This book is just one click away on Amazon but why should a psychiatrist buy it? You could just recommend it to the designated therapist in your team or your trainee who is struggling to get their psychotherapy Assessment of Clinical Expertise. The trainee particularly would find it useful because it has excellent, up-to-date, succinct and clear summaries of theories of cognition, learning and emotion – not what I had expected from the title but relevant to understanding formulation models. What I had expected was a comparison of different ways of formulating cases but instead, more usefully, a straightforward approach is described to developing a problem list, mechanisms and precipitants, and a paragraph summarising the case. Then a series of examples are provided illustrating this, as well as advice on how to use formulation to guide treatment goals and decision-making.
In the process, strategies and techniques are indicated that have since sent me off looking for more detail to use in practice, for example ‘caring days’ in couple therapy whereby the couple acts ‘as if’ they cared for each other (it could be usefully adapted for some fraught manager–clinician partnerships). This example appears in a chapter on the therapeutic relationship – again not quite what I had expected in a book on formulation but apposite and reinforcing the importance and ways of developing a working alliance, especially when obstacles get in the way. Any psychological intervention and certainly cognitive–behavioural therapy (CBT) depends on such a firm foundation on which more specific techniques can be built.
The acronym EST gets regular mention but it is not referring to Erhard Seminars Training that strove infamously in the 1970s to allow participants to achieve, in a very brief time (60 hours in two weekends), a sense of personal transformation and enhanced power, but to empirically supported therapies. Its detractors might say that CBT tries to achieve the same but with fewer hours spread thinly over a few months. However, this text claims less – more about coping more effectively – and cites the existing empirical support (evidence).
The case formulation approach seems particularly useful for those patients who do not fit into single DSM or ICD boxes but straddle them – with mental or physical problems – or get lost somewhere inside the vast expanses of ‘depressive illness’ or ‘schizophrenia’. These are those patients we see, as psychiatrists, every day and for that reason one click might just be worth making.
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