Family Functional Formulations as Guides to Psychological Treatment

Abstract

This paper proposes that clinical practice based on psychiatric diagnoses and categories of harmful behavior may be inadequate at best and harmful at worst. An alternative model of functional family formulations is proposed based on exposure to danger, developmental processes around danger, information processing regarding danger, and strategies for coping with danger. These are encompassed by the dynamic-maturational model of attachment and adaptation (DMM). DMM theory is outlined, then four types of harmful behavior that have resisted treatment are described, each with a case and treatment outcomes: physical abuse, disruptive child behavior, psychosis, and autism. We conclude by describing how these four cases address both children’s and parents’ need for safety and developmental progress in representing and responding to threats, and also professionals’ need for a treatment-relevant nosology of human suffering.