(2017). 0000118792 00000 n As you do more formulation, you will notice that patients tend to present in templates, that is, certain diagnoses tend to follow a certain common theme of predisposing, precipitating, and perpetuating factors. B., Lemle Becker, V., & Tompkins, M. A. 0000200185 00000 n They may also present in the form of family, friends, or hobbies. To help treat the client with psychosis maintaining specific behaviour can be beneficial and help avoid frustration and upsetting experiences (Johnstone 2009). https://doi.org/10.1002/jclp.22516 0000186981 00000 n (2018). 0000180123 00000 n This population often experiences stigma and suboptimal health care results (McNeely et al., 2018; van Boekel et al., 2013). Presenting Issue(s) - please use the DSM-What assessment tools. We would anticipate when engaging in treatment, the patient may have [resistance/transference/countertransference]. 0000003178 00000 n The case formulation in child and adolescent psychiatry. Factors in the 5 P's Model of Formulation - UKEssays.com Henkel, D. (2011). The Five Ps can be used in a variety of settings such as a community mental health agency, primary care clinic, and inpatient or residential treatment centers. For the year 2016, the Centers for Disease Control and Prevention (CDC) found that 18% of the U.S. population aged 12 and older had used illicit substances or misused prescription medications (CDC, 2018). https://doi.org/10.1016/j.avb.2010.01.006 All rights reserved. Finally, the number of U.S. adults with a comorbid SUD and mental illness has been shown to be almost 8 million, with only about 5% receiving treatment for both (SAMHSA, 2017). There are numerous methods and combinations of methods to address substance use and misuse, such as family therapy, cognitive behavioral therapy, and self-help groups. This conversation can lead to investigating strategies for how each can be heard, including short role-plays with opportunities to practice (Worrell, 2015). One of the strengths of this formulation is that it is not fixed. The "5 Ps" we recommend include: Purpose: Every meeting should have a reason. The CBHSQ report: Substance use and substance use disorder by industry. Here, a conversation about what counseling entails as well as psychoeducation related to the effects of alcohol on executive functioning may prove beneficial (Day et al., 2015). https://www.centeronaddiction.org/addiction-research/reports/behind-bars-ii-substance-abuse-and-americas-prison-population The night he was pulled over, he had had two additional beers and one additional shot of whiskey on top of his usual consumption after a telephone argument with his wife, Sara. https://doi.org/10.1177/0017896918763462 The counselor may also assist Dax in emotional regulation, which may prevent the initiation of arguments (Aldao & Nolen-Hoeksema, 2013). Garland, E. L., Froeliger, B., & Howard, M. O. This is often the opportunity for the client to share what may help them move forward, what their assets are, who can support them, and any other self-identified skills (de Shazer, 1985). 0000200485 00000 n One such framework is the Five Ps (Macneil et al., 2012). health? Presenting problems are concerns that clients find difficult to manage. A logical analysis using gentle Socratic dialogue may help to challenge his emotional reactions to his daughters heart murmur (Etoom & Ratnapalan, 2014). 0000155309 00000 n Family therapy: Systemic approaches to practice. (2011). 0000013350 00000 n In the Five Ps context, protective factors are used to potentially prevent substance use and misuse from having more negative impact as well as to increase client resilience. It can assist both novice and experienced clinicians working with clients who present for counseling with substance use and misuse. Cognitive behavioral therapy for substance use disorders. Cognitive Behavior Therapy (CBT) case conceptions have follows a 5p's model. A review of CBT treatments for substance use disorders. (2018, August 31). Motivational interviewing: Building rapport with clients to encourage desirable behavioral and lifestyle changes. Hawton, K.E., Salkovskis, P.M., Kirk, J.E. What are the 5 Ps in psychology? Additionally, its holistic and creative style provides opportunities to address concerns at various points with a variety of strategies and interventions that will best suit clients unique situations. 0000156014 00000 n This area explores significant occurrences that preceded or triggered the presenting problem and its consequences. Testing case formulation hypotheses in psychotherapy: Two case examples. While being mandated to attend counseling, Dax shares concerns that he is afraid of what his daughters test results will show. From a biological perspective, the patient is vulnerable because, The patient's early childhood and developmental history suggest, Used substances as a coping style in [the past], and now this is occurring again (or there is a relapse) due to [social factor]., Used substances as a coping style in [the past], and now this is occurring again (or there is a relapse) due to [psychological vulnerability]., I wonder if [psychological factor] is contributing to [current symptoms/struggles], Tell