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The purpose of this paper is to understand staff experiences of cognitive analytic team formulation, within an inpatient unit for women with a diagnosis of personality disorder.

In total, 16 staff completed an online questionnaire, rating their views on how helpful formulation sessions had been in regards to ten domains. Following this, six staff participated in semi-structured interviews exploring their experiences of the process and impact of cognitive analytic team formulation. Transcripts were analysed using thematic analysis.

Responses from questionnaires indicated the general process of team formulation was helpful across each domain. Interviews highlighted benefits such as an increased capacity to think and work relationally. This was impacted upon by staff’s confidence in using the model and the practicalities of attending sessions.

Team formulation has been described as the facilitation of a group of professionals to create a shared understanding of service-users’ difficulties. Team formulation continues to demonstrate benefits for staff working within complex mental health. The challenges of this are considered, however overall, a cognitive analytic framework seems to offer staff the opportunity to integrate learning from a service-user’s history, and current relational difficulties, in a way that develops reflective capacity and informs intervention.

Limited research has explored the theoretical models underpinning team formulation, and the impact for staff learning and practice. The current study develops previous work by specifically focussing on the contribution of cognitive analytic theory to team formulation.

Team formulation, used to understand patient problems and plan care, is a growing practice in adult mental health and learning disability services. The purpose of this paper is to explore definitions applied to team formulation (as distinct to therapy formulation), its underpinning theories, and the inter-relationship between the team and the process of formulation.

A database search (main search term of team formulation) of peer-reviewed studies was conducted using PRISMA guidelines. A main and second reviewer conducted quality appraisals and thematic analysis. Data were analysed by convergent qualitative synthesis design using thematic analysis to transform evidence from quantitative and qualitative studies into qualitative findings.

Initial searching produced 4,532 papers, 10 of which were eligible for inclusion. Team formulation has no distinct definition. Theories underpinning the practice of therapy formulation emanating from general psychological theory underpin team formulation. Seven studies applied psychological theories to the examination of team formulation. No studies examined the impact of the team on the formulation. Six themes were generated regarding the impact of team formulation on the team; “increased knowledge and understanding”, “altered perceptions, leading to altered relationships, feelings and behaviours”, “space to reflect”, “useful when stuck or challenged”, “perceived increase in effectiveness” and “improved team working”.

Limited evidence and variable quality compromised the availability of review evidence.

This is the first review to examine team formulation through the context of the team. The authors argue that a conceptual framework to encompass team inputs, processes and outputs in team formulation practice should guide future research.

The purpose of this paper is to explore the process of co-producing a formulation alongside a service user and the clinical team within a secure inpatient service. This paper has been co-authored by the service user and members of the multi-disciplinary team (MDT).

An open-ended focus group discussion was facilitated with the service user and members of her MDT. The process of thematic analysis was applied to the focus group transcript.

The following themes highlighted important outcomes of co-producing a formulation within a secure inpatient setting; “Meaningful Collaboration”, “Co-Produced Understanding” and a “Shift in Power Differential”. This paper demonstrates the importance of meaningful co-production within a secure inpatient service whilst also highlighting the challenges and tensions of working in a co-produced way within this context.

This paper explores the process of co-producing and developing a formulation from the perspective of one service user and their MDT within a secure inpatient setting. It would be unhelpful to extrapolate broad assumptions from this case study although this study does raise important considerations for future research and encourages an emphasis on a co-produced design and dissemination.

This case study highlights the importance of co-production in clinical endeavours, service delivery and development perspectives and in the dissemination of this information.

The importance of co-producing and co-authoring alongside service users have been highlighted in this paper. This approach to co-production and co-authorship is highly recommended in future research endeavours.

The 2011 Offender Personality Disorder Strategy promoted formulation-led approaches to offender management. The purpose of this paper is to demonstrate how formulation can inform partnership-working with women offenders, specifically those with complex needs including personality difficulties.

Learning from partnership case-work is shared to highlight a psychological understanding of the needs of one female offender, and the organisational system operating around her.

The paper describes the development of a “volcano metaphor” as a conceptual framework to assist workers, without psychological training, to better understand the complexity of a client’s intense emotional world. It also reflects the impact of an individualised formulation for through-the-gate working.

The challenges and advantages of “joined-up” inter-agency working are highlighted, including some ideas on how to promote consistency. These include the use of formulation as the basis for decision making and to help “contain” strong emotions attached to working with complex women offenders. Importance is attached to stable and appropriate housing for such women by anticipating their resettlement needs prior to points of transition, and coordinating provision through multi-agency public protection arrangements.

The paper’s originality lies with the development of the volcano diagram as an accessible format for considering individualised formulation and risk assessment. The paper also offers detailed reflections on wider systemic processes attached to working with complex women offenders. It is particularly relevant to psychological practitioners working within probation and prisons, and also to offender managers.

Despite the popularity of team formulation, there is a lack of knowledge about workable implementation in practice. The purpose of this paper is twofold: first, to characterise team formulation, based upon examples from practice; and second, to identify factors perceived to support or obstruct workable implementation in practice.

An online survey recruited UK Clinical Psychologists (n=49) with experience in team formulation from a range of work contexts. Examples of team formulation in practice were analysed using both deductive and inductive framework analysis.

Four novel types of team formulation with different functions and forms are described: case review, formulating behaviour experienced as challenging, formulating the staff-service user relationship and formulating with the service-user perspective. A number of factors perceived to support and obstruct team formulation were identified including team distress, facilitating change, managing difference and informing practice. These were common across team formulation types.

The team formulation types identified could be used to standardise team formulation practice. Several common factors, including managing team distress, were identified as aiding workable implementation across team formulation types. Future research should investigate the key processes and links to outcomes of team formulation in practice.

