5 ps formulation example

https://doi.org/10.1097/NCM.0b013e318253f029 0000200021 00000 n There are limitations to the Five Ps framework as a way to formulate and intervene with clients substance use and misuse. Regrettably, most do not receive treatment while incarcerated (Belenko et al., 2013). I will go into further detail of the 5 Ps Model below. https://doi.org/10.1016/j.drugalcdep.2014.06.012 Based on these factors, the following [treatment and management] would be the most helpful for this patient. 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). The more you formulate, it can be helpful to have a rough template of different formulations for different diagnoses (e.g. It can be used in outpatient, inpatient, and residential settings and possibly as part of an aftercare program. hTILSQ=HC@K(`$*P2C 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. Published data on those incarcerated appears to be several years old. Disclaimer: This is an example of a student written essay.Click here for sample essays written by our professional writers. 0000017180 00000 n Cognitive behaviour therapy for psychiatric problems: A practical guide. Ploy: The Strategy has to analyze What Tactics can be Implemented. 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. 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. Mintzberg's 5 Ps of Strategy with Examples 1. 0000199672 00000 n 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. 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. Professional Case Management, 17(4), 164172. 0000238450 00000 n xref Use this table as a general guide, but don't memorize it for the sake of memorizing it! For Dax, he shares that when he and his wife argue, it follows a very predictable pattern. How do you present all this information and data? Alcohol Research Current Reviews, 31(2), 111118. 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 . Selzer, R., & Ellen, S. (2014). Mindfulness-based strategies are not as effective when used alone as when used with other approaches (Sancho et al., 2018). Kleiman, M. A. R., Caulkins, J. P., & Hawken, A. What level of care is required (outpatient or inpatient)? 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). 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). Additionally, many individuals who engage in substance use and misuse have co-occurring major medical conditions, such as cancers, cardiovascular accidents (strokes), and respiratory and cardiac illnesses (Bahorik et al., 2017). In S. G. Hofmann & G. J. G. Asmundson (Eds. all (2004) it is essential to reduce stress and traumatic events for people recovering from Paranoid Schizophrenia, and start to contribute in social activities. What we understand today is shaped by what we believe and what we have experienced in our life. 0000003215 00000 n This factor differs markedly from the first four. 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). 0000180123 00000 n 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! University-educated. Case conceptualization research in cognitive behavior therapy: A state of the science review. You've got your table all filled out now. Morin, J.-F. G., Harris, M., & Conrod, P. J. It also provides opportunities for a variety of interventions and strategies targeted to clients and their substance use and misuse or contributing factors. 300 words trailer https://doi.org/10.1016/j.avb.2010.01.006 The clinician may also discuss strategies to help Dax regulate his reactions using emotion-focused interventions such as positive reframing to ameliorate the stress of his daughters cardiac condition (Plate & Aldao, 2017). However, each has some shortcomings. (2012). (Goldman & Greenberg 1997). Equally if there is lack of collaboration, this can be as a result of expectations from either client or the therapist for example if the client have expectations from the therapist because he sees him as the expert and should be able to provide all the answers to his problems without him the client having an input. They disagree, interrupt one another, yell, and he calms down by having several beers. What can be done, realistically speaking. One versus many: Capturing the use of multiple emotion regulation strategies in response to an emotion-eliciting stimulus. Additionally, Dax often struggles with strong and painful emotions, and alcohol helps to address them. These symptoms have been further perpetuated by the personality factors and traits described above, and her ongoing financial stressors. Routledge. Precipitating Factors This is why the psychological section of the table is filled last, so we can understand what biological and social factors led to the, Jane Doe is a 30-year-old female who presents to the emergency room with acute. 