5 ps formulation example5 ps formulation example

Engel, G. L. (1977). 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). This is an essential step. Mintzberg's 5 Ps of Strategy with Examples 1. The effects of treatment for substance use problems on intimate partner violence: A review of empirical data. https://doi.org/10.1016/j.psc.2010.04.012 0000010086 00000 n They are. PREDISPOSING FACTORS: What led to the problem starting? It is important to remember that not everything will fit neatly into each box. Unemployment and substance outcomes in the United States 20022010. Counselling with reality therapy (2nd ed.). Testing case formulation hypotheses in psychotherapy: Two case examples. For Dax, he shares that when he and his wife argue, it follows a very predictable pattern. Keys to solution in brief therapy. 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. Dax can then share his and his wifes perspectives on their daughters care. They may also present in the form of family, friends, or hobbies. Following a discussion of the Five Ps, a brief case illustration will demonstrate the framework. This area explores significant occurrences that preceded or triggered the presenting problem and its consequences. 2004;2(6):576-582. doi:10.1370/afm.245. hTILSQ=HC@K(`$*P2C endstream endobj 1263 0 obj <>/Filter/FlateDecode/Index[262 927]/Length 50/Size 1189/Type/XRef/W[1 1 1]>>stream The more cases you go through (and more of the sample formulations below) the more comfortable you will be with formulating! What are the 5 Ps in psychology? One versus many: Capturing the use of multiple emotion regulation strategies in response to an emotion-eliciting stimulus. 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. 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. A concerned best friend called and talked to her this evening, and brought her to the hospital. (Eds.). 0 In addition, using these approaches may result in omitting the uniqueness of clients as a consideration in treatment. Persons, J.B., 1989. Treating complex cases: The cognitive behavioural. (2017). 0000239101 00000 n https://doi.org/10.1377/hlthaff.2013.0879 It's useful to employ the 5 Ps throughout the planning process. Cognitive and Behavioral Practice, 20(4), 399409. Journal of Anxiety Disorders, 36, 18. Behavioral health treatments and services. Journal of Clinical Psychology, 74(3), 356384. xref 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. Penguin. Furthermore, the Five Ps helps clients and counselors explore relationships between each factor and the presenting problem. Worrell, M. (2015). Annual surveillance report of drug-related risks and outcomes. Using a framework to assist in case formulation may prove useful to beginning counselors. all (2004) it is essential to reduce stress and traumatic events for people recovering from Paranoid Schizophrenia, and start to contribute in social activities. 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). 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. 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. What are the 5 Ps of case formulation? Given that client substance use and misuse can be quite complicated, using various approaches within the Five Ps framework may yield positive results. Review of outcome research on marital and family therapy in treatment for alcoholism. Walsh, F. (2014). 1189 76 This factor has generally been underutilized despite being shown as beneficial to clients (Kuyken et al., 2009). https://doi.org/10.1111/j.1521-0391.2011.00187.x W. W. Norton. The approach that is highlighted in the 5Ps includes presenting, predisposing, precipitating, perpetuating, and protective factors. Narrative therapy to therapeutic ends. https://www.centeronaddiction.org/addiction-research/reports/behind-bars-ii-substance-abuse-and-americas-prison-population %PDF-1.4 % 0000186981 00000 n These beliefs are set off by occurrences in the client life, and once this belief is activated it can lead to automatic negative thinking. 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]. health? 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 . 160185). There are several approaches to managing client substance use and misuse that have demonstrated effectiveness. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860452/ Information. Studies utilizing the Five Ps with mandated clients may demonstrate its efficacy, notably with agencies that require substance-related counseling. 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. What can be done, realistically speaking. 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. Formulation: A multiperspective model. 0000180034 00000 n These symptoms have been further perpetuated by the personality factors and traits described above, and her ongoing financial stressors. https://doi.org/10.1016/S0005-7967(02)00033-5 Copyright 2023 National Board for Certified Counselors, Inc. and Affiliates. 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 . (2015). Henkel, D. (2011). Drug and Alcohol Dependence, 142(1), 350353. Precipitating and perpetuating factors: the stressor of losing her job has reactivated these more primitive defense mechanisms and coping strategies. Day, A. M., Kahler, C. W., Ahern, D. C., & Clark, U. S. (2015). Clinical Pediatrics, 53(2), 111117. Let's do a simplified formulation for the patient (Jane Doe) below. What is a psychiatric case formulation? From simple essay plans, through to full dissertations, you can guarantee we have a service perfectly matched to your needs. The 5 P's of Strategy is a planning process. 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. 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. 0000000016 00000 n Facing addiction in America: The Surgeon Generals report on alcohol, drugs, and health. Your formulation of a patient evolves and changes as you collect more information. After being told she was fired from her job, she went home and self-harmed to cope with the distress of this loss. https://doi.org/10.1093/oxfordhb/9780199935291.013.57 low mood) Precipitating Factors https://doi.org/10.1016/j.addbeh.2006.09.008 0000119085 00000 n Those who engage in substance use and misuse often have higher rates of unemployment (Compton et al., 2014; Dieter, 2011). 