Week 7: Formulation

Question 1

Who’s quote is the following:
“What helps one person can damage another, even if the presenting problems of the two people seem comparable, and even if a particular strategy has reduced target symptoms in a significant number of people in well-defined pool of subjects with similar problems.”

Answer 1

Dr. Nancy McWilliams.

Question 2

What is Case Formulation?

Answer 2

A HYPOTHESIS about the causes, precipitants, and maintaining influences of a person’s psychological, interpersonal, and behavioral problems.

Question 3

What’s the main aim of formulation?

Answer 3

To increase likelihood of effective treatment.

Question 4

Identify the 3 corners of the Triangle of Adaptation.

Answer 4

left corner: Defense
right corner: Anxiety/Affect
low middle corner: Attachment Need/Interpersonal Style

Question 5

Describe how the Triangle of Adaptation works.

Answer 5

1. When fundamental needs don’t get met, it creates turmoil inside - terror. That’s where Anxiety/Affect comes in.
2. And when you feel those emotions, you generally try to get rid of them by engaging in Defensive behaviors - reducing anxiety, shame and negative affect to bring stability. Some of those defenses are healthy, adaptive and fantastic. Some of them are maladaptive, from way in the past or now.
3. Some defenses will be working to meet those fundamental needs.

Question 6

Identify the 3 corners of the Triangle of Object Relations.

Answer 6

left corner: Therapist/Group (relationships)
right corner: Current (relationships - including self)
low middle corner: Past (relationships)

Question 7

Describe how the Triangle of Object Relations works.

Answer 7

1. Deep motivators consist of feelings of belonging, but also feelings of worth. They are thought to underlie all our behavior (dependency and self worth). We look at patterns in the past of a person to see if these needs were being met healthily or not.
2. We also look in current relationships for those same patterns that were in the past.
3. Ultimately we look in the therapeutic relationship or in group therapy for the patterns to show up there too (transference).

Question 8

What are Two Foundational Assumptions of the Triangles.

Answer 8

1. Understanding of personality and interpersonal patterns is essential to therapeutic work
2. One’s needs/wishes (even fantasies) underlie interpersonal patterns

Question 9

True or false: Attachment needs are often conscious.

Answer 9

False, they are often unconscious.

Question 10

True or false: Anxiety/Affect → often generated by frustrated/unfulfilled attachment needs.

Answer 10

True.

Question 11

True or false: Defenses → means of coping with unwanted anxiety/affect which are always maladaptive.

Answer 11

False. Though defenses are means of coping with anxiety, they are not always maladaptive.

Question 12

Describe the Relational Inquiry of the triangles.

Answer 12

1. How defenses are manifested and influence interpersonal interactions
2. How interpersonal interactions are continued
3. How interactions shape self concept
4. How this is cyclic/How this continues to reinforce defensive style and interpersonal pattern

Question 13

What is Empirically-Supported Treatment/Scientific approach to clinical work?

Answer 13

1. Based on information/evidence available, a model/theory of human behavior is developed to understand it.
2. Develop a hypothesis based on that theory and design appropriate means to assess the model/theory.
3. Accept or refute the model/theory based on the results.
4. If you refuse it, develop a new model/theory.

Question 14

What is Formulation based clinical work?

Answer 14

1. Develop the hypothesized model of the unique person seeking help - and alter, refine, refute and expand details of the model according to new info about them.
2. Model guides the behavior of the therapist - both in terms of attempting to understand the individual but also to effect change.