Psychodynamic formulation, consensual response method, and interpersonal problems

We describe a new method for aggregating psychodynamic formulations of independent clinicians. 15 patients (10 female and 5 male, aged 23-41) were interviewed before they began brief dynamic psychotherapy. Different panels of 8 formulators (drawn from a pool of 72 psychodynamic clinicians with 10-38 years of clinical experience) observed each videotaped interview and wrote individual formulations. The text of each formulation was divided into thought-units, and thought-units that occurred 3 or more times were combined into a final consensual formulation. (One case was formulated twice to demonstrate the replicability of the method). Other clinical raters then read each consensual formulation and judged, for a list of interpersonal problems, whether each problem was apt to be distressing for that patient. The raters were very successful in predicting which problems were later discussed in treatment. Predictions were best for formulations with a high proportion of interpersonal content.