The Psychodynamic Approach
Jack formulation
Identifying experiences of distress – naming them – what are they
- Becoming homeless
- Substance abuse and theft
- Suffering hallucinations
- Distance from reality – Robbie Williams stole his fame and fortune, believes that Robbie Williams raped his sister.
Can you identify possible causes (there might be more than one) of those experiences and/or circumstances that might be contributing to those experiences?
- Sexual abuse at a young age – explains why he believed his sister was raped during a reality break
- Stealing things – he feels he is entitled to more things than he has in his life, this links to the delusion of Robbie Williams stealing his royalties and his stardom, feel he deserves more than what he has been served.
- Becoming homeless- started over drinking and getting involved in substance abuse, rude to his mother- ended up being kicked out for a few months.
- Emotional abuse – not being able to talk to anyone about what happened, having to sleep rough having no one care about him, finding out mother was sick- result in possible more hallucinations.
- Loss of father – drinking and drugs, in order to escape the reality of the
What diagnosis might be offered and why? Remember a formulation is not premised on a functional psychiatric diagnosis
- Psychosis/ delusional disorder: person has trouble correctly recognising reality
- Carry false belief in which is based on an incorrect interpretation of reality.
What kinds of interventions might you suggest in this situation?
- Some antipsychotic drugs
- Psychotherapy
- Support, reassurance and pointing out the difference between symptoms and what reality actually is, can all be helpful if the person is willing to meet with their therapist.
Service-user’s strengths and achievements?
- Did well at school
- Was very popular within social aspects- sociable
- Talented with music
- Managed to get a Saturday job
- Put into contact with a project for homeless, helped him settle
Anything else to note?
- Doesn’t have effective defences that has put him a regressed state of psychotic and blurred realities- Hallucinations.
- Possible issue with masculinity- not being close to father and then losing father, and only having women role models to grow up with.
Good start in highlighting the main features of a formulation, paid attention to linking previous history with current experiences of distress and service user strengths
Tips for the summative assignment: Add some basic background information and further detail on thoughts feelings and behaviours that demonstrate his difficulties. You have begun to link Jack’s distressing experiences throughout his life to his current experiences of distress. This is good. For the main assignment be explicit about the core features of your chosen approach in the service users case (e.g. for a CBT approach, underlying core beliefs, negative automatic thoughts etc.). Ensure to cover both the cause of their problems, and why they are continuing (maintenance). Explicitly link your intervention plan to your formulation – e.g if you took a CBT approach then it should first and foremost be a CBT intervention.