Jason just had one more outburst and smashed his hand through a window. He pushed one of the other boys. This is his third violent event this week. What should we do? How should we respond? What is most likely to help Jason reduce his dangerous behaviors?
Our treatment will be most effective and powerful if it is guided by a careful formulation. The formulation is the foundation of the treatment. It expresses how we understand Jason’s behavior. What has gone wrong in his life? What problems are his behaviors solving for him? What beliefs and skills does he need in order to solve his problems in less dangerous ways
To create a formulation, we examine:
- The child’s history and experiences
- Materials from other treaters and adults
- History from family
- Program assessments
- The child’s ideas
- The family’s ideas
- What has happened to him?
- What has he learned about other people?
- What biological changes has he experienced?
- What skills has he learned to survive?
- What skills does he need to learn?
The formulation connects the child’s past with his present behavior through a theoretical model of how inherited tendencies combine with experience to shape the person.
By considering the formulation, the team can see what the goals are: what changes will have to happen for the child to move to a lower level of care? What skills need to be learned? How will success look?
Jason never knew his biological father. He grew up observing men be violent towards his mother. His mother’s visits have recently become less frequent and currently her whereabouts are unknown. He has been in three foster homes, and in one he was abused by an older foster brother.
We can formulate that Jason has learned not to trust others, and that people, especially men, hurt you. Also, that he is feeeling scared and sad but has learned to fear vulnerability, and turn towards violence for power.
What does this formulation suggest we should do to help Jason? How do we work on trust and legitimate power?
More in upcoming posts… meanwhile click here to down load a guide to formulation for clinicians.
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