5 ps formulation example

Unemployment and substance use: A review of the literature (19902010). 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. Given the variations in substances, the extent of use, functional impairment, concomitant onset with other mental disorders, and inherent differences between clients, an idiographographically sound framework seems particularly appropriate for this population. Substance Use & Misuse, 53(4), 596605. This essay may contain factual inaccuracies or out of date material. Case formulation, also referred to as conceptualization, is a skill new counselors often lack (Liese & Esterline, 2015). 5 Ps narrative table, from Comprehensive Care Resource Guide: 4 : The Integrated Formulation : The Integrated formulation builds on the familiarity of the '5Ps', with the aim of specifically integrating that . 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. 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). Results from the 2016 National Survey on Drug Use and Health: Detailed tables. 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). Note that in this example, since the precipitating cause for acute psychosis (also applies to manic episodes) is more biological, it may be harder to identify underlying psychological factors (but that's OK too even the most biological psychiatric disorders can often be precipitated by psychosocial stressors). 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. 0000016414 00000 n This could be achieved with more specific and in depth trauma therapy, but given the acuity of her symptoms, this is something that would follow after DBT. Fundamental Changes in DSM-5 Dimensional Approach The conundrum with categories 2004;2(6):576-582. doi:10.1370/afm.245. https://doi.org/10.1016/S0740-5472(03)00212-5 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). Good interpersonal support from her best friend who brought her to hospital. For Dax, he shares that when he and his wife argue, it follows a very predictable pattern. One versus many: Capturing the use of multiple emotion regulation strategies in response to an emotion-eliciting stimulus. 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. Liese, B. S., & Esterline, K. M. (2015). Behind bars II: Substance abuse and Americas prison population. CBT has been found to not be effective in schizophrenia (Lynch et al. Predisposing factors include biological, environmental, or personality considerations that may put clients at risk of further substance use and misuse. Many formulation models are administered within a cognitive behavioral grounding (Chadwick et al., 2003; Easden & Kazantzis, 2018; Persons et al., 2013). And that's okay! Counselling with reality therapy (2nd ed.). Lack of adaptive coping mechanisms resulted in using self-harm to cope and avoid further emotional dysregulation. https://www.samhsa.gov/treatment However, patient has the following [protective factors], which may be a good prognostic factor. Previous studies using frameworks to formulate have often used cognitive behavioral therapy as the primary intervention (Chadwick et al., 2003; Persons et al., 2013). This factor has generally been underutilized despite being shown as beneficial to clients (Kuyken et al., 2009). Implementing the Five Ps: The Case of Dax. Journal of Clinical Psychology, 74(3), 356384. Introduction to formulation. https://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014.htm 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. In fact, this stigmatization can come from those who are treating them (Luoma et al., 2007). Scott W. Peters, PhD, LPC-S, is an associate professor at Texas A&M University San Antonio. These symptoms have been maintained by [psychological factors/personality factors], and [social/environmental factors]. It is open to modification any time during the treatment period and any new evidence that crop up at any time will be discussed with the client. 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 Formulation in psychology and psychotherapy: Making sense of peoples problems (2nd ed.). 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. A, & Otto, M. W. (2010). 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 . However, each has some shortcomings. The 5 P's of Strategy is a planning process. Aggression and Violent Behavior, 15(5), 325333. Bacon, M. Winters, N. C., Hanson, G., & Stoyanova, V. (2007). 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. Remember there is no right or wrong way to present your formulation. 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). White, M., & Epston, D. (1990). Oxford Handbooks Online, 149. Australasian Psychiatry, 22(4), 397-401. Jane Doe presents with a diagnosis of borderline personality disorder and history of depression. of this manuscript. SAMHSAs recommendations fit well with a more holistic framework in that such a structure allows clinicians to develop a multidimensional picture of clients. Wu, J. Q., Szpunar, K. K., Godovich, S. A., Schacter, D. L., & Hofmann, S. G. (2015). An example formulation is available (see A case example: "Sandra")* as an example of the type of output you 0000118792 00000 n 0000187506 00000 n However, there are others who use substances to such an extent that it causes significant distress and impairment in their lives, a phenomenon clinically referred to as a substance use disorder (SUD). (2011). 