Description

Open University

TMA 04

The Assignment

Cut off date : 18^th March 2025

 

Task: Write a formulation report

In this TMA, you are asked to write a formulation report, drawing on a mindfulness approach, that aims to advise on an intervention strategy that would be applicable to the client in the case study.

Word limit: 2000 words

Case study

Lexie

You are working as a psychologist at an adult women’s prison and you have your first session with Lexie, a 26-year-old female offender who is serving a three-year sentence for supplying class A drugs. Her probation officer has referred her to you for therapy because she believes that Lexie could benefit from it. She would like you to assess Lexie’s suitability for therapy and provide a formulation report that demonstrates how it could help her to overcome her current difficulties. Lexie’s history and background Lexie told you that she had a difficult childhood. Her dad was an alcoholic who was often violent towards her mum, and towards her and her two younger brothers. When Lexie was six, things became so bad that they had to move out of the council house where they were living and into a refuge. Lexie didn’t see much of her dad after that, but things didn’t get much better as her mum had several boyfriends who were similar to her father. Her mum’s boyfriends also had unpredictable moods and resorted to verbal abuse or physical violence towards Lexie and the other children. Lexie said that she did not have a good relationship with her mum whom she felt did not have much time for her and her brothers. When Lexie was nine, Social Services placed all three children into care.

Lexie’s first foster family consisted of two parents who already had two children of their own who were both older than Lexie. Lexie stayed with them until she was 12, and this was described as a relatively stable and happy period of his life. She enjoyed school and she had a particularly good relationship with one female teacher. Unfortunately, the placement had to end as the foster family moved abroad and Lexie also had to move school and was in a children’s home for a short time.

The next foster placement was not successful as the new foster family struggled to care for Lexie as her behaviour became more difficult to control. Lexie described being treated like a servant and that she was forced to work for them all the time.

She was eventually placed with another set of foster carers who had experience of coping with children whose behaviour could be quite challenging but by the time Lexie was 15, she was back in a children’s home. Between the ages of 12 and 15 was an unstable period in Lexie’s life when she also became separated from her two brothers although she had occasional contact with her mother throughout this time. By this time her mother had another two children, both of whom were considered by Social Services to be at risk of neglect. Lexie told you that from these experiences in her childhood she learned not to trust other people, and that you must look after yourself because nobody else will.

Lexie didn’t do well at school; she often truanted and began hanging out with boys who were older than her, drinking alcohol and smoking weed. When Lexie was 16 she became pregnant and gave birth to a baby boy, Jordan. After she gave birth she moved out of the children’s home that she was living in with her son, and into a flat provided by the council. Although she had no ongoing intimate relationship with the father of her son, he stayed in touch with them and visited occasionally. Lexie described this as a major positive time in her life and she enjoyed being a mother to her son. However, the flat that Lexie moved to was in a different town and she became increasingly lonely. She began to miss the company provided by the people she used to hang out with. She started to try and find ways of being able to meet up with them again, placing her son with neighbours and friends whenever she could.

A couple of years later she met a man called Tony, who initially gave her a lot of attention. The relationship developed to the extent that Tony spent most evenings with her. Tony was involved in dealing and supplying drugs and Lexie became drawn into his work, which became quite lucrative, enabling them to drive a nice car and go abroad for their holidays; something that Lexie had never experienced before. Eventually Lexie was able to give up her flat and move into Tony’s house. Although she had some concerns about Tony’s extensive dealing and supplying network and the kind of people who would visit the house, she was able to dismiss these worries because of the better standard of living they were now having.

This all changed early one morning after a visit from the Drugs Squad. She and Tony were arrested for dealing and supplying class A drugs. Following an investigation, they were both prosecuted and each given lengthy prison sentences. Her son Jordan was placed in foster care.

Lexie’s current situation

She arrived at the prison three months ago and has found it difficult to settle and make friendships. Things got worse for Lexie after an incident in the kitchen when the fellow workers accused her of being lazy and gave her the more difficult jobs to do. She has also begun to take some drugs (e.g. ‘spice’) when she can get them, but she regrets it afterwards as they only provide temporary relief and in the long-term make her feel worse.

Lexie’s mood began to deteriorate on arrival at prison, and she reports the following symptoms:

• lack of energy and enthusiasm for previously enjoyable pursuits
• missing her son, feeling like a failure and hopeless about the future
• difficulty concentrating, particularly on jobs at the prison, and day-to-day decision-making
• constantly ruminating and feeling guilty about having abandoned her son
• avoiding socialising and talking to others.

Lexie is keen to find a way of overcoming her difficulties and wants to feel more accepting of what has happened in her life and where she finds herself now. She also wants to find some things she can do to change, and focus on preparing for her life outside prison in the future, particularly to become a good mother for her son, Jordan. For the purposes of this report there is no need to include any assessment of current risk and safety, as this has already been provided in a separate report.

