Diagnostic Formulation Lesson Plan Formulation Focus
Clinical Instruction Lesson Plan
Session Duration
45 Minutes
Learning Objective
By the end of this 45-minute session, adult learners will be able to identify the key components of psychiatric diagnostic formulation, organize patient information systematically, and apply the 5Ps framework to structure a coherent, biopsychosocial clinical case analysis.
Why This Matters
Diagnostic formulation equips practitioners with a structured approach to assessment and treatment planning, enhancing diagnostic accuracy and fostering individualized clinical decision-making in real-world psychiatric settings.
Quick Specs
Audience MH Practitioners & Trainees
Approach Mini-lecture, Guided Analysis, Hands-on Practice
Required Materials
Framework Slide Deck
Case Vignette Handout
Formulation Worksheet
Instructor Preparation
Estimated Time: 10 Minutes
Review the Framework Slide Deck to ensure familiarity with formulation components.
Preview the Case Vignette Handout and anticipate clinical discussion points.
Print copies of the Formulation Worksheet and Case Vignette Handout for all participants.
Ensure AV equipment is ready for slide presentation.
Delivery Guide Step-by-Step Instructions
5
Introduction & Objectives
Welcome participants and outline session goals.
Display objectives slide from Framework Slide Deck .
Clarify the practical relevance of formulation to diagnostic accuracy and treatment planning in clinical practice.
10
Framework Overview
Present core components (Symptoms, Predisposing, Precipitating, Perpetuating, Protective factors) using Framework Slide Deck .
Illustrate each component with brief, relatable clinical examples to build foundational knowledge.
10
Guided Group Example
Walk through Case Vignette 1 (David) from the handout.
Facilitate group identification of key factors: "What are the predisposing factors here?" "What triggered this presentation?"
Draft a collective formulation outline on a flipchart or shared screen to model the process.
15
Independent Application
Critical Path
Have participants analyze Case Vignette 2 (Aisha) independently.
Instruct participants to complete the Formulation Worksheet .
Circulate through the room to provide targeted support, answer clarifying questions, and observe clinical reasoning.
5
Debrief and Next Steps
Invite volunteers to share their formulations for Aisha.
Provide constructive feedback, highlighting nuances in biopsychosocial integration.
Summarize key takeaways and suggest Roy Grinker or Fonagy as further reading for advanced practice.
Framework Slide Deck Formulation Focus
A systematic approach to understanding patient presentations and guiding treatment planning.
Clinical Training Series
Learning Objectives
1
Identify the core components of diagnostic formulation.
2
Apply the 5Ps framework to structure clinical case analysis.
3
Integrate biopsychosocial factors into treatment planning.
What is a Diagnostic Formulation?
A narrative synthesis of a patient's presenting symptoms, history, and contextual factors.
Clinical Reasoning
Individualized Care Planning
Professional Communication
The 5Ps Formulation Framework
1
Presenting Symptoms
Key signs, severity, and timeline of the current issue.
2
Predisposing Factors
Long-term vulnerabilities (genetics, childhood experiences).
3
Precipitating Factors
Triggers leading directly to the current presentation.
4
Perpetuating Factors
Factors maintaining or exacerbating the problem.
5
Protective Factors
Personal and environmental strengths and supports.
Case Study
Example: Maria, 30
Symptoms
Recurrent panic attacks
Predisposing
Family history of anxiety
Precipitating
Recent job loss, financial stress
Perpetuating
Avoidance of public spaces, lack of coping skills
Protective
Strong social support, high motivation
Guided Case Walkthrough
Review Case Vignette 1 (David)
Identify each of the 5Ps as a group
Draft a collective formulation outline
Independent Application
Analyze Case Vignette 2 (Aisha) and complete your Formulation Worksheet .
15 Minutes
Biopsychosocial focus
Next Steps & Resources
Takeaways
Practice with diverse clinical cases
Debrief formulations with peers
Further Reading
Case Vignette Handout Clinical Case Vignettes
Psychiatric Diagnostic Formulation Practice
Guided Analysis
Case 1: David
34-year-old Software Engineer
Presentation
David presents with a 3-month history of low mood and fatigue. He reports difficulty falling asleep and early morning awakening. Once sociable, he has withdrawn from friends and stopped attending weekend soccer games. At work, he struggles with concentration and has missed two project deadlines. He describes feeling “worthless” and guilty about letting his team down.
Depressed mood daily
Anhedonia (soccer/friends)
Poor appetite (8lb weight loss)
Sleep disturbance
Background
Family history of depression (mother). Raised by single parent; experienced financial hardship in adolescence. Recent painful separation from long-term partner 2 months ago.
Supports
Remains close to his younger sister, who is highly supportive. Expresses strong motivation to return to previous level of work performance.
Independent Task
Case 2: Aisha
27-year-old Graduate Student
Presentation
Aisha reports recurrent panic attacks over the past 6 weeks. Attacks occur unexpectedly but often when anticipating driving on the freeway. During attacks, she experiences heart palpitations, breathlessness, trembling, and an intense fear of losing control. She now avoids her car and takes public transit, though she feels uneasy in crowded buses.
Attacks 2–3 times/week
10–15 min duration
Situational avoidance (driving)
Occupational disruption
Background
Family history of GAD (father). History of bullying in high school causing social withdrawal. Recently moved to a new city for a doctoral program.
Supports
Strong relationship with peer mentor. Practices regular yoga which helps reduce general tension.
Action Required
Complete Formulation Worksheet
Use these vignettes to practice applying the 5Ps framework: Presenting, Predisposing, Precipitating, Perpetuating, and Protective factors.
Formulation Worksheet Practitioner:
Date:
Formulation Worksheet
5Ps Diagnostic Framework
Instructions: Using Case Vignette 2 (Aisha) , complete the sections below. Focus on conciseness and the integration of biopsychosocial factors.
1 Presenting Symptoms
(List key signs, severity, and clinical timeline.)
2 Predisposing
(Genetics, early life, developmental history.)
3 Precipitating
(Recent stressors or triggering events.)
4 Perpetuating
(Factors maintaining or worsening symptoms.)
5 Protective
(Strengths, coping skills, and supports.)
Narrative Formulation Summary
(Integrate the above 5Ps into a coherent narrative synthesis of the patient's presentation.)
Clinical Training Tool | Formulation Focus
