Formulation, conversation and therapeutic engagement.
OBJECTIVE
The aim of this study was to review psychodynamic formulation with respect to the language used and the evidence it provides about variations of clinical purpose.


METHODS
The purpose of the psychodynamic formulation is considered in training and clinical contexts. Three formulations are presented: two written from alternative theoretical perspectives and one designed to be spoken to the patient. Linguistic comparisons are made using these examples, emphasizing differences in grammatical complexity, lexical density ('wordiness') and other qualities.


RESULTS
The essential purpose of psychodynamic formulation is to develop an understanding that can be shared in the service of effective care. Significant differences were found between written and spoken versions with greater grammatical complexity and lower lexical density in the spoken form. An intrapsychic theoretical model was more grammatically complex and 'noun-based' compared to an inter-subjective model. Other differences are also described, including the tendency for the intrapsychic account to efface the sense of personal agency. This contributes to the impression of a subject under the influence of 'unseen' forces.


CONCLUSIONS
The communicability of psychodynamic formulation is essential to its utility in clinical practice.
Korner
Anthony
A
Master of Medicine (Psychotherapy) Program, University of Sydney, Sydney, NSW, Australia. Anthony_korner@wsahs.nsw.gov.au
Bendit
Nicholas
N
Ptok
Ursula
U
Tuckwell
Kathryn
K
Butt
David
D
D000328:Adult; D003142:Communication; D004532:Ego; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008016:Life Change Events; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D009769:Object Attachment; D010347:Patient Care Planning; D010552:Personality Assessment; D010817:Physician-Patient Relations; D011570:Psychiatry / Q000193:education*; D011574:Psychoanalytic Theory; D011575:Psychoanalytic Therapy / Q000193:education* / Q000379:methods*; D011578:Psycholinguistics; D014473:Unconscious, Psychology; D014705:Verbal Behavior; D014956:Writing