How do you present all this information and data? A good biopsychosocial formulation allows you to come up with a comprehensive and holistic treatment plan for your patient. https://doi.org/10.2174/1874473711104010004 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. 0000011422 00000 n %PDF-1.4 % (Goldman & Greenberg 1997). For example, we diagnose someone with a major depressive episode if they meet 5 of the 9 symptomatic criteria. These symptoms have been further perpetuated by the personality factors and traits described above, and her ongoing financial stressors. Treating complex cases: The cognitive behavioural. The goal here is to build Daxs competence in communicating, both in listening and expressing. Most learners will use this method as it is the most simple. It is usually presented as Predisposing Precipitating Perpetuating Protective factors. Nurcombe B, Drell M, Leonard H, et al. Jane has been working at a start up company for the past 2 years. 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. Mindfulness-based strategies are not as effective when used alone as when used with other approaches (Sancho et al., 2018). The emphasis here is on features that continue the presenting problem. Journal of Marital and Family Therapy, 38(1), 122144. Do you have a 2:1 degree or higher? Lack of adaptive coping mechanisms resulted in using self-harm to cope and avoid further emotional dysregulation. 0000240043 00000 n Substance use and misuse has significant impact on the occupational sector as well. https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf Given that client substance use and misuse can be quite complicated, using various approaches within the Five Ps framework may yield positive results. A logical analysis using gentle Socratic dialogue may help to challenge his emotional reactions to his daughters heart murmur (Etoom & Ratnapalan, 2014). Wubbolding, R. E., & Brickell, J. Behaviour and Research Therapy, 41(6), 671680. W. W. Norton. 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. We've received widespread press coverage since 2003, Your UKEssays purchase is secure and we're rated 4.4/5 on reviews.co.uk. Addressing client substance use and misuse can be quite complicated, and as mentioned previously, substance use and misuse impacts users and society in a variety of ways beyond substance intake. Narrative therapy to therapeutic ends. Information. The internal and external factors that maintain the current problems. 0000004656 00000 n Episodic future thinking in generalized anxiety disorder. She has the following protective factors, including a supportive psychiatrist and friend. 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. What are perpetuating factors? and her being fired from her job is connected to her underlying struggles in the following way: After being fired from her job, she experienced strong feelings of rejection, and was unable to cope with this major stressor. She is, Her underlying history of experiencing trauma and sexual abuse at a young age, A history of invalidating experiences in childhood, That she is not deserving of love or close relationships, a core belief of her being unlovable, and that self-harm is the main way of coping with stressors, That others may leave or abandon her any time, increased rejection sensitivity, and a future fear of being rejected, That the world can be a fearful and scary place. Design of individualized behavioral treatment programs using functional analytic clinical case models. 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. Family therapy and the treatment of substance use disorders: The family matters model. 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. Bahorik, A. L., Satre, D. D., Kline-Simon, A. H., Weisner, C. M., & Campbell, C. I. https://doi.org/10.1111/j.1752-0606.2011.00280.x https://www.apa.org/pubs/journals/pas/index Alcohol, cannabis, and opioid use disorders, and disease burden in an integrated healthcare system. (2003) noted, examining positive client experiences may be one way to discover how to increase client participation in substance use and misuse treatment. https://doi.org/10.3389/fpsyt.2013.00173 The CBT formulation consists of 5 key stages which is known as the 5 P's model. xref Copyright 2003 - 2023 - UKEssays is a trading name of Business Bliss Consultants FZE, a company registered in United Arab Emirates. 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). Having a framework for understanding of different psychological treatments and psychological theories can be helpful in making your psychological formulation flow intuitively (e.g. van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013). [1][2] Biopsychosocial formulation combines biological, psychological, and social factors to understand a patient, and uses this to guide both treatment and prognosis. https://doi.org/10.1007/s11920-013-0414-z https://www.centeronaddiction.org/addiction-research/reports/behind-bars-ii-substance-abuse-and-americas-prison-population low mood) 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. 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. 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). Scott W. Peters, PhD, LPC-S, is an associate professor at Texas A&M University San Antonio. " [Formulation is] The lynch pin that holds theory and practice together" (Butler, 1998). The counselor may also assist Dax in emotional regulation, which may prevent the initiation of arguments (Aldao & Nolen-Hoeksema, 2013). 