5 ps formulation example

More ominously, substance use and misuse has been correlated with intimate partner violence (Murphy & Ting, 2010). Unlike summary, it is a discussion about alternative ideas about diagnosis, aetiology, treatment and prognosis and of the arguments for and against each alternative. U.S. Department of Health and Human Services. What are the 5 Ps in psychology? Research on the success of family-based interventions has methodological challenges, such as small sample sizes and the difficulty of examining long-term outcomes (Rowe, 2012). 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). Wiley. https://doi.org/10.1037/a0038618 As you get better and more expert at formulating, you may not need to use this rigid structured format, and instead, will be able to present a more intuitive and organic formulation of the patient instead (see other methods below). Liese, B. S., & Esterline, K. M. (2015). His father started out drinking occasionally and over the years slowly developed a dependency on alcohol. Given the variations of substances, the level of use, the functional impairment, co-occurrence with other mental disorders, and inherent client differences, an idiographically based framework seems particularly appropriate with this population. Easden, M. H., & Kazantzis, N. (2018). Based on these factors, dialectical behavioural therapy would be the most helpful for this patient. 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). Scott W. Peters, PhD, LPC-S, is an associate professor at Texas A&M University San Antonio. (2018). Centers for Disease Control and Prevention. 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. This condition did not develop six months ago but developed during childhood when he failed to meet his father's expectations. Bentall (2004) had stated that obsessed person is highly sensitive to any threats to their self-esteem, therefore it is important to the individual to sustain the behaviour that they believe is protecting them from hurt to their self-esteem. These are historical psychological, biological, developmental, and socio-cultural factors that increased the person's vulnerability to their current problems. Case formulations have been used in a number of areas such as those with psychosis, anxiety, and trauma (Chadwick et al., 2003; Ingram, 2012; Persons et al., 2013). Drug and Alcohol Dependence, 142(1), 350353. A good biopsychosocial formulation allows you to come up with a comprehensive and holistic treatment plan for your patient. 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). The choice of the above approaches is only meant as an illustration and not as definitive ways to address this particular client. In implementing the Five Ps framework with Dax, the clinician chose to use psychoeducation and strategies borrowed from acceptance and commitment, reality, Bowenian family systems, and solution-focused brief therapies to assist Dax with his substance use and misuse. According to Read et. Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust 0000199386 00000 n (2012). 0000200305 00000 n This likely led to an attachment style that was likely insecure and disorganized. 0000004656 00000 n She has the following protective factors, including a supportive psychiatrist and friend. First and foremost, it should be emphasized that this particular framework has not been empirically tested with client substance use and misuse. Formulation for beginners. Client substance use and misuse at that level may need medical stabilization and detoxification prior to utilization of the Five Ps. Perpetuating factors are those that sustain and possibly reinforce clients current substance use and misuse challenges. 0000180256 00000 n 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). This population often experiences stigma and suboptimal health care results (McNeely et al., 2018; van Boekel et al., 2013). (Goldman & Greenberg 1997). https://www.samhsa.gov/data/report/results-2016-national-survey-drug-use-and-health-detailed-tables He denies any significant increase in alcohol use or any other substance use. Henkel, D. (2011). Family history of mental disorders and substance use, Fears of abandonment which developed early in childhood, Early parental divorce, unstable home life, history of trauma, Increase in alcohol use in the last 3 months, Re-experienced these feelings of invalidation and abandonment after being fired from work, Her lack of adaptive coping mechanisms resulted in using self-harm to cope. 0000009229 00000 n https://doi.org/10.1177/0017896918763462 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). To help treat the client with psychosis maintaining specific behaviour can be beneficial and help avoid frustration and upsetting experiences (Johnstone 2009). (2013). 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! 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. 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. Executive functioning in alcohol use studies: A brief review of findings and challenges in assessment. - depression, self-harm, mania/psychosis, anxiety, etc.) Dax, however, is hyper-focused on surgery and seems to dismiss Saras position. Liao, J.-Y., Huang, C.-M., Lee, C. T.-C., Hsu, H.