5 ps formulation example

Precipitating factors are those that proximally bring about substance use and misuse and its resulting difficulties. Do they have ability to be reflective or modulate their affect? It allows for client individualization, use of a variety of strategies, ongoing assessment, and modifications as needed. White, M., & Epston, D. (1990). Some different presentation styles are suggested here. Twelve-step attendance is most beneficial with inpatient substance use and misuse treatment (Karriker-Jaffe et al., 2018). 0000005575 00000 n (2013). 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). Study for free with our range of university lectures! Do you have a 2:1 degree or higher? 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). 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. Previous studies using frameworks to formulate have often used cognitive behavioral therapy as the primary intervention (Chadwick et al., 2003; Persons et al., 2013). 0000200610 00000 n 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. 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. The Canadian Journal of Psychiatry, 38(5), 351-358. What are the 5 Ps of case formulation? 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 . The choice of the above approaches is only meant as an illustration and not as definitive ways to address this particular client. Worrell, M. (2015). Moreover, the Five Ps align with SAMHSAs recommendation that clinicians tailor treatment to each client because no single treatment is particularly superior (SAMHSA, 2020). Client substance use and misuse can be quite challenging for counselors, both novice and experienced. Concept mapping: A supervision strategy for introducing case conceptualization skills to novice therapists. 0000066425 00000 n 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 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. 0000186981 00000 n 5 Ps narrative table, from Comprehensive Care Resource Guide He is also adamant that he does not have a problem with alcohol. 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. Easden, M. H., & Kazantzis, N. (2018). In this article, we'll explore the 5 Ps in more detail and the tools that you can use in each area. Wubbolding, R. E., & Brickell, J. The Five Ps is a systematic way to look at clients and their presentation, and its idiographic construction takes clients uniqueness into account. of this manuscript. Here, the clinician may use reality-based strategies that address choice and consequences (Wubbolding & Brickell, 2017). 1. Even weekly status meetings or things of that nature should have a clearly defined purpose. What is the purpose of formulation? Additionally, there may be a discussion using aspects of existentialism to process inherent anxiety and its connection to unknowable future events (May, 1950; Wu et al., 2015). Strategy as a Plan Planning comes naturally to many managers and as such, has become the default first step. 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. Etoom, Y., & Ratnapalan, S. (2014). 0000241644 00000 n 0000180256 00000 n Acknowledging that his reticence is due to being obligated to attend counseling may assist in relationship building (Tahan & Sminkey, 2012). In addition, mindfulness strategies can assist in helping Dax to cognitively diffuse from present to future events (Harris, 2019). New York: WW Norton. 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. It also allows clinicians to target specific areas of concern (Macneil et al., 2012) and may be used in a variety of clinical settings. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638323/pdf/nihms734766.pdf It can be changed and reviewed as the treatment is in progress if any new information come to light. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. Substance Use & Misuse, 53(4), 596605. While being mandated to attend counseling, Dax shares concerns that he is afraid of what his daughters test results will show. (2003). The clinician may discuss the concept of circularity and assist in moving from vicious cycles to virtuous cycles and problem resolution (Walsh, 2014, p. 162). A logical analysis using gentle Socratic dialogue may help to challenge his emotional reactions to his daughters heart murmur (Etoom & Ratnapalan, 2014). 0000119267 00000 n Understanding how each factor contributes to a disease can better guide treatment decisions. 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). We then move onto Perpetuating which looks at what factors are contributing to the remain of the problems the person is facing. 0000008644 00000 n The meaning of anxiety. 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. Luoma, J. Selzer, R., & Ellen, S. (2014). Chapter. Addictive Behaviors, 32(7), 13311346. - depression, self-harm, mania/psychosis, anxiety, etc.) The patient appears to have adopted self-harming as a primitive coping strategy by early adulthood, and these have continued on in adulthood. 0 A systematic review of the evidence. In addition, the vast majority of those with an SUD never receive treatment (Han et al., 2015). 0000011818 00000 n 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). 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. Substance use and misuse is exceedingly common and has numerous implications, both individual and societal, impacting millions of Americans directly and indirectly every year. Looking for a flexible role? British Journal of Clinical Psychology, 37(3), pp.269-284. 