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What is a psychodynamic formulation? What do we need to know to construct one? What use is it in initial evaluations? In ongoing psychodynamic psychotherapy? In a range of treatment settings? In psychopharmacological treatment? And when and how do we communicate a formulation to a patient?
Constructing a psychodynamic formulation is a complex challenge. It requires the detailed articulation of a person's current complaints and strengths across a number of domains, as well as a broad knowledge of genetic endowments and the biological, psychological, and social tasks, dangers, and derailments typically encountered in each era of normal human development. It requires some notion of the epigenetic, hierarchical nature of development itself. It also requires a set of motivational theories of intrapsychic life within which to link past to present in order to generate hypotheses about the patient's intrapsychic life—to wit, how the person experiences the world and is motivated to act in it. Finally, it requires the skill of data collection in a psychodynamic setting. In other words, what makes a formulation psychodynamic are the dynamics of the formulating process itself, in which both empathic understanding and verbal reports are sources of information regarding the person's experience in navigating life. It is through this dynamic process that we can make reasonable inferences about unconscious thoughts and motives.
Deborah Cabaniss and her colleagues teach this complex integrative task in the psychodynamic psychotherapy curriculum for psychiatric residents at Columbia. Like its companion volume, Psychodynamic Psychotherapy: A Clinical Manual (Cabannis et al. 2011), Psychodynamic Formulation is a distillation of their course.