An exploration of the use of language within therapeutic interventions for people experiencing psychosis

Formulation is a fundamental component in many of the psychological therapies practised within the National Health Service (e.g. cognitive behavioural therapy and psychodynamic therapy) (British Psychology Society, Division of Clinical Psychology, [BPS, DCP], 2011). It is seen as a starting point for the process of intervention (DCP, 2011). However, despite the importance placed on formulation, it is under conceptualised and under researched (Johnstone & Dallos, 2015). More specifically, little is known about how service users experience and make use of formulation in therapy for psychosis.

Semi structured interviews were undertaken with 11 service users and two clinical psychologists with experience of formulation in therapy for psychosis. Data from the interviews were analysed from a critical realist perspective using grounded theory methodology.

An emerging model was constructed to depict the processes that occur during the sharing of a formulation. ‘Linking previous experiences with current ways of being’ and ‘building the therapeutic relationship’ emerged as core reciprocally influential processes. ‘Making use of new understandings’ was also identified as an important process.

The findings suggest that formulations should be developed collaboratively and progressively with service users, and that care should be given to the emotions that arise as a result. Further research is necessary to elaborate our understanding of formulation given the importance placed on it in UK clinical psychology.