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When people seek psychological support, formulation is the theory-driven methodology used by many practitioners to guide identification of the processes, mechanisms, and patterns of behaviour that appear to be contributing to the presenting difficulties. However, the process of formulating – or applying psychological theory to practice – can often...
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... 761). Dawson and Moghaddam (2015) developed evaluation criteria to promote the coherence and quality of case conceptualization. These are (a) clarity and parsimony, where key concepts are used specifically and nonredundantly; (b) precision and testability, meaning that the components of the case conceptualization are potentially measurable and/or lead to testable hypotheses that are relevant to diagnosis, treatment, and outcomes; (c) comprehensiveness and relative generalizability-for example, the case conceptualization is applicable across a range of situations and clinical phenomena; (d) utility-that is, it facilitates shared meaning among clinicians as well as between clinician and patient; and (e) applied value, related to the effectiveness of interventions based on the conceptualization. ...
... 761). Dawson and Moghaddam (2015) developed evaluation criteria to promote the coherence and quality of case conceptualization. These are (a) clarity and parsimony, where key concepts are used specifically and nonredundantly; (b) precision and testability, meaning that the components of the case conceptualization are potentially measurable and/or lead to testable hypotheses that are relevant to diagnosis, treatment, and outcomes; (c) comprehensiveness and relative generalizability-for example, the case conceptualization is applicable across a range of situations and clinical phenomena; (d) utility-that is, it facilitates shared meaning among clinicians as well as between clinician and patient; and (e) applied value, related to the effectiveness of interventions based on the conceptualization. ...
See https://www.apa.org/pubs/books/psychological-approach-diagnosis-icd-11 for further information.
This groundbreaking volume, published by the American Psychological Association in partnership with the International Union of Psychological Science, provides a detailed guide to clinical diagnosis by psychologists and other health professionals based on the eleventh revision of the World Health Organization's International Classification of Diseases (ICD-11).
The ICD-11 was adopted by the World Health Assembly in 2019 and came into effect as the global standard for health information and reporting in 2022. The ICD is the diagnostic system for mental disorders most widely used by mental health professionals around the world in their day-to-day clinical practice. This edited volume offers a step-by-step approach to diagnosis, giving mental health professionals around the world the tools they need to apply ICD-11 diagnostic requirements for mental, behavioral, and neurodevelopmental disorders as the basis for delivering high quality, evidence-informed care.
A psychological approach to diagnosis is a conceptually driven, person-oriented, biopsychosociocultural formulation that integrates pertinent history, behavior, symptoms, phenomenology, and functioning. A psychological approach focuses on psychological mechanisms and principles as an aspect of diagnostic practice and case formulation, regardless of professional discipline.
The chapters of this book cover the major groupings of mental disorder as well as related areas that are important parts of psychological practice, such as sexual dysfunctions, sleep-wake disorders, and relationship problems and maltreatment. The authors of this book are leading global experts in each area, many of whom were integrally involved in developing the respective sections of the ICD-11.
Authors describe the overarching logic for the classificatory arrangement and the elements of a psychological approach to the set of disorders discussed in each chapter, including psychological models for conceptualizing their symptoms and recommendations for psychological assessment. The chapters also discuss presentations and symptom patterns for each major group of disorders, specifiers and subtypes, the threshold between normal variation and disorder, differential diagnoses, co-occurring disorders, developmental course, cultural and contextual considerations, and gender-related features.
A Psychological Approach to Diagnosis is the first comprehensive training resource on WHO’s ICD-11 classification of mental, behavioural and neurodevelopmental disorders. It provides practicing psychologists and other mental health professionals, primary care clinicians, educators, and trainees with essential tools for the competent practice of diagnosis using the ICD-11 as a framework.
... Broader research literature also indicated that treatments were more effective when based on a case formulation (Eells, 2022;Page et al., 2008). A good case formulation is as clear and brief as possible, holistic, precise, and empirically testable, and the hypothesized mechanisms of the etiology and the treatment are evidence based (Dawson & Moghaddam, 2015). Thus, the case formulation within the manual was based on the systematic assessment of the evidence-based clinical and etiological models (in the case of TA: ego-states, social functioning, and self-efficacy), and used to formulate a tailored case formulation, and it was in turn used for monitoring treatment progress and their adjustment (Van Rijn, 2015). ...