This paper presents two original, practice-based and practice-informing frameworks: describing, first, novel forms and functions of team formulation and, second, the factors supporting and obstructing facilitation in practice. This paper is the first to highlight the common factors that seem to facilitate workable implementation of team formulation in practice.

This purpose of this paper is to outline how a combination of different psychological models may inform formulation and treatment, and the benefits for the client and the therapist of working in this way.

This is a single case study, describing an integrative approach in which psychodynamic ideas were used to inform cognitive-behavioural treatment.

The integrated approach reported here not only allowed the client to develop his skills in problem solving and taking different perspectives, but also to take a more active role in decisions about his life.

Integrative approaches may be of particular use for individuals who have not shown a full response to interventions based on a single theoretical model. Malan's triangles of insight provide a clear structure to psychodynamic formulation that is easily accessible to emerging psychodynamic practitioners.

Little previous research has described integrative approaches for psychological difficulties in people with an intellectual disability. The approach outlined in this study describes reasons for using an integrative approach, provides one example of how different models may be combined in practice, and describes ways in which the integrative approach enriched the intervention.

The SECURE STAIRS framework has promoted young person involvement as a key feature of innovative service provision. In the North East of England, Secure Children’s Homes (SCHs) have pioneered young person involvement in team formulation. Young people have also led on the development of formulation materials through a young person involvement project. Young people’s attendance at team formulation meetings has become embedded. These service developments have also begun to expand across broader SCHs, Secure Training Centres (STCs) and Young Offender Institutions (YOIs) and reflect the national impact of such pioneering developments. There is a notable lack of research examining the impact of young person involvement in formulation. The purpose of this study is to elucidate this area.

Between April and August 2019, there were 86 staff attendances at formulation meetings where young people were present across two SCHs in the North East of England.

Paired samples t-tests indicated staff-reported significant post-formulation improvements across all domains measured including knowledge [t(85) = 11.38, p < 0.001]; confidence working with the young person [t(85) = 5.87, p < 0.001]; motivation [t(85) = 3.58, p < 0.001]; understanding [t(85) = 9.03, p < 0.001]; and satisfaction with the treatment plan [t(85) = 8.63, p < 0.001].

Implications of findings are discussed and further developments outlined.

Young people attending team formulation is a new and evolving area, and to the best of the authors’ knowledge, there is no existing research evaluating this area. The current findings suggest that staff knowledge, motivation, confidence and satisfaction with the treatment plan is improved following attendance at team formulation where the young person is present and actively participating. Young people’s participation and involvement is central to planning, developing and progressing meaningful provision within children and young people secure provision.

Involving children and young people in decision-making, service development and evaluation are also key components of ensuring the voice of young people is central in our minds. It also supports empowering the young people we work with. Young people and their journey should always be at the heart of what we do.

Young people attending team formulation is a new and evolving area, and to the best of the authors’ knowledge, there is no existing research evaluating this area. This is the first study of its type evaluating formulation directions within the SECURE STAIRS framework.

This single case study design describes the process in the care and treatment of Martin, a 28‐year‐old man with a learning disability and a diagnosis of emotionally unstable personality disorder within a medium secure unit for people with learning disabilities and associated difficulties. The purpose of this project was to make clear the links between understanding the personal phenomenology through formulation and therapy and the usefulness of this ‘knowledge’ in helping to guide difficulties, impasse and nurture positive relationships. The central theory underpinning treatment was cognitive analytic therapy (CAT), with an emphasis on the relational components and shared formulation.

The purpose of this paper is to review the evidence base for the use of risk formulation in forensic practice settings.

Systematic literature review principles were adopted to identify literature exploring risk formulation in forensic practice settings in relation to offending behaviour.

Data were analysed using a narrative synthesis approach, and commonalities were observed across some of the studies in terms of definitions, outcomes, and implementation, of risk formulation; however, the findings of the review did not provide a definitive account of risk formulation practice in forensic settings. This is due to the narrow scope of the included studies, the small yet diverse samples, the heterogeneity in research aims and the methodological weaknesses apparent within the included studies.

Further research is needed to understand the application and outcomes of risk formulation in forensic practice settings.

Practitioners should be clear about how they are defining, implementing and assessing the outcomes of risk formulation, alongside being mindful of the evidence base when utilising forensic risk formulation in practice.

To the best of the authors’ knowledge, this is the first paper to focus solely on the evidence base for forensic risk formulation in practice.

The involvement of service users within clinical psychology training is written into policy. However, the practice of evaluating involvement from both trainees’ and service users’ viewpoint is minimal. The purpose of this paper is to evaluate recent service user involvement in psychometrics and formulation teaching on a clinical psychology training programme, from both service user and trainee perspectives.

Focus groups were held with service users (n=3) involved in the teaching, as well as trainees (n=3). Additional questionnaire data were captured from trainees (n=11). Service user and trainee data were analysed separately using thematic analysis. Themes generated for trainees were also mapped on to a competency framework for clinical psychologists.

Both parties found the teaching beneficial. Service users enjoyed supporting trainees and engaged positively in their roles. They identified relational aspects and reflections on their own therapy as other benefits. Trainees reported enhanced clinical preparedness, critical and personal reflection. Trainee anxiety was evident. Learning mapped well to competency frameworks.

The samples were small and some data truncated. Findings speak to broader issues and may transfer to other involvement contexts.

A good degree of meaningful involvement can be achieved through such initiatives, to mutual benefit and enhanced learning.

Nature of the exercise and dual-aspect approach to evaluation described here helps to minimise tokenism. The mapping of findings to competency frameworks supports evaluative processes and helps to legitimise involvement initiatives that challenge the boundaries of existing practice.