Introduction
Formulation forms the basis of this report as it extensively explores the role it plays in counselling and therapeutic practice. Specifically, it will focus on a case study involving the client Robbie, outlining the way person-centered counselling approaches are integrated into formulating. For the same reason, this exercise proves key as it simulates the writing process of a formulation report to a counselling supervisor. The report is intended to frame an in-depth examination of the principles, techniques, and challenges linked with the formulation of a case pertaining to the application of person-centered counselling strategies.
Critical Review of Formulation
Core Principles and Purposes of Formulation
Formulation in counselling and therapy is a structured process of understanding and interpreting the psychological concerns of a client (Johnstone,nd). It is of huge importance as it can enable a therapist to structurally integrate diverse information, such as the history, symptoms, and contextual factors of the client, into a holistic picture. The principal key principles in formulation involve an understanding of the holistic nature of mental health, which takes into consideration the biological, psychological, and social parts of the client. A therapeutic principle, individualization, emphasizes tailoring interventions according to the specific needs and experiences of a client.
Benefits of Formulation
Formulation has various advantages in therapeutic practice. First, it presents a map for the clinician to understand the underlying causes of a client’s problems. This depth of understanding enables the development of targeted interventions that are not only appealing but also make sense to the client. The process of formulation greatly contributes, to a great extent, to the accuracy of diagnosis and the preparation of a treatment plan. It increases and enhances the therapeutic alliance through an explanation of what is happening, paving the way for collaborative work with the client. Also, it enables the empowerment of clients through instilling awareness and active participation in their healing process.
Controversies in Formulation
Despite its merits, formulation is not without drawbacks. The link between formulation and psychiatric diagnosis is a topic of much controversy. In many circumstances, a medical diagnosis will be required along with a formulation. Noted concerns range from the potential for stigmatization and labelling of clients, rooted in diagnostic formulations, to the risk of oversimplification.
Models of Formulation
Diversity in the formulation models can be viewed as theoretical variations. Some of the models that vary include the psychodynamic, cognitive-behavioral, and person-centered models, just to mention a few, among which therapists look to conceptualize and understand their clients. Psychological formulation is based on fundamentally different principles from those of psychiatric diagnosis. The difference between them is the contrast between the messages. Psychodynamic models place an emphasis on unconscious processes; cognitive-behavioral models underline a need to recognize and change maladaptive thought patterns; and person-centered models underline support for the client in self-exploration. Each provides a unique viewpoint on the therapeutic configuration.
Section 2: The Client and Their Difficulties
Robbie is a 69-year-old gay man, born in 1951 to working-class parents in a small Scottish town. In his twenties, he went through a difficult period of low mood and had unsuccessful therapy focused on changing his sexual orientation rather than providing support. Robbie found acceptance through his local gay community and a long-term 30-year relationship with his partner Kenny.
Robbie’s core presenting issue is loneliness since Kenny passed away from cancer and Robbie retired from his skilled technical job years ago. He describes feeling a “tremendous vacuum” and craving someone “to wake up with” after losing his partner of 30 years. Though desiring a new relationship, Robbie struggles with how to meet potential partners, as he previously found connections through gay bars that no longer exist in his small retired town. He worries he may be too old now at 69 to find love again.
Robbie is distressed by profound feelings of isolation and lack of companionship in the years since Kenny’s death. Having been in a committed long-term relationship for decades, Robbie misses the constancy of having a partner in his daily life. His loneliness is compounded by uncertainties about dating again as a single older gay man.
Section 3: Writing a Formulation Report
What Robbie went through can be fully understood under the scope of person-centered therapy. Carl Rogers, the father of the theory of person-centeredness, states that every human person naturally tends towards self-actualization and personal growth (Sims and Di Malta, 2021). The articulation of Lambers examines the discrepancy between a client’s organismic experiences and their self-concept, building upon the basic framework of Rogers’ (1959) theory of personality(Week 14 Humanistic therapies: 4.2 Theories of person-centred formulation | OU online, no date). This, however, can be hindered from the outside, with individuals developing psychological distress. All the problems that Robbie is having in life—starting from his experiences as a kid, to his family, to his experiences as a grown-up individual—refer back to the central principles of person-centered therapy. In person-centered terms, Robbie’s early life, marked by economic difficulties and a lack of emotional support, in all likelihood impeded the development of a positive self-concept. The absence of empathetic understanding and unconditional positive regard in some critical formative years may have caused a gap between a person’s self-image and his or her experiences. This has caused Robbie to feel inadequate, worthless, and hesitant to initiate meaningful relationships.
His impoverished upbringing and the emotional void created by strained family dynamics appear to have significantly constrained his actualizing tendency from an early age. The lack of empathetic understanding and unconditional positive regard during his formative years likely caused an incongruence between his organismic self (his authentic feelings and experiences) and the self-concept he constructed based on the conditional regard and harsh conditions he faced.