a story and narrative that is unique to your patient, Be specific and demonstrate your understanding of the patient as a, Use words like precipitating, protective, and perpetuating factors to anchor your listener, Focus on the most salient features and be concise, Try and use a psychological theory (but only if you understand it), Try to be perfect only to overwhelm yourself, Be generic (your formulation needs to be unique to your patient), Tell the patient's whole story all over again, Mention life events or trauma without an understanding of its meaning or impact, Try to formulate a grand unified theory of the patient and over-reach with your theory (if it doesnt fit, it doesnt fit! Biopsychosocial Model and Case Formulation - PsychDB Case Formulation DSM-5 Criteria Sets DSM-5 Background Information Treatment Planning Best practice guidelines are often tied to a diagnosis DSM-5 measures to monitor progress . We've received widespread press coverage since 2003, Your UKEssays purchase is secure and we're rated 4.4/5 on reviews.co.uk. Current Psychiatry Reports, 15(11), 211. Humphreys, K., Wing, S., McCarty, D., Chappel, J., Gallant, L., Haberle, B., Horvath, A. T., Kaskutas, L. A., Kirk, T., Kivlahan, D., Laudet, A., McCrady, B. S., McLellan, A. T., Morganstern, J., Townsend, M., & Weiss, R. (2004). In addition, mindfulness strategies can assist in helping Dax to cognitively diffuse from present to future events (Harris, 2019). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860452/ Mental health professionals evaluations of the Integral Intake, a metatheory-based, idiographic intake instrument. 0000012481 00000 n Diagnostic and statistical manual of mental disorders (5th ed.). Ideally, each step should flow logically and intuitively into the next based on your framework, as you'll see in our case of Jane Doe. Mindfulness-based strategies are not as effective when used alone as when used with other approaches (Sancho et al., 2018). Oftentimes, when the topic of protective factors is used in substance use and misuse, it is related to deterrence of substance use, notably with adolescents (Liao et al., 2018). (2013). This stage of formulation involves articulating the external and internal factors that can activate presenting problems (Johnstone & Dallos, 2010). and Clark, D.M., 1989. Using case formulation in clinical practice. Use this table as a general guide, but don't memorize it for the sake of memorizing it! Looking for a flexible role? 0000180256 00000 n (2017). Their effectiveness has been well researched, and this paper does not propose a superior way to address substance use and misuse. If he cannot identify a time, simple role-plays in which Dax does not interrupt or yell and instead experiences different outcomes may provide optimism to Dax. As she was unable to develop a sense of self and personal identity, these psychological factors are reflected in her adulthood with unstable relationships, and fears of abandonment. https://doi.org/10.3389/fpsyt.2013.00173 Case Formulation and Intervention: Application of the Five Ps Framework Morin, J.-F. G., Harris, M., & Conrod, P. J. He is also adamant that he does not have a problem with alcohol. This may include a direct conversation about Daxs decision to drink, resulting in his becoming impaired, with the consequence of being detained, charged, and adjudicated. 2. Receipt of services for behavioral health problems: Results from the 2014 National Survey on Drug Use and Health. To position his business, John may consult the 5 Ps of marketing in the following manner: Product: By-the-hour jet ski rentals for people who are in the city for a short duration of time. However, patient has the following [protective factors], which may be a good prognostic factor. According to Dr Oliver James (Hussain 2009) CBT is over praised; what CBT achieves any other therapy can achieve to. Chapter 5 - Psychological Models for Case Formulation The clinician may also discuss strategies to help Dax regulate his reactions using emotion-focused interventions such as positive reframing to ameliorate the stress of his daughters cardiac condition (Plate & Aldao, 2017). I can state that formulations of everyone must be taken with care, since they are hypothesis and not statements of facts as pointed out by Butler (G Butler 2009). Bahorik, A. L., Satre, D. D., Kline-Simon, A. H., Weisner, C. M., & Campbell, C. I. The more cases you go through (and more of the sample formulations below) the more comfortable you will be with formulating! Equally if there is lack of collaboration, this can be as a result of expectations from either client or the therapist for example if the client have expectations from the therapist because he sees him as the expert and should be able to provide all the answers to his problems without him the client having an input. However, each has some shortcomings. The goal here is to build Daxs competence in communicating, both in listening and expressing. The simplest format looks at just three key areas: thoughts, feelings (emotions and physical sensations) and behaviours. Current stressors, plus salient developmental history, The patient presents at this time with [problem and symptoms], in