E. V. Bliss, September 2013

SOLUTION FOCUSED FORMULATIONSE. Veronica (Vicky) Bliss

Southport & Ormskirk NHS Trust

Brief Therapy Support Svc. Ltd

E. V. Bliss, September 2013

THE STARTING POINT

• Are there any publications that clarify the SF position on formulations? (Suzi Curtis)

E. V. Bliss, September 2013

SO I THOUGHT I’D BETTER WRITE ONE

• No interdisciplinary agreement as to what constitutes a formulation

• No literature on effectiveness

• Nothing linked to outcomes

• But everyone thinks it’s important

E. V. Bliss, September 2013

DESCRIPTIONS OF FORMULATING

• Core Skill of Psychologists• Critical skill of psychiatrists• Central to organising assessment findings• Central to interpreting meaning of client’s issues• An iterative process• Involves working WITH client

E. V. Bliss, September 2013

DESCRIPTIONS OF A FORMULATION

•Central aspect of good, competent care• Explain client’s problems•Gives road map for treatment•Provides yardstick by which treatment efficacy can be measured• Is central to ethical interventions

E. V. Bliss, September 2013

I NOTICED

• Definite focus on client problems, where they came from, how they developed, what maintains them and how they ought to be treated• Definite Expert-driven• Entirely related to therapist’s view of

behaviour change• Clear fit with medicalization of mental

ill health

E. V. Bliss, September 2013

HOW IS A PERSON TO MAKE SENSE OF VARIOUS

FORMULATIONS?

• Attachment troubles?• Crooked Thinking?• Chemical Imbalance?• Flawed Parenting?• Repressed Trauma?• Irrationality?• Unrealistic?

E. V. Bliss, September 2013

DO SF’ERS WANT TO FORMULATE?

• We could be seen as unethical without it?• It seems an excellent idea to be able to show how our conversations with others flow from principles we hold about ‘reality’ and ‘change’• It could ensure SF workers are competent and properly trained?• It places us within the therapeutic field alongside the ‘big’ players?

E. V. Bliss, September 2013

DO SF’ERS WANT TO FORMULATE PROBLEMS?

Nah

E. V. Bliss, September 2013

FORMULATIONS WITH A DIFFERENCE

• SF initial ‘formulation’ would always be:• Sarah is expert in her own life• Sarah knows what she wants to change

and keep• Sarah already has skills that have

helped her cope so far, and these can be used to attain future goals• Sarah will know when she’s moving

forward

Talk talk talk talk

E. V. Bliss, September 2013

END OF 1ST SESSION FORMULATION

• Sarah has survived this long with humour and hope intact by playing music, by talking to her mother, by staying quiet, by believing in herself, and by putting on foot in front of the other every damned day no matter what.

• In the long term, she wonders if she should be single again

• In the short term, she’d like to notice herself feeling more energetic in the morning

E. V. Bliss, September 2013

E. V. Bliss, September 2013

Sarah

• Single?• Feel energy in

morning• What else?• What else?

• Seeing funny side• Music• Talking to mum• Quietness

• Bullied at school / work

• Lost jobs• Bullied in marriage• Self-medicates/

alcohol

• Set aside iTunes money

• Let mum in on how to help

• What else?• What else?

E. V. Bliss, September 2013

SO IT TURNS OUT

• That an SF formulation (according to Bliss)

Involves:

• Knowing where the person wants to get to

• Identifying competencies to get there

• Knowing when they’ve arrived

E. V. Bliss, September 2013

PLEASE CONTACT VICKY

• E. Veronica (Vicky) BlissClinical PsychologistBrief Therapy Support Services, Ltd106 Deepdale RoadPreston, LancashirePR1 5AR

01772-200589vicky@btss.org.ukbrief.therapyservices@nhs.netwww.btss.org.uk