Psychodynamic Formulation
l~HE
AMERICAN JOURNAL
O~~
PSYCHIA1'RY
The Psychodynamic Formulation: Its Purpose, Structure, and Clinical Application
Samuel Perry, M.D., Arnold M. Cooper, M.D., and Robert Michels, M.D.
The authors present a brief written psychodynamic formulation that focuses on central conflicts, anticipates transferences and resistances, and helps guide all psychiatric treatments. After placing the presenting problem in the context of the patient's life and identifying nondynamic determinants of the psychopathology, the formulation explains the development of central conflicts and their repetitive effect on the patient's behavior. It concludes by describing how these conflicts will be manifested in treatment. Three sample formulations and their application are presented to illustrate the value of this clinical tool. (Am J Psychiatry 1987; 144:543-550)
I
n the course of supervising mental health professionals, we have noted that a comprehensive psychodynamic formulation is seldom offered and almost never incorporated into the written record. Our experience is reflected in the psychiatric and psychoanalytic literature, where psychodynamics are often discussed but psychodynamic formulations are rarely presented. In this paper we discuss the purpose and structure of the psychodynamic formulation, provide three illustrations, and indicate how these formulations can help guide all treatments.
PURPOSE OF THE FORMULAnON
In many respects a dynamic formulation and a clinical diagnosis share a common purpose. Although
Received Dec. 16, 1985; revised June 3, 1986; accepted Aug. 1, 1986. From the Department of Psychiatry, Cornell University Medical College, New York. Address reprint requests to Dr. Perry, Payne Whitney Clinic, 525 East 68th St., New York, NY 10021.
AMERICAN JOURNAL
O~~
PSYCHIA1'RY
The Psychodynamic Formulation: Its Purpose, Structure, and Clinical Application
Samuel Perry, M.D., Arnold M. Cooper, M.D., and Robert Michels, M.D.
The authors present a brief written psychodynamic formulation that focuses on central conflicts, anticipates transferences and resistances, and helps guide all psychiatric treatments. After placing the presenting problem in the context of the patient's life and identifying nondynamic determinants of the psychopathology, the formulation explains the development of central conflicts and their repetitive effect on the patient's behavior. It concludes by describing how these conflicts will be manifested in treatment. Three sample formulations and their application are presented to illustrate the value of this clinical tool. (Am J Psychiatry 1987; 144:543-550)
I
n the course of supervising mental health professionals, we have noted that a comprehensive psychodynamic formulation is seldom offered and almost never incorporated into the written record. Our experience is reflected in the psychiatric and psychoanalytic literature, where psychodynamics are often discussed but psychodynamic formulations are rarely presented. In this paper we discuss the purpose and structure of the psychodynamic formulation, provide three illustrations, and indicate how these formulations can help guide all treatments.
PURPOSE OF THE FORMULAnON
In many respects a dynamic formulation and a clinical diagnosis share a common purpose. Although
Received Dec. 16, 1985; revised June 3, 1986; accepted Aug. 1, 1986. From the Department of Psychiatry, Cornell University Medical College, New York. Address reprint requests to Dr. Perry, Payne Whitney Clinic, 525 East 68th St., New York, NY 10021.