-P., Chang, C.-C., Chuang, C.-J., & Guo, J.-L. (2018). Regrettably, most do not receive treatment while incarcerated (Belenko et al., 2013). Their effectiveness has been well researched, and this paper does not propose a superior way to address substance use and misuse. Penguin. Cognitive behaviour therapy for psychiatric problems: A practical guide. This stage of formulation involves articulating the external and internal factors that can activate presenting problems (Johnstone & Dallos, 2010). 1189 0 obj <> endobj University-educated. Here the clinician may incorporate a solution-focused strategy exploring a time with Dax when he and his wife have disagreed, but he did not interrupt and the outcome was positive (de Shazer, 1985). Delivery of mindfulness-based interventions may help to address stressful events that previously triggered substance use (Garland et al., 2014). She was suddenly fired from her job today due to conflicts at work with co-workers and being late at work several times from sleeping in. van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013). It acknowledges your strengths and resources. The essay will describe Greg's case study using 5P's model. Case conceptualization research in cognitive behavior therapy: A state of the science review. 0000118792 00000 n Current Drug Abuse Reviews, 8(1), 2640. He was recently driving home from work in the evening and law enforcement stopped him because of erratic driving. 0000180123 00000 n Her ongoing alcohol use is another example of a maladaptive coping strategy. Having a framework for understanding of different psychological treatments and psychological theories can be helpful in making your psychological formulation flow intuitively (e.g. BMC Medicine, 10(111), 13. The biopsychosocial model considers the 4 Ps for each of the biological, psychological, and social factors: The 4 Ps can be laid out in a 3 x 4 table to systematically do formulation and identity factors. 0000186690 00000 n ACT made simple (2nd ed.). Such a framework may enhance the effectiveness of the aforementioned interventions (Wormer & Davis, 2018). Even weekly status meetings or things of that nature should have a clearly defined purpose. As shown above, there are numerous ways to examine and treat client substance use and misuse. However, this can be done intuitively even without an in-depth understanding of these frameworks (we don't need to be Freud to do this). Aggression and Violent Behavior, 15(5), 325333. 0000119267 00000 n In this article, we'll explore the 5 Ps in more detail and the tools that you can use in each area. Substance use and misuse also has a negative impact on intimate partners, such as assuming increased responsibility and navigating unpredictability (Hussaarts et al., 2012). apply to your case. https://doi.org/10.3109/10826084.2013.770027 Chadwick, P., Williams, C., & Mackenzie, J. [1][2] Biopsychosocial formulation combines biological, psychological, and social factors to understand a patient, and uses this to guide both treatment and prognosis. Good interpersonal support from her best friend who brought her to hospital. (e.g. 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). Unemployment and substance use: A review of the literature (19902010). 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). Academic Press. Free resources to assist you with your university studies! Case formulation, also referred to as conceptualization, is a skill new counselors often lack (Liese & Esterline, 2015). 0000015792 00000 n McNeely, J., Kumar, P. C., Rieckmann, T., Sedlander, E., Farkas, S., Chollak, C., Kannry, J. L., Vega, A., Waite, E. A., Peccoralo, L. A., Rosenthal, R. N., McCarty, D., & Rotrosen, J. This involves explaining that interactions can act as a kind of back-and-forth loop of actionreactionaction without any resolution, leaving both parties feeling unheard, misunderstood, and frustrated. As part of his adjudication, Dax was required to attend five counseling sessions and have a clinicians report provided to the court. Cognition and Emotion, 27(4), 753760. Addictive Behaviors, 32(7), 13311346. Johnstone & Dallos (2010) suggest a framework for CBT formulation which refers to the levels and process of formulation in regards to the five Ps; presenting issues, precipitating factors, perpetuating factors and protective factors presenting issues which define the current problems in term of emotions thoughts and . Morin, J.-F. G., Harris, M., & Conrod, P. J. 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. Copyright 2003 - 2023 - UKEssays is a trading name of Business Bliss Consultants FZE, a company registered in United Arab Emirates. Annual surveillance report of drug-related risks and outcomes. 0000187506 00000 n In his report on alcohol, drugs, and health, the U.S. Routledge. ), Cover every box in the 4 Ps just for the sake of doing it (not all boxes will always apply!). Journal of Substance Abuse Treatment, 26(3), 151158. However, it does suggest that more than 60% had a substance use disorder and 20% were under the influence at the time of their offense (National Center on Addiction and Substance Abuse at Columbia University, 2010). Ingram, B. L. (2012). 