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. 0000006666 00000 n (Persons, 1998). However, an important skill that they should try to perform is to assess a situation before jumping to conclusions. One or more perpetuating psychological processes: Chronic marital/relationship discord, lack of empathy from family/friends, developmentally inappropriate expectations. https://doi.org/10.1111/j.1521-0391.2011.00187.x Evidence-based approaches, such as cognitive behavioral therapy, tend to be nomothetic, assuming homogeneity and generally geared toward symptom amelioration (Robinson, 2011). It is another way to address the multifaceted and complicated nature of client substance use and misuse. Client substance use and misuse is a significant problem in the United States, and it continues to cause difficulty for individuals, families, and society. Novice clinicians, who often have a more limited repertoire of strategies, may find the Five Ps valuable because of its systematic framework to clients. Psychological Assessment, 9(4), 334348. 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! This framework is idiographic in nature, as it looks at clients individually and holistically (Marquis & Holden, 2008). Persons, J. 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. <<6D17E8AF19023D4BAD06A1AFD23B08FB>]/Prev 415012/XRefStm 2760>> Treating substance use disorders in the criminal justice system. Oxford University Press. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860452/ - attachment theory, cognitive behavioural therapy, dialectical behavioural therapy, interpersonal therapy, psychodynamic therapy). This factor differs markedly from the first four. As shown above, there are numerous ways to examine and treat client substance use and misuse. Abnormal and normal obsessions. (2020, April 21). 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. 0000017180 00000 n This area explores significant occurrences that preceded or triggered the presenting problem and its consequences. The therapist provides a route easiest for the client by identifying methods that build on the clients current resilience and strengths. Journal of Clinical Psychology, 74(3), 356384. 0000001856 00000 n 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). Following a discussion of the Five Ps, a brief case illustration will demonstrate the framework. (2016). Cognitive behavioural couple therapy. 0000241723 00000 n 1. Results from the 2016 National Survey on Drug Use and Health: Detailed tables. 0000241644 00000 n Mintzberg's 5 Ps of Strategy with Examples 1. In spite of these limitations, there may be several potential areas of inquiry. He fears that she will need open-heart surgery and that she may die. (2018). Dax further reports his paternal grandfather died from liver failure. 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). Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. Kuyken, W., Padesky, C. A., & Dudley, R. (2009). Fundamental Changes in DSM-5 Dimensional Approach The conundrum with categories A, & Otto, M. W. (2010). Substance Use & Misuse, 53(4), 596605. trailer Long-term, Jane might also benefit from a more in-depth understanding of how her past trauma affects her present self and symptoms. What is the purpose of formulation? This likely led to an attachment style that was likely insecure and disorganized. A concerned best friend called and talked to her this evening, and brought her to the hospital. 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. 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. Impact of case formulation in cognitive behaviour 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). This condition did not develop six months ago but developed during childhood when he failed to meet his father's expectations. Problem areas reported by substance abusing individuals and their concerned significant others. It also appears they may have had difficulty with [drives], stemming from [psychoanalytic concept], These experiences impacted the patient's view of themselves as being [view of self], and this has continued into adulthood based on [experiences]., The patient appears to have adopted [defense mechanisms] as coping strategies by early adulthood, and these have continued on, The patient's interpersonal relationships appear to be [give examples of patterns of relationships], These underlying factors may have precipitated the patient's [current presentation]. Wiley. (2013). The meaning of anxiety. What are the 5 Ps in psychology? It is important to remember that not everything will fit neatly into each box. 0000017296 00000 n It may include past difficulties and experiences if these are relevant to the present. Wu, J. Q., Szpunar, K. K., Godovich, S. A., Schacter, D. L., & Hofmann, S. G. (2015). According to Read et. 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. Marquis, A., & Holden, J. It can assist both novice and experienced clinicians working with clients who present for counseling with substance use and misuse. Perpetuating factors are those that sustain and possibly reinforce clients current substance use and misuse challenges. There was a parental divorce at age 5. We would anticipate when engaging in treatment, the patient may have difficulties with using primitive defense mechanisms. Journal of Public Health, 38(3), e282e291. Predisposing Factors 0000009229 00000 n 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. 