The role of psychological formulation in inpatient settings in supporting staff empathy and therapeutic optimism for adults diagnosed with borderline personality disorder: A pre- and post-vignette study

Abstract

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.

Method

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.

Results

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.

Conclusion

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.