0000010825 00000 n This can result in lack of access to treatment services, contributing to increased stress. Poverty, low socioeconomic status, teenage parenthood, or poor access to health care? Hypotheses are generated about the origins and causes of a patient's symptoms. Type. Substance use and misuse has significant impact on the occupational sector as well. They are. 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 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). Five additional elements are often added to this (referred to as 'the five Ps'): presenting problem (s) predisposing factors precipitating factors perpetuating factors protective factors. Concept mapping: A supervision strategy for introducing case conceptualization skills to novice therapists. 0000014220 00000 n (2015). Many formulation models are administered within a cognitive behavioral grounding (Chadwick et al., 2003; Easden & Kazantzis, 2018; Persons et al., 2013). Keys to solution in brief therapy. Like most things in medicine, there are multifactorial causes of diseases, illnesses, and disorders. As I stated above this factor looks to get a wider understanding of what the issues is. Additionally, many individuals who engage in substance use and misuse have co-occurring major medical conditions, such as cancers, cardiovascular accidents (strokes), and respiratory and cardiac illnesses (Bahorik et al., 2017). *sbJ&KcO0gfk1/G0isFuHe/Mcmf&*=QMh[pN[-.jzJ{g).k!1 M{[RSXn.+LhWi*z@-pMOcF52zZ#f!CSn^X&hN>nRu-w&7g5{P2C*.Es7@,IR35qHfwKxgGeK4QVBa?%(72e]7_/y!>$=Lx3ljHlGZL6eai7@*T!'HX)cE Molecular psychiatry, 17(4), 377-388. It should be noted that several evidence-based substance use and misuse approaches were integrated in an eclectic approach throughout the case example to demonstrate the idiographic nature of the Five Ps. One such framework is the Five Ps (Macneil et al., 2012). 0000012481 00000 n She describes an invalidating childhood, where parents did not acknowledge or praise her. While being mandated to attend counseling, Dax shares concerns that he is afraid of what his daughters test results will show. The Five P's approach provides a structured way of constructing this formulation. Alcohol, cannabis, and opioid use disorders, and disease burden in an integrated healthcare system. https://doi.org/10.1377/hlthaff.2013.0879 https://doi.org/10.1016/j.drugalcdep.2014.06.012 Oxford University Press. It is believed that CBT receives government support and funding because it is cheap and quick, even though the empirical evidence for it is weak (Hussain 2009). Book ReviewCollege Counseling and Student Development: Theory, Practice, and Campus Collaboration, Reflections on Power From Feminist Women Counselor Educators, Evaluating the Impact of Solution-Focused Brief Therapy on Hope and Clinical Symptoms With Latine Clients, Guidelines and Recommendations for Writing a Rigorous Quantitative Methods Section in Counseling and Related Fields. (2017). (2013). One of the strengths of this formulation is that it is not fixed. Current Drug Abuse Reviews, 4(1), 427. The effects of treatment for substance use problems on intimate partner violence: A review of empirical data. *You can also browse our support articles here >. (2014). 0000238491 00000 n Substance use and misuse carries numerous potential repercussions. Evaluation of children with heart murmurs. 0000239964 00000 n Cognitive behavioral therapists use individually tailored formulations as a framework with which to understand their patients' difficulties and to plan effective treatment. All work is written to order. SNACIy` iOUOb&U}+v$]MH"{8v%h= _ Formulation in psychology and psychotherapy: Making sense of peoples problems (2nd ed.). The counselor may also assist Dax in emotional regulation, which may prevent the initiation of arguments (Aldao & Nolen-Hoeksema, 2013). Problem areas reported by substance abusing individuals and their concerned significant others. https://www.apa.org/pubs/journals/pas/index 1. 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. A brief description of Dax, a hypothetical client, and the events that prompted him to seek services is followed by a detailed application of the Five Ps in addressing Daxs substance use and misuse. Oxford Handbooks Online, 149. xref As mentioned previously, novice counselors often lack sufficient case formulation skills (Liese & Esterline, 2015). Societally, substance use and misuse consequences exceed $400 billion in crime, health, and lost productivity (U.S. Department of Health and Human Services, 2016, p. 2). These symptoms have been maintained by [psychological factors/personality factors], and [social/environmental factors]. Van Wormer, K., & Davis, D. R. (2018). Furthermore, the Five Ps helps clients and counselors explore relationships between each factor and the presenting problem. https://doi.org/10.1016/j.avb.2010.01.006 Jane Doe presents with a diagnosis of borderline personality disorder and history of depression. This has further exacerbated her alcohol use disorder. What are perpetuating factors? White, M., & Epston, D. (1990). Case Formulation with the Biopsychosocial Model The biopsychosocial model ensures that your case formulation will be holistic, and will capture biological, psychological and social factors. 