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. Her mood was stable prior to this job loss, and she had no self-harm or suicidal thoughts in the past 1 year. 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. Concurrently treating both is very complex, challenging, and expensive. 0000241121 00000 n 0000245206 00000 n https://doi.org/10.1016/S0005-7967(02)00033-5 However, the patient has protective factors including psychological mindedness and previous response to therapy, which is a good prognostic factor. Professional Case Management, 17(4), 164172. 0000200021 00000 n & Haddock, G. (1990). For example, many precipitating and perpetuating factors may overlap and fit in other boxes. What we understand today is shaped by what we believe and what we have experienced in our life. This is where you'll need to be creative and also think more in-depth about your patient. Evaluation of children with heart murmurs. 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. Using case formulation in clinical practice. - depression, self-harm, mania/psychosis, anxiety, etc.) National Center on Addiction and Substance Abuse at Columbia University. ), Essentials of clinical social work (pp. https://doi.org/10.1016/j.janxdis.2015.09.005 New York: WW Norton. There are several approaches to managing client substance use and misuse that have demonstrated effectiveness. - Eriksonian developmental stages, psychodynamic defenses, and dialectical behavioural): Yet another way to present a formulation is in chronological order, starting from birth until present time: Having certain common phrases to use can be helpful to structure your presentation. 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). *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 This is in keeping with the inherent uniqueness of clients, their concerns, and a variety of factors. all (2004) it is essential to reduce stress and traumatic events for people recovering from Paranoid Schizophrenia, and start to contribute in social activities. 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. In addition, there may be clients who are simply not ready or able to address some or most of the dimensions of the Five Ps. A course of action you intend to take or a series of guidelines you intend to follow. Hawton, K.E., Salkovskis, P.M., Kirk, J.E. Even weekly status meetings or things of that nature should have a clearly defined purpose. One way to do this is to use the "5 Ps.". 0000003215 00000 n She also drank 10 beers prior to arriving in the hospital. ACT made simple (2nd ed.). 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. 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). It can be changed and reviewed as the treatment is in progress if any new information come to light. The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. 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). Precipitating factors are those that proximally bring about substance use and misuse and its resulting difficulties. 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. However, each has some shortcomings. 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. Protective factors are those that help to moderate actual or potential substance use and misuse impact. In Formulation in psychology and psychotherapy (pp. Addiction treatment: A strengths perspective (4th ed.). It looks at situations both past and present which can be both experiences and distresses that lead to symptoms of a psychotic nature can lead to resolving the psychosis. The clinician can intervene here by simply normalizing and validating his fears about the test results. The idiographic/nomothetic dichotomy: Tracing historical origins of contemporary confusions. These symptoms have been maintained by [psychological factors/personality factors], and [social/environmental factors]. Nothing gets resolved, and this cycle appears once again when they have conflict. 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). 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 Schoen, C., Osborn, R., Squires, D., & Doty, M. M. (2013). 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. Motivational interviewing: Building rapport with clients to encourage desirable behavioral and lifestyle changes. What are the 5 Ps of case formulation? 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!). Dax can then share his and his wifes perspectives on their daughters care. Here you can choose which regional hub you wish to view, providing you with the most relevant information we have for your specific region. In psychiatry, formulation appears more complicated because human behaviour and the brain itself is extraordinarily complex. Substance use and misuse has been correlated with both higher rates of absenteeism and workplace injuries (Bush & Lipari 2015). Journal of Addiction Medicine, 11(1), 39. OFarrell, T. J., & Clements, K. (2012). Health Education Journal, 77(7), 749761. https://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014.htm After being told she was fired from her job, she went home and self-harmed to cope with the distress of this loss. His father started out drinking occasionally and over the years slowly developed a dependency on alcohol. She has also previously responded well to psychotherapy and appears to be psychologically-minded. This has led to her adulthood self-perception of being unworthy of being loved, a constant fear of rejection, and increased rejection sensitivity. All rights reserved. Poverty, low socioeconomic status, teenage parenthood, or poor access to health care? Formulation in psychology and psychotherapy: Making sense of peoples problems (2nd ed.). The goals here are to both break the pattern and to facilitate healthy conversations. Psychiatric Clinics of North America, 33(3), 511525. Facing addiction in America: The Surgeon Generals report on alcohol, drugs, and health. Published data on those incarcerated appears to be several years old. There could be a discussion of alcohol use disorder being a disease, not that different from any other passed-on trait or disease. Selzer, R., & Ellen, S. (2014). 