Praxical.Psych
Formulation

4P formulation (predisposing, precipitating, perpetuating, protective)

A theory-neutral scaffold for organising why this person, why this problem, why now, and why it persists.

After assessment, before treatment planning. The best starting formulation for a trainee in any modality.15 fields

How this document is used well

The 4P grid is the most portable formulation tool in the field because it is not owned by any school. It answers four questions in order, and it makes the crucial distinction that trainees most often miss: what caused the problem is frequently not what maintains it, and only the maintaining factors are available to treat.

ColumnQuestionClinical use
PredisposingWhat made this person vulnerable, long before?Explains and de-shames; rarely modifiable
PrecipitatingWhy now? What set it off?Identifies the trigger and often the lever
PerpetuatingWhat keeps it going?The treatment targets live here
ProtectiveWhat is working, and what is holding?Resources for the plan; protective in risk terms

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Shows why each item is asked
The problem
The grid
Synthesis
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8 required fields outstanding: Client identifier; Problem list, in priority order; Why now? …

Educational use only

Praxical.Psych is a teaching tool. It is not medical, clinical, psychological or legal advice, not a diagnosis, not treatment, not supervision, and not a credential. Nothing here creates a clinician–patient or solicitor–client relationship. Every patient, case, transcript and simulated session is fictional. Clinical and legal requirements vary by jurisdiction and change over time — verify anything that bears on a real decision against your own regulator, statute and current professional guidance, and consult a qualified professional.

Do not enter real patient information. If you or someone else is in crisis: US & Canada 988 · UK & Ireland 116 123 · Australia 13 11 14 · elsewhere findahelpline.com · immediate danger, your local emergency number.

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Before you begin

What Praxical.Psych is, and is not

Praxical.Psych is an educational tool. It teaches the theory, evidence base and clinical method of psychotherapy at the level of an advanced survey course, and it lets you rehearse a complete session in a simulator.

It is not medical, clinical, psychological or legal advice. It cannot diagnose or treat anyone, and it does not state the law where you practise — requirements differ by jurisdiction and change. Nothing here creates a clinician–patient or solicitor–client relationship.

  • Every patient, transcript and case in this app is fictional — a composite written for teaching. None depicts a real person.
  • Praxical.Psych is not therapy, not a substitute for supervision, and not a credential. Competence to practise comes from training, supervised hours and licensure.
  • Scores from the instruments here are for learning how they behave. They are not a diagnosis and not a risk assessment, and must not inform a decision about a real person.
  • Do not enter real patient information. Everything you type stays in this browser, but that is not the same as a compliant clinical record system.
If you are in crisis

In the US and Canada, call or text 988. In the UK and Ireland, call 116 123 (Samaritans). Elsewhere, find a local line at findahelpline.com. In immediate danger, use your local emergency number.

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