Since the birth of transactional analysis (TA) in the 1950s, many psychotherapists have provided and tested TA psychotherapy (TAP) in clinical trials. However, most descriptions of TA therapy within these trials offered a general guide rather than a systematic treatment manual. This makes it difficult to attribute their outcomes directly to TAP as the variations in the therapists’ ways of working have not been sufficiently accounted for. The existing manuals are based on particular schools of TA and research-informed personal best practice, rather than systematic reviews and meta-analyses, which would ensure that they could be replicated. This article addresses that apparent gap by describing the systematic development of a semistructured treatment manual for Brief Transactional Analysis Psychotherapy for depression, in order to enable its use in practice and research. The manual was based on an international survey of TA therapists, a systematic literature review of TA psychometric instruments, and meta-analyses of TAP clinical trials, which fed into the development of the evidence-based integrated conceptual model. This model formed an operational definition of TAP and the basis of a 16-session treatment manual for mild to moderate depression. The manual consists of four stages: initial assessment and therapeutic agreement (“contract”), systematic assessment, experiential processing, decision-making and applying script changes. Two new instruments were also developed: Transactional Analysis Goal Attainment Form (TAGAF) and Transactional Analysis Psychotherapeutic Self Report Competencies Scale (TAP-SRCS).
... Contextualism proposes that thoughts, emotions, and internal bodily sensations are not inherently dysfunctional or problematic, rather it depends on the context in which they occur. Hence, ACT views distress as a function of context; There is nothing faulty or maladaptive 'inside' the client (Dawson & Golijani Moghaddam, 2015). ...
Introduction: People with dementia can experience a high level of psychological distress (Muliyala & Varghese, 2010; Badrakalimuthu & Tarbuck, 2012). Although psychological approaches have been proposed as potential treatments for this population (NICE, 2018), there is indication that older adults (Laidlaw, 2013) and people with dementia have reduced opportunities for psychological treatments designed to improve their wellbeing. An increasing number of studies have evidenced the efficacy of Acceptance and Commitment Therapy (ACT) for anxiety, depression (Ӧst, 2014), distress in older adults (Gould et al., 2021; O’Keeffe et al., 2021) and illness-related distress (Mccracken & Gutiérrez-martínez, 2011). But, to date, no studies have investigated the effectiveness of ACT specifically for a dementia population, despite a conceptual case for its suitability, which is empirically supported by its use with parallel populations (other long-term and neurological conditions). Furthermore, no dementia studies involving therapeutic intervention have used a case series approach to explicitly examine change processes, integral for understanding and refining interventions. Therefore, the current research aims to investigate the effectiveness and acceptability of ACT for people with dementia. Methods: A hermeneutic single case efficacy design (HSCED) series was used to analyse therapy process and outcome data to ascertain whether and how changes may have occurred over the ACT intervention. Three clients with a diagnosis of dementia, who experienced psychological distress, and their caregivers were recruited from a National Health Service (NHS) Memory Assessment Service (MAS) in Nottinghamshire and the Dementia Research UK website. Clients were offered 12 sessions of ACT. Quantitative and qualitative clinical data was collated (‘rich case records’) and subject to critical analyses by three independent psychotherapy experts who identified change processes and determined the outcome for each client. Results: Adjudication concluded that one client made positive changes which were largely attributable to ACT, whilst two clients remained unchanged. Where change occurred, ACT-specific processes, namely values, committed action and acceptance, seemed to mediate change, alongside the client-carer relationship. Moderating factors included client willingness, resilience and perseverance, a history of values-based behaviour and established coping and hobbies. Discussion/Conclusion: The HSCED enabled a dismantling of therapy components to understand change processes for people with dementia. For the client who demonstrated change, ACT processes and a strong working alliance between client and carer, in combination with existing client interests and individualised therapy adaptations, appeared to provide the setting in which an ACT intervention was effective. Reliable distress reduction occurred for this client without therapeutic aims to change their distressing thoughts, which has important theoretical implications for understanding the use of acceptance-based approaches for people with dementia. ACT may be a feasible, effective vehicle for therapeutic change by helping carers to better meet the needs of their loved ones. Based on the outcomes of the current study (one improved case and two cases of no change), future research to optimise ACT delivery in this population may be beneficial. Furthermore, to explore whether change processes occur by proxy, assessing carer factors (e.g., their psychological flexibility, the client-carer relationship) may enhance the evidence-base for systemic ACT-use.