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. Weerasekera, P. (1993). These are historical psychological, biological, developmental, and socio-cultural factors that increased the person's vulnerability to their current problems. Additionally, the lack of coping mechanisms leading to intense thoughts of suicide. 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! de Shazer, S. (1985). (Eds.). Dax, however, is hyper-focused on surgery and seems to dismiss Saras position. J Am Acad Child Adolesc Psychiatry 2002;41(1):927. One such framework is the Five Ps (Macneil et al., 2012). https://doi.org/10.1093/pubmed/fdv148 (2008). However, the Five Ps presents a framework in which counselors can examine and intervene with client substance use and misuse using a variety of approaches and strategies. <<6D17E8AF19023D4BAD06A1AFD23B08FB>]/Prev 415012/XRefStm 2760>> Health Education Journal, 77(7), 749761. Note that this table is extremely comprehensive and long, and not everything will (or should!) https://doi.org/10.1186/s13722-018-0110-8 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. 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. The dappled nature of causes of psychiatric illness: Replacing the organicfunctional/hardwaresoftware dichotomy with empirically based pluralism. These can be in the form of personal characteristics such as tenacity, intellect, or insight. You are probably already formulating, but just don't know it. 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!). 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. One of the weakness of this formulation is identifying that the clients strength is not included the initial assessment and data collection. Belenko, S., Hiller, M., & Hamilton, L. (2013). We've received widespread press coverage since 2003, Your UKEssays purchase is secure and we're rated 4.4/5 on reviews.co.uk. This can be both positive or negative but they have a direct correlation to how the person is today. This area explores significant occurrences that preceded or triggered the presenting problem and its consequences. It also provides opportunities for a variety of interventions and strategies targeted to clients and their substance use and misuse or contributing factors. The patient has genetic vulnerabilities for mental illness in her family history, a history of anxious temperament, ongoing substance use, and subtherapeutic medication levels. 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). Moreover, the Five Ps align with SAMHSAs recommendation that clinicians tailor treatment to each client because no single treatment is particularly superior (SAMHSA, 2020). Day, A. M., Kahler, C. W., Ahern, D. C., & Clark, U. S. (2015). Here, the clinician may use reality-based strategies that address choice and consequences (Wubbolding & Brickell, 2017). The emphasis here is on features that continue the presenting problem. Ronald Press. It allows for client individualization, use of a variety of strategies, ongoing assessment, and modifications as needed. Persons, J. Cognitive Behavior Therapy (CBT) case conceptions have follows a 5p's model. 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. Free resources to assist you with your university studies! 0000003215 00000 n 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). Routledge.21-37). The meaning of anxiety. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Frontiers in Psychiatry, 9, 19. More ominously, substance use and misuse has been correlated with intimate partner violence (Murphy & Ting, 2010). 1264 0 obj <>stream 0000241644 00000 n 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 this article, we'll explore the 5 Ps in more detail and the tools that you can use in each area. For example, we diagnose someone with a major depressive episode if they meet 5 of the 9 symptomatic criteria. Cognitive therapy in practice: A case formulation approach. Patterns: Study what Worked in the Past and What can be Replicated. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. 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. 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). Protective factors are those that help to moderate actual or potential substance use and misuse impact. Becks States that life experiences play a part in people dysfunctional beliefs and assumptions about themselves, others and the world around them (Beck 1967, 1979). 0000009229 00000 n What can be done, realistically speaking. 0000011422 00000 n 0000008363 00000 n The narrative formulation of the patient is a less rigid presentation structure where you may not choose to present everything in the 4 Ps table, and instead focus on the key factors that you think are relevant: A much more advanced and nuanced presentation might be using a more comprehensive formulation that integrates the 4Ps formulation through multiple lenses (e.g. The clinician can intervene here by simply normalizing and validating his fears about the test results. This can result in lack of access to treatment services, contributing to increased stress. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860452/ Annals of Family Medicine. Substance use and misuse is exceedingly common and has numerous implications, both individual and societal, impacting millions of Americans directly and indirectly every year. Evidence-based approaches, such as cognitive behavioral therapy, tend to be nomothetic, assuming homogeneity and generally geared toward symptom amelioration (Robinson, 2011). https://doi.org/10.1080/10826084.2017.1349800 (2015). https://doi.org/10.1177/0017896918763462 Dax can then share his and his wifes perspectives on their daughters care. 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. In addition, mindfulness strategies can assist in helping Dax to cognitively diffuse from present to future events (Harris, 2019). Dax presents as extremely frustrated and embarrassed at being mandated to attend counseling sessions. For example, we diagnose someone with a major depressive episode if they meet 5 of the 9 symptomatic criteria. 1189 0 obj <> endobj Chadwick, P., Williams, C., & Mackenzie, J. Strategy as a Plan Planning comes naturally to many managers and as such, has become the default first step. Mintzberg's 5 Ps of Strategy with Examples 1. Protective Factors https://doi.org/10.1016/j.addbeh.2006.09.008 Wiley. Precipitating factors are those that proximally bring about substance use and misuse and its resulting difficulties. Dax is a 33-year-old married father of two children: a 9-year-old son, Cam, and a 7-year-old daughter, Zoe. Planning is an essential part of the strategy formulation process, so take time to Brainstorm new opportunities. 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. Based on these factors, dialectical behavioural therapy would be the most helpful for this patient. In S. G. Hofmann & G. J. G. Asmundson (Eds. According to Dr Oliver James (Hussain 2009) CBT is over praised; what CBT achieves any other therapy can achieve to. In addition, using these approaches may result in omitting the uniqueness of clients as a consideration in treatment. Family therapy: Systemic approaches to practice. Oxford University Press. People with paranoia tend to avoid these situations which would lead to distress (Clark et al 2005). Following a discussion of the Five Ps, a brief case illustration will demonstrate the framework. Born in Canada. Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: A meta-analysis. Further, substance use and misuse is a significant risk factor for suicidality (Poorolajal et al., 2016). Behavioral health treatments and services. However, like with anything, the more you practice, the better you will become at formulating. Formulation is like cooking, and there is no 'right' or 'wrong' way to do it, but most get better over time with increasing clinical experience. What are perpetuating factors? Here is an example of a set of treatment recommendations for Jane Doe: For good measure, here is another sample formulation for someone with a diagnosis of schizophrenia. 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). Cognitive behaviour therapy for psychiatric problems: A practical guide. (2017). They are examples that the author chose to illustrate the Five Ps in practice. 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! In psychiatry, formulation appears more complicated because human behaviour and the brain itself is extraordinarily complex. OFarrell, T. J., & Clements, K. (2012). Currently, there are a variety of empirically based interventions for treating clients who engage in substance use and misuse. This factor differs markedly from the first four. 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). (2019). To help treat the client with psychosis maintaining specific behaviour can be beneficial and help avoid frustration and upsetting experiences (Johnstone 2009). 0000010086 00000 n Tahan, H. A., & Sminkey, P. V. (2012). What are the 5 Ps in psychology? 0000240043 00000 n Morin, J.-F. G., Harris, M., & Conrod, P. J. 0000241200 00000 n This is where you'll need to be creative and also think more in-depth about your patient. He then stopped at a local pub and had several drinks. Episodic future thinking in generalized anxiety disorder. Perpetuating Factors endstream endobj 1263 0 obj <>/Filter/FlateDecode/Index[262 927]/Length 50/Size 1189/Type/XRef/W[1 1 1]>>stream 0000186690 00000 n or funding contributions for the development 0000243959 00000 n This likely led to an attachment style that was likely insecure and disorganized. Compton, W. M., Gfroerer, J., Conway, K. P., & Finger, M. S. (2014). Her mood was stable prior to this job loss, and she had no self-harm or suicidal thoughts in the past 1 year. 