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). Nurcombe B, Drell M, Leonard H, et al. The "5 Ps" we recommend include: Purpose: Every meeting should have a reason. - depression, self-harm, mania/psychosis, anxiety, etc.) Sara is unequivocal in her confidence in Zoes cardiologist and his competence. 0000200305 00000 n Behaviour and Research Therapy, 41(6), 671680. 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. It acknowledges your strengths and resources. 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! or funding contributions for the development The following samples can be taken as basic templates for case conceptualization, in the context of Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and family therapy. The internal and external factors that maintain the current problems. One of the strengths of this formulation is that it is not fixed. Their effectiveness has been well researched, and this paper does not propose a superior way to address substance use and misuse. 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. While being mandated to attend counseling, Dax shares concerns that he is afraid of what his daughters test results will show. van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013). 1. The CBHSQ report: Substance use and substance use disorder by industry. Chiesa, A., & Serretti, A. 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). Abnormal and normal obsessions. (2018). 0000003178 00000 n 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. Perpetuating factors are those that sustain and possibly reinforce clients current substance use and misuse challenges. Psychotherapy, 52(2), 190194. It can assist both novice and experienced clinicians working with clients who present for counseling with substance use and misuse. Substance Abuse and Mental Health Services Administration. His father started out drinking occasionally and over the years slowly developed a dependency on alcohol. 0000245206 00000 n (2014). https://doi.org/10.1093/pubmed/fdv148 300 words Introduction to formulation. 0000238491 00000 n (Rachman & de Silva 1978, Salkovskis & Harrison 1984, sited in Tarrier et al. This condition did not develop six months ago but developed during childhood when he failed to meet his father's expectations. 0000001856 00000 n She describes an invalidating childhood, where parents did not acknowledge or praise her. Bentall (2004) had stated that obsessed person is highly sensitive to any threats to their self-esteem, therefore it is important to the individual to sustain the behaviour that they believe is protecting them from hurt to their self-esteem. 0000199672 00000 n He then stopped at a local pub and had several drinks. 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). Mindfulness-based strategies are not as effective when used alone as when used with other approaches (Sancho et al., 2018). 0000187506 00000 n In the context of this article, the word abusable indicates substances that when taken are pleasurable enough to result in excessive dosing or increased frequency of intake (Linden, 2011). hA 4-`76>m{dKs. Family therapy: Systemic approaches to practice. The need for a new medical model: a challenge for biomedicine. She also drank 10 beers prior to arriving in the hospital. He is confident that he does not have a problem and that counseling should be reserved for those who cannot stop drinking. The five Ps allow consultants to evaluate and intervene at . This research could point to populations for whom the Five Ps is more and less effective. Using case formulation in clinical practice. Such a framework may enhance the effectiveness of the aforementioned interventions (Wormer & Davis, 2018). Substance use and misuse carries numerous potential repercussions. Alcohol Research Current Reviews, 31(2), 111118. Harris, R. (2019). Presenting Problem " [Formulation is] The lynch pin that holds theory and practice together" (Butler, 1998). 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). Predisposing Factors The more you formulate, it can be helpful to have a rough template of different formulations for different diagnoses (e.g. Here's what the completed table would look like with the psychological factors incorporated. 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). https://doi.org/10.1007/s11920-013-0414-z 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). 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. Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust This can result in lack of access to treatment services, contributing to increased stress. 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. National Center on Addiction and Substance Abuse at Columbia University. In spite of these limitations, there may be several potential areas of inquiry. Please refer to an authoritative source if you require up-to-date information on any health or medical issue. This may have reactivated/exacerbated her emotional dysregulation, and resulted in negative coping styles such as her self-harming and suicidal ideation. The CBT formulation consists of 5 key stages which is known as the 5 P's model. The Five Ps is a systematic way to look at clients and their presentation, and its idiographic construction takes clients uniqueness into account. W. W. Norton. 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. This may open the door to a conversation regarding how his substance use and misuse may progress to alcohol use disorder and its definition as a pattern of alcohol use leading to clinically significant problems, including increase in use, failed attempts to stop, and use leading to an impaired ability to meet role obligations (American Psychiatric Association, 2013). 0000006923 00000 n 0000006666 00000 n Van Wormer, K., & Davis, D. R. (2018). 0000118792 00000 n Routledge.21-37). However, each has some shortcomings. 