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Causes of Depression & Anxiety

Have you ever wondered what goes on in a psychologist’s mind during the first few sessions of psychological therapy

Today I would like to share with you what goes on in my mind when meeting with you for the first time, and how this is related to working out together the causes of your depression, anxiety, or any other psychological difficulty.

I drawn on a skill which I have studied, practised, and fine-tuned over many years, and this clinical skill is called psychological formulation.

So what does this mean and what are we trying to psychologically formulate?

Psychological formulation is the process of making sense of your struggles and symptoms. It is about collaboratively finding a way forward  through your difficulties, and hopefully out of them as well. Your struggles maybe related to depression, stress, anxiety,  OCD, burnout, childhood trauma, unprocessed grief, post-traumatic stress, or in fact any other psychological difficulty.

In a nutshell, psychological formulation is a process of gathering and psychologically making sense of the information you share with me in the early sessions. This happens in a calm, curious, inquisitive, non-judgmental way, in which we create a thoughtful, reflective, and collaborative climate of inquiry.

It is a little bit like explorers going on a journey together, a journey into your inner world.

I see you, without a doubt, as the expert of your life, that you begin to share with me – and I am beginning to learn about. I am guiding the process by bringing my psychological understanding and expertise to the table. So we both bring very valuable, yet very different ingredients to the process.

When I am sitting with you, I listen deeply and also ask some questions so that we can begin to locate and understand your difficulties within the context of your whole life: your current difficulties and life situation, childhood experiences, possibly childhood trauma and important life events.

I am also listening to the kind of ‘filter’ and ‘psychological lense’ through which you have been experiencing, processing, and making sense of your life’s challenges. This ‘psychological lens’ is really important – it points to underlying patterns of thinking, emotional responses, belief systems, perceptions, and attitudes that tend to operate below the level of awareness in the realm of our unconscious minds.

These underlying patterns of thinking and responses, perceptions, and attitudes are often below the threshold of our conscious mind and tend to be strongly linked to our emotional and psychological difficulties. And it is part of the psychological work to bring these into the realm of consciousness for reflection and possible change.

So, the Psychological Formulation is a bit like putting together a complex puzzle. In this way, we are collaboratively exploring and putting together an understanding of the causes of your emotional and psychological struggles and difficulties.

In summary, the process of psychological formulation serves not only to collaboratively make sense of the causes of your emotional difficulties, but it also informs and guides the way forward into the therapeutic process.

The therapeutic process is initially aimed at symptom relief, which is most often followed and accompanied by increased self-awareness, self-understanding, and improved emotional regulation and resilience.

In this sense, the process of psychological formulation is very different to being given a diagnosis such as anxiety disorder or depression or any other diagnosis. In contrast to diagnosis, a psychological formulation is individual, personal and collaborative – it is a process of making sense of your difficulties and vulnerabilities, but also identifying your strengths and resources that you bring to the process.

I hope this is helpful.

Kirsten Heynisch


I have trained and worked as a Clinical Psychologist and Psychotherapist for over 25 years, and specialise in Depression Therapy, PTSD counselling, Group Therapy, and BPD Therapy.

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