This discrepancy between the experiential organismic self and the self-concept, as articulated by person-centered theorists like Lambers, can lead to psychological distress and a distortion of one’s genuine experience and sense of self-worth. For Robbie, the emotional deprivation and need to repress his true identity due to the stigma around his sexuality may have led him to form unhealthy conditions of worth, where he saw himself as only worthy of love and acceptance if he met certain external expectations and standards.
Linking Theory to Robbie’s Experiences:
Robbie’s account of his childhood appears to be about a particular lack of emotional support and financial resources. The person-centered perspective is that such early experiences can result in the individual forming conditions of worth, where the person comes to see that love and acceptance are only available when certain conditions are met. For Robbie, this might manifest as an internalized belief that his value is tied to his ability to provide for others.
His strained family relations further compound Robbie’s challenges. The person-centered theory refers to the need to create an environment that promotes openness and authenticity. The family dynamics Robbie grew up under may have discouraged him from the need to express his real self, and from there flow the apparent lack of connection and emotional suppression in his present life.
Perhaps his schooling experiences contributed to his having a distorted self-concept. If Robbie faced challenges or criticism in academic settings, maybe it was because he internalized these experiences, which affected his confidence and self-esteem. Person-centered therapy would argue that the exploration of such early influences is important because they form a foundation upon which current distress may be understood and worked with.
Adult life is characterized by the interrelatedness of work and family life and, from a person-centered therapy perspective, reflecting opportunities to grow and become. Robbie’s issues in terms of coping with his family and managing his emotional well-being would best be addressed from within the constructs of the person-centered perspective, since this provides an open and accepting framework within which to help process these issues.
Person-Centred Techniques
The first session therapist focused on the creation of a therapeutic environment through the use of person-centered techniques. He uses a non-directive approach in that he listens to Robbie’s story without making any judgment or interpretation of it in advance. The therapist reflects empathetic understanding back towards Robbie in terms of his feelings and experiences, creating a sense of being validated and accepted.
When, for example, Robbie presented a case where he talked about how he wasn’t able to meet his needs and inadequacy in relation to providing for his family, on his part, the therapist would reflect with responses that are designed to show unconditional positive regard, like, “So it was just the two of you. It’s like the happy couple.” (Week 14: Humanistic Therapies: 3.3 In Therapy: Session 1 | OU Online) They carry with them the aspect of unconditional positive regard with empathy, which is crucial to a person-centered therapy approach.
In the following sessions, the therapist continued to work person-centeredly and to let Robbie explore further his feelings, thoughts, and perceptions at his own pace. Open-ended questions were used so as to encourage self-exploration and let Robbie find a deeper basis for his distress. Instead of really offering him any kind of solution or advice, the therapist merely maintained an atmosphere where Robbie could actually come to his own realizations.
All the while, he was always reminding himself of the guiding principles within the practice of unconditional positive regard and empathy, like giving Robbie a safe place to express himself without any masks. These are in the form of active listening and reflection, which have proved facilitative for Robbie in helping him process his feelings. Such approaches helped Robbie develop self-insight and move him along the path to a clear understanding and resolution of his dilemmas.
Assessment of Robbie’s Strengths and Resources
Robbie is shown to have a number of resources and strengths that would be helpful in the therapy process. The strength that comes out so clearly is Robbie’s resilience; he couldn’t have considered going to a therapist if he didn’t have it. Besides, Robbie’s readiness to look at and deal with his problems is an assertive sign of personal development. Another strong point about Robbie is that he is reflected in good depth, as revealed in the verbalization of emotions and reflection on self-occurring during the sessions. This capacity for introspection has the potential to become an excellent foundation for deeper self-awareness and positive change. Also, Robbie is responsible and cares for the well-being of his family.
Future sessions could work to extend Robbie’s strengths and augment his self-esteem and self-efficacy. The therapist could potentially work with Robbie to develop goals that were appropriate for him and had personal meaning for him, and that helped him develop an appreciation for his accomplishments. One of the main therapeutic goals would be to connect Robbie’s sense of self with his positive attributes.
Summary of Relevant Theory and Research
According to Carl Rogers, at the heart of the person-centred theory is the idea that every single person possesses an intrinsic drive towards self-actualization and self-growth. The therapeutic process, therefore, remains non-directive in a client-centred approach where an accepting, non-evaluative, and empathetic atmosphere is provided to the individual to help the individual freely. The building blocks for person-centred therapy are unconditional positive regard, empathy, and congruence. Applied to the case of Robbie, when one wants to understand and help him overcome his problems, a person-centred approach focuses on the impact of early experiences, the establishment of conditions of worth, and the cultivation of an empathic therapeutic relationship.
In the person-centered model, it is important to consider wider social and environmental factors that may affect a person’s experiences. Stigma associated with mental health problems, along with the weight of social expectations, may lead to one’s own sense of worth, in turn affecting self-esteem and well-being. The loneliness—coming out of a lack of actual relations “He talks about the ‘tremendous vacuum’ in his life, the pain of having ‘nobody to wake up to’ and missing the affection and hugs of his partner (Week 9 Relationships: 5.2) Case story: Robbie’s loneliness (OU online,). It can be probed into in the therapeutic setting for its associations with Robbie’s difficulties in relating to people on an authentic, sincere basis.