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. (2019). Currently, there are a variety of empirically based interventions for treating clients who engage in substance use and misuse. Rowe, C. L. (2012). The implementation of the Five Ps with clients with mild substance use and misuse and those with more significant substance use and misuse, possibly using the DSM-5 diagnosis for SUD, may be another area to explore. What it wants to Achieve. It has been documented that 90% of the population at some point have intrusive thoughts, or feel paranoid and feel people are doing things on purpose towards them. Please refer to an authoritative source if you require up-to-date information on any health or medical issue. 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. The formulation can be used by the psychiatrist, therapist, treating team and patient, and when constructed, at times it can be similar to a piece of art or poetry - capturing the essence of the patient's difficulties and providing a deep insight in a condensed form. BMC Medicine, 10(111), 13. Dax shares that he and his wife are conflicted about how to proceed with their daughters medical care. 0 For some, receiving substance use and misuse services can be stigmatizing. https://doi.org/10.1080/10826084.2017.1349800 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. Child and Adolescent Psychiatric Clinics, 16(1), 111-132. The counselor may also assist Dax in emotional regulation, which may prevent the initiation of arguments (Aldao & Nolen-Hoeksema, 2013). Etoom, Y., & Ratnapalan, S. (2014). The idiographic/nomothetic dichotomy: Tracing historical origins of contemporary confusions. 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). Health Affairs, 32(12), 22052215. Moreover, the Five Ps align with SAMHSAs recommendation that clinicians tailor treatment to each client because no single treatment is particularly superior (SAMHSA, 2020). What are the 5 Ps of case formulation? The Biopsychosocial Model and Case Formulation (also known as the Biopsychosocial Formulation) in psychiatry is a way of understanding a patient as more than a diagnostic label. Johnstone, L. and Dallos, R., 2013. Fundamental Changes in DSM-5 Dimensional Approach The conundrum with categories Marquis, A., & Holden, J. Evidence-based approaches, such as cognitive behavioral therapy, tend to be nomothetic, assuming homogeneity and generally geared toward symptom amelioration (Robinson, 2011). 0000200735 00000 n They are. 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 may also present in the form of family, friends, or hobbies. Worrell, M. (2015). Substance Use & Misuse, 49(5), 492512. Seminars in the Psychotherapies , pp. Dax is a 33-year-old married father of two children: a 9-year-old son, Cam, and a 7-year-old daughter, Zoe. One way to do this is to use the "5 Ps.". A concerned best friend called and talked to her this evening, and brought her to the hospital. It is likely that other clinicians presented with Dax would use a different combination of approaches. Australasian Psychiatry, 22(4), 397-401. Many formulation models are administered within a cognitive behavioral grounding (Chadwick et al., 2003; Easden & Kazantzis, 2018; Persons et al., 2013). One such framework is the Five Ps (Macneil et al., 2012). Family therapy: Systemic approaches to practice. 0000000016 00000 n For example, the clinician may ask Dax if they can share how genes are passed on and expressed, like genes for eye color or hypertension. All rights reserved. SAMHSAs recommendations fit well with a more holistic framework in that such a structure allows clinicians to develop a multidimensional picture of clients. These are historical psychological, biological, developmental, and socio-cultural factors that increased the person's vulnerability to their current problems. If he cannot identify a time, simple role-plays in which Dax does not interrupt or yell and instead experiences different outcomes may provide optimism to Dax. startxref Their effectiveness has been well researched, and this paper does not propose a superior way to address substance use and misuse. He is also adamant that he does not have a problem with alcohol. In addition, the vast majority of those with an SUD never receive treatment (Han et al., 2015). Sara is unequivocal in her confidence in Zoes cardiologist and his competence. 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). 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 . In addition, aspects of narrative therapy may provide an opportunity for Dax to re-author a unique outcome that gives meaning and provides a functional identity to him as a father and husband, thus building a sense of optimism (White & Epston, 1990). 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. (2008). 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). Persons, J. ), Cover every box in the 4 Ps just for the sake of doing it (not all boxes will always apply!). A review of CBT treatments for substance use disorders. Additionally, as it is a continuous process it allows the therapist to revise any incorrect hypothesis about any underlying mechanism at any stage. Behaviour and Research Therapy, 41(6), 671680. Luoma, J. 0000012481 00000 n 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). Here you can choose which regional hub you wish to view, providing you with the most relevant information we have for your specific region. 