The patient has genetic vulnerabilities for mental illness in her family history, a history of anxious temperament, ongoing substance use, and subtherapeutic medication levels. J Am Acad Child Adolesc Psychiatry 2002;41(1):927. 0000003215 00000 n Lack of adaptive coping mechanisms resulted in using self-harm to cope and avoid further emotional dysregulation. 3. This framework is idiographic in nature, as it looks at clients individually and holistically (Marquis & Holden, 2008). Addressing the potential genetic link to substance use and misuse may prove beneficial in raising Daxs awareness (Dick & Agrawal, 2008). Information. 0000011818 00000 n What are the 5 Ps of case formulation? It can assist both novice and experienced clinicians working with clients who present for counseling with substance use and misuse. This may have reactivated/exacerbated her emotional dysregulation, and resulted in negative coping styles such as her self-harming and suicidal ideation. Case Conceptualization - Psychology Tools Twelve-step attendance is most beneficial with inpatient substance use and misuse treatment (Karriker-Jaffe et al., 2018). Planning is an essential part of the strategy formulation process, so take time to Brainstorm new opportunities. Unemployment and substance use: A review of the literature (19902010). More ominously, substance use and misuse has been correlated with intimate partner violence (Murphy & Ting, 2010). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. 1264 0 obj <>stream Clinical Psychology 5 P Case Formulation - StuDocu Some different presentation styles are suggested here. 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. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. 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. 0000011422 00000 n Substance use and misuse has been correlated with both higher rates of absenteeism and workplace injuries (Bush & Lipari 2015). Journal of Marital and Family 0000243959 00000 n The five Ps allow consultants to evaluate and intervene at . For Dax, he shares that when he and his wife argue, it follows a very predictable pattern. These symptoms have been further perpetuated by the personality factors and traits described above, and her ongoing financial stressors. Acknowledging that his reticence is due to being obligated to attend counseling may assist in relationship building (Tahan & Sminkey, 2012). startxref 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. 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). In addition, the vast majority of those with an SUD never receive treatment (Han et al., 2015). Looking for a flexible role? Evidence-based approaches, such as cognitive behavioral therapy, tend to be nomothetic, assuming homogeneity and generally geared toward symptom amelioration (Robinson, 2011). Kendler, K. S. (2012). Behavioral health treatments and services. Day, A. M., Kahler, C. W., Ahern, D. C., & Clark, U. S. (2015). Addiction Science and Clinical Practice, 13(8), 115. It will make your job of formulating much easier. Such a framework may enhance the effectiveness of the aforementioned interventions (Wormer & Davis, 2018). From simple essay plans, through to full dissertations, you can guarantee we have a service perfectly matched to your needs. Remember there is no right or wrong way to present your formulation. 0000119267 00000 n McHugh, R. K., Hearon, B. 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. In addition, using these approaches may result in omitting the uniqueness of clients as a consideration in treatment. 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). Substance Abuse and Mental Health Services Administration. A good biopsychosocial formulation allows you to come up with a comprehensive and holistic treatment plan for your patient. https://doi.org/10.1016/j.psc.2010.04.012 (2010, February). The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. Testing case formulation hypotheses in psychotherapy: Two case examples. It also provides opportunities for a variety of interventions and strategies targeted to clients and their substance use and misuse or contributing factors. Diagnostic and statistical manual of mental disorders (5th ed.). Precipitating factors are those that proximally bring about substance use and misuse and its resulting difficulties. New Harbinger. 0000007444 00000 n Alcohol, cannabis, and opioid use disorders, and disease burden in an integrated healthcare system. Another weakness is that sometimes the client might not want to disclose some information in their past which might assist the therapist in making the client understand that sometimes important part of their history in fluence the way they view the world. They may also present in the form of family, friends, or hobbies. The Canadian Journal of Psychiatry, 38(5), 351-358. Cognitive behavioral therapists use individually tailored formulations as a framework with which to understand their patients' difficulties and to plan effective treatment. Presenting Problem She subsequently planned to overdose on her medications. (Rachman & de Silva 1978, Salkovskis & Harrison 1984, sited in Tarrier et al. 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). The more you formulate, it can be helpful to have a rough template of different formulations for different diagnoses (e.g. She notably has a past history of childhood trauma and abuse. Bush, D. M., & Lipari, R. N. (2015, April 16). 0000007722 00000 n Academic Press. As part of his adjudication, Dax was required to attend five counseling sessions and have a clinicians report provided to the court. Liao, J.-Y., Huang, C.-M., Lee, C. T.-C., Hsu, H.-P., Chang, C.-C., Chuang, C.-J., & Guo, J.