Demonstration of a Respectful, Sensitive Approach
Robbie’s social context, under financial strains and strained relations in the family, is dealt with sensitively. The therapist becomes aware of this and includes these factors in the therapeutic dialogue. This will explore social influences in Robbie’s life on self-perception and address systemic challenges because understanding the context within which a person lives is intrinsic to a person-centered commitment.
A trauma-informed lens is held throughout practice. The therapist will know to be careful about any potential traumatic experiences that occurred in Robbie’s past and approach these issues with caution and sensitivity. Trauma-informed practice is based on an understanding of trauma and its prevalence, a realization about the impact of trauma on life and mental health, and a series of principles by the service provider about helping the client through building a safe and supportive environment.
With this consideration at the back of his mind, the therapist shall therefore recognize and respect Robbie’s right to access reports and information relating to his therapy. This is also in accordance with ethical considerations and further enhances the relationship through collaboration.
Section 4: Evaluation
The person-centered approach had at least some positive consequences for Robbie. It allowed him to explore his feelings more openly due to the empathic and non-judgmental space. He gave more insight into his difficulties and became more self-aware. Emphasizing unconditional positive regard enhanced Robbie’s self-esteem and, thus, his acceptance or validation of his person. The framework of the person-centered nature chimes with the nature of Robbie’s character, which is contemplative in nature, hence getting content with self-reflection and personal development.
Person-centered techniques have proven to be quite supportive in Robbie’s therapeutic journey. Some of these involve active listening, reflective empathetic responses, and open questioning, which have helped Robbie explore and express himself and his condition. A major benefit of the non-directedness in the approach has been Robbie’s ownership over the narrative, and hence his autonomy during therapy. The strengths’ focus has helped evoke Robbie’s resilience and commitment towards personal growth in a positive manner that therefore arouses his motivation towards change.
However, attending to particular patterns of behavior or even offering a structured intervention can be challenging within person-centered therapy. After all, there isn’t a natural place within the nondirective frame of person-centered therapy for the more directive support that may be needed in certain specific instances, such as the one in which Robbie’s behaviors were most disabling. And dealing with immediate coping strategies for distress in the moment might call for additional approaches.
If such specific behavioral goals or skill-attainment deficits arise out of Robbie’s difficulties, then parts of cognitive-behavioral therapy (CBT) or solution-focused brief therapy (SFBT) may be suggested. This can provide some practical tools to deal with certain challenges and complement the person-centered approach.
Section 5: Reflection
Building rapport with Robbie was very difficult at first, being that he was very guarded by his character. But as the therapeutic relationship started to unfold further, the trust was strengthened, and he opened himself to the therapist. The constant application of person-centered principles of empathy and unconditional positive regard applied by the therapist played a major role in building the rapport.
My therapeutic relationship with Robbie reflected a person-centered therapeutic relationship still in the process of development. There was an element of partnership that was communicated through a collaborative approach and shared explorations between the therapist and Robbie. In reflection, that would tend more towards a flexible approach where the alliance shifted and where unique needs emerged from the client in the person-centered approach. Another aspect that joined them was their commitment to personal growth and capacity for introspection. A joint commitment provided a therapeutic process through collaboration.
In conclusion, the therapist remains curious about how the experiences of Robbie during his childhood have an impact on his engagements at present, both with his friends and himself. Exploring how societal factors like economic challenges contribute to the difficulties of Robbie continues to be a consideration that is ongoing. In addition, a determination is to be made of how successful the chosen coping mechanisms used by Robbie are in various situations.
References
Johnstone, L. (nd), Understanding Psychological Formulation
Sims, M., and Di Malta, G. (2021), ‘The Humanistic Approach’. Available at: https://us.sagepub.com/en-us/nam/understanding-mental-health-and-counselling/book267350#contents (Accessed: February 18, 2024).
Week 1 Introduction to the module: Gosia | OU online (no date). Available at: https://learn2.open.ac.uk/mod/oucontent/view.php?id=2141589§ion=4.3.3 (Accessed: 18 February 2024).
Week 14: Humanistic Therapies: 3.3 In Therapy: Session 1 | OU Online (no date). Available at: https://learn2.open.ac.uk/mod/oucontent/view.php?id=2141607§ion=5.3 (Accessed: February 18, 2024).
Week 9 Relationships: 5.2 Case story: Robbie’s loneliness | OU online (no date). Available at: https://learn2.open.ac.uk/mod/oucontent/view.php?id=2141601§ion=7.2 (Accessed: February 18, 2024).
Week 14 Humanistic therapies: 4.2 Theories of person-centred formulation | OU online (no date). Available at: https://learn2.open.ac.uk/mod/oucontent/view.php?id=2141607§ion=6.2 (Accessed: 18 February 2024).
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