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. Problem areas reported by substance abusing individuals and their concerned significant others. https://www.samhsa.gov/treatment U.S. Department of Health and Human Services. Hussaarts, P., Roozen, H. G., Meyers, R. J., van de Wetering, B. J. M., & McCrady, B. S. (2012). (2017). 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. A good biopsychosocial formulation allows you to come up with a comprehensive and holistic treatment plan for your patient. Copyright 2003 - 2023 - UKEssays is a trading name of Business Bliss Consultants FZE, a company registered in United Arab Emirates. 0000002760 00000 n Precipitating factors are those that proximally bring about substance use and misuse and its resulting difficulties. The image (. Furthermore, the Five Ps helps clients and counselors explore relationships between each factor and the presenting problem. Looking for a flexible role? The clinician may also seek more information on the cause of the reported stress between him and his wife. Now what? Journal of Clinical Psychology, 74(3), 356384. Note that this table is extremely comprehensive and long, and not everything will (or should!) There are several approaches to managing client substance use and misuse that have demonstrated effectiveness. You are probably already formulating, but just don't know it. 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. In spite of these limitations, there may be several potential areas of inquiry. ACT made simple (2nd ed.). This has further exacerbated her alcohol use disorder. 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). Persons, J.B., 1989. 0000155309 00000 n headspace recommends a formulation framework using the five Ps, as follows: Presenting problem (s): Initial signs, symptoms or other difficulties that are clinically important for the young person. Bahorik, A. L., Satre, D. D., Kline-Simon, A. H., Weisner, C. M., & Campbell, C. I. 107127). Cognitive behavioral therapy for substance use disorders. Current Drug Abuse Reviews, 4(1), 427. The following pages describe two approaches to documenting the formulation using the 5Ps structure, including a narrative and flowchart. Journal of Substance Abuse Treatment, 26(3), 151158. This area explores significant occurrences that preceded or triggered the presenting problem and its consequences. Dax was quite upset, cursed at her, and then hung up the phone. We would anticipate when engaging in treatment, the patient may have difficulties with using primitive defense mechanisms. 58 - 65. %PDF-1.4 % The five perspectives are: A strategy has a PLAN A strategy has a PLOY A strategy has a PATTERN A strategy has a POSITION A strategy has a PERSPECTIVE Let's examine each of the 5 Ps of Strategy in turn 1. Dax further reports his paternal grandfather died from liver failure. 0000239101 00000 n Jane Doe is a 30-year-old female who presents with acute suicidal ideation in the context of a job loss. Journal of Public Health, 38(3), e282e291. Predisposing looks at a wider understanding of the issues, looking at it in more lengthily way. https://doi.org/10.1002/jclp.22516 Engel, G. L. (1977). <<6D17E8AF19023D4BAD06A1AFD23B08FB>]/Prev 415012/XRefStm 2760>> These symptoms have been maintained by [psychological factors/personality factors], and [social/environmental factors]. The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. We would anticipate when engaging in treatment, the patient may have [resistance/transference/countertransference]. Fundamental Changes in DSM-5 Dimensional Approach The conundrum with categories 0000119085 00000 n Protective factors are those that help to moderate actual or potential substance use and misuse impact. In addition, the interventions demonstrated are not to be assumed the only ones that can be applied to Dax. Like most things in medicine, there are multifactorial causes of diseases, illnesses, and disorders. Precipitating and perpetuating factors: the stressor of losing her job has reactivated these more primitive defense mechanisms and coping strategies. Robinson, O. C. (2011). https://doi.org/10.1377/hlthaff.2013.0879 0000240043 00000 n 0000239180 00000 n 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. Annual surveillance report of drug-related risks and outcomes. Oftentimes, when the topic of protective factors is used in substance use and misuse, it is related to deterrence of substance use, notably with adolescents (Liao et al., 2018). This may have reactivated/exacerbated her emotional dysregulation, and resulted in negative coping styles such as her self-harming and suicidal ideation. 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. Motivational interviewing: Building rapport with clients to encourage desirable behavioral and lifestyle changes. And that's okay! The following readings below are excellent resources to further develop your formulation skills: As you can see in the table above, it's a lot of questions to ask and a lot of things to think about! 