Formulating can inform inquiry
• Tentative inquiries around themes supporting formulations
• Prioritise vicious and virtuous cycles rather than underneath explanations

As clinicians we are trained to develop formulations, hypothetical understandings of the elements in the person’s presentation and story which makes sense of it. When these are fed back to the person the experience that sense can be made of their story can be containing and they can feel confidence in the clinician who is able to understand and make sense of all this. These formulations can be offered as a question. For instance:

“Do you think the abuse you experienced as a child has hampered the learning you were able to do around identifying appropriate boundaries between a stepfather and a young child?”

is offered as a question with the potential of being accepted or not. But using the hypothetical theme underlying the explanation to form a question is more likely to bring forward the person’s knowledge, and with it a sense of agency and more potential for movement:

“How do you think the experience you have had of sexual abuse affects the parenting that you do?”

This needs to be made genuinely as an inquiry with an attitude of discovery and openness to hearing the answer.

From a social constructionist epistemology there is less interest in ‘underneath’ explanations than in active systemic processes. There is a range of possible formulations, rather than a right explanation. Formulations, as with diagnostic labels, can be evaluated by their effect and usefulness, rather than ‘truth’. Vicious and virtuous cycles can be helpful ideas as they imply multiple openings for small steps effecting significant change.