Clinical formulations and the person-centered approach


Following on from last week’s post:


The second part of this for me was about clinical formations and how I think they have something to teach us as person-centered practitioners. For a long time I have had issue with the ‘processes’ that we have a tendency to use in the person-centered world- ‘fragile process’; ‘dissociative process’ ‘psychotic process’ (other processes incoming) and my issue is as to whether it’s inherently any better to say someone has ‘autistic process’ than it is to say they have ‘autism’, or ‘dissociative process’ rather than that they dissociate, or whether ‘dissociative process’ is a better way of describing than a client’s own potential label of ‘I’m a multiple’.


In all the process definitions I have most often seen them referred to as something someone has, rather than a way in which we do something. That for me feels as stigmatising as sticking with the diagnostic codes in the DSM. When people start saying they have ‘fragile process’ in the same way that they might have said they have ‘borderline personality disorder’ or ’emotionally unstable personality disorder’, are we missing a point? Are we in some way finding a new way to diagnose someone? As a trainee, I hear these as absolutes a lot, rather than any kind of ‘in process’ thing. It’s labelled as ‘difficult process’ in the person-centered world, and I have to wonder: ‘difficult for whom?’ Undoubtedly society is set up so that these processes probably often ARE difficult to the client, but is it also that they are difficult for ‘us’?


Clinical psychology with its use of formulations (as explained in the book) seem like a good way to get to ‘why’ things happen, and I would suggest that for the most part, things don’t happen because someone has ‘fragile process’, they happen because someone experienced some early trauma that contributed to the resulting action that we now see. What would be more helpful to the client:


You have dissociative process?


Because you dissociate.

Why do I dissociate?

Because you have dissociative process


(The above by the way, is the example Lucy gives, only using standard DSM diagnoses, in the book). Or

You dissociate


What has happened to you in your life?



I wonder if we have become too keen to label our clients as having some ‘processes’ and whether that actually gets in the way of relating to our clients, and whether it would be better to put those aside also.

One thought on “Clinical formulations and the person-centered approach

  1. Paul Colley says:

    Always thought it was labelling by any other name. This post is an awesome ’emperor’s new clothes’ moment and I hope it is appreciated as such.

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