Watkin Felicity, Scott Helen, Richards Ruth
Staffordshire University, Stoke-on-Trent, UK.
North Staffordshire Combined Healthcare Trust, Stoke-on-Trent, UK.
J Psychiatr Ment Health Nurs. 2025 Feb;32(1):31-42. doi: 10.1111/jpm.13084. Epub 2024 Jul 16.
WHAT IS KNOWN ON THE SUBJECT?: Psychological formulation brings together a service user story and expertise, with psychological knowledge, research, and practitioners clinical experience to make sense of a service users' presentation (thinking about their difficulties but also strengths). Evidence into the effectiveness of formulation is largely anecdotal, qualitative, or small scale. Although this is very valuable research, there is not a lot of research which quantitatively evidences the role of formulation for service users or services. Quantitative evidence that does exist is also conflicting. Considering how widely psychological formulation is used, and the governing guidelines that recognize this as a core competency for psychological practitioners, it is important to continue to add to the evidence base. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Psychological formulation can increase staff empathy and hope. This could help service users to feel more understood and hopeful. Formulation; however, did not impact feelings of personal distress in staff. This research may suggest a need for the two distinct processes (i.e. team formulation and reflective practice) to support all components of empathy within inpatient services. Psychological formulation could support the provision of psychologically informed care within inpatient services, of which promotes effective care delivery.
OBJECTIVES: National Health Service (NHS) values, such as empathy and therapeutic optimism, are integral when supporting service users with complex mental health presentations. There is some evidence to suggest that psychological formulation can increase empathy and optimism in healthcare professionals. This study, therefore, aimed to investigate whether a psychological formulation of a hypothetical service user with a complex presentation, typically labelled with a diagnosis of borderline personality disorder (BPD), increased empathy and therapeutic optimism in professionals working in mental health inpatient services.
Sixty-six mental health professionals working in NHS inpatient services took part in a pre- and post-vignette study. Participants were asked to read a case vignette about a hypothetical service user, with a diagnostic label of BPD, and complete questionnaires capturing levels of empathy and therapeutic optimism. Participants were then randomized into two conditions and either asked to read the same information again (control condition) or read a psychological formulation based on the same hypothetical service user (intervention condition). The findings were analysed using a series of ANCOVAs/ANCOHETs.
Two constructs of empathy (i.e. perspective taking and empathic concern), and therapeutic optimism significantly increased following exposure to the psychological formulation when compared to the control group condition.
This study warrants further replication. These initial findings; however, indicate that psychological formulation can significantly increase the ability to perspective take, display empathic concern, and hold therapeutic optimism towards service users with a presentation associated with a diagnosis of BPD.
关于该主题已知的信息有哪些？心理构想将服务使用者的经历与专业知识、心理学知识、研究以及从业者的临床经验结合起来，以理解服务使用者的表现（既要考虑他们的困难，也要考虑他们的优势）。关于构想有效性的证据大多是轶事性的、定性的或小规模的。虽然这是非常有价值的研究，但定量证明构想对服务使用者或服务机构作用的研究并不多。现有的定量证据也相互矛盾。鉴于心理构想的应用如此广泛，且管理指南将其视为心理从业者的核心能力，继续扩充证据基础很重要。本文对现有知识的补充：心理构想可以增强工作人员的同理心和希望感。这有助于服务使用者感到更被理解和充满希望。然而，构想并未影响工作人员的个人困扰情绪。这项研究可能表明需要两个不同的过程（即团队构想和反思实践）来支持住院服务中同理心的所有要素。心理构想可以支持住院服务中提供有心理依据的护理，从而促进有效的护理服务。
目的：在为有复杂心理健康问题的服务使用者提供支持时，国民医疗服务体系（NHS）的价值观，如同理心和治疗性乐观态度，是不可或缺的。有证据表明心理构想可以增强医疗保健专业人员的同理心和乐观态度。因此，本研究旨在调查，对于一个表现复杂、通常被诊断为边缘型人格障碍（BPD）的假设服务使用者进行心理构想，是否会增强心理健康住院服务工作人员的同理心和治疗性乐观态度。
66名在NHS住院服务部门工作的心理健康专业人员参与了一项 vignette（案例描述）前后对照研究。参与者被要求阅读一份关于一个诊断为BPD的假设服务使用者的案例描述，并完成捕捉同理心和治疗性乐观态度水平的问卷。然后参与者被随机分为两组，一组被要求再次阅读相同信息（对照组），另一组被要求阅读基于同一假设服务使用者的心理构想（干预组）。研究结果使用一系列协方差分析/协方差齐性检验进行分析。
与对照组相比，在接触心理构想后，同理心的两个构成要素（即观点采择和共情关注）以及治疗性乐观态度显著增强。
本研究值得进一步重复验证。然而，这些初步研究结果表明，心理构想可以显著提高对表现与BPD诊断相关的服务使用者进行观点采择、表现共情关注以及持有治疗性乐观态度的能力。
