ANT Formulation Guide

PROBLEM/S:   Understandings of the problem/s, ideas about cause focus of the problems, who is identified as having the problems, diagnosis – family , school, extended family, professional services…
PREDISPOSING:  Background and history,  Dangers (traumas and losses) , attachment strategies of parents/carers/children (Facts and defensive processes in how facts are narrated)  Financial, racial, gender related dangers
PRECIPITATING: Key events that are seen as triggering the difficulties, dangers, losses,  separations, transitions, illnesses etc
PRPOTECTIVE:  Corrective script/positive intentions, sources of support, skills ,/abilities, resources
PERPETUATING:  relational dynamics maintaining the problems,  core circularities( specific episodes and overall dynamics
INTEGRATIVE FORMULATION:  How the 5 Ps can be integrated to an overall dynamic of how  the problems are being maintained by current attachment/systemic dynamics

EXAMPLE: Jane and family 

PROBLEM/S:   Understandings of the problem/s in different contexts ( home, school etc) ,  ideas about causes,  focus of the problems -  who is identified as having the problems, diagnosis – family , school, extended family, professional services…	Jane thinks her children Freda and Carl  are suffering with anxiety and bereavement problems School thinks Jane’s anxiety about death of their neighbour is ‘rubbing off’ on the children
PREDISPOSING:  Background and history,  Dangers (traumas and losses) , attachment strategies of parents/carers/children (Facts and defensive processes in how facts are narrated)  Financial, racial, gender related dangers	Janes’  own attachment history  is of a ‘harsh critical mother’ , she had to be independent – a  De-activating self- protective strategy History of her neighbour being depressed and suicidal Husband ( Matt)  working long hours, Jane managing the children, suffered with fibro - myalgia
PRECIPITATING: Key events that are seen as triggering the difficulties, dangers, losses,  separations, transitions, illnesses etc	2 years previously  neighbour  (Stan) who was an older family friend committed suicide 6 months after his wife left him. Jane discovered his body and had to shortly go to the scene again to identify him when police arrived.
PRPOTECTIVE:  Corrective script/positive intentions, sources of support, skills ,/abilities, resources	Corrective scripts – Jane wants to be  a more emotionally available, warm and supportive mother than her own mother. Describes her marriage as close and supportive. School described as supportive
PERPETUATING:  relational dynamics maintaining the problems,  core circularities( specific episodes and overall dynamics	Jane and  Matt decided to tell the children neighbour died of cancer. But children  pick up mum’s anxiety (trauma)  when they ask about him and  consequently become more anxious.   In interactions with the children Jane become anxious/angry with them. Matt tells her to ‘chill out’  which make her feel unsupported and failing
INTEGRATIVE FORMULATION:  How the 5 Ps can be integrated to an overall dynamic of how  the problems are being maintained by current attachment/systemic dynamics	Jane’s  pre-dominant self - protective  attachment strategy is to avoid confrontation and difficult emotions if possible. So, she  minimises her own needs and attempts to dismiss her trauma and displaces it into concern for her children . But in turn the children’s display of anxiety  leads to her feeling a failure and blamed as a mum and therefore  seeking help for the children rather than herself. She also feels blamed by services which aggravates her sense of failure and further fosters the focus on the children. Attempts to minimise the problem  and ‘move on’ by Matt makes Jane feel she is at fault  and further pushes the problems as ‘in the children’

An Example:    Jean and her family 

The children were reported by mum to be highly anxious. Older boy had a diagnosis of autism. School observed that the children were not anxious at school and felt mum was projecting her anxiety on to them. There had been a suicide of an older neighbour that the family and parents were close to. His wife had left him 2 years ago and mum had been offering some support for him. She found him hanging in his shed. She said she had flash backs about this and wanted to protect the children who asked about the neighbour. She made up a story with her husband’s agreement that he had committed suicide. However, the children repeatedly asked, and she was finding it hard to maintain the story and also started to see the children as developing anxiety.   She wanted help for the children which was not forthcoming from CAMHS (because it was a bereavement issues) not from the bereavement services because there was deception about the loss. Her husband was said to be ‘laid back’ and felt she was making too much of all this. 

Her formulation:  the children are anxious and need treatment

School: Mum’s anxiety is rubbing off on the children

Our systemic/attachment formulation:  Mum’s distress is becoming aggravated by being in a continual, position of having to engage in deception with the children. They are picking up that ‘something is not right’ and so keep asking for more information. The school seeing mum as the cause and her husband as her making ‘too much’ of things is aggravating her trauma. Her ow parents are ‘strict’ and she feels do not support her apart from with practical help.