On Formulating Clinical Fact to a Patient

This paper approaches the issue of formulation to the patient by examining the interpretations offered to one patient concerning her reactions to three analytic holiday breaks. Detailed material from several sessions is presented in the context of the author's attempt to try to understand how she arrived at what she said and understood and how the interchange with her patient developed. The author suggests that the material shows a gradual deepening both in her understanding and in her patient's insight into the patient's responses to being left; to recognising that her analyst was pursuing an independent life of her own; and to becoming aware of her unconscious beliefs about her analyst's unconscious motives for leaving. The author concludes that her method of arriving at formulations varied. Generally speaking, conceptualisation of clinical facts does precede formulation to the patient and is then succeeded by validation or non-validation. In one instance, however, formulation, guided perhaps by an unconscious hunch on the part of the analyst, preceded conceptualisation. This particular formulation also led to far-reaching and integrating interpretations. The implication is that there are several methods of arriving at valuable formulations of clinical fact, none of which should necessarily be privileged.