5 ps formulation example

), The science of cognitive behavioral therapy (pp. In addition, there are frameworks that use a formulation model examining various aspects of clients (Johnstone & Dallos, 2013) such as causal, contributing, environmental, and personal features, providing a much more expansive view of clients concerns. 0000239964 00000 n Additionally, Dax often struggles with strong and painful emotions, and alcohol helps to address them. 0000243959 00000 n Incorporating the Five Ps, with its holistic framework, may prove attractive to clients and counselors, thus potentially increasing the numbers of clients engaged in substance use and misuse treatment. (2008). 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). It may include past difficulties and experiences if these are relevant to the present. Current Psychiatry Reports, 15(11), 211. 0000241644 00000 n Centers for Disease Control and Prevention. 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). Dax presents as extremely frustrated and embarrassed at being mandated to attend counseling sessions. Protective factors move away from the problem areas that need interventions to hope and optimism and look to future success and competence (Macneil et al., 2012). 0000200610 00000 n <<6D17E8AF19023D4BAD06A1AFD23B08FB>]/Prev 415012/XRefStm 2760>> Cognitive and Behavioral Practice, 20(4), 399409. Another potential area of study might involve comparing novice counselors to more experienced counselors. Cognitive therapy in practice: A case formulation approach. 0000200021 00000 n The following samples can be taken as basic templates for case conceptualization, in the context of Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and family therapy. 0000118792 00000 n Alcohol, cannabis, and opioid use disorders, and disease burden in an integrated healthcare system. Abnormal and normal obsessions. U.S. Department of Health and Human Services. (2018). Plan: The Company must define and Plan its Goals and Milestones. van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013). Example of the 5 P's of Marketing John is considering operating a jet ski shop catering to travelers and tourists. A, & Otto, M. W. (2010). The implementation of the Five Ps with clients with mild substance use and misuse and those with more significant substance use and misuse, possibly using the DSM-5 diagnosis for SUD, may be another area to explore. What is a psychiatric case formulation? Presenting Issue(s) - please use the DSM-What assessment tools. Health Affairs, 32(12), 22052215. An example formulation is available (see A case example: "Sandra")* as an example of the type of output you and Clark, D.M., 1989. Predisposing Factors He was recently driving home from work in the evening and law enforcement stopped him because of erratic driving. Predisposing factors include biological, environmental, or personality considerations that may put clients at risk of further substance use and misuse. https://doi.org/10.1016/j.avb.2010.01.006 This population often experiences stigma and suboptimal health care results (McNeely et al., 2018; van Boekel et al., 2013). Child and Adolescent Psychiatric Clinics, 16(1), 111-132. Drugs and drug policy: What everyone needs to know. He is also adamant that he does not have a problem with alcohol. J Am Acad Child Adolesc Psychiatry 2002;41(1):927. *You can also browse our support articles here >. 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. Positive relationships, supportive community, and/or extended family/friends? Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. Jane Doe presents with a diagnosis of borderline personality disorder and history of depression. Winters, N. C., Hanson, G., & Stoyanova, V. (2007). (2011). 0000016414 00000 n It will make your job of formulating much easier. Now that you've filled in the easy parts from the history, the hardest part is conceptualizing the predisposing social factors (Step 3), and all of the psychological factors (Steps 4, 5, 6, 7). 5 Ps narrative table, from Comprehensive Care Resource Guide The clinician can provide a variety of potential spousal responses, allowing for more adaptability and flexibility in Daxs responses. The effects of treatment for substance use problems on intimate partner violence: A review of empirical data. therapy for psychosis. The dappled nature of causes of psychiatric illness: Replacing the organicfunctional/hardwaresoftware dichotomy with empirically based pluralism. 0000002964 00000 n https://www.ncbi.nlm.nih.gov/books/NBK343542 0000011818 00000 n This factor differs markedly from the first four. 