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Question How do you write a formulation report, drawing on systemic…
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How do you write a formulation report, drawing on systemic approaches, about the problems faced by the client’s family in the provided case study.
The formulation report needs to include sections on possible causes of the problems, factors maintaining the problems and factors that might help to facilitate change for the client.
Case study
You are working as a systemic therapist in community service for adolescents with anti-social behaviour. You have your first session with Jenny, a 15-year-old female who has been referred by social care, and her family. The social worker who referred the family would like you to assess their suitability for family therapy and provide a formulation report that demonstrates how your systemic intervention could help them to overcome Jenny’s risk-taking and aggressive behaviour and related problems.
Jenny’s history and background
Jenny lives with her biological mum Jo (32y), her stepfather Smithy (40y) and her two half-brothers Theo, nine years old and John, four years old. Jo fled Jenny’s biological father when Jenny was two years old due to severe domestic violence and there has been no contact with him since. Jo suffered from postnatal depression after the birth of Jenny. She married Smithy ten years ago. The two younger boys (Theo and John) are doing well at school. Jo has given up her job to look after the children but does not feel fully satisfied with her life as a housewife. Smithy works full-time as a warehouse operator and is mostly away from home as he is often working long hours (sometime seven days a week).
There has been a history of reported behavioural problems with Jenny, and the parents use harsh punishment or threats to try to control it. The problems started when Smithy moved in ten years ago. Jenny reported being hit by her mother a few years ago and made so-called ‘unsubstantiated allegations. She also started to go missing from home two years ago, staying with family and friends and not wanting to go home. The family has support from Smithy’s parents but recently they didn’t want to have Jenny any longer for respite. Jo has no contact with her parents but has a younger sister who lives not far away and who has a good relationship with Jenny.
Jenny’s current situation
Jenny’s risk-taking behaviour has increased recently, and she went missing for several days last month. Although the parents knew where she might have been, they weren’t able to get her home and felt frustrated by the police involvement as the police did not interfere in the houses where they thought Jenny went. In the last months, her aggressive outbreaks have become worse. Jenny is hitting out at her mother and half-brothers about once a week and has damaged property in the house (especially in her bedroom). In a typical escalating conflict Jenny will act aggressively and ‘push her mum’s buttons’ to make her listen to her (she often feels her mum is not listening to the things that concern her), which will lead to her mum ‘shutting down’ and shouting at her in an attempt to control the situation (as she is worried the boys could be affected by the conflict, and Jenny could run away again), which gives Jenny the feeling her mum is not really interested in her concerns.
At school, Jenny is at risk of permanent exclusion due to her aggressive behaviour and her refusal to comply with some rules. She is also truanting a day a week on average. After school Jenny likes to hang around with a group of peers in the neighbourhood as she feels at ease with them. She has been involved in shoplifting and anti-social behaviour and her parents see some of her friends as ‘negative models’ for Jenny. Jenny feels she doesn’t belong at home and there is no real place for her there.
Both parents tend to allocate all problems to Jenny and think that she may suffer from a mental health problem, although the local specialist Child and Adolescent Mental Health Service (CAMHS) has ruled out any mental health diagnosis. The parents often shout at her and make threats to send her away if she doesn’t change, rather than looking at alternative ways of understanding and dealing with Jenny’s behaviour. Their couple relationship is strained by the frequent arguments they have about how to best deal with Jenny, with Smithy thinking that Jo is too soft at times but then suddenly switching to harsh punishment, with no real results. In an attempt to stop her from shoplifting Jo once posted a picture on Facebook showing a police officer and a shopkeeper questioning Jenny after she had been caught in a local shop. Jo has also walked out of the family home and disappeared for hours in a situation when she felt overwhelmed. Smithy is very worried about the impact of Jenny’s behaviour on the two younger boys.
Although the parents are somehow reluctant to accept help, as previous interventions haven’t worked, they are concerned about Jenny’s future and have quite a fatalistic view of it. They would like her to do better at school and be safe in the community. They would also like Theo and John not to be exposed to aggressive and chaotic behaviours in their home anymore. They are prepared to do some work on their communication with Jenny. Jenny would like to have fewer conflicts and a welcoming place at home. She would also want to do some pro-social activities with her parents/family.
Tips for writing
As a formulation report, you will follow a specific structure. You should start the formulation report by briefly summarising the client’s family’s current problems (what are they struggling with and what has brought them to therapy?).
This section should be brief. As your formulation will draw on systemic approaches, you should especially provide information on:
problem descriptions (what is seen to be the problem, by whom?)
relationships and interactional processes in the family
conflict situations and behaviour
contextual factors (e.g. peer influences).
The subsequent sections of your formulation report should provide answers to the following three questions (you should use these as section headings in your report):
1. What has caused the problems?
In discussing the causes of the difficulties you need to remember that from a systemic perspective ‘individual problems’ are seen as linked to and shaped by a range of contextual factors, including relationships and relational dynamics, language that emerges between individuals in social systems (e.g. labelling of behaviour) and factors in the wider social and cultural context.
Your task here is therefore to identify and discuss the relevant contextual factors for the problems in Jenny’s family.
This could include information on:
how ‘the problem is constructed in the family (beliefs and problem explanations)
family history and experiences (e.g. bonds/attachment)
roles and availability of family members
current family dynamics and conflicts
parental interventions and their relational impact
school and peer influences
dominant cultural concepts and pressures (e.g. for teenage girls, ‘housewives’).
You might of course come up with additional/other contextual factors. Where possible, try to support your hypothesis with references to systemic concepts and/or research evidence.
2. What factors are maintaining problems?
In this section, you should describe the relationship and interactional pattern that might be responsible for the maintenance of the problems in the family. A problem-maintaining pattern might include a repetitive/circular interaction pattern between two or more family members in conflict situations.
You should also discuss relational dynamics and constellations in the family system (e.g. ‘triangulation’) that might play a role in maintaining the problems.
3. What might facilitate change?
Based on the information in the previous two sections, you should be able to show how the problems in Jenny’s family can be understood, and in this final part of the formulation you will need to be able to identify what elements of your formulation your client family could work on with you. You should then discuss specific, realistic and time-limited goals for the systemic informed work you will be doing with this client’s family.
This will be followed by a discussion of specific ideas and recommendations for systemic interventions and ways to work with the client’s family in a community service setting. You can revert to the systemic concepts and techniques that are used in ‘Multi-Systemic Therapy’ (MST) if you feel this would be appropriate for the work with this family.
You can also use interventions from other systemic approaches to help the family to achieve their goals and look at alternative ways of understanding and dealing with the problems (e.g. methods to produce new insights for clients, to explore circularity and change the meaning attached to behaviours, methods focusing on strength and resources).
It might be useful to look at the feedback you have received on other reports (from previous modules) and also on the previous TMAs on this module. You are asked to write this assignment ‘considering the client information like a therapist working with the client’. In writing this formulation report you can therefore use the first person where appropriate (e.g. ‘for future therapeutic work with Jenny and her family, I recommend the use of…’).
In therapeutic practice, formulation reports don’t necessarily include references. However, as you are writing this formulation report for an assignment in an academic context it should be referenced as usual. You don’t need to reference the information in the case study but need to reference material from the VLE/Video/Book chapter, as well as any independent sources that you might want to include.
Diagrams (e.g. a genogram of the client family) can be used in the formulation report but are not an essential requirement. This means that the highest marks are still possible without the inclusion of a diagram in your report.
