7 - Formulation and diagnosis

Summary

A formulation is an attempt to understand an individual’s predicament. In contrast, a psychiatric diagnosis is a way of categorising difficulties.Making a formulation or diagnosis is not a straightforward task, especially given differences of culture and power.It is helpful to think of both as constructed narratives.

With people seeking asylum, both present specific benefits, disadvantages and challenges.They can powerfully affect the person themselves, determine what help is offered and influence third parties, such as asylum decision-makers. A helpful approach to formulation and diagnosis depends on the therapeutic relationship and the clinician’s skill in working with differences in culture and power. Clinicians need tobear in mind how formulations and diagnoses depend on the quality of assessment and the cultural context in which they are embedded.

Formulations for people seeking asylum need to pay particular attention to culture, family, and physical health, and to the impact of the asylum process, of being a refugee, and of discrimination. Diagnoses should be made only after discussing formulation and considering the potential additional impacts of a diagnosis.