Understanding the story of an addiction

The psychological formulation is a key strategic tool in the psychologist’s armoury, which helps us to write the ultimate story of an individual’s addiction. How and when it started, the contributing background factors, what triggers it, what keeps it going. A picture of the entire process, laid out clearly and simply so both the therapist and the individual being treated can understand exactly what’s going on.

It’s a way to make sense of things, but unlike a typical ‘diagnosis’, it takes into account everything in an individual’s life, and makes sense of the addiction within this context. So the formulation might include key situations and life events, upbringing, working life, relationships, family, social life, financial situation, living situation… in fact, everything that could be a contributing factor to the development of the addiction.

Importantly, as well as the facts, the formulation also explores the impact of these various factors on the individual, and the personal meaning given to the different elements of the story. These help the therapist and individual to reach a true understanding of what’s really going on – and the fullest, most complete story possible.

Visualising the story

In order to create this clear but detailed story, a number of different templates can be used, (see the example shown), however they all cover similar basic categories of information and show how these connect together. At their simplest, most will explore the following key areas, although other areas may also be explored as appropriate:

• How the individual feels at the moment – their emotional state, general mood, specific feelings and how they react to things
• What’s going on in their life right now – their current work and life situation, their family, friends and relationships
• When and how the addiction started – the initial trigger(s) or situation(s) that seemed to kick things off in the first place, or how the addiction developed
• What keeps the addiction going – the triggers and drivers that fuel the cycle of addiction and sustain it
• The key experiences, relationships and situations in their life – the background context and factors which may have contributed to the addiction developing
• What these experiences, relationships and situations mean to them – their personal interpretation of the meaning of these factors, and their impact on the individual’s life

Intervening to create change

Once the process has been articulated and summarised, it becomes clear where we can intervene to create change. The aim is to disrupt the negative cycle of emotions, thoughts and behaviours experienced in addiction, transforming it into a positive cycle of healthy responses.

For example, destructive thinking patterns and behaviours which fuel the cycle of addiction can be combatted successfully using Cognitive Behavioural Therapy (CBT) and related techniques such as Acceptance and Commitment Therapy (ACT).
Using the formulation as a guide, the individual and therapist will together agree specific therapeutic interventions which work in conjunction with each other. It’s a many-pronged attack on the very mechanisms that fuel the addiction – ultimately leading to a transformation into healthy thinking patterns and behaviours.

A tool used throughout treatment

The formulation is first created during the initial assessment sessions, as the individual and therapist together explore the situation in detail and uncover the full picture. This story then provides a starting point for therapy.

As treatment progresses the therapist and individual may together review the formulation and add more detail, as more information becomes available, as circumstances change, or as the individual finds out more about themselves during treatment. Just as life moves on for the individual, the formulation is an ever evolving storyline which is used to guide the therapy throughout.