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! The Canadian Journal of Psychiatry, 38(5), 351-358. Cognitive behaviour therapy for psychiatric problems: A practical guide. This may open the door to a conversation regarding how his substance use and misuse may progress to alcohol use disorder and its definition as a pattern of alcohol use leading to clinically significant problems, including increase in use, failed attempts to stop, and use leading to an impaired ability to meet role obligations (American Psychiatric Association, 2013). Journal of Substance Abuse Treatment, 26(3), 151158. Psychotherapy, 52(2), 190194. BMC Medicine, 10(111), 13. You've got your table all filled out now. A concerned best friend called and talked to her this evening, and brought her to the hospital. The next step Precipitating is used to look at both internal and external factors and discover where they are linked, from this you get a greater picture of the overall problem. 1189 0 obj <> endobj 0000241121 00000 n This is where you'll need to be creative and also think more in-depth about your patient. 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. Routledge. Day, A. M., Kahler, C. W., Ahern, D. C., & Clark, U. S. (2015). 0000005575 00000 n (2017). 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). Cognitive behavioral therapy for substance use disorders. 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). CBT has been found to not be effective in schizophrenia (Lynch et al. The five Ps allow consultants to evaluate and intervene at . Formulation in psychology and psychotherapy: Making sense of peoples problems (2nd ed.). She presents to hospital today with acute suicidal ideation and self-harm after being fired from her job. https://doi.org/10.1111/j.1752-0606.2011.00280.x Dax reports a strong paternal history of substance use and misuse. 0000007444 00000 n 0000200735 00000 n Once the protective factors are identified, the ensuing conversation provides opportunities to imagine future outcomes in which protective factors may come into play should situations occur that the client finds problematic. Sancho, M., De Gracia, M., Rodrguez, R. C., Mallorqu-Bagu, N., Snchez-Gonzlez, J., Trujols, J., Snchez, I., Jimnez-Murcia, S., & Menchn, J. M. (2018). This has further exacerbated her alcohol use disorder. For example, many precipitating and perpetuating factors may overlap and fit in other boxes. Some different presentation styles are suggested here. 0000006666 00000 n Unemployment and substance outcomes in the United States 20022010. (2013). Client substance use and misuse can be quite challenging for counselors, both novice and experienced. 0000010086 00000 n (Goldman & Greenberg 1997). https://www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdf Born in Canada. Dax drinks two to three times a week, usually having one or two shots of whiskey and two to three draft beers. Journal of Clinical Psychology, 74(3), 356384. 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. 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. (2017). & Haddock, G. (1990). Previous studies using frameworks to formulate have often used cognitive behavioral therapy as the primary intervention (Chadwick et al., 2003; Persons et al., 2013). https://doi.org/10.1016/j.drugalcdep.2014.06.012 0000119626 00000 n (2014). 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). ), Cover every box in the 4 Ps just for the sake of doing it (not all boxes will always apply!). 2. (2020, April 21). 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 is an essential step. She describes an invalidating childhood, where parents did not acknowledge or praise her. According to Dr Oliver James (Hussain 2009) CBT is over praised; what CBT achieves any other therapy can achieve to. The officers evaluated him, detained him, and subsequently arrested him for driving while intoxicated. She has several early developmental and pathogenic psychological factors, including growing up in a family characterized by invalidation, with parents who were distant and unavailable. Those who engage in substance use and misuse often have higher rates of unemployment (Compton et al., 2014; Dieter, 2011). 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 . However, like with anything, the more you practice, the better you will become at formulating. This likely led to an attachment style that was likely insecure and disorganized. Oxford Handbooks Online, 149. We would anticipate when engaging in treatment, the patient may have difficulties with using primitive defense mechanisms. 0000006894 00000 n Her mood was stable prior to this job loss, and she had no self-harm or suicidal thoughts in the past 1 year. Based on what I have reviewed in this essay. If your specific country is not listed, please select the UK version of the site, as this is best suited to international visitors. 