0000187506 00000 n (2013). What are the 5 Ps of case formulation? Planning is an essential part of the strategy formulation process, so take time to Brainstorm new opportunities. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860452/ The approach that is highlighted in the 5Ps includes presenting, predisposing, precipitating, perpetuating, and protective factors. Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. 0000200485 00000 n Scott W. Peters, PhD, LPC-S, is an associate professor at Texas A&M University San Antonio. Unemployment and substance outcomes in the United States 20022010. Dax shares that he and his wife are conflicted about how to proceed with their daughters medical care. https://doi.org/10.1097/NCM.0b013e318253f029 )jB' */NNM;2=Kc.w}9XXtj+%]{IF UA_ Introduction to formulation. This condition did not develop six months ago but developed during childhood when he failed to meet his father's expectations. 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). We then move onto Perpetuating which looks at what factors are contributing to the remain of the problems the person is facing. Design of individualized behavioral treatment programs using functional analytic clinical case models. Ploy: The Strategy has to analyze What Tactics can be Implemented. (2020, April 21). (2008). In addition, the collaborative nature of the Five Ps reinforces the concept of an idiographic formulation. For example, we diagnose someone with a major depressive episode if they meet 5 of the 9 symptomatic criteria. of this manuscript. Remember there is no right or wrong way to present your formulation. https://doi.org/10.1186/1741-7015-10-111 As you get better and more expert at formulating, you may not need to use this rigid structured format, and instead, will be able to present a more intuitive and organic formulation of the patient instead (see other methods below). 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. Previous studies using frameworks to formulate have often used cognitive behavioral therapy as the primary intervention (Chadwick et al., 2003; Persons et al., 2013). 0000004344 00000 n 0000006779 00000 n 2. This is in keeping with the inherent uniqueness of clients, their concerns, and a variety of factors. Family therapy: Systemic approaches to practice. Presenting Issue(s) - please use the DSM-What assessment tools. 0 Now what? The emphasis here is on features that continue the presenting problem. 0000200735 00000 n 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 . 0000186981 00000 n 5 Ps Formulation Example. 1189 0 obj <> endobj *You can also browse our support articles here >. 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). 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 . It is systematic, while allowing for flexibility and creativity. 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. (2011). Etoom, Y., & Ratnapalan, S. (2014). 0000004306 00000 n (2015). However, the Five