the context of [situation and stressors], Genetics, temperament, medical history, substances, medications, The patient has the following [genetic vulnerabilities, medical history], The patient grew up in a family characterized by [factors], with a caregiver who was [distant/available/invalidating], Capacity for interaction, communication, empathy, and attachment, The patient may have had difficulty in [stage of development], and this is reflected in [examples from adult relationships], It appears that the patient may have struggled with conflicts in early life. Within the 'Presenting issues stage' its about looking at the current problems or issues the person is facing, to get a clear understanding of what they are and then set goals or targets based around this. Oxford University Press. Client substance use and misuse can be quite challenging for counselors, both novice and experienced. Case Study 5P Model Example The Presenting Problem Predisposing factors 5P Model Question to Mac Environmental influences 5P Model: Precipitating factors History of Co-morbidity 5P Model: Perpetuating factors Risk assessment 5P Model: Protective factors Client's support network 5P Model: Appropriate intervention goals for the client, Treatment plan 0000199386 00000 n Addiction treatment: A strengths perspective (4th ed.). Patterns: Study what Worked in the Past and What can be Replicated. Surgeon General Vivek Murthy reported that more than 20 million Americans have an SUD (U.S. Department of Health and Human Services, 2016). However, as mentioned previously, case formulations have been used across a variety of client concerns (Chadwick et al., 2003; Ingram, 2012; Persons et al., 2013). https://doi.org/10.1186/s13722-018-0110-8 Experienced counselors, even with competence in a variety of approaches, can also benefit from using a framework to help address anticipated challenges (Macneil et al., 2012). 5 Ps Formulation Handout.docx - PSYC212: Abnormal 1: A step-by-step way of filling out a Biopsychosocial Table. The meaning of anxiety. Precipitating and perpetuating factors: the stressor of losing her job has reactivated these more primitive defense mechanisms and coping strategies. (2003). 0000238450 00000 n Predisposing looks at a wider understanding of the issues, looking at it in more lengthily way. This has led to her adulthood self-perception of being unworthy of being loved, a constant fear of rejection, and increased rejection sensitivity. https://doi.org/10.1097/ADM.0000000000000260 Please refer to an authoritative source if you require up-to-date information on any health or medical issue. Many formulation models are administered within a cognitive behavioral grounding (Chadwick et al., 2003; Easden & Kazantzis, 2018; Persons et al., 2013). Here the clinician may utilize strategies drawn from acceptance and commitment therapy related to his control strategy of using alcohol to avoid his emotions (Harris, 2019). Routledge. Concept mapping: A supervision strategy for introducing case conceptualization skills to novice therapists. Behind bars II: Substance abuse and Americas prison population. It has been documented that 90% of the population at some point have intrusive thoughts, or feel paranoid and feel people are doing things on purpose towards them. Barriers and facilitators affecting the implementation of substance use screenings in primary care clinics: A qualitative study of patients, providers, and staff. 0000119267 00000 n 2008). 0000000016 00000 n 0000011818 00000 n W. W. Norton. Dax is a 33-year-old married father of two children: a 9-year-old son, Cam, and a 7-year-old daughter, Zoe. 0000004656 00000 n National Center on Addiction and Substance Abuse at Columbia University. Additionally, the lack of coping mechanisms leading to intense thoughts of suicide. 2004;2(6):576-582. doi:10.1370/afm.245. W. W. Norton. Case Conceptualization - Psychology Tools We then move onto Perpetuating which looks at what factors are contributing to the remain of the problems the person is facing. Current dose of sertraline is subtherapeutic, Ongoing discord in her romantic relationship, Good interpersonal support from her best friend who brought her to hospital, Re-experienced these feelings of abandonment after being fired from work. In mental health, when there is a group of consistent symptoms seen in a population, these symptoms can be categorized into a distinct entity, called a diagnosis (this is what the DSM-5 does). 0000006105 00000 n In spite of these limitations, there may be several potential areas of inquiry. (2012). Substance Use & Misuse, 53(4), 596605. [Patient] presents with a [diagnosis]. Following formulation, there should be an identification of the prioritised areas of focus for care - to inform the Care Plan. Implementing the Five Ps: The Case of Dax. Idiographic case formulation can be useful for complicated cases, such as those encountered with clients engaged in substance use and misuse (Haynes et al., 1997). Here is the classic grid model of biological, psychological, social factors, along with the 4 P's. Factors include (but are not limited to) the following The 5 P's of Strategy is a planning process. Behavioral health treatments and services. Who created the 5p formulation? - Alqatirat These symptoms have been further perpetuated by the personality factors and traits described above, and her ongoing financial stressors. Journal of Marital and Family Drugs and drug policy: What everyone needs to know. Winters, N. C., Hanson, G., & Stoyanova, V. (2007). <<6D17E8AF19023D4BAD06A1AFD23B08FB>]/Prev 415012/XRefStm 2760>> 0000238491 00000 n Additionally, there may be a discussion using aspects of existentialism to process inherent anxiety and its connection to unknowable future events (May, 1950; Wu et al., 2015). 