Formulation and treatment planning in complex cases involving a young person are particularly challenging because of the sheer volume of information available to us. The key question is how to make effective use of it all. My suggestion is that we extend the well-known 4P approach to take into account 4 more critically important areas. In my view, ‘4P + 4’ would enable us to reach much greater clarity on what to target, why and how in order to improve a young person’s situation.
Complex cases involving young people come in a whirlwind of politics, spent and burnt-out workers and a trail of services that, for whatever reason, have been unable to help. In fact, Taz the Tasmanian Devil, the animated cartoon character, comes to mind. He usually moves around in a whirlwind of chaos, but sometimes steps outside to watch from arm’s length. And that’s exactly what we need to do: step back in order to separate the actual presenting problem from the chaos in a complex case.