-L. (2018). Friendly Formulation - Psychology Tools Journal of Marital and Family Therapy, 38(1), 122144. Further, substance use and misuse is a significant risk factor for suicidality (Poorolajal et al., 2016). https://doi.org/10.17744/mehc.30.1.j40256207h0581t1 Psychiatric Clinics of North America, 33(3), 511525. This research could point to populations for whom the Five Ps is more and less effective. We then move onto Perpetuating which looks at what factors are contributing to the remain of the problems the person is facing. 0000187506 00000 n Substance Abuse and Mental Health Services Administration. The need for a new medical model: a challenge for biomedicine. 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. Plate, A. J., & Aldao, A. 0000180256 00000 n 5Ps Formulation | PDF | Substance Abuse | Mental Disorder The clinician can intervene here by simply normalizing and validating his fears about the test results. Protective Factors Surgeon General Vivek Murthy reported that more than 20 million Americans have an SUD (U.S. Department of Health and Human Services, 2016). 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. There are several approaches to managing client substance use and misuse that have demonstrated effectiveness. While being mandated to attend counseling, Dax shares concerns that he is afraid of what his daughters test results will show. 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. 0000199386 00000 n Precipitating and perpetuating factors: the stressor of losing her job has reactivated these more primitive defense mechanisms and coping strategies. At its most basic, you could present each box sequentially and describe each factor. Journal of Mental Health Counseling, 30(1), 6794. (2008). 0000010086 00000 n Formulation for beginners. University-educated. 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). 0000239101 00000 n *You can also browse our support articles here >. Do they have ability to be reflective or modulate their affect? Results from the 2016 National Survey on Drug Use and Health: Detailed tables. 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. https://doi.org/10.1097/ADM.0000000000000260 The Five Ps is an idiographically based framework providing clinicians with a systematic and flexible means of addressing substance use and misuse that can be used in conjunction with standard substance use and misuse interventions. OFarrell, T. J., & Clements, K. (2012). Treating complex cases: The cognitive behavioural. 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). It acknowledges your strengths and resources. Thus, there exists a need to concurrently examine and address the potentially complex nature of client substance use and misuse. It also allows clinicians to target specific areas of concern (Macneil et al., 2012) and may be used in a variety of clinical settings. The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. This gives you a sense of their current level of functioning, prognosis, and guides your direction for treatment and management decisions. 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 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). These symptoms have been maintained by [psychological factors/personality factors], and [social/environmental factors]. The dappled nature of causes of psychiatric illness: Replacing the organicfunctional/hardwaresoftware dichotomy with empirically based pluralism. It may include past difficulties and experiences if these are relevant to the present. Case formulation in process-experiential therapy. Case Formulation and Intervention: Application of the Five Ps Framework low mood) Alcohol Research Current Reviews, 31(2), 111118. 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. The Five Ps framework promotes a very clear and systematic approach to case formulation or assessment that potentially provides a wealth of data. (Ed.). But the most important thing about formulation is that it should be intuitive and flow logically. https://doi.org/10.1016/j.cbpra.2013.03.004 Han, B., Hedden, S. L., Lipari, R., Copello, E. A. P., & Kroutil, L. A. van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013). 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. (e.g. B., Twohig, M. P., Waltz, T., Hayes, S. C., Roget, N., Padilla, M., & Fisher, G. (2007). (2013). Professional Case Management, 17(4), 164172. 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). 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). Moreover, the Five Ps align with SAMHSAs recommendation that clinicians tailor treatment to each client because no single treatment is particularly superior (SAMHSA, 2020). No plagiarism, guaranteed! 0000008363 00000 n 5P Model Case Formulation [Case Study Example] | KESSAYS.COM Dax, however, is hyper-focused on surgery and seems to dismiss Saras position. 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. Even weekly status meetings or things of that nature should have a clearly defined purpose. https://doi.org/10.3389/fpsyt.2013.00173 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 Executive functioning in alcohol use studies: A brief review of findings and challenges in assessment. https://doi.org/10.1080/02699931.2012.739998 Annals of Family Medicine. Nurcombe B, Drell M, Leonard H, et al. <<6D17E8AF19023D4BAD06A1AFD23B08FB>]/Prev 415012/XRefStm 2760>> Substance use and misuse in the United States is extremely common. Chadwick, P., Williams, C., & Mackenzie, J. By examining and exploring clients use or misuse within the context of a multidimensional framework, interventions can be personalized, and areas of concern can be targeted. https://doi.org/10.3389/fpsyt.2018.00095 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. Poorolajal, J., Haghtalab, T., Farhadi, M., & Darvishi, N. (2016). The essay will describe Greg's case study using 5P's model. These can be in the form of personal characteristics such as tenacity, intellect, or insight. We've received widespread press coverage since 2003, Your UKEssays purchase is secure and we're rated 4.4/5 on reviews.co.uk. Impact of case formulation in cognitive behaviour An investigation of stigma in individuals receiving treatment for substance abuse. 