Long time friend, colleague and psychiatrist Mike McGee recently asked me to look over a paper he had just written titled, “Good Formulations Beget Good Outcomes - A Comprehensive, Collaborative, and Compassionate Framework for Helping Clients Heal and Recover.” Mike defined a Formulation as “a working hypothesis that explains the origin, development, and maintenance of a person’s distress and impairment in a way that informs how we help them. It is not a fixed conclusion—it is dynamic and evolves with new information.”
Like me, Mike enjoys creating alliterative, natty phrases if they have meaningful content. He developed a doozy of a one in his Formulation “C’s”: Clinicians Collaboratively and Curiously Co-creating a Comprehensive, Compassionate, Coherent, Chronicle of a Client’s life and their Current and past Conditions, Concerns, Capacities, and their Conception of a better life.
The excerpted tips in this blog focus primarily on the collaboration and co-creation aspects of this framework.
What does it look like to have "Clinicians Collaboratively” work with clients?
Collaboration is at the heart of our healing work with our patients. The spirit is one of partnership and respect, privileging what our patients want, their ideas about how to achieve what they want, and then helping them in any ways that we realistically can.
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We talk about negotiating goals and interventions. If a patient wants us to help them with their anger by working to find a way to murder their boss, we could not collaborate with them in either the goal or any methods we might come up with to achieve this goal.
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This is where the relationship becomes the touchstone of healing; we sit with our patients and their dilemmas as we try and find our way to shared goals and actions to achieve those goals.
An example
I recently had a patient who wanted me to give her Adderall for “ADHD” because she had “trouble getting going in the morning” after drinking roughly 6 drinks every night. She had recently been discharged from a withdrawal management facility, but did not see her alcohol use as a problem. The collaborative work with her was to sit with her in this tension with empathy and care as we worked to negotiate goals and interventions we could both feel good about.
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Another part of collaboration is to honor our patients as the experts in their lives.
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We are guides, and can offer perspective and information, and help patients brainstorm their options.
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I almost never give advice anymore, but will instead ask patients about what they know and what they think might help them. This almost always works.
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Rarely will I give suggestions. If I do, I will ask permission first. For example, if a patient is having trouble with insomnia, I might ask, “What do you know about sleep hygiene?” If they say they do not know about this, I might ask, “Would you like me to teach you about this, or give you a handout?”
What does it look like to be "Curiously Co-creating” with clients?
Our understanding of our patients arises from continuous, curious inquiry combined with reflection and confirmation. The formulation is not something we impose on our patients -- we co-create it with them. Our patients provide us with information and their own understandings, we offer our tentative understandings in return, and together we arrive at a shared understanding.
But “arrive” is not quite the correct word, as we never arrive.
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The formulation is always tentative and evolving.
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We must maintain clinical humility, knowing that our understanding of our patients is always incomplete, and often incorrect.
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I have been astounded over the years at how my understandings evolve and deepen over time, as new revelations occur, sometimes after years of work together!
So, the curious co-creation process is ongoing. It leads to deepening insight, awareness, understanding, coherence, and ultimately compassion and forgiveness. This is an important component of our healing work.
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Authored by Dr. David Mee-Lee, “Tips & Topics” is a monthly blog covering three sections: Savvy, Skills and Soul, with additional sections varying from month to month. Topics include Stump the Shrink, Success Stories and Shameless Selling.