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. Dax presents as extremely frustrated and embarrassed at being mandated to attend counseling sessions. (Persons, 1998). This inspires the development of a longitudinal understanding of a persons problems. Psychological Assessment, 9(4), 334348. Substance Use & Misuse, 49(5), 492512. Murphy, C. M., & Ting, L. (2010). 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. What is the purpose of formulation? 0000008363 00000 n It is another way to address the multifaceted and complicated nature of client substance use and misuse. ,"Sb.&;.+Y&&_{} G|ku!dKMwU*jMdDN In addition, the interventions demonstrated are not to be assumed the only ones that can be applied to Dax. 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. Remember there is no right or wrong way to present your formulation. Cognition and Emotion, 27(4), 753760. This gives you a sense of their current level of functioning, prognosis, and guides your direction for treatment and management decisions. This is to ensure that the client understand any reason for change from what was originally agreed. A, & Otto, M. W. (2010). (2008). Problem areas reported by substance abusing individuals and their concerned significant others. 5 Ps narrative table, from Comprehensive Care Resource Guide Protective Factors This has led to her adulthood self-perception of being unworthy of being loved, a constant fear of rejection, and increased rejection sensitivity. Moreover, the Five Ps align with SAMHSAs recommendation that clinicians tailor treatment to each client because no single treatment is particularly superior (SAMHSA, 2020). Here the clinician may incorporate a solution-focused strategy exploring a time with Dax when he and his wife have disagreed, but he did not interrupt and the outcome was positive (de Shazer, 1985). In addition, the vast majority of those with an SUD never receive treatment (Han et al., 2015). Correspondence may be addressed to Scott Peters, One University Way, San Antonio, TX 78224, scott.peters@tamusa.edu. Long-term, Jane might also benefit from a more in-depth understanding of how her past trauma affects her present self and symptoms. Addictive Behaviors, 32(7), 13311346. 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). Marquis, A., & Holden, J. New York: WW Norton. Mental health professionals evaluations of the Integral Intake, a metatheory-based, idiographic intake instrument. The genetics of alcohol and other drug dependence. Implementing the Five Ps: The Case of Dax. 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. 0000200610 00000 n For example, many precipitating and perpetuating factors may overlap and fit in other boxes. 0000013321 00000 n An example formulation is available (see A case example: "Sandra")* as an example of the type of output you This can be both positive or negative but they have a direct correlation to how the person is today. 0000003215 00000 n This could be achieved with more specific and in depth trauma therapy, but given the acuity of her symptoms, this is something that would follow after DBT. https://doi.org/10.1186/1741-7015-10-111 Morin, J.-F. G., Harris, M., & Conrod, P. J. ), Essentials of clinical social work (pp. Most learners will use this method as it is the most simple. It is usually presented as Predisposing Precipitating Perpetuating Protective factors. 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). Substance Use & Misuse, 53(4), 596605. All work is written to order. 0000119448 00000 n Positive relationships, supportive community, and/or extended family/friends? Dax further reports his paternal grandfather died from liver failure. Looking for a flexible role? https://doi.org/10.1177/0017896918763462 https://www.samhsa.gov/treatment (2011). Compton, W. M., Gfroerer, J., Conway, K. P., & Finger, M. S. (2014). Wubbolding, R. E., & Brickell, J. Addressing the potential genetic link to substance use and misuse may prove beneficial in raising Daxs awareness (Dick & Agrawal, 2008). Client substance use and misuse can be quite challenging for counselors, both novice and experienced. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. You've got your table all filled out now. This essay may contain factual inaccuracies or out of date material. 0000006105 00000 n Aldao, A., & Nolen-Hoeksema, S. (2013). 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! https://doi.org/10.1080/10826084.2017.1349800 Journal of Addiction Medicine, 11(1), 39. https://doi.org/10.1111/j.1752-0606.2011.00280.x 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. Drug and Alcohol Dependence, 131(12), 2335. As mentioned previously, novice counselors often lack sufficient case formulation skills (Liese & Esterline, 2015). (2018). 0000199386 00000 n She subsequently planned to overdose on her medications. As shown above, there are numerous ways to examine and treat client substance use and misuse. (2017, September 7). This likely led to an attachment style that was likely insecure and disorganized. The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. Novice clinicians, who often have a more limited repertoire of strategies, may find the Five Ps valuable because of its systematic framework to clients. Like most things in medicine, there are multifactorial causes of diseases, illnesses, and disorders. In addition, the collaborative nature of the Five Ps reinforces the concept of an idiographic formulation. (2013). The therapist provides a route easiest for the client by identifying methods that build on the clients current resilience and strengths. 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 One of the weakness of this formulation is identifying that the clients strength is not included the initial assessment and data collection. Chadwick, P., Williams, C., & Mackenzie, J. Tarrier, N., Wells, A. https//doi.org/10.1016/j.drugalcdep.2013.02.018 Drugs and drug policy: What everyone needs to know. The systematic but flexible nature of this framework affords clinicians numerous ways to address substance use and misuse. 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. Evaluation of children with heart murmurs. 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. 0000004501 00000 n https://doi.org/10.1111/j.1752-0606.2011.00242.x
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