Formulation NOT Diagnosis

A formulation is a type of “hypothesis” or theory about what has happened during a person’s life that might have led them to be experiencing difficulties at the current time.

It is a collaborative process that is created and agreed upon by both the therapist and client as a way of making sense of how an individual’s life experiences (usually negative) might have given rise to the (maladaptive) coping strategies (called symptoms in the bio-medical model) they are experiencing today (what they have consulted for).

In this sense, a formulation is the opposite of a psychiatric diagnosis which argues that the current life difficulties are the result of “chemical imbalances” or “diseases of the brain” and have little to do with the context or experiences the client has had.

By recognising how difficult life experiences (particularly in earlier, ‘formative’ years) can contribute to poor coping mechanisms and suffering in later life, formulations are known as “Trauma Informed” strategies, and this is certainly the case with the approach taken by Tranceform Psychology.

Psychiatric Diagnosis is NOT Scientific!

People are often very surprised to learn that a psychiatric diagnosis is nothing more than an “opinion”, based on observing a person’s behaviours and then categorising those behaviours (feelings) as being indicative of a certain type of brain disease that has been labelled as a “disorder”.

People who feel very sad over prolonged periods of time, for example, are likely to be diagnosed as having a brain disease in which they have depleted levels of Serotonin in their cerebro-spinal fluid (CSF – the fluid in which the brain sits) which needs to be ‘corrected’ by the introduction of a psychotropic drug which prevents the neurons ‘re-absorbing’ this Serotonin (re-uptake inhibition) thus leaving more ‘happy chemicals’ in the CSF (although Serotonin only amounts to around 5% of the CSF by volume).

These chemicals are known as Selective Serotonin Re-uptake Inhibitors, or, more commonly, SSRI anti-depressants.

A Psychiatric diagnosis of ‘depressive disorder’ therefore argues that the person being ‘diagnosed’ as depressed has these feeling of sadness because they have a “brain disease” (chemical imbalance) and not because they may have had some experiences in their life making it completely understandable that they might experience prolonged feelings of sadness!

This is like saying that “really happy people” have a chemical imbalance disease in which they have too much Serotonin in their CSF, which obviously sounds ridiculous.

Surely people who are happy or sad have had experiences which have led to them ‘feeling’ happy or sad and not that they feel that way because of some theorised proposition that their brains are somehow faulty.

Unlike the types of medical tests that can be used to provide real, scientific evidence of the presence of pathogens (such as the presence of the Coronavirus pathogen in the bloodstream), or the scanning methods that can be utilised to observe a broken bone (X-rays), there are ZERO objective, scientific tests that can be carried out to establish any of the “brain disease” propositions cited by psychiatric diagnoses.

“Low Serotonin Levels” – The RESULT of Feeling Sad or the CAUSE of Feeling Sad?

If we scan the brain of a person experiencing prolonged feelings of sadness (“Depressed”) we invariably find that they DO have lower levels of Serotonin in the CSF.

Does this mean that low levels of Serotonin CREATE depressed feelings, or that when people feel depressed that they produce LESS Serotonin than happy people?

Psychiatry argues, of course, that this is the CAUSE of depression, that it is a “medical” problem and therefore requires a “medical” solution – in this case, the prescribing of drugs which are claimed to “correct” the medical problem or brain disease.

Psychologists and psychotherapists (including the British Psychological Society and vast numbers of academic scientists) argue that feelings of depression can be understood as the result of negative or traumatic life experiences and that this can result in low levels of Serotonin in a sufferers’s brain chemistry.

Scientific research also shows that Counselling, Psychotherapy and other “talking therapies” are highly effective at helping sufferers of depression to overcome their feeling of sadness and make complete “recoveries”.

Unlike anti-depressant medication, however, the side-effects of effective psychotherapy do not harm the client in anyway.

Psychiatric Modelling Inhibits Agency

One of the key problems with the bio-medical, psychiatric modeling of human emotional distress as being due to “medical illness” is that many people suffering mental distress come to believe that the way they feel is something they can do very little about through their own volition.

One certainly cannot recover from a broken leg by exploring past experiences and learning to attribute different meanings to those experiences. NO, you really do need to get medical help. It is a medical problem and a medical intervention will solve the problem.

Agency is a measure of how much a person believes that WHAT they do and how much EFFORT they put into an enterprise will have a bearing on the result that they obtain.

If you want to pass an exam, for example, you are most likely going to need to study hard and do it with sufficient commitment and effort if you expect to pass it. In other words, you believe that passing an exam requires you to DO something in order to pass and that you CAN do what is required.

This is having “agency”.

If you believe, however, that no amount of hard effort, will and determination is going to produce the result that you want, then you are more likely to ‘give-up’ and not bother trying.

This is an expression of “low agency”.

Many people who are “informed” that the way they feel is due to a medical illness of the brain (feeling depressed for example) may conclude (understandably) that the solution to the problem lies outside of the scope of their own abilities (no amount of effort and determination will make any difference) and ‘surrender’ to the idea that their problem can only be solved by the use of medication which has been prescribed by a “professional”.

Unfortunately, subscribing to diagnostic categories is more likely to keep a person trapped inside their misery over long periods of time and do very little to address the real cause of their problems… WHAT has happened to them during their lives.

Formulation Enhances Agency

Because a formulation involves the collaborative efforts of both the client and the therapist in working towards an historical, experiential and contextual explanation for the current problems, clients feel that they are instrumental in bringing about a resolution to their problems.

In other words, they have more ‘agency’ because they are the expert when it comes to what has happened to them during their lives.

Free Initial Consultations

We offer all prospective clients a FREE initial consultation to discuss your problems prior to commencing any treatment plans.

The consultation is free and lasts around 50 minutes.

During this consultation we will discuss the various therapy options that are available to you and make a considered recommendation based on your individual personal circumstances.

Initial consultations are also available as part of our online therapy service.

At Tranceform Psychology we recognise the importance of the therapeutic relationship in helping people to bring about effective change, so its important to be able to ‘meet’ to discuss any therapy treatments BEFORE proceeding.

Our policy is to help people make a fully balanced & considered decision about undertaking work with us, including both the financial and personal implications.