Psychodynamic formulation

In plain words

A formulation is a clinician's working explanation of why this person is struggling in this way now. It is short and tentative. It names a few central conflicts, says how they probably formed, and predicts how they will appear in treatment. It is not a diagnosis. A diagnosis says what category a problem belongs to; a formulation tries to say why it is this person's.

Where the idea comes from

The most-cited statement is a 1987 paper in the American Journal of Psychiatry by S. Perry, A. M. Cooper and R. Michels, "The psychodynamic formulation: its purpose, structure, and clinical application". Its abstract describes a brief written formulation that identifies core conflicts, anticipates transference and resistance, and can guide any psychiatric treatment. The approach first places the presenting problem within the patient's life and notes non-dynamic factors that contribute to it. It then explains how the core conflicts developed and how they repeatedly shape the patient's behaviour, and describes how they are likely to show up in treatment. The paper gives three sample formulations.

The Psychodynamic Diagnostic Manual (PDM) is a related attempt at a systematic framework, designed to complement the DSM and ICD and not to replace them. According to Wikipedia, the second edition (PDM-2, Guilford Press, 2017) was edited by Vittorio Lingiardi and Nancy McWilliams, and a third edition (PDM-3) was published on 6 January 2026. It uses three axes: personality syndromes (P), profiles of mental functioning (M) and symptom patterns (S).

How it shows up

A formulation turns a long history into a few connected sentences: what the person wants, what they fear, what they do about it, and the situation in which the pattern costs them. It changes as the clinician learns more, and a good one is revised in the room. Clinicians use repetition and defences as building blocks.

TwentyThird produces readings and a written report from what a member shares; it says what it noticed in plain words and gives a clinical term second. It is not a psychodynamic formulation. A formulation is a clinician's judgement, made with the person, and the report is meant to be taken to a clinician. Oneli, the AI agent, does not formulate or diagnose. See what psychodynamic AI is.

What it is not

It is not a diagnosis, a prediction or a test result. It is a hypothesis held by one clinician, and a different clinician may reach a different one. Evidence on how reliable formulations are was not reviewed for this entry. The Wikipedia article on the PDM carries a notice that parts of its taxonomy section may be outdated, so check the current edition before citing details.