0000003215 00000 n https://doi.org/10.1097/ADM.0000000000000260 The next step Precipitating is used to look at both internal and external factors and discover where they are linked, from this you get a greater picture of the overall problem. People with paranoia tend to avoid these situations which would lead to distress (Clark et al 2005). These approaches can be accomplished via outpatient counseling, partial hospitalization programs, inpatient and medically managed substance treatment programs, as well as residential and therapeutic communities. Planning is an essential part of the strategy formulation process, so take time to Brainstorm new opportunities. Patterns: Study what Worked in the Past and What can be Replicated. She has several early developmental and pathogenic psychological factors, including growing up in a family characterized by invalidation, with parents who were distant and unavailable. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860452/ Family therapy for drug abuse: Review and updates 20032010. There could be a discussion of alcohol use disorder being a disease, not that different from any other passed-on trait or disease. 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). Copyright 2003 - 2023 - UKEssays is a trading name of Business Bliss Consultants FZE, a company registered in United Arab Emirates. In S. G. Hofmann & G. J. G. Asmundson (Eds. Rachman, S. and de Silva, P., 1978. Drug and Alcohol Dependence, 131(12), 2335. https://doi.org/10.3389/fpsyt.2013.00173 University-educated. The goal here is to build Daxs competence in communicating, both in listening and expressing. 0000187506 00000 n 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. trailer It's useful to employ the 5 Ps throughout the planning process. 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. 1264 0 obj <>stream https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf https://doi.org/10.1111/j.1521-0391.2011.00187.x Dax drinks two to three times a week, usually having one or two shots of whiskey and two to three draft beers. 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. %%EOF This condition did not develop six months ago but developed during childhood when he failed to meet his father's expectations. 0000008363 00000 n Cognitive behaviour therapy for psychiatric problems: A practical guide. https://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014.htm The need for a new medical model: a challenge for biomedicine. ), Cover every box in the 4 Ps just for the sake of doing it (not all boxes will always apply!). National Center on Addiction and Substance Abuse at Columbia University. B., Twohig, M. P., Waltz, T., Hayes, S. C., Roget, N., Padilla, M., & Fisher, G. (2007). 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 . https://doi.org/10.1016/j.psc.2010.04.012 You are probably already formulating, but just don't know it. Current Drug Abuse Reviews, 8(1), 2640. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. Morin, J.-F. G., Harris, M., & Conrod, P. J. low mood) 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. 1. 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! (2018, August 31). Here the focus is on investigating resources and/or supports that may help prevent client substance use and misuse from further becoming problematic. (2018). Routledge. Thus, there exists a need to concurrently examine and address the potentially complex nature of client substance use and misuse. Participants: The leader of a meeting should carefully consider who he or she invites. <<6D17E8AF19023D4BAD06A1AFD23B08FB>]/Prev 415012/XRefStm 2760>> A brief description of Dax, a hypothetical client, and the events that prompted him to seek services is followed by a detailed application of the Five Ps in addressing Daxs substance use and misuse. Sara is unequivocal in her confidence in Zoes cardiologist and his competence. History & Philosophy of Psychology, 13(2), 3239. Academic Press. Following a discussion of the Five Ps, a brief case illustration will demonstrate the framework. Plan: The Company must define and Plan its Goals and Milestones. Substance use and misuse in the United States is extremely common. 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. 0000239964 00000 n Their effectiveness has been well researched, and this paper does not propose a superior way to address substance use and misuse. Psychiatric Clinics of North America, 33(3), 511525. 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. Perpetuating Factors We would anticipate when engaging in treatment, the patient may have [resistance/transference/countertransference]. Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. Some of these evidence-based approaches will be demonstrated later in a case illustration. Concurrently treating both is very complex, challenging, and expensive. 0000014220 00000 n de Shazer, S. (1985). Liao, J.-Y., Huang, C.-M., Lee, C. T.-C., Hsu, H.-P., Chang, C.-C., Chuang, C.-J., & Guo, J.-L. (2018). In addition, using these approaches may result in omitting the uniqueness of clients as a consideration in treatment. The Five Ps framework promotes a very clear and systematic approach to case formulation or assessment that potentially provides a wealth of data. Schoen, C., Osborn, R., Squires, D., & Doty, M. M. (2013). Treating complex cases: The cognitive behavioural. Frontiers in Psychiatry, 4(173), 115. 