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). Science, 196(4286), 129-136. 0000012631 00000 n 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. White, M., & Epston, D. (1990). These beliefs are set off by occurrences in the client life, and once this belief is activated it can lead to automatic negative thinking. How do you present all this information and data? The Five Ps permits counselors to both assess and intervene essentially simultaneously. 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. 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. (Goldman & Greenberg 1997). 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 internal and external factors that maintain the current problems. https://doi.org/10.1016/j.addbeh.2006.09.008 Your formulation of a patient evolves and changes as you collect more information. might you consider? 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. A course of action you intend to take or a series of guidelines you intend to follow. His father started out drinking occasionally and over the years slowly developed a dependency on alcohol. Unlike summary, it is a discussion about alternative ideas about diagnosis, aetiology, treatment and prognosis and of the arguments for and against each alternative. Another potential area of study might involve comparing novice counselors to more experienced counselors. 5 Ps Formulation Example - SocialEroi.it The choice of the above approaches is only meant as an illustration and not as definitive ways to address this particular client. Participants should be people who can . ), Cover every box in the 4 Ps just for the sake of doing it (not all boxes will always apply!). https://doi.org/10.1177/0017896918763462 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. (2017). Participants: The leader of a meeting should carefully consider who he or she invites. This has led to her adulthood self-perception of being unworthy of being loved, a constant fear of rejection, and increased rejection sensitivity. They conceptualized a way to look at clients and their problems, systematically and holistically taking into consideration the (1) Presenting problem, (2) Predisposing factors, (3) Precipitating factors, (4) Perpetuating factors, and (5) Protective factors. However, formulation tells us how the person became depressed as a result of their genetics, personality, psychological factors, biological factors, social circumstances (childhood adverse events and social determinants of health), and their environment. https://doi.org/10.1016/j.drugalcdep.2014.06.012 1. Ingram, B. L. (2012). Disclaimer: This is an example of a student written essay.Click here for sample essays written by our professional writers. The case formulation in child and adolescent psychiatry. https://doi.org/10.1016/j.avb.2010.01.006 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). 0000002760 00000 n 0000200735 00000 n Predisposing factors include biological, environmental, or personality considerations that may put clients at risk of further substance use and misuse. As mentioned previously, the Five Ps is not meant to replace any other substance use and misuse intervention. Motivational interviewing: Building rapport with clients to encourage desirable behavioral and lifestyle changes. 0000009229 00000 n The meaning of anxiety. Johnstone, L. and Dallos, R., 2013. Oxford Handbooks Online, 149. https://doi.org/10.1111/j.1521-0391.2011.00187.x National Center on Addiction and Substance Abuse at Columbia University. This is in keeping with the inherent uniqueness of clients, their concerns, and a variety of factors. Luoma, J. 5 Ps Formulation Example. For example, we diagnose someone with a major depressive episode if they meet 5 of the 9 symptomatic criteria. Rowe, C. L. (2012). Jane Doe presents with a diagnosis of borderline personality disorder and history of depression. The CBHSQ report: Substance use and substance use disorder by industry. 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 . Jane Doe is a 30-year-old female who presents with acute suicidal ideation in the context of a job loss. Having a framework for understanding of different psychological treatments and psychological theories can be helpful in making your psychological formulation flow intuitively (e.g. Mindfulness-based strategies are not as effective when used alone as when used with other approaches (Sancho et al., 2018). Current Drug Abuse Reviews, 8(1), 2640. 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! 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. New York: WW Norton. Born in Canada. 0000017296 00000 n Episodic future thinking in generalized anxiety disorder. Formulation: A multiperspective model. Molecular psychiatry, 17(4), 377-388. https://doi.org/10.1186/s13722-018-0110-8 Wu, J. Q., Szpunar, K. K., Godovich, S. A., Schacter, D. L., & Hofmann, S. G. (2015). Routledge. Jane has been working at a start up company for the past 2 years. Macneil, C. A., Hasty, M. K., Conus, P., & Berk, M. (2012). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638323/pdf/nihms734766.pdf

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