1. The internal and external factors that maintain the current problems. Dax drinks two to three times a week, usually having one or two shots of whiskey and two to three draft beers. For example, some interventions use an individual lens, such as cognitive behavioral therapy, which examines connections between thoughts, feelings, and behaviors (Morin et al., 2017). Sample #1: Conceptualization for CBT case This is a 35-year-old Caucasian man referred by his physician for treatment of generalized anxiety. What are the 5 ps In formulation? - TheNewsIndependent For some, receiving substance use and misuse services can be stigmatizing. Karriker-Jaffe, K. J., Klinger, J. L., Witbrodt, J., & Kaskutas, L. A. It should be noted that the strategies and interventions applied here are used as illustrations and are specific to Dax and his concerns. 1. Cognitive behavioral therapists use individually tailored formulations as a framework with which to understand their patients' difficulties and to plan effective treatment. Macneil, C. A., Hasty, M. K., Conus, P., & Berk, M. (2012). Here you can choose which regional hub you wish to view, providing you with the most relevant information we have for your specific region. This is intended to inspire the identification of more in-depth interventions that aim to sustain change and prevent relapse (i.e., promote long-term behavioural adjustment). (2017). Based on these factors, dialectical behavioural therapy would be the most helpful for this patient. Using a framework to assist in case formulation may prove useful to beginning counselors. Walsh, F. (2014). https://doi.org/10.1016/S0740-5472(03)00212-5 More ominously, substance use and misuse has been correlated with intimate partner violence (Murphy & Ting, 2010). Macneil and his colleagues (2012) posited that diagnosing was insufficient and it was critical to include other factors such as causal, lifestyle, and personal factors in conceptualizing the case and formulating a plan. It acknowledges your strengths and resources. 1189 0 obj <> endobj Other approaches observe substance use and misuse from a family or systems perspective, looking at familial patterns such as communication and normalization of substance use (Bacon, 2019). SAMHSA (2020) pointed out the significance of addressing clients individually based on their distinctive needs in order to provide the best chance for recovery from substance use and misuse. Substance use and misuse carries numerous potential repercussions. 0000015792 00000 n 0000155905 00000 n Second, it also tends to shift the conversation toward what is present and going well in their lives and away from those areas that cause distress and suffering (de Shazer, 1985). Based on what I have reviewed in this essay. 0000013321 00000 n This factor differs markedly from the first four. Australasian Psychiatry, 22(4), 397-401. The Diagnostic and Statistical Manual of Mental Disorders (5th ed. Design of individualized behavioral treatment programs using functional analytic clinical case models. Dax denies any other negative consequences from his alcohol use. She has also previously responded well to psychotherapy and appears to be psychologically-minded. hTILSQ=HC@K(`$*P2C People with paranoia tend to avoid these situations which would lead to distress (Clark et al 2005). Predisposing factors include biological, environmental, or personality considerations that may put clients at risk of further substance use and misuse. Mintzberg's 5 Ps of Strategy with Examples 1. Among those are 12-step programs (Humphreys et al., 2004), mindfulness-based interventions (Chiesa & Serretti, 2014), evidence-based approaches such as cognitive behavioral therapy (McHugh et al., 2010), and family counseling (OFarrell & Clements, 2012). %PDF-1.4 % Wubbolding, R. E., & Brickell, J. Compton, W. M., Gfroerer, J., Conway, K. P., & Finger, M. S. (2014). The goals here are to both break the pattern and to facilitate healthy conversations. The image (. Thus, there exists a need to concurrently examine and address the potentially complex nature of client substance use and misuse. The National Survey on Drug Use and Health asserted that close to 30% of respondents aged 12 and older reported use of illicit substances in the past month (Substance Abuse and Mental Health Services Administration [SAMHSA], 2017). - Eriksonian developmental stages, psychodynamic defenses, and dialectical behavioural): Yet another way to present a formulation is in chronological order, starting from birth until present time: Having certain common phrases to use can be helpful to structure your presentation.