnaire feedback session, where scores are communicated and schemas education is provided, use the questionnaires to inform your formulation and feed your formulation back to the client.
Here’s the most important aim when offering a formulation-instil hope. This is does not mean promising a magic solution, it means conveying they’re not alone with their problems and that your intention is to help them. Remember that the vulnerable child, as Wendy Behary has said, is always listening.
Here's a brief example of offering formulation feedback to a client: I know you’ve come to see me because of low self-esteem. I’ve only just met you, so tell me what you think, but I’m wondering if at the core there's a sense, a deep feeling, that you're no good (e.g. defectiveness and shame schema) and then to cope you tend to avoid things that might trigger shame? And then your inner critic beats you up for avoiding (e.g. demanding critic), which makes everything worse. Is that right so far?...and then that little vulnerable part feels like she's no good (e.g. vulnerable child). How does that resonate with your experience?.... I want you to know that together we're going to work on that critical part that gives you such a hard time, we'll work on that avoidance and over time help you make choices that are in your best interests to look after that little vulnerable part. I want that little part of you to feel like she's enough because that what she deserves. Would that be ok? While I don’t have a magic wand, we’ll work on this together and I really want to help you with this.
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