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. The officers evaluated him, detained him, and subsequently arrested him for driving while intoxicated. 0000200485 00000 n Journal of Marital and Family (2010, February). (2003) noted, examining positive client experiences may be one way to discover how to increase client participation in substance use and misuse treatment. The American Journal on Addictions, 21(1), 3846. National Center on Addiction and Substance Abuse at Columbia University. Cognitive Behavior Therapy (CBT) case conceptions have follows a 5p's model. The last P looked at is Protective which as the name suggest looks at ways to prepare the client so that relapse is unlikely, this is done by looking at the strengths of the client as a platform to build on. Participants: The leader of a meeting should carefully consider who he or she invites. Clinical Psychology 5 P Case Formulation (Macneil et al., 2012) Your mindset for intervention should be geared towards CBT - in NHS IAPT services this would be 'your' approach along with assessment as part of your case formulation. 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 . Precepting factors draw upon the ABC model (Burns, 1989; Ellis, 1977; Trower et al 1998) which refers to A- activating event, B Beliefs and C- consequences. https://doi.org/10.1177/0009922813488653 It acknowledges your strengths and resources. Twelve-step attendance is most beneficial with inpatient substance use and misuse treatment (Karriker-Jaffe et al., 2018). Let's do a simplified formulation for the patient (Jane Doe) below. Haynes, S. N., Leisen, M. B., & Blaine, D. D. (1997). Journal of Anxiety Disorders, 36, 18. B., Twohig, M. P., Waltz, T., Hayes, S. C., Roget, N., Padilla, M., & Fisher, G. (2007). It may include past difficulties and experiences if these are relevant to the present. 0000010086 00000 n The emphasis here is on features that continue the presenting problem. If your specific country is not listed, please select the UK version of the site, as this is best suited to international visitors. This has led to her adulthood self-perception of being unworthy of being loved, a constant fear of rejection, and increased rejection sensitivity. Mindfulness training targets neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface. (2017). 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. In J. R. Brandell (Ed. Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. https://doi.org/10.1177/0017896918763462 Jane has been working at a start up company for the past 2 years. The compass of pleasure: How our brains make fatty foods, orgasm, exercise, marijuana, generosity, vodka, learning, and gambling feel so good. It will make your job of formulating much easier. de Shazer, S. (1985). Study for free with our range of university lectures! It is important to remember that not everything will fit neatly into each box. It is another way to address the multifaceted and complicated nature of client substance use and misuse. 0000245206 00000 n 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). 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. Nothing gets resolved, and this cycle appears once again when they have conflict. Murphy, C. M., & Ting, L. (2010). This is in keeping with the inherent uniqueness of clients, their concerns, and a variety of factors. Patterns: Study what Worked in the Past and What can be Replicated. Journal of Addiction Medicine, 11(1), 39. However, the patient has protective factors including psychological mindedness and previous response to therapy, which is a good prognostic factor. The CBT formulation consists of 5 key stages which is known as the 5 Ps model. 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. 1: A step-by-step way of filling out a Biopsychosocial Table. We then move onto Perpetuating which looks at what factors are contributing to the remain of the problems the person is facing. (e.g. 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. Free resources to assist you with your university studies! 0000004805 00000 n Treating complex cases: The cognitive behavioural. Behavioral health treatments and services. Penguin. 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 . People with paranoia tend to avoid these situations which would lead to distress (Clark et al 2005). Your formulation of a patient evolves and changes as you collect more information. 0000238491 00000 n Greg experiences feelings of stress and anxiety over the past six months. Perpetuating Factors Therapy, 38(1), 5981. Frontiers in Psychiatry, 9, 19. First and foremost, it should be emphasized that this particular framework has not been empirically tested with client substance use and misuse. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors.

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