Focus of the assignment

TMA 04 is intended to particularly assess your skills in drawing on the concepts and ideas of a particular therapeutic approach to make sense of a client’s problems, and your knowledge of theory and practice in this approach. For this assignment you have been asked to consider the client information from the case study above and write a formulation report for this client drawing on a mindfulness approach as covered in VLE Week 20 and Chapter 16. For this task, you do not need to consider DBT even though this is covered in Week 20 and in Chapter 16. You should focus instead on general mindfulness concepts.

The idea is for you to consider the information in the case study as though you were a therapist working with the client and apply your knowledge of a mindfulness approach to explain the presented problems and ways to work with them.

However, unlike a ‘real therapist’ you will obviously not have the opportunity to ask the client further questions, or gain further insights by observing their interaction in the therapy session. The task with this assignment is rather to use the limited information available in the case study and to construct the best formulation report you can, based on the information available.

You can interpret the information in the case study and infer assumptions.

It will generally be important to remember that there is not one ‘correct’ answer to this assignment but that your formulation report should provide a good fit between the client’s problems and the concepts and ideas you apply to them.

Structuring your report

As your formulation will provide a rationale for a psychotherapeutic intervention that is based on a mindfulness approach, it is recommended that you should structure your report around the following themes:

1. Short summary of Lexie’s presentation (up to 300 words)

You should start the formulation report by briefly summarising Lexie’s current problems, highlighting those that you think would be suitable for intervention. This section should be brief and not take more than 300 words.

2. Brief overview of mindfulness

You should briefly explain the underlying concepts of a mindfulness approach in counselling and how it relates to mental health with reference to relevant literature.

3. Possible causes for Lexie’s problems

Highlight what you think might be possible causes for Lexie’s problems from a mindfulness perspective. Draw on the mindfulness understanding of mental health difficulties that you learnt about in Chapter 16 such as the causes of suffering and consider how these could apply to Lexie’s case.

4. Factors maintaining Lexie’s problems

In this section, you should explain what you believe are the factors that maintain Lexie’s problems in light of mindfulness theory. In what ways does Lexie’s approach to her thoughts and feelings keep her stuck or even make her feel worse? How does she approach the difficulties she encounters?

5. What might facilitate change?

Here you are asked to identify what might support and facilitate change in Lexie from a mindfulness perspective. What might help Lexie manage her feelings and her situation better? There is no right or wrong answer here, but you must be able to justify your choice.

6. Outline ideas for interventions and ways to work with Lexie

In this section you should outline a plan of treatment for Lexie including ideas for interventions and ways you could work with her. What mindfulness techniques could you use with Lexie? What evidence is there for the effectiveness of mindfulness in a prison context? You could also consider what barriers might exist for your suggestions and how you might address these. You should make reference to your previous discussion of mindfulness concepts and Lexie’s experience.

Tips for writing

It might be useful to look at the feedback you have received on other reports (from previous modules) and also on the previous TMAs on this module, such as TMA 01. Remember that a report is not an essay and in order to pass you will be expected to structure this TMA accordingly, making appropriate use of sections, headings and sub-headings. You can include bullet points and diagrams if you wish.

You are asked to write this assignment considering the client information as though you were a therapist working with the client. In writing this formulation report you can therefore use the first person where appropriate (e.g. ‘for future therapeutic work with Lexie, I recommend the use of …’).

In therapeutic practice formulation reports do not necessarily include references. However, as you are writing this formulation report for an assignment in an academic context it should be referenced as usual. You don’t need to reference the information in the case study but need to reference material from the VLE/Video/Book chapter, as well as any independent sources that you might want to include.

Relevant material

You will find it helpful to review the Block 4 introduction, especially Section 3 on ‘Formulation’, for this assignment. The section provides you with a short introduction to what formulations are and how they are used in counselling and psychotherapy. Activity 2: Diagnosis vs. formulation should have helped you to learn about the main differences between diagnosis and formulations, and the way formulations are utilised to make sense of a client’s problems in considering multiple contexts, from biological and psychological factors to the social and relationship context and life events.

You can find the main relevant material for this assignment in Week 20 on ‘Mindfulness’. It will also be important that you draw on material from the book Chapter 16. You may also find some of the material in the Independent Study section of Week 20 useful.

Chapter 16

The book chapter provides an introduction to mindfulness core concepts, key ideas and techniques in mindfulness counselling and therapy. There are also examples of the use of mindfulness in therapy and in the criminal justice system, which you might find useful for your formulation report.

VLE Week 20

The material in the VLE Week 20 includes a great deal of relevant material that will help you with this assignment including experiencing mindfulness for yourself. Sections 3 and 4 will help you think about how you could work with a client and you will find Activity 6 based on a fictionalised case study of Alfred particularly helpful in developing your formulation for Lexie.

 

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