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. startxref To help treat the client with psychosis maintaining specific behaviour can be beneficial and help avoid frustration and upsetting experiences (Johnstone 2009). Behaviour research and therapy, 16(4), pp.233-248. One way to do this is to use the "5 Ps.". https://doi.org/10.3389/fpsyt.2013.00173 https://doi.org/10.1186/s13722-018-0110-8 Hawton, K.E., Salkovskis, P.M., Kirk, J.E. 107127). Twelve-step attendance is most beneficial with inpatient substance use and misuse treatment (Karriker-Jaffe et al., 2018). ; DSM-5) bases an SUD on a pathological pattern related to the use of a substance (American Psychiatric Association, 2013, p. 483). Plan A good strategy must have a plan. Precipitating and perpetuating factors: the stressor of losing her job has reactivated these more primitive defense mechanisms and coping strategies. 0000012631 00000 n Van Wormer, K., & Davis, D. R. (2018). Dax shares that he and his wife are conflicted about how to proceed with their daughters medical care. 0000017109 00000 n or funding contributions for the development 0000155905 00000 n 300 words Walsh, F. (2014). Is diagnosis enough to guide interventions in mental https://doi.org/10.1016/S0005-7967(02)00033-5 of this manuscript. 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). All work is written to order. Type. In addition, aspects of narrative therapy may provide an opportunity for Dax to re-author a unique outcome that gives meaning and provides a functional identity to him as a father and husband, thus building a sense of optimism (White & Epston, 1990). 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. Review of outcome research on marital and family therapy in treatment for alcoholism. Predisposing looks at a wider understanding of the issues, looking at it in more lengthily way. xref 0000200305 00000 n Motivational interviewing: Building rapport with clients to encourage desirable behavioral and lifestyle changes. Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. The five perspectives are: A strategy has a PLAN A strategy has a PLOY A strategy has a PATTERN A strategy has a POSITION A strategy has a PERSPECTIVE Let's examine each of the 5 Ps of Strategy in turn 1. The goals here are to both break the pattern and to facilitate healthy conversations. The American Journal on Addictions, 21(1), 3846. In addition, the collaborative nature of the Five Ps reinforces the concept of an idiographic formulation. Copyright 2023 National Board for Certified Counselors, Inc. and Affiliates. 0000199672 00000 n History & Philosophy of Psychology, 13(2), 3239. Routledge. This is in keeping with the inherent uniqueness of clients, their concerns, and a variety of factors. What are the 5 Ps of case formulation? Karriker-Jaffe, K. J., Klinger, J. L., Witbrodt, J., & Kaskutas, L. A. 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). 0000017296 00000 n 0000156091 00000 n Dick, D. M., & Agrawal, A. 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. However, each has some shortcomings. However, patient has the following [protective factors], which may be a good prognostic factor. 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. Social isolation and withdrawn from family members, Ongoing social isolation due to psychosis causing him to be fearful of others, Followed by an early intervention in psychosis team, History of immigration (increases risk for psychosis), Long-standing feelings of isolation and insecurity since childhood, Joined a gang, entering a stressful lifestyle, led to increased hyper-vigilance and paranoia in the past few months, Ongoing delusions leading patient become suspicious of healthcare workers/family, Previously responded well to CBT for psychosis, Family history of psychosis and schizophrenia. Fundamental Changes in DSM-5 Dimensional Approach The conundrum with categories Garland, E. L., Froeliger, B., & Howard, M. O. As mentioned earlier different therapists have a different structure of formulations in CBT, this can be seen as a downside to the therapy, since it doesnt have a particular structure that everyone follows. The Oxford Textbook of Psychiatry[7] states that 'formulation is a concise statement of the case. New York: WW Norton. Clinical problem solving: the case of Matthew, part 1. Bush, D. M., & Lipari, R. N. (2015, April 16). 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). This condition did not develop six months ago but developed during childhood when he failed to meet his father's expectations. Planning is an essential part of the strategy formulation process, so take time to Brainstorm new opportunities. What we understand today is shaped by what we believe and what we have experienced in our life. https://doi.org/10.1093/pubmed/fdv148 Science, 196(4286), 129-136. The counselor may also assist Dax in emotional regulation, which may prevent the initiation of arguments (Aldao & Nolen-Hoeksema, 2013). This research could point to populations for whom the Five Ps is more and less effective. (2017). Aldao, A., & Nolen-Hoeksema, S. (2013). Addiction treatment: A strengths perspective (4th ed.). Jane is able to articulate a safe plan to stay with a friend, and is suitable for outpatient care, Jane might benefit from an increase of her, Jane might benefit from the use of anti-craving medications such as. The Biopsychosocial Model and Case Formulation (also known as the Biopsychosocial Formulation) in psychiatry is a way of understanding a patient as more than a diagnostic label. Due to her history of abuse at age 12, she may have struggled with identity versus role confusion during that Eriksonian stage of psychosocial development. Copyright 2003 - 2023 - UKEssays is a trading name of Business Bliss Consultants FZE, a company registered in United Arab Emirates. What are the 5 Ps in psychology? Diagnostic and statistical manual of mental disorders (5th ed.). Following formulation, there should be an identification of the prioritised areas of focus for care - to inform the Care Plan. 