0000180123 00000 n Ronald Press. Keys to solution in brief therapy. Johnstone, L. and Dallos, R., 2013. 0000001856 00000 n Use this table as a general guide, but don't memorize it for the sake of memorizing it! 0000118792 00000 n 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. For the year 2016, the Centers for Disease Control and Prevention (CDC) found that 18% of the U.S. population aged 12 and older had used illicit substances or misused prescription medications (CDC, 2018). For example, type II diabetes does not develop because of a single pathophysiological cause. Mindfulness-based interventions for the treatment of substance and behavioral addictions: A systematic review. As shown above, there are numerous ways to examine and treat client substance use and misuse. 5 Ps Formulation Example. An investigation of stigma in individuals receiving treatment for substance abuse. We've received widespread press coverage since 2003, Your UKEssays purchase is secure and we're rated 4.4/5 on reviews.co.uk. (Johnstone & Dallos 2009). Journal of Clinical Psychology, 74(3), 356384. It is another way to address the multifaceted and complicated nature of client substance use and misuse. Fundamental Changes in DSM-5 Dimensional Approach The conundrum with categories 0000156091 00000 n W. W. Norton. This can be even more problematic given the lack of health care access for large numbers of Americans (Schoen, 2013). https://doi.org/10.1093/pubmed/fdv148 She also drank 10 beers prior to arriving in the hospital. From simple essay plans, through to full dissertations, you can guarantee we have a service perfectly matched to your needs. The effects of treatment for substance use problems on intimate partner violence: A review of empirical data. https://doi.org/10.1002/jclp.22516 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. Impact of case formulation in cognitive behaviour After being told she was fired from her job, she went home and self-harmed to cope with the distress of this loss. (2017). Family therapy: Systemic approaches to practice. 0000012631 00000 n https://doi.org/10.2174/1874473711104010004 Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. Formulation for beginners. Free resources to assist you with your university studies! Dax further reports his paternal grandfather died from liver failure. The goals here are to both break the pattern and to facilitate healthy conversations. 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 . Guilford. " [Formulation is] The lynch pin that holds theory and practice together" (Butler, 1998). Presenting Problem May, R. (1950). Fig. Wiley. Here's what the completed table would look like with the psychological factors incorporated. In J. R. Brandell (Ed. The genetics of alcohol and other drug dependence. Dax can then share his and his wifes perspectives on their daughters care. https://doi.org/10.1080/02699931.2012.739998 Please refer to an authoritative source if you require up-to-date information on any health or medical issue. 0000200185 00000 n CBT case formulations often have 5 ingredients: Presenting problem (s) Predisposing factors which made the individual vulnerable to the problem Precipitating factors which triggered the problem Perpetuating factors such as mechanisms which keep a problem going or unintended consequences of an attempt to cope with the problem Protective factors 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. 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 . 0000004344 00000 n Here you can choose which regional hub you wish to view, providing you with the most relevant information we have for your specific region. Additionally, he reports significant stress and conflict in his marriage as well as concerns over some upcoming diagnostic tests for their daughter related to a heart murmur. Jane has been working at a start up company for the past 2 years. The more cases you go through (and more of the sample formulations below) the more comfortable you will be with formulating! 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. Cognitive Behavior Therapy (CBT) case conceptions have follows a 5p's model. 0000200021 00000 n Based on these factors, dialectical behavioural therapy would be the most helpful for this patient. 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 . 0000155905 00000 n This population often experiences stigma and suboptimal health care results (McNeely et al., 2018; van Boekel et al., 2013). 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]. Psychotherapy, 52(2), 190194. +O1\lp#\ health? 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). 0000241723 00000 n The approach that is highlighted in the 5Ps includes presenting, predisposing, precipitating, perpetuating, and protective factors. All work is written to order. New Harbinger. In spite of these limitations, there may be several potential areas of inquiry. 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! 