5 ps formulation example

Case formulation, also referred to as conceptualization, is a skill new counselors often lack (Liese & Esterline, 2015). van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013). 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. Here's what the completed table would look like with the psychological factors incorporated. 0000012631 00000 n Journal of Public Health, 38(3), e282e291. There are several approaches to managing client substance use and misuse that have demonstrated effectiveness. 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). Delivery of mindfulness-based interventions may help to address stressful events that previously triggered substance use (Garland et al., 2014). 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. SAGE. Note that this table is extremely comprehensive and long, and not everything will (or should!) He is also adamant that he does not have a problem with alcohol. In J. R. Brandell (Ed. - depression, self-harm, mania/psychosis, anxiety, etc.) The Five Ps permits counselors to both assess and intervene essentially simultaneously. 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). Although these statistics are significant, it should be noted that Most people who use abusable drugs, even most people who use them nonmedically, do so in a reasonably controlled fashion and without much harm to themselves or anyone else (Kleiman et al., 2011, p. 2). 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. If your specific country is not listed, please select the UK version of the site, as this is best suited to international visitors. Correspondence may be addressed to Scott Peters, One University Way, San Antonio, TX 78224, scott.peters@tamusa.edu. 0000119267 00000 n Treating complex cases: The cognitive behavioural. Study for free with our range of university lectures! 0000016414 00000 n 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). Predisposing factors include biological, environmental, or personality considerations that may put clients at risk of further substance use and misuse. Here you can choose which regional hub you wish to view, providing you with the most relevant information we have for your specific region. 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. (2014). 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. This is an essential step. 2009). His father started out drinking occasionally and over the years slowly developed a dependency on alcohol. 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. Kleiman, M. A. R., Caulkins, J. P., & Hawken, A. Goldman, R. and Greenberg, L.S., 1997. ,"Sb.&;.+Y&&_{} G|ku!dKMwU*jMdDN https://doi.org/10.1111/j.1521-0391.2011.00187.x Some of these evidence-based approaches will be demonstrated later in a case illustration. Born in Canada. 0000006666 00000 n 0000238491 00000 n Mindfulness-based interventions for the treatment of substance and behavioral addictions: A systematic review. J Am Acad Child Adolesc Psychiatry 2002;41(1):927. Design of individualized behavioral treatment programs using functional analytic clinical case models. Remember there is no right or wrong way to present your formulation. 0000006894 00000 n This likely led to an attachment style that was likely insecure and disorganized. 0000156091 00000 n 0000187506 00000 n These can be in the form of personal characteristics such as tenacity, intellect, or insight. Child and Adolescent Psychiatric Clinics, 16(1), 111-132. New Harbinger. Alcohol Research Current Reviews, 31(2), 111118. 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). In Formulation in psychology and psychotherapy (pp. Keywords: substance use and misuse, Five Ps, idiographic, systematic, flexible. Frontiers in Psychiatry, 9, 19. What are the 5 Ps in psychology? This factor differs markedly from the first four. Additionally, as it is a continuous process it allows the therapist to revise any incorrect hypothesis about any underlying mechanism at any stage. Family therapy for drug abuse: Review and updates 20032010. Substance Abuse and Mental Health Services Administration. Macneil, C. A., Hasty, M. K., Conus, P., & Berk, M. (2012). Weerasekera, P. (1993). 0000006923 00000 n 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!). 0000238570 00000 n Journal of Anxiety Disorders, 36, 18. It is believed that CBT receives government support and funding because it is cheap and quick, even though the empirical evidence for it is weak (Hussain 2009). Examining the two groups experiences using the Five Ps may provide insight to assist counselor training programs related to substance use and misuse skill development. This research could point to populations for whom the Five Ps is more and less effective. Finally, the number of U.S. adults with a comorbid SUD and mental illness has been shown to be almost 8 million, with only about 5% receiving treatment for both (SAMHSA, 2017). Problem areas reported by substance abusing individuals and their concerned significant others. Harris, R. (2019). https://doi.org/10.1377/hlthaff.2013.0879 Murphy, C. M., & Ting, L. (2010). 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). Episodic future thinking in generalized anxiety disorder. 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). Cognitive behaviour therapy for psychiatric problems: A practical guide. The Five Ps framework promotes a very clear and systematic approach to case formulation or assessment that potentially provides a wealth of data. 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. Unemployment and substance outcomes in the United States 20022010. This has led to her adulthood self-perception of being unworthy of being loved, a constant fear of rejection, and increased rejection sensitivity. https://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014.htm Substance Use & Misuse, 49(5), 492512. University-educated. ; DSM-5) bases an SUD on a pathological pattern related to the use of a substance (American Psychiatric Association, 2013, p. 483). Health Affairs, 32(12), 22052215. 107127). (Eds.). 0000200610 00000 n https://doi.org/10.1177/0009922813488653 Scott W. Peters, PhD, LPC-S, is an associate professor at Texas A&M University San Antonio. She also drank 10 beers prior to arriving in the hospital. Abnormal and normal obsessions. These symptoms have been further perpetuated by the personality factors and traits described above, and her ongoing financial stressors. Cognitive Behavior Therapy (CBT) case conceptions have follows a 5p's model. 0000180034 00000 n 160185). In fact, this stigmatization can come from those who are treating them (Luoma et al., 2007). Journal of Mental Health Counseling, 30(1), 6794. Luoma, J. New York: WW Norton. Counselling with reality therapy (2nd ed.). https://doi.org/10.1080/10826084.2017.1349800 0000199672 00000 n The five Ps allow consultants to evaluate and intervene at . https://doi.org/10.3389/fpsyt.2013.00173 The patient may have a strong family history of the disease, a sedentary job, environmental exposures, and/or a nutritionally-poor diet. The "5 Ps" we recommend include: Purpose: Every meeting should have a reason. The internal and external factors that maintain the current problems. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. 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 . At its most basic, you could present each box sequentially and describe each factor. The case formulation in child and adolescent psychiatry. Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. Here the clinician may utilize strategies drawn from acceptance and commitment therapy related to his control strategy of using alcohol to avoid his emotions (Harris, 2019). The 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 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. In spite of these limitations, there may be several potential areas of inquiry. Routledge. 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. Our academic experts are ready and waiting to assist with any writing project you may have. Jane Doe is a 30-year-old female who presents with acute suicidal ideation in the context of a job loss. After being told she was fired from her job, she went home and self-harmed to cope with the distress of this loss. 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. Dallos, R. and Vetere, A., 2018. Risk and protective factors for adolescents illicit drug use: A population-based study. Frontiers in Psychiatry, 4(173), 115. CBT has been found to not be effective in schizophrenia (Lynch et al. Addiction Science and Clinical Practice, 13(8), 115. As she was unable to develop a sense of self and personal identity, these psychological factors are reflected in her adulthood with unstable relationships, and fears of abandonment. 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. https://www.apa.org/pubs/journals/pas/index Penguin. The emphasis here is on features that continue the presenting problem. Worrell, M. (2015). Behavioral health treatments and services. The 5 P's of Strategy is a planning process. She notably has a past history of childhood trauma and abuse. Surgeon General Vivek Murthy reported that more than 20 million Americans have an SUD (U.S. Department of Health and Human Services, 2016). Impact of case formulation in cognitive behaviour 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. Easden, M. H., & Kazantzis, N. (2018). Health Education Journal, 77(7), 749761. 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). 1264 0 obj <>stream For Dax, he shares that when he and his wife argue, it follows a very predictable pattern. Book ReviewCollege Counseling and Student Development: Theory, Practice, and Campus Collaboration, Reflections on Power From Feminist Women Counselor Educators, Evaluating the Impact of Solution-Focused Brief Therapy on Hope and Clinical Symptoms With Latine Clients, Guidelines and Recommendations for Writing a Rigorous Quantitative Methods Section in Counseling and Related Fields. (2014). Presenting Issue(s) - please use the DSM-What assessment tools. Therapy, 38(1), 5981. An example formulation is available (see A case example: "Sandra")* as an example of the type of output you Oxford University Press. Precipitating factors are those that proximally bring about substance use and misuse and its resulting difficulties. Based on these factors, the following [treatment and management] would be the most helpful for this patient. 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). However, as mentioned previously, case formulations have been used across a variety of client concerns (Chadwick et al., 2003; Ingram, 2012; Persons et al., 2013). Henkel, D. (2011). But the most important thing about formulation is that it should be intuitive and flow logically. 0000002760 00000 n 0000003215 00000 n https://doi.org/10.1016/j.addbeh.2006.09.008 The 4 Ps formulation table can be a very rigid and systematized way of presenting a formulation. Bacon, M. 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/10.1002/jclp.22516 0 A formulation is a joint effort between you and the psychologist to summarise your difficulties, to explain why they may be happening and to make sense of them. https://doi.org/10.1097/NCM.0b013e318253f029 Let's do a simplified formulation for the patient (Jane Doe) below. Linden, D. J. For example, we diagnose someone with a major depressive episode if they meet 5 of the 9 symptomatic criteria. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. Example of the 5 P's of Marketing John is considering operating a jet ski shop catering to travelers and tourists. (2011). 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. Using a framework to assist in case formulation may prove useful to beginning counselors. Presenting problems are concerns that clients find difficult to manage. ), The science of cognitive behavioral therapy (pp. 0000002964 00000 n If present categories are used, formulation can be limiting and dangerous. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638323/pdf/nihms734766.pdf Cognitive and Behavioral Practice, 20(4), 399409. ), Essentials of clinical social work (pp. Client substance use and misuse can be quite challenging for counselors, both novice and experienced. Cognitive behavioural couple therapy. Perpetuating factors are those that sustain and possibly reinforce clients current substance use and misuse challenges. 0000239964 00000 n - 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. Family therapy and the treatment of substance use disorders: The family matters model. Use this table as a general guide, but don't memorize it for the sake of memorizing it! One such framework is the Five Ps (Macneil et al., 2012). Participants should be people who can . It is another way to address the multifaceted and complicated nature of client substance use and misuse. Predisposing looks at a wider understanding of the issues, looking at it in more lengthily way. 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. What it wants to Achieve. How do you present all this information and data? Mindfulness-based strategies are not as effective when used alone as when used with other approaches (Sancho et al., 2018). 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! 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. Substance use and misuse has significant impact on the occupational sector as well. Now what? (Goldman & Greenberg 1997). Her mood was stable prior to this job loss, and she had no self-harm or suicidal thoughts in the past 1 year. (e.g. Twelve-step attendance is most beneficial with inpatient substance use and misuse treatment (Karriker-Jaffe et al., 2018). 0000241200 00000 n Chadwick, P., Williams, C., & Mackenzie, J. The Five Ps is a type of framework utilizing five factors developed by Macneil et al.

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