Sexual Medicine and Medical Collaboration · Capstone

The Formulation You Would Have Written

You write the formulation first, with only what the client offered. Then you are shown the history nobody took, and you write it again.

What this exercise practises

Noticing diagnostic overshadowing from the inside, applying Table 10A to a client in whom two presentation patterns are present at once, and writing a record that meets the documented screening standard without deferring the formulation entirely.

The order matters and it is deliberate. You commit before you are shown anything, because that is the condition under which the error actually occurs. Your first formulation is shown back to you twice.

Estimated time to complete this exercise: 30 minutes

1Your formulation
2The history
3Rewrite
4The file
5Close

Before you begin

How this one works

You write first. The case is presented as the client presents it, and you write the formulation you would offer after that session, before you are shown anything else.
Then you are shown the history nobody took, and you decide which of those findings changes what you wrote.
Then you write it again, and finally you choose what goes in the file.
The writing is required to continue and it stays in your browser. Nothing is graded and nothing is recorded. Reloading starts it again.

Mental health settings carry an implicit framing: clients come because they have psychological needs. The framing is often accurate, and it creates a systematic risk at the intersection where sexual dysfunction sits. This exercise asks you to commit to a formulation before you have the information, because that is the condition under which the error actually occurs.

References

  1. Balon, R. (2006). SSRI-associated sexual dysfunction. American Journal of Psychiatry, 163(9), 1504–1509. https://doi.org/10.1176/ajp.2006.163.9.1504
  2. Basson, R., Wierman, M. E., van Lankveld, J., & Brotto, L. (2010). Summary of the recommendations on sexual dysfunctions in women. The Journal of Sexual Medicine, 7(1), 314–326. https://doi.org/10.1111/j.1743-6109.2009.01617.x
  3. Clayton, A. H., Pradko, J. F., Croft, H. A., Montano, C. B., Leadbetter, R. A., Bolden-Watson, C., Bass, K. I., Donahue, R. M. J., Jamerson, B. D., & Metz, A. (2002). Prevalence of sexual dysfunction among newer antidepressants. The Journal of Clinical Psychiatry, 63(4), 357–366. https://doi.org/10.4088/jcp.v63n0414
  4. Jackson, G., Boon, N., Eardley, I., Kirby, M., Dean, J., Hackett, G., Montorsi, P., Montorsi, F., Vlachopoulos, C., Kloner, R., Sharlip, I., & Miner, M. (2010). Erectile dysfunction and coronary artery disease prediction: Evidence-based guidance and consensus. International Journal of Clinical Practice, 64(7), 848–857. https://doi.org/10.1111/j.1742-1241.2010.02410.x