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Advances in Psychiatric Treatment (2005) 11: 416-423
© 2005 The Royal College of Psychiatrists

Teaching psychodynamic formulation to psychiatric trainees

Part 1: Basics of formulation

Chris Mace and Sharon Binyon

Chris Mace is consultant psychotherapist and Director of Medical Education at South Warwickshire Primary Care Trust (The Pines, St Michael’s Hospital, Warwick CV34 5QW, UK. E-mail: C.Mace{at}Warwick.ac.uk) and honorary senior lecturer in psychotherapy at the University of Warwick. He is a training programme director in psychotherapy and has a research interest in assessment for psychotherapy. Since this article was written, he has joined the UK OPD task force. Sharon Binyon is a consultant in adult psychiatry with a special interest in psychotherapy, and Associate Medical Director to North Warwickshire Primary Care Trust. She is clinical tutor and scheme organiser for the Coventry & Warwickshire SHO training scheme.

All psychiatrists should be able to construct a psychodynamic formulation of a case. A key advantage of formulation over diagnosis is that it can be used to predict how an individual might respond in certain situations and to various psychotherapies. This article looks in some depth at what psychiatric trainees need to be taught about psychodynamic formulation. We introduce formulation in terms of four levels, each level corresponding to a different degree of theoretical and clinical sophistication and therefore to different trainees’ needs. We use a case vignette to illustrate how a clinical situation might be formulated at each of these levels.




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