The Pros And Cons Of Diagnosis And Formulation

Diagnosis is the procedure of determining whether the particular problems afflicting an individual meet all the criteria for a psychological disorder, as set by the Diagnostic and Statistical Manual of Mental Disorders (DSM) (American Psychiatric Association, 2000). In contrast, ‘formulation’ is a process that draws up on psychological theory in order to create a working hypothesis or ‘best guess’ about the reasons and nature of the difficulties of the client, in the light of their relationships, social contexts and the way they make sense of events in their life (Johnstone & Dallos, 2013). Formulation is a topic that is growingly attracting professionals in psychiatry, and is a defining feature of Clinical Psychology (Division of Clinical
However, for the purposes of this essay, the advantages and disadvantages of this question will be considered in relation to psychosis. DSM-5 classifies psychosis in to the category “schizophrenia spectrum and other psychotic disorders”, which is defined by abnormalities in one or more of the following five domains; delusions, hallucinations, disorganized thinking, grossly disorganized or abnormal behaviour including catatonia, and negative symptoms (American Psychiatric Association, 2013). Formulation may be a better option than diagnosis in some cases however this is not so straightforward to claim, especially for psychosis. Before claiming psychological formulation can replace psychiatric diagnosis, it is important to examine psychosis, its causes and triggers, and what advantages and disadvantages both diagnosis and formulation can offer for
Fowler, (2000) reported that formulation as part of CBT administered to individuals with psychosis enhanced therapeutic alliance, and eased distress (John & Turkington, 1996). However, a study by Chadwick, Williams & Mackenzie (2003) found no evidence that formulation has a direct impact on any of the main targets of CBT for psychosis such as therapeutic relationship, delusions or self-evaluations, and distress. Therefore, it appears that there is no clear link between formulation and clinical outcome for psychosis (Kuyken et al, 2009). Nevertheless, formulation draws back to several theories that are evidence based, such as the attachment theory, developmental psychology theories and other knowledge about traumas (Johnstone & Dallos, 2013). In other words, although effectiveness may seem controversial, formulation is an evidence based approach. In contrast, diagnosis and its effectiveness on clinical outcome remains as an area that has insufficient research. Nevertheless, diagnosis itself does not aim to have therapeutic effect (American Psychiatric Association, 2000). However, this does not reject the notion that further investigation in to its usefulness is