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). What level of care is required (outpatient or inpatient)? Haynes, S. N., Leisen, M. B., & Blaine, D. D. (1997). Evidence-based approaches, such as cognitive behavioral therapy, tend to be nomothetic, assuming homogeneity and generally geared toward symptom amelioration (Robinson, 2011). She also appears to use alcohol as a way of managing distressing emotions, but does not have any psychological coping strategies. What we understand today is shaped by what we believe and what we have experienced in our life. This factor has generally been underutilized despite being shown as beneficial to clients (Kuyken et al., 2009). Formulation in psychology and psychotherapy: Making sense of peoples problems (2nd ed.). Protective Factors One of the weakness of this formulation is identifying that the clients strength is not included the initial assessment and data collection. The Essay Writing ExpertsUK Essay Experts. The image (. (Ed.). Narrative therapy to therapeutic ends. Rowe, C. L. (2012). This inspires the development of a longitudinal understanding of a persons problems. 0000017109 00000 n Following formulation, there should be an identification of the prioritised areas of focus for care - to inform the Care Plan. 0000200485 00000 n https://doi.org/10.1097/NCM.0b013e318253f029 Disclaimer: This is an example of a student written essay.Click here for sample essays written by our professional writers. The internal and external factors that maintain the current problems. Plate, A. J., & Aldao, A. Behaviour and Research Therapy, 41(6), 671680. She presents to hospital today with acute suicidal ideation and self-harm after being fired from her job. & Haddock, G. (1990). Persons, J. Marquis, A., & Holden, J. 0000238450 00000 n ,"Sb.&;.+Y&&_{} G|ku!dKMwU*jMdDN The American Journal on Addictions, 21(1), 3846. Type. These symptoms have been further perpetuated by the personality factors and traits described above, and her ongoing financial stressors. 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. Sancho, M., De Gracia, M., Rodrguez, R. C., Mallorqu-Bagu, N., Snchez-Gonzlez, J., Trujols, J., Snchez, I., Jimnez-Murcia, S., & Menchn, J. M. (2018). https://doi.org/10.1377/hlthaff.2013.0879 Australasian Psychiatry, 22(4), 397-401. 0000156014 00000 n Molecular psychiatry, 17(4), 377-388. 0000241121 00000 n 0000199672 00000 n Murphy, C. M., & Ting, L. (2010). Family therapy and the treatment of substance use disorders: The family matters model. According to Dr Oliver James (Hussain 2009) CBT is over praised; what CBT achieves any other therapy can achieve to. 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). 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. 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). Mindfulness training targets neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface. 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. 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 It should be noted that the strategies and interventions applied here are used as illustrations and are specific to Dax and his concerns. 0000004656 00000 n Cognitive and Behavioral Practice, 20(4), 399409. https://doi.org/10.1093/oxfordhb/9780199935291.013.57 therapy for psychosis. 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). In fact, this stigmatization can come from those who are treating them (Luoma et al., 2007). )jB' */NNM;2=Kc.w}9XXtj+%]{IF UA_ Ploy: The Strategy has to analyze What Tactics can be Implemented. Oxford University Press. Early attachment experience and recovery from psychosis. 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. Implementing the Five Ps: The Case of Dax. What are the 5 Ps of case formulation? (2010, February). https://www.ncbi.nlm.nih.gov/books/NBK343542 Garland, E. L., Froeliger, B., & Howard, M. O. This is to ensure that the client understand any reason for change from what was originally agreed. 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). Linden, D. J. The officers evaluated him, detained him, and subsequently arrested him for driving while intoxicated. ), Essentials of clinical social work (pp. 0000119626 00000 n 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). This can be both positive or negative but they have a direct correlation to how the person is today. all (2004) it is essential to reduce stress and traumatic events for people recovering from Paranoid Schizophrenia, and start to contribute in social activities. The patient has genetic vulnerabilities for mental illness in her family history, a history of anxious temperament, ongoing substance use, and subtherapeutic medication levels. 0000199386 00000 n https://doi.org/10.1177/0009922813488653 0000007444 00000 n The CBT formulation consists of 5 key stages which is known as the 5 Ps model. The Five Ps permits counselors to both assess and intervene essentially simultaneously. They may also present in the form of family, friends, or hobbies. The night he was pulled over, he had had two additional beers and one additional shot of whiskey on top of his usual consumption after a telephone argument with his wife, Sara. 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. Risk and protective factors for adolescents illicit drug use: A population-based study. Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. Dax, however, is hyper-focused on surgery and seems to dismiss Saras position. https://doi.org/10.1186/s13722-018-0110-8 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.

5 ps formulation example 2023