0000017109 00000 n Current Psychiatry Reports, 15(11), 211. This can be both positive or negative but they have a direct correlation to how the person is today. Jane Doe is a 30-year-old female who presents with acute suicidal ideation in the context of a job loss. Registered office: Creative Tower, Fujairah, PO Box 4422, UAE. 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 Seminars in the Psychotherapies , pp. Mindfulness-based strategies are not as effective when used alone as when used with other approaches (Sancho et al., 2018). Worrell, M. (2015). Participants should be people who can . 0000002760 00000 n 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). In Formulation in psychology and psychotherapy (pp. Of course, the Mintzberg 5 P's of Strategy are part of an organisation's strategy, but it's also wise to look at the 5 P's as separate standpoints that all need to be considered for developing a strong and successful strategy. 0000240043 00000 n It should be noted that several evidence-based substance use and misuse approaches were integrated in an eclectic approach throughout the case example to demonstrate the idiographic nature of the Five Ps. therapy for psychosis. He then withdraws and becomes sullen for a few days. In addition, the collaborative nature of the Five Ps reinforces the concept of an idiographic formulation. https://doi.org/10.1177/0009922813488653 Precipitating factors are those that proximally bring about substance use and misuse and its resulting difficulties. and Clark, D.M., 1989. Copyright 2023 National Board for Certified Counselors, Inc. and Affiliates. Precipitating and perpetuating factors: the stressor of losing her job has reactivated these more primitive defense mechanisms and coping strategies. Garland, E. L., Froeliger, B., & Howard, M. O. 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. This factor differs markedly from the first four. B., Lemle Becker, V., & Tompkins, M. A. However, they may find this framework valuable as it provides one more way to address the often-encountered complex challenges of substance use and misuse. Furthermore, the patient's difficulties can be understood as arising from the following developmental processes: which has led to the following thinking patterns: and the [precipitating event] is connected to their underlying struggles in the following way: They have the following: [protective factors], Jane Doe presents with a diagnosis of borderline personality disorder and history of depression. The ball in the pool metaphor (i.e., holding a beach ball under the water works temporarily, but eventually it pops back up) can be compared to alcohol temporarily holding those painful emotions down, eventually to resurface. To export a reference to this article please select a referencing stye below: If you are the original writer of this essay and no longer wish to have your work published on UKEssays.com then please: Our academic writing and marking services can help you! Results from the 2016 National Survey on Drug Use and Health: Detailed tables. It may include past difficulties and experiences if these are relevant to the present. Borrell-Carri F, Suchman AL, Epstein RM. Kendler, K. S. (2012). Plan: The Company must define and Plan its Goals and Milestones. A, & Otto, M. W. (2010). Our academic experts are ready and waiting to assist with any writing project you may have. Furthermore, clients like Dax who are mandated to attend substance-related counseling may have service plans that are not congruent with the Five Ps framework. Precepting factors draw upon the ABC model (Burns, 1989; Ellis, 1977; Trower et al 1998) which refers to A- activating event, B Beliefs and C- consequences. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. (2008). might you consider? J Am Acad Child Adolesc Psychiatry 2002;41(1):927. Concurrently treating both is very complex, challenging, and expensive. Additionally, as it is a continuous process it allows the therapist to revise any incorrect hypothesis about any underlying mechanism at any stage. These approaches can be accomplished via outpatient counseling, partial hospitalization programs, inpatient and medically managed substance treatment programs, as well as residential and therapeutic communities. Abnormal and normal obsessions. 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. 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). https://doi.org/10.1093/pubmed/fdv148 Johnstone, L., & Dallos, R. 0000004344 00000 n Dick, D. M., & Agrawal, A. 0000004306 00000 n Dax denies any other negative consequences from his alcohol use. startxref 0000007444 00000 n Introduction to formulation. This essay may contain factual inaccuracies or out of date material. What must be looked at in every formulation is if the particular formulation seems to be the right one and benefit for the person with the psychosis. Examining the two groups experiences using the Five Ps may provide insight to assist counselor training programs related to substance use and misuse skill development. Another potential area of study might involve comparing novice counselors to more experienced counselors. ,"Sb.&;.+Y&&_{} G|ku!dKMwU*jMdDN But the most important thing about formulation is that it should be intuitive and flow logically.