How language shapes psychiatric case formulation


  • John Walsh University of Adelaide
  • Nayia Cominos University of Adelaide
  • Jon Jureidini University of Adelaide



case formulation, mental health, psychiatry, systemic functional linguistics


The aim of this paper is to describe, analyse, and discuss the process of formulation in the specific context of mental health (MH). Formulation is a fundamental element of the work of psychiatrists and other MH clinicians that is expected to be mastered during training. The literature, however, shows that formulation is rarely explicitly addressed in the psychiatric curriculum; rather, it is implicitly developed through modelling, and/or clinical practice. This paper focuses on case formulation in one MH context in Australia. It tracks the iterative formulation of one patient in a hospital emergency department. The analysis uses resources from systemic functional linguistics (SFL) situated within a broader framework of discourse analysis. It highlights patterns of lexical relations and nominalisation as well as the range of conjunctions. These make explicit how the clinicians talk about the patient’s illness and shape their developing understanding into a logical formulation. We see applications of this work for the training of mental health professionals. These data make explicit the ways in which the participating clinicians use language in the process of formulation. By bringing this process to the level of consciousness, it can be discussed and evaluated and become a pedagogic resource.

Author Biographies

John Walsh, University of Adelaide

John Walsh is Senior Lecturer in Linguistics in the School of humanities at the University of Adelaide. he works within the systemic functional tradition in linguistics, which promotes the application of language studies to all social and professional domains. he has interest and experience in describing and analysing language use in the fields of education, health, and sport.

Nayia Cominos, University of Adelaide

Nayia Cominos is an Associate Lecturer and researcher at the University of Adelaide, and manager of Good.Better.Best.Communication. She has been involved in language teaching, management, and linguistic research for over 20 years, in Australia and in Europe. Her research interests include systemic functional linguistics, in particular discourse semantics, medical discourse, language revival, ESL, and academic literacies.

Jon Jureidini, University of Adelaide

Jon Jureidini is a Child Psychiatrist at the Women’s and Children’s hospital, Adelaide, working with ill and disabled children and their families. He has trained in philosophy, and is Professor in the Disciplines of Psychiatry and Paediatrics at the University of Adelaide. His most recent publications have addressed prescribing for children, immigration detention, suicide, and child abuse.


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How to Cite

Walsh, J., Cominos, N., & Jureidini, J. (2017). How language shapes psychiatric case formulation. Communication and Medicine, 13(1), 99–114.