One of the questions I am often asked is,

 

"Why do I keep reacting in the same way, even when I know it isn't helping?"

 

Psychological formulation is one way of helping us answer that question. Unlike diagnosis, which focuses primarily on describing symptoms, formulation asks something different: ​

 

Why is this particular person experiencing these particular difficulties at this point in their life?

​

Where difficulties have been present for many years, it also asks:

 

What has allowed these patterns to persist despite repeated efforts to change them?

 

A formulation brings together different parts of a person's life - relationships, significant experiences, emotions, beliefs, coping strategies and current circumstances - to create a shared understanding of how these pieces fit together.

​

While diagnosis can provide a valuable framework for understanding symptoms, guiding treatment and facilitating access to support,  psychological formulation complements it by explaining how a person's unique experiences, relationships, circumstances  and patterns have developed over time and  contributed to their current difficulties.

 

In other words, diagnosis and formulation are not competing approaches.

Rather, they answer different questions.  Diagnosis helps us to identify what difficulties a person is experiencing. Formulation helps us to understand why those difficulties may have developed and what continues to maintain them.

​

It also helps us identify what function that symptoms or behaviours may be serving. 

That function is not always immediately obvious and may not even be fully conscious to the individual.

​

Understanding it can help identify where change is most likely to occur and what may need to shift for those difficulties to become less necessary.  For clinicians, taking time to develop  a thoughtful preliminary formulation before moving into treatment can often provide a clear therapeutic direction and help ensure that the interventions are informed by an understanding of an individual, rather than the diagnosis alone.

 

For example, two people may both receive a diagnosis of depression, yet their formulations may look very different. One person's depression may have been triggered by a recent bereavement that also reactivated unresolved guilt  linked to grief from earlier life and become maintained by social withdrawal and loss of meaning.

 

Another's may be rooted in longstanding self-criticism, perfectionism and early experiences of conditional acceptance. Although the diagnosis is the same, the pathways into the difficulty, and therefore the most helpful therapeutic focus, may be quite different.

 

The value of formulation extends far beyond the therapy room. Many of us unknowingly develop recurring patterns in the way we think about ourselves, interpret other people's behaviour, respond to difficult emotions and relate within close relationships.

We may automatically assume others are disappointed in us, expect rejection, become highly self-critical after making mistakes, or withdraw when we feel vulnerable.

 

Because these patterns often operate outside our immediate awareness, they can begin to feel like facts about who we are rather than habits of mind that have developed over time. Developing a formulation helps bring these patterns into awareness. That awareness is not about blame. It is about creating choice.

​

For example, recognising that "I often assume people are judging me when I feel uncertain" creates a very different starting point from simply believing "People always think the worst of me." In that moment, there is space to pause, reflect and consider alternative possibilities rather than automatically reacting in familiar ways.

 

This is why formulation matters.

 

It helps us understand not only where our patterns came from, but also how they continue to influence our everyday lives. Once we can recognise them, we are no longer simply repeating them. We can begin to respond differently, make more intentional choices and gradually develop healthier ways of relating to ourselves and others.

 

In many ways, psychological formulation is not simply a clinical tool; it is  also a way of thinking.

It encourages us to move beyond labels, look beneath the surface and ask not only what is happening, but why.

 

Whether in therapy, relationships or contemporary conversations, this way of thinking invites us to approach complexity with greater curiosity, context and nuance. 

​

Whether its principles are applied in therapy, relationships, or everyday life, formulation is ultimately about creating new possibilities, rather than remaining trapped in old patterns. 

​

​It is not about living in the past.

It is about understanding the present well enough to create a different future.​​​

​

​

​

 

About the author

Dr Anna Wachowska is an HCPC-registered Counselling Psychologist and founder of RelationalMind Practice. Her clinical work is integrative, formulation-led, and informed by psychodynamic, relational and attachment-based thinking.​

​

​

Psychological Essays | Dr Anna Wachowska | RelationalMind Practice