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. The CBT formulation consists of 5 key stages which is known as the 5 P's model. In Formulation in psychology and psychotherapy (pp. https://doi.org/10.1377/hlthaff.2013.0879 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. 0000006923 00000 n Such a framework may enhance the effectiveness of the aforementioned interventions (Wormer & Davis, 2018). (2016). Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: A meta-analysis. The more you formulate, it can be helpful to have a rough template of different formulations for different diagnoses (e.g. At its most basic, you could present each box sequentially and describe each factor. The Five Ps does not adhere to any particular theoretical orientation, thus allowing for a greater repertoire of strategies to draw from to help clients with substance use and misuse. SNACIy` iOUOb&U}+v$]MH"{8v%h= _ She subsequently planned to overdose on her medications. 0000119085 00000 n 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 health? Hypotheses are generated about the origins and causes of a patient's symptoms. The patient may have a strong family history of the disease, a sedentary job, environmental exposures, and/or a nutritionally-poor diet. Unlike summary, it is a discussion about alternative ideas about diagnosis, aetiology, treatment and prognosis and of the arguments for and against each alternative. 1. What are perpetuating factors? (Rachman & de Silva 1978, Salkovskis & Harrison 1984, sited in Tarrier et al. 0 Looking for a flexible role? Dax, however, is hyper-focused on surgery and seems to dismiss Saras position. Effects of treatment type on alcohol consumption partially mediated by Alcoholics Anonymous attendance. His father started out drinking occasionally and over the years slowly developed a dependency on alcohol. Substance use and misuse in the United States is extremely common. Treating substance use disorders in the criminal justice system. Again let's fill out the easiest parts of the table first: Now here is one potential example of a predisposing social and psychological formulation of psychosis (again, there are no right or wrong ways to formulate, it depends on the patient you have in front of you!). In addition, mindfulness strategies can assist in helping Dax to cognitively diffuse from present to future events (Harris, 2019). These psychological symptoms/factors are then observed by the clinician to give a psychiatric diagnosis. Applying this approach with clients who engage in substance use and misuse would allow more individual and flexible ways to intervene with client substance use and misuse. Another potential limitation is that the Five Ps may not be particularly beneficial for substance use and misuse in which there is clinical evidence of an SUD that includes significant withdrawal symptoms. 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). 0000156014 00000 n 0000238450 00000 n Long-term, Jane might also benefit from a more in-depth understanding of how her past trauma affects her present self and symptoms. Poorolajal, J., Haghtalab, T., Farhadi, M., & Darvishi, N. (2016). Our academic experts are ready and waiting to assist with any writing project you may have. 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). 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. 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. trailer One such framework is the Five Ps (Macneil et al., 2012). The approach that is highlighted in the 5Ps includes presenting, predisposing, precipitating, perpetuating, and protective factors. Journal of Addiction Medicine, 11(1), 39. Emotion regulation in cognitive-behavioral therapy: Bridging the gap between treatment studies and laboratory experiments. https://doi.org/10.1002/jclp.22516 0000186690 00000 n Furthermore, the Five Ps helps clients and counselors explore relationships between each factor and the presenting problem. Substance Use & Misuse, 49(5), 492512. 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. 0000010825 00000 n https://doi.org/10.1016/j.addbeh.2006.09.008 0000200485 00000 n " [Formulation is] The lynch pin that holds theory and practice together" (Butler, 1998).