The Whole Person Formulation: Beyond Simple Diagnosis in Personal Injury Cases
A single diagnosis is a static label that can be easily challenged. A comprehensive psychological formulation provides the dynamic, defensible model your case needs.
When you retain a forensic psychologist for a personal injury case, you might expect a straightforward diagnosis: "The plaintiff has PTSD" or "The plaintiff suffers from Major Depressive Disorder." While these diagnoses are important, they are only the beginning of what a strong expert opinion should provide.
The Problem with Diagnosis Alone
A diagnosis like "PTSD" is a static label. It tells you what condition the plaintiff meets criteria for, but it doesn't answer the critical legal questions:
- Did this specific incident cause the PTSD, or was it a pre-existing condition?
- How has this condition impacted the plaintiff's overall functioning?
- What is the prognosis for recovery?
- Are the symptoms genuine, or is there evidence of exaggeration or malingering?
A simple diagnosis is easily challenged by opposing counsel. It can be dismissed as subjective, questioned on methodological grounds, or countered with an alternative diagnosis from the defense expert.
The Critical Distinction
A diagnosis is a snapshot. A formulation is a narrative—a comprehensive story that explains not just what the plaintiff has, but why they have it, how it developed, and where it's likely to go.
What is a "Whole Person" Formulation?
A psychological formulation is a dynamic model that integrates multiple data sources to create a comprehensive understanding of the individual. It goes beyond diagnosis to provide:
Historical Context
What was the plaintiff's baseline psychological functioning before the incident? What prior traumas or stressors existed? What were their coping mechanisms?
Personality Structure
How does the plaintiff's personality type influence their response to trauma? Are there pre-existing personality traits that make them more vulnerable to certain conditions?
Event Analysis
What specific elements of the incident were psychologically traumatic? How does this event differ from prior life experiences?
Current Test Data
What do objective psychological tests reveal about current functioning? Are symptom validity tests consistent with genuine distress?
This integrated approach demonstrates a clear, defensible nexus between the incident and the outcome—exactly what the court needs to understand.
Why Formulation Matters in Personal Injury Cases
1. Establishing Causation
The most critical question in personal injury litigation is causation: Did the incident cause the psychological harm?
A formulation approach addresses this by:
- Establishing baseline: Documenting the plaintiff's psychological functioning before the incident
- Identifying new-onset symptoms: Distinguishing symptoms that appeared after the incident from pre-existing conditions
- Analyzing exacerbation: If a condition existed previously, explaining how and why the incident made it worse
- Ruling out alternative explanations: Considering and eliminating other potential causes for the symptoms
2. Assessing Prognosis
A diagnosis alone doesn't predict the future. A formulation evaluates:
- Psychological factors that complicate recovery (e.g., personality structure, co-occurring disorders)
- Social support systems and their adequacy
- Treatment responsiveness and engagement
- Realistic timeline for improvement or need for ongoing care
3. Addressing Symptom Validity
One of the most contentious issues in personal injury litigation is whether the plaintiff's symptoms are genuine or exaggerated for litigation purposes.
A comprehensive formulation includes:
- Symptom Validity Tests (SVTs): Objective measures designed to detect exaggeration or feigning
- Pattern consistency: Comparing self-reported symptoms with objective test data and collateral records
- Behavioral observations: Noting inconsistencies between reported impairment and observed functioning
Important Note on Symptom Validity
Symptom validity testing is not about calling the plaintiff a "liar." It's about providing the court with objective data on the credibility of reported symptoms. This protects both genuine claimants (by demonstrating their symptoms are real) and the legal system (by identifying exaggerated presentations).
How I Build a Formulation
My approach to forensic evaluation is designed to build this comprehensive formulation through a multi-method process:
Comprehensive Record Review
This is often the most time-consuming phase. I rigorously review all relevant documents—medical and psychiatric records, legal documents, police reports, employment records, depositions. This establishes the plaintiff's baseline functioning and identifies patterns over time.
Forensic Clinical Interview
This is not a therapy intake. It's a structured interview designed to gather objective data relevant to the legal question, including detailed history, trauma exposure, symptom onset, and functional impairment.
Psychological Testing
I use a battery of standardized tests to measure trauma, PTSD, anxiety, depression, personality factors, and—critically—symptom validity. This provides objective data to support or challenge self-reported symptoms.
Data Integration & Formulation
This is where the "whole person" model comes together. I synthesize all data sources to create a narrative that answers the specific legal question with a clear, defensible explanation.
The Courtroom Advantage
A well-developed formulation provides significant advantages in litigation:
- Defensibility: It's much harder to challenge a comprehensive narrative supported by multiple data sources than a single diagnosis
- Clarity: Judges and juries can understand a story about a person's life much better than abstract diagnostic criteria
- Credibility: The depth of analysis demonstrates thoroughness and objectivity
- Persuasiveness: A formulation shows not just what happened, but why it matters
Case Example: The Difference in Action
Diagnosis-Only Approach:
"The plaintiff meets diagnostic criteria for Post-Traumatic Stress Disorder (PTSD) as a result of the motor vehicle accident."
Whole Person Formulation:
"Prior to the accident, the plaintiff demonstrated strong psychological resilience, with no history of psychiatric treatment and stable occupational and social functioning. The plaintiff's personality profile suggests moderate trait anxiety but strong coping mechanisms developed through prior life experiences.
The motor vehicle accident represented the plaintiff's first experience with a life-threatening trauma. The combination of physical injury, loss of control, and ongoing pain created a perfect storm for PTSD development. Symptom onset was acute and temporally linked to the accident.
Current psychological testing reveals genuine trauma symptoms with valid symptom presentation on all measures. The plaintiff's limited social support network and ongoing pain are complicating factors that will likely extend recovery time. Prognosis is fair with appropriate trauma-focused treatment, though some residual symptoms may persist long-term given the severity of the initial trauma and the plaintiff's ongoing physical limitations."
Which approach is more persuasive? Which is harder to challenge? Which truly educates the court?
The Bottom Line
My expertise is not just in what I diagnose, but in how I synthesize the data. Instead of a simple clinical summary, I provide a robust forensic analysis that:
- Demonstrates clear causation through baseline comparison and temporal analysis
- Assesses prognosis based on psychological factors and support systems
- Addresses symptom validity with objective measures
- Provides a comprehensive narrative that educates the court
This formulation-based approach provides the clear, defensible, and comprehensive education the legal system requires—and that your case deserves.
Need a Comprehensive Psychological Formulation for Your Case?
I provide rigorous, multi-method forensic evaluations that go beyond simple diagnosis to give your case the depth and credibility it needs. Contact my office to discuss how I can support your litigation strategy.
Schedule a ConsultationAbout the Author: Dr. Marco G. Morelli is a Licensed Clinical Psychologist (CA PSY 34288) specializing in comprehensive forensic psychological evaluations for personal injury and workers' compensation cases. His background in biological sciences provides a rigorous, analytical foundation for complex causation analysis.