Alternatives to Psychiatric Diagnosis: Psychological Formulation
Insisting that we need ‘alternatives’ before diagnosis can be discarded is not a legitimate position but a strategy used to maintain the status quo. The simplest response to the question ‘What do we do instead of diagnosing people?’ is: ‘Stop diagnosing people.’ Ask people what their problems are and what they want help with instead, and proceed on that basis. This is essentially Peter Kinderman’s suggestion. Like many clinical psychologists, and like the best psychiatrists, I have never used diagnosis in my whole career. At a day-to-day clinical level, it is neither necessary nor helpful.
Lucy Johnstone has also written:
Using Psychological Formulation in Teams
It should be noted that in this version of formulation practice the main client is, in effect, the team, whose counter-transference feelings of stuckness, hopelessness, anger or despair are likely to have prompted the request for a discussion. In effect, a team formulation meeting is a type of supervision or consultation, and in the same way as with those activities, it may not always be appropriate or helpful to share the aspects that deal with strong staff reactions directly with the service user. However, careful thought needs to be given as to how to involve the service user as closely as possible. Wherever possible (bearing in mind factors like severe learning disability, dementia etc) a parallel formulation is developed with and for the service user, and the two versions feed back into and inform each other. Sometimes this is most appropriately done via a conversation, or series of conversations, with the service user rather than a written document.