‘Like walking with someone as opposed to trying to catch up to them’—Dynamics at play when clinicians and young people formulate together

Objective: The aim of the present study was to explore the social process of formulation in talk therapy between young people and clinicians. Design: Qualitative semi-structured interview study. Method: Ten young people (male=6, female=4, age range=16–23 years) and nine clinicians from various disciplines within a youth mental health service were interviewed. Constructivist grounded theory was used for the analysis. Results: Four themes were constructed from the data; a ‘level playing field’ between young person and clinician enables formulation, formulating is a constant process of getting it right and getting it wrong, emotional expression and attunement get us closer to each other and to understanding, and ‘formulation versus diagnosis’ can create tension in the therapy room. The constructivist grounded theory devised demonstrated how the dynamics of power, collaboration, openness, and the therapeutic relationship are constantly in flux during the process of formulation. Conclusion: The paper presents a constructivist grounded theory which incorporates dynamics relating to power, collaboration, and openness. The importance of the therapeutic relationship is also emphasised. The theory encourages continuous and recursive personal reflection by the therapist Practitioner points • Dynamics of power, collaboration, and openness inform the social process of formulation. • The therapeutic relationship acts as a ‘tuning fork’, honing in on the needs of the young person. • Model proposed has scope for use as reflective practice tool in supervision spaces.