Formulation and treatment planning in complex cases involving a young person are particularly challenging because of the sheer volume of information available to us. The key question is how to make effective use of it all. My suggestion is that we extend the well-known 4P approach to take into account 4 more critically important areas. In my view, ‘4P + 4’ would enable us to reach much greater clarity on what to target, why and how in order to improve a young person’s situation.
For a long time now, good psychologists have been considering client issues with reference to the 4 Ps: predisposing factors, precipitating factors, perpetuating issues and protective factors. I believe that in complex cases involving young people, the 4Ps need to be developed further to take individual development, established evidence, bio-psycho-social approach and system politics into account.
Complex cases involving young people come in a whirlwind of politics, spent and burnt-out workers and a trail of services that, for whatever reason, have been unable to help. In fact, Taz the Tasmanian Devil, the animated cartoon character, comes to mind. He usually moves around in a whirlwind of chaos, but sometimes steps outside to watch from arm’s length. And that’s exactly what we need to do: step back in order to separate the actual presenting problem from the chaos in a complex case.
Complex cases involving young people can seem chaotic. There’s the trauma of their own experience; the multitude of variables introduced by the families, carers and agencies supporting them; and the confusion that can arise from interagency politics, policies and rules. It can be difficult to know where to start in formulation and treatment planning.I suggest taking a step back, like Taz. In my experience, what follows is the clarity that leads to formulation and treatment that are useful. Here’s what you should consider:
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