... As such, the process can look quite different depending on the treatment model and professional discipline. Regardless of the model, all share some key similarities [5][6][7]. The process of formulating typically includes at least four core components: a) a co-created summary of the person or family's current difficulties, b) hypotheses concerning the onset, and factors that may have contributed to the development and/or maintenance of the problems c) an explanation of 'why now' and in the current context (social, cultural, political etc.), and d) the meaning, or sense, that the person or family make of their difficulties [4,8]. ...
In the broadest sense, formulation, or case conceptualisation, is the process of collaborative sense-making. It is something all clinicians are doing constantly, whether formally and consciously or not. Most clinicians are familiar with the general principals and need to formulate as it is a core part of clinical training across most disciplines. Treatment manuals often discuss formulation, but the practical steps involved and the process of developing,
building upon and revising formulations are not always provided. In clinical practice, the active use and continued development of formulation during treatment is not always prioritised, especially beyond the initial assessment. This could be due to a number of reasons, such as a potential lack of clarity, understanding or confidence in the use of formulation across treatment, a lack of dedicated time and reflective space for formulation in the context of increasingly busy clinical settings, or a perception that it may be less necessary in the context of treatment approaches that are more structured and prescriptive. This article outlines the use of formulation in family therapy for child and adolescent eating disorders, provides guidance on how to actively include formulation more throughout treatment and discusses why this might be useful.
... South Asian parents of children with asthma were represented. During these meetings, a formulation-based approach was adopted [70]. The prioritised objective was matched, via psychosocial theories, to an evidence-based intervention [71]. ...
Background
To describe how using a combined approach of community-based participatory research and intervention mapping principles could inform the development of a tailored complex intervention to improve management of asthma for South Asian (SA) children; Management and Interventions for Asthma (MIA) study.
Methods
A qualitative study using interviews, focus groups, workshops, and modified intervention mapping procedures to develop an intervention planning framework in an urban community setting in Leicester, UK. The modified form of intervention mapping (IM) included: systematic evidence synthesis; community study; families and healthcare professionals study; and development of potential collaborative intervention strategies. Participants in the community study were 63 SA community members and 12 key informants; in-depth semi-structured interviews involved 30 SA families, 14 White British (WB) families and 37 Healthcare Professionals (HCPs) treating SA children living with asthma; prioritisation workshops involved 145 SA, 6 WB and 37 HCP participants; 30 participants in finalisation workshops.
Results
Two key principles were utilised throughout the development of the intervention; community-based participatory research (CBPR) principles and intervention mapping (IM) procedures. The CBPR approach allowed close engagement with stakeholders and generated valuable knowledge to inform intervention development. It accounted for diverse perceptions and experiences with regard to asthma and recognised the priorities of patients and their families/caregivers for service improvement. The ‘ACT on Asthma’ programme was devised, comprising four arms of an intervention strategy: education and training, clinical support, advice centre and raising awareness, to be co-ordinated by a central team.
Conclusions
The modified IM principles utilised in this study were systematic and informed by theory. The combined IM and participatory approach could be considered when tailoring interventions for other clinical problems within diverse communities. The IM approach to intervention development was however resource intensive. Working in meaningful collaboration with minority communities requires specific resources and a culturally competent methodology.
... prevention activity, to the evaluation of the therapy beyond the reductionism / limits imposed by the pharmacological treatment (Dawson D, Moghaddam N, 2015) and at the understanding of the psychosocial context of the psychosomatic diseases (Kallivalayl RA& Varghese PP,2010). Its purpose is not limited to basic research, its extension being represented by a diagnostic algorithm of patients with psychosomatic disease, which has utility in clinical practice. ...
