Co-construct a formulation with the patient — CASC communication station

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in outpatient clinic. [1]

Candidate instructions. The person asks why they feel this way. Collaboratively develop a simple formulation using predisposing, precipitating, perpetuating, and protective factors across biological, psychological, and social domains. Use plain language. Include strengths. Explore cultural or personal meaning of the illness. Agree a shared plan (biological, psychological, social, safety). Avoid blame and jargon piles. Check understanding and invite corrections. [1][2][3]

Candidate scenario

Your patient is 26, with 3 months of low mood, panic attacks on public transport, and incomplete university attendance after a humiliating presentation. They drink four standard drinks most nights “to switch off”. They describe an anxious childhood and a father who called them weak. They identify as belonging to a minority cultural community and worry the family will see mental health care as shameful. They still have a close cousin and want to finish their degree. No active suicide plan; passive thoughts when panic peaks. [1][4]

Marking domains

• Empathy, collaborative stance, jargon control
• Elicits patient’s explanatory model (“what do you think is going on?”)
• Structures 4Ps clearly in accessible language
• Touches biological (sleep/alcohol), psychological (self-criticism/avoidance), social/family/cultural meaning
• Names at least one protective factor (cousin, degree goal)
• Links each major plan item to the formulation
• Safety: explores suicidal thoughts; agrees safety net without over- or under-reacting
• Invites correction; summarises shared understanding [1][3][4][5]

Common fails

Lecturing a textbook BPS list without collaboration; blaming the father as the entire story; ignoring culture/shame; no protective factors; no link from formulation to plan; skipping risk; drowning the patient in jargon (schemas, EE, diathesis-stress) without translation. [1][4]