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). Addiction treatment: A strengths perspective (4th ed.). A logical analysis using gentle Socratic dialogue may help to challenge his emotional reactions to his daughters heart murmur (Etoom & Ratnapalan, 2014). The case formulation in child and adolescent psychiatry. Substance use and misuse in the United States is extremely common. Professional Case Management, 17(4), 164172. Published data on those incarcerated appears to be several years old. Centers for Disease Control and Prevention. Borrell-Carri F, Suchman AL, Epstein RM. Their effectiveness has been well researched, and this paper does not propose a superior way to address substance use and misuse. There are several approaches to managing client substance use and misuse that have demonstrated effectiveness. A good biopsychosocial formulation allows you to come up with a comprehensive and holistic treatment plan for your patient. Selzer, R., & Ellen, S. (2014). She also appears to use alcohol as a way of managing distressing emotions, but does not have any psychological coping strategies. Treating complex cases: The cognitive behavioural. It can be changed and reviewed as the treatment is in progress if any new information come to light. (2008). Formulation: A multiperspective model. (2010, February). Conflict of Interest and Funding Disclosure Frontiers in Psychiatry, 4(173), 115. The Five Ps permits counselors to both assess and intervene essentially simultaneously. 0000017296 00000 n PREDISPOSING FACTORS: What led to the problem starting? What is a psychiatric case formulation? Client substance use and misuse can be quite challenging for counselors, both novice and experienced. Dax shares that he and his wife are conflicted about how to proceed with their daughters medical care. https://doi.org/10.1016/j.avb.2010.01.006 300 words https://doi.org/10.1097/NCM.0b013e318253f029 The Essay Writing ExpertsUK Essay Experts. The patient appears to have adopted self-harming as a primitive coping strategy by early adulthood, and these have continued on in adulthood. 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. 0000014220 00000 n 5 Ps narrative table, from Comprehensive Care Resource Guide As I stated above this factor looks to get a wider understanding of what the issues is. Predisposing Factors https://doi.org/10.1111/j.1521-0391.2011.00187.x The essay will describe Greg's case study using 5P's model. Additionally, he reports significant stress and conflict in his marriage as well as concerns over some upcoming diagnostic tests for their daughter related to a heart murmur. The goals here are to both break the pattern and to facilitate healthy conversations. (Johnstone & Dallos 2009). Diagnostic and statistical manual of mental disorders (5th ed.). Concept mapping: A supervision strategy for introducing case conceptualization skills to novice therapists. As shown above, there are numerous ways to examine and treat client substance use and misuse. Henkel, D. (2011). https://doi.org/10.1016/j.drugalcdep.2014.06.012 https://doi.org/10.1186/1741-7015-10-111 https://doi.org/10.1016/j.cbpra.2013.03.004 Dax denies any other negative consequences from his alcohol use. Oxford University Press. Keywords: substance use and misuse, Five Ps, idiographic, systematic, flexible. This research could point to populations for whom the Five Ps is more and less effective. CBT case formulations often have 5 ingredients: Presenting problem (s) Predisposing factors which made the individual vulnerable to the problem Precipitating factors which triggered the problem Perpetuating factors such as mechanisms which keep a problem going or unintended consequences of an attempt to cope with the problem Protective factors (2018). Cognitive and Behavioral Practice, 20(4), 399409. (e.g. Drugs and drug policy: What everyone needs to know. 0000004306 00000 n https://doi.org/10.1177/0009922813488653 This framework is idiographic in nature, as it looks at clients individually and holistically (Marquis & Holden, 2008). It is systematic, while allowing for flexibility and creativity. One or more perpetuating psychological processes: Chronic marital/relationship discord, lack of empathy from family/friends, developmentally inappropriate expectations. 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. The goal here is to build Daxs competence in communicating, both in listening and expressing. - depression, self-harm, mania/psychosis, anxiety, etc.) Schoen, C., Osborn, R., Squires, D., & Doty, M. M. (2013). Substance Abuse and Mental Health Services Administration. Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. 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. For some, receiving substance use and misuse services can be stigmatizing. 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. Therapy, 38(1), 5981. This has led to her adulthood self-perception of being unworthy of being loved, a constant fear of rejection, and increased rejection sensitivity. (2003). 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). W. W. Norton. 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). 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). National Center on Addiction and Substance Abuse at Columbia University. This has further exacerbated her alcohol use disorder. 2009). 0000199386 00000 n 0000180123 00000 n Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. It should be noted that the strategies and interventions applied here are used as illustrations and are specific to Dax and his concerns. Client substance use and misuse at that level may need medical stabilization and detoxification prior to utilization of the Five Ps. Here are some examples: A good formulation should be integrative, and let you understand how all of the patient's factors interact to lead to the current situation.

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