Meeting-The-Challenge-Making-a-Difference-Practitioner-Guide

The aim is to identify patterns
which connect childhood
development and adult
personality, so that we have
an understanding of the
person’s history, and how they
come to have these problems.
We can then design an
intervention to help them to
overcome their difficulties.
Thinking about
the individual,
and arriving at a
‘formulation’ of
their difficulties
A formulation is like a
thumbnail sketch of a person,
our best understanding at that
point in time of how the person
developed these problems,
how they affect them now,
what triggers them and what
implications this has for how
we should treat them. It’s very
helpful to write it down but
always with a willingness to
modify it as new information
becomes available or on the
basis of the service user’s
response to our intervention.
A useful model of formulation
is called the ‘Five P’ model:
PROBLEMS
PREDISPOSING
FACTORS
PRECIPITATING
FACTORS
PERPETUATING
FACTORS
PROTECTIVE
FACTORS
It is always important to work to develop a shared
view with the service user of what the problems are
that they need help with. Their experience of their
difficulties won’t always tally with yours. You might
think that they need to stop using drugs and alcohol
but they may feel they need help with their relationships
first of all. In order to engage them effectively it is
necessary to take seriously their point of view. For
example, their alcohol and drug use may be a way
of coping with relationship difficulties, so working
with them on the relationship issues may open the
door to addressing their drug and alcohol use.
These are early childhood experiences, such as
trauma, neglect and deprivation that increase
vulnerability in adult life. An understanding of how
these affect the person’s adult personality will
inform you of how they are likely to respond to your
efforts to help them. This hopefully will help you to
be prepared for the kind of difficulties in the
relationship that may arise.
These are factors currently present in the person’s
life that trigger the problems. These can be triggers
in the mind or in the external environment, such as
recent loss of a relationship, or substance misuse.
Identifying these triggers, in partnership with
service users, can be of great practical help as it is
something concrete that you might be able to help
the person to change or reduce.
These are factors which maintain the problem, that
is, make it more likely that the problem will
continue to recur, for example lack of support, or
only being cared for when you are in crisis. Again, it
is important to do this in collaboration with the
person experiencing the problems as different people
experience the same circumstances in different ways
These are factors which contribute to the person’s
resilience and capacity to cope with adversity.
Relationships, employment, housing, and a support
network can sometimes increase stress, but very
often they work to promote resilience. If you can
harness them in your work to overcome problems
you are more likely to be successful. Again, it is
important to identify these collaboratively with
the individual, as they may well draw on resources
which are not obvious to others.
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