When did it begin? 

What makes it worse/better?

Medical/genetic/trauma/losses

Developmental history

• Were developmental milestones normal or accelerated ?

• When did reading begin ? 

• Are there areas of asynchronous development?

• Have interpersonal relationships been appropriate and gratifying ?

• Did the educational environment succeed or fail in fostering gifted development

• Were there occupational opportunities to use giftedness ?

Giftedness: Discovered, Identified, and Developed 

• How would you describe your giftedness?

• Was it’s development supported or neglected?

• Were there dramatic successes and unexplained failures?

• Were there conflicts about being gifted and conflicts about how to use it?

The formulation identifies each of the internal and external forces in a gifted person’s life that contribute to their problems.

A “Hierarchy of Causality”

• The formulation establishes an order of importance for the different stressors and makes a concise statement of how they individually and in interaction with each other cause the symptoms and maladaptive behavior.

• The Psychodynamic Component of the Formulation

  • Describes and distinguishes unresolved conscious from unresolved unconscious conflicts

  • It describes and explains how these – individually and together – lead to a gifted person’s psychological symptoms and to h/h repetitive maladaptive behaviors in school, work, and relationships that undermined the expression of this particular gifted person’s potential and well being.

  • It helps in avoiding misdiagnosis: the symptoms of a gifted person in crisis can be mistaken for one with a true psychiatric disorder. The most common of these are:

    • Bipolar disorder

    • Mood disorder 

    • Anxiety disorders

    • Personality disorders

    • Depressive disorders

    • ADHD

The “Inner Experience” of giftedness

• The psychodynamic formulation helps separate the conflicts and anxieties a gifted individual feels about his/her very personal “inner experience” of giftedness from conflicts and anxieties that he/she has with school, peers and parents.

Family Dynamics

• The psychodynamic formulation helps clarify if a gifted child’s underachievement, self-destructive behavior or psychological symptoms are an acting out of family dynamics. For instance, a family’s ambivalence about having an exceptional child or the child’s way of holding a marriage together.

A Learning Disorder or Difference vs. A Learning Inhibition

• A gifted individual whose inhibitions about being gifted have caused certain cognitive problems is often misdiagnosed as a twice exceptional individual a gifted individual whose learning problems are caused by a, as yet to be identified, neurological deficit or defect.

Existential Depression

• Gifted individuals may become resigned to living in physical or emotional isolation feeling that no one understands them and that they are unlovable. The cause is often thought to be a set of unlucky circumstances. However, existential depression may result from an inability to find ways to be adaptable and flexible without compromising gifted integrity. A psychodynamic evaluation can help clarify whether conflicts in this arena exist.

Distinguishing a gifted polymath from a person with an Attention Deficit Disorder.

• Under extreme stress, a gifted polymath’s ability to multi-task may unravel. The resultant erratic, behavior and distractibility may mimic a person with Attention Deficit Disorder.

• Distinguishing a Gifted Polymath– a person gifted in many different domains whose creative process can appear scattered, unfocused, and distracted – from a gifted individuals with ADD.

The formulation is the final step in the assessment process.

It identifies the primary emotional cause of the crisis and points to where the psychotherapy should begin.