Psychological Formulation as an Alternative to Psychiatric Diagnosis

  • Lucy Johnstone
  • Journal of Humanistic Psychology, July 2017, SAGE Publications
  • DOI: 10.1177/0022167817722230

Personal stories about people's distress as a replacement for psychiatric diagnosis.

What is it about?

In the UK, psychological formulation is a widely used addition to, or sometimes alternative to, psychiatric diagnosis. Clinical psychologists are trained to combine their knowledge of the evidence and their clinical experience with their clients' accounts of the events of their lives and the impact they had. This becomes a jointly constructed best guess, or hypothesis, about the reasons for their distress. It helps to suggest the way forward, and is re-visited throughout the intervention.

Why is it important?

Psychiatric diagnosis is coming under increasing criticism for lack of reliability and validity. Formulation is practised in many parts of the UK mental health system, both one to one and in helping teams to understand their patients' difficulties. Many UK clinical psychologists do not use diagnosis at all, and argue that this structured way of developing an evidence-based personal story is a far better guide to recovery.


Lucy Johnstone

I am the leading UK writer, practitioner and trainer in psychological formulation, author of the standard textbook 'Formulation in psychology and psychotherapy', lead author of the Division of Clinical Psychology Good Practice Guidelines in formulation, and a national and international trainer.

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The following have contributed to this page: Lucy Johnstone