What we’ve said about Case formulation

“a formulation to me is much deeper and richer and actually gives you an idea of what's going on with a person”

“the fundamental work of mental health treatment. It's basically conceptualizing things into words in a way that makes sense and produces causes and effects and therefore solutions, right”

“the art of eliciting the right information at the right time and putting it together in the right way to get to a treatment that will actually get somebody better and not worse, and that they will accept and carry through with and change with, that's the whole of treatment and psychiatry”

“For me, and maybe this is because I was trained in a medical setting, you go from diagnosis to treatment. You have to identify what's going on before you move to how do we help this person”

“a core component of the work I do is I'm trying to develop a diagnosis or at least a formulation if I can't get a specific diagnosis and get on the same page with the patient”

“every serious or clinically significant depression that anyone can encounter is going to be from a biological source, a psychological source, a social source, or some combination of any of those, and sometimes all three”

“I think it's responsible in psychiatry still to conceptualize well, each of us, what we think is more biological, what is more social, what is more psychological, not to say that I love the biopsychosocial approach because I think it's too simple”

“You want to make links between causes and effects and put things together. into some kind of abstract name so that you can refer to it with the patient, regardless of the source”

“just kind of sitting down in the interview until I have a story that can make some sort of sense is just a helpful guiding principle in interviews”

“If this is a true pattern, I want to see it more than twice. I like to say twice is a coincidence, three times is a pattern. That's a little conservative, but I want to see more”

“with anxiety in particular, DSM diagnosis may not cut it, right? You might have to go on to a full-on psychotherapy-type formulation to really understand the patient's situation”

“The basic gist is, is this person relatively healthy in their personality functioning or unhealthy in their personality functioning? And with patients who are unhealthy, you really need to tighten and have your boundaries be very, very strict”

“when I say that this most resembles a personality problem, I'm not even saying that's a diagnosable personality disorder. And I'm also not saying that this person doesn't have ADHD”

“there's an amount that when you're just chilling, there's an amount when it gets activated. There's an amount of time that it takes to burn off. And then how much stimulus do you need to kind of get set off”

“before we jump to formulation, we need to have a diagnosis of the patient, a descriptive diagnosis, because lots of things cause depressed mood, right? It doesn't make sense to jump into some psychological formulation if the patient has a brain tumor”

“I have a, you know, really high threshold. If someone is not doing well on antidepressants to say that they have treatment resistant depression. I would much rather reformulate the patient. I would much rather make sure we're doing the work on affect or personality”

“It gives a rich way to formulate patients. From the last podcast, the help-rejecting patient example shows the value of thinking psychologically instead of just, you know, the patient has depression, I'm going to follow the medication algorithm”

“the correct response to suicidality really depends on the patient. So here, as you're saying, is the best treatment for a patient that has what you're describing, which is an adjustment disorder, is hospitalization”

“Even in a therapy of any kind, I think formulating and sharing that formulation of the patient is absolutely key”

“It's only complex formulation, really getting deeply into why people do what they do. In my opinion, that gets people something actionable and lets you really weigh and deliberate. Should I change myself or not”

“Quote-unquote diagnosis that's pertinent to a therapist is surely the formulation. And then I wonder how many practicing therapists out in the community are actively formulating and then delivering that formulation to the patient within the first four to six sessions”

“I always save the last like 15 minutes for discussing my case formulation. And patients at the end are like, oh, you're definitely not a reductionistic kind of doctor”

“if you can explain this patient's problems in a way that a completely uneducated person will understand, that's better because that's how you should formulate with the patient in plain language”

“you need to gather enough information together with the patient to string it together into a story that they're going to accept”

“I think a lot of providers have a tendency to let things go unsaid. And it mucks up the treatment”

“A lot of clinicians can't formulate how personality shapes a presentation. And then that clinician thinks everything that doesn't respond to meds is some form of treatment resistance”

“we may pretend that we're playing a biological game. And we're not. We're playing a psychosocial game”

“The loss in terms of, you know, where the question comes from, is it still relevant today, is that many clinicians aren't as able to think psychologically as they were before”

“a diagnosis can obscure if we simply call it generalized anxiety disorder or PTSD. And then we ignore the personality components, the developmental components, all kinds of components that should belong in that formulation. Then the diagnosis robs us of vision rather than gives us clarity”

“You have a patient who's cutting themselves, identity diffusion, chaotic, unstable interpersonal relationships, devaluing the therapist. And the therapist is reluctant to call that borderline personality disorder”