How language shapes psychiatric case formulation
Issue: Vol 13 No. 1 (2016) Teamwork and Team Talk in Healthcare Delivery
Journal: Communication & Medicine
Subject Areas: Healthcare Communication Linguistics
DOI: 10.1558/cam.18978
Abstract:
The aim of this paper is to describe, analyse, and discuss the process of formulation in the specific context of mental health (MH). Formulation is a fundamental element of the work of psychiatrists and other MH clinicians that is expected to be mastered during training. The literature, however, shows that formulation is rarely explicitly addressed in the psychiatric curriculum; rather, it is implicitly developed through modelling, and/or clinical practice. This paper focuses on case formulation in one MH context in Australia. It tracks the iterative formulation of one patient in a hospital emergency department. The analysis uses resources from systemic functional linguistics (SFL) situated within a broader framework of discourse analysis. It highlights patterns of lexical relations and nominalisation as well as the range of conjunctions. These make explicit how the clinicians talk about the patient’s illness and shape their developing understanding into a logical formulation. We see applications of this work for the training of mental health professionals. These data make explicit the ways in which the participating clinicians use language in the process of formulation. By bringing this process to the level of consciousness, it can be discussed and evaluated and become a pedagogic resource.
Author: John Walsh, Nayia Cominos, Jon Jureidini
References :
Antaki, C., Barnes, R. and Leudar, I. (2005) Diagnostic formulations in psychotherapy. Discourse Studies 7 (6): 627–647. http://dx.doi.org/10.1177/1461445605055420
Beckwith, A. and Crichton, J. (2010) The negotiation of the problem statement in cognitive behavioural therapy. Communication & Medicine 7 (1): 23–32. http://dx.doi.org/10.1558/cam.v7i1.23
Cicourel, A. V. (1981) Notes on the integration of micro- and macro-levels of analysis. In A. V. Cicourel and K. D. Knorr-Cetina (eds) Advances in Social Theory and Methodology: Toward an Integration of Micro- and Macro-Sociologies, 58–80. London: Routledge & Kegan Paul.
Davis, K. (1986) The process of problem (re)formulation in psychotherapy. Sociology of Health and Illness 8 (1): 44–74. http://dx.doi.org/10.1111/1467-9566.ep11346469
Eggins, S. and Slade, D. (2004 [1997]) Analysing Casual Conversation. London: Equinox.
Fairclough, N. (2010) Critical Discourse Analysis: The Critical Study of Language. London: Longman. http://dx.doi.org/10.4324/9780203809068.ch1
Fernando, I., Cohen, M. and Henskens, F. (2012) Pattern-based formulation: A methodology for psychiatric case formulation. Australasian Psychiatry 20 (2): 121–126. http://dx.doi.org/10.1177/1039856212437255
Fitzgerald, P. E. and Leudar, I (2012) On the use of formulations in person-centred, solution-focused short-term psychotherapy. Communication & Medicine 9 (1): 13–22.
Hak, T. and de Boer, F. (1996) Formulations in first encounters. Journal of Pragmatics 25: 83–99. http://dx.doi.org/10.1016/0378-2166(94)00076-7
Halliday, M. A. K. and Matthiessen, C. M. I. M. (2014) Halliday’s Introduction to Functional Grammar. Fourth edition. London and New York: Routledge.
Luke, A. (2002) Beyond science and ideology critique: Developments in critical discourse analysis. Annual Review of Applied Linguistics 22: 96–110. http://dx.doi.org/10.1017/S0267190502000053
Royal Australian and New Zealand College of Psychiatrists. (2012) Formulation Guidelines for Candidates. Melbourne: Royal Australian and New Zealand College of Psychiatrists.
Sarangi, S. (2007) Editorial. The anatomy of interpretation: Coming to terms with the analyst’s paradox in professional discourse studies. Text & Talk 27 (5/6): 567–584. http://dx.doi.org/10.1515/cam.2007.001
Sim, K., Gwee, K. P. and Bateman, A. (2005) Case formulation in psychotherapy: Revitalizing its usefulness as a clinical tool. Academic Psychiatry 29 (3): 289–292. http://dx.doi.org/10.1176/appi.ap.29.3.289
Smith, G. C. (2014a) Revisiting formulation: Part 1. The tasks of formulation: Their rationale and philosophical basis. Australasian Psychiatry 22 (1): 23–27. http://dx.doi.org/10.1177/1039856213511671
Smith, G. C. (2014b) Revisiting formulation: Part 2. The task of addressing the concept of the unique individual: Remediating problems with formulation. Australasian Psychiatry 22 (1): 28–31. http://dx.doi.org/10.1177/1039856213511672
Walsh, J., Cominos, N. and Jureidini, J. (2016) Maintaining and generating knowledge in multidisciplinary mental health handovers. In S. Eggins (ed.) Effective Communication in Clinical Handover: Research and Practice, 245–264. Mouton de Gruyter: Berlin.