0000010825 00000 n The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. Current Drug Abuse Reviews, 4(1), 427. Second, it also tends to shift the conversation toward what is present and going well in their lives and away from those areas that cause distress and suffering (de Shazer, 1985). You've got your table all filled out now. British Journal of Clinical Psychology, 37(3), pp.269-284. 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). Annals of Family Medicine. Jane Doe presents with a diagnosis of borderline personality disorder and history of depression. Previous studies using frameworks to formulate have often used cognitive behavioral therapy as the primary intervention (Chadwick et al., 2003; Persons et al., 2013). 0000016414 00000 n therapy for psychosis. Stressor that activate one or more psychological processes: Loss of or separation from close family, partner, or friends, Do they have a chronic illness, functional impairment caused by. 0 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. 0000002964 00000 n Etoom, Y., & Ratnapalan, S. (2014). Cengage. Predisposing looks at a wider understanding of the issues, looking at it in more lengthily way. It also allows clinicians to target specific areas of concern (Macneil et al., 2012) and may be used in a variety of clinical settings. Kendler, K. S. (2012). This can be both positive or negative but they have a direct correlation to how the person is today. The more cases you go through (and more of the sample formulations below) the more comfortable you will be with formulating! A review of CBT treatments for substance use disorders. Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: A meta-analysis. Dax reports a strong paternal history of substance use and misuse. Dallos, R. and Vetere, A., 2018. Dick, D. M., & Agrawal, A. Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. https://doi.org/10.1186/1741-7015-10-111 It's useful to employ the 5 Ps throughout the planning process. Karriker-Jaffe, K. J., Klinger, J. L., Witbrodt, J., & Kaskutas, L. A. Luoma, J. 0000066425 00000 n 300 words It would be difficult to say which formulation is correct, and if there is such a thing as a correct one, since everyone has an individual view of what is right or wrong. Cognitive behaviour therapy for psychiatric problems: A practical guide. Cognitive behavioral therapy for substance use disorders. An example formulation is available (see A case example: "Sandra")* as an example of the type of output you Thus, there exists a need to concurrently examine and address the potentially complex nature of client substance use and misuse. 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). 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. https://doi.org/10.1037/a0038618 0000200305 00000 n ), The science of cognitive behavioral therapy (pp. Weerasekera, P. (1993). Concept mapping: A supervision strategy for introducing case conceptualization skills to novice therapists. It also provides opportunities for a variety of interventions and strategies targeted to clients and their substance use and misuse or contributing factors. 0000180256 00000 n or funding contributions for the development 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 (2017). What can be done, realistically speaking. If present categories are used, formulation can be limiting and dangerous. The following pages describe two approaches to documenting the formulation using the 5Ps structure, including a narrative and flowchart. 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. Born in Canada. Clients who engage in substance use and misuse can present with a variety of issues beyond use (Bahorik et al., 2017; Compton et al., 2014; Poorolajal et al., 2016). 0000187506 00000 n You are probably already formulating, but just don't know it. The most common and clinically practical way to formulate is through the biopsychosocial approach, first described in 1980 by George Engel. 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. Disclaimer: This is an example of a student written essay.Click here for sample essays written by our professional writers. The Five P's approach provides a structured way of constructing this formulation. 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 . 0000011818 00000 n I will go into further detail of the 5 Ps Model below. Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. Drug and Alcohol Dependence, 131(12), 2335. 0000239180 00000 n https://doi.org/10.1377/hlthaff.2013.0879 Precipitating and perpetuating factors: the stressor of losing her job has reactivated these more primitive defense mechanisms and coping strategies.
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