... This research needs to be developed further. Despite the currently limited evidence base for psychological interventions for this population, the broader evidence base for the efficacy of CBT ( Jassim et al., 2015;Moghaddam & Dawson, 2016) suggests that CBT-based interventions warrant continued investigation, with suitably rigorous study designs. ...
This systematic review and meta-analysis aimed to evaluate the effectiveness of psychological interventions in improving quality of life for head and neck cancer patients. Five databases were systematically searched in July 2016. Studies were included if they reported original empirical data from intervention studies utilising psychological approaches (excluding psychoeducational-only interventions) and provided data on quality of life outcomes. Six studies, involving 185 participants, fulfilled eligibility criteria. Study designs included a case study, single-group designs, non-randomised controlled trials and one randomised controlled trial. Meta-analysis of two studies did not provide support for the effectiveness of psychological intervention improving total quality of life scores (or subscales) compared to control groups at end of intervention. Intervention studies evaluating psychological interventions for patients with head and neck cancer have produced insufficient data to support their effectiveness for improving quality of life. This review further highlights the limited evidence base within this area. Existing studies are based on small samples and are inconsistent regarding: intervention type, duration and intensity; follow-up measurement periods; and methodological quality. Further research, addressing these limitations, is required for more definitive conclusions to be drawn about the effectiveness of psychological interventions with this population.
Huntington’s disease (HD) is an inherited, life-limiting neurodegenerative condition. People with HD experience changes in cognitive, motor and emotional functioning, and can also, mainly at later stages, exhibit behaviours that professionals and carers might find distressing such as hitting others, throwing objects, swearing or making inappropriate comments. While clinical formulation (an individualised approach used by mental health professionals to describe an individual’s difficulties) is a helpful tool to conceptualise patients’ wellbeing, a specific formulation framework has not yet been developed for HD. However, evidence has shown that formulation can help guide clinical interventions and increase consistency of approach across multi-disciplinary teams, refine risk management, and improve staff or carers’ empathic skills and understanding of complex presentations. As a consequence, this paper proposes a new clinical formulation model for understanding distress among people with HD, based on a biopsychosocial framework. More specifically, this includes key elements centring on an individual’s past experience and personal narratives, as well as anticipatory cognitions and emotions about the future. In-depth discussions regarding the components of the model and their importance in HD formulations are included, and a fictional yet representative case example is presented to illustrate their application within the context of personalised care.
This article presents a focused review of the research literature in transactional analysis (TA). TA was developed in the 1950s as a theory of human personality and social behavior and as a comprehensive form of psychotherapy, but there has not been any systematic research to test the empirical evidence for the efficacy of TA theory and practice. The aim of this study was to develop the conceptual model of transactional analysis on the basis of a systematic review of the actual, self-reported practice of international TA psychotherapists and on the evidence found in research. The article systematically reviews common conceptual components of TA and their empirical evidence by examining the common denominator and the empirical evidence for the central clinical phenomenon, etiology, therapeutic mechanisms, therapeutic competencies, outcomes, and synthesis. TA focuses on problems in ego states (operationalized as Parent, Adult, and Child) with distinctive behavioral functions of Controlling Parent, Nurturing Parent, Adult, Adapted Child, and Free Child. Individuals can develop long-term problems in their ego states, social functioning, and self-efficacy as the result of unfavorable messages from their social context (negative parental messages in early life, lack of developing mature coping mechanisms, intergenerational messages, negative stroke balance), script decisions (accepting or rejecting unfavorable messages via behavior, emotional disconnection, or cognitive styles), life events, and genetics/temperament. TA treatment intends to help clients by developing constructive ego states, improving social functioning, and stimulating a sense of self-efficacy. Research confirms that TA improves psychopathology, behavior, and general well-being thanks to improvement in ego states, self-efficacy, and social functioning. These effects are achieved by four evidence-based therapist competencies: creating a positive client-practitioner relationship, working with experiences in the present, etiological analysis (life scripts, injunctions, counterinjunctions), and therapeutic structure (treatment contracts, treatment stages, psychoeducation/didactics). Meta-analysis of 75 studies shows that TA has moderate to large positive effects on psychopathology, self-efficacy, social functioning, and ego states. This conceptual model shows that TA can be considered a bona fide and evidence-based treatment for a wide range of clients.
