Case formulation with offenders: What, who, where, when, why and how?

Abstract

The catalyst for this themed issue on case formulation was the 2012/2013 implementation of the UK government’s ‘next phase of strategic development for offenders with severe personality disorder in England and Wales’. The immediate previous ‘phase’ had been the dangerous and severe personality disorder programme. The new phase unites the National Health Service and the National Offender Management Service in a coordinated approach to developing an Offender Personality Disorder Pathway (Joseph and Benefield, 2012). Case formulation is, perhaps, the pivotal feature of this pathway. Formulation is not a new concept. In clinical psychology, it was born out of the evolution of the scientist-practitioner model in the 1950s. In this, clinical psychologists apply scientific methods to understand people’s problems and generate hypotheses about what might bring about change in them. For decades, psychiatric texts have also carried descriptions of formulation and guidance on how to do it. It is embedded as a core ‘intended learning outcome’ in the competency-based curriculum for specialist training in general and forensic psychiatry (Royal College of Psychiatrists, 2010). The innovation is that practitioners from non-clinical disciplines will be expected to engage in the process, too, and across service boundaries. Formulation skills must, therefore, be sufficiently robust to support people from very different backgrounds and philosophies and their patient/client in reaching a mutually acceptable, structured narrative about the offender’s problems, which leads logically to effective planning of supervision, care and treatment throughout his/her pathway. Our aim in this issue is to explore the concept of formulation in this context, the nature and quality of systemised approaches to it and to consider evidence on its effectiveness. One would expect it to be a straightforward matter to define case formulation, at least in clinical practice, but it is not. The British Psychological Society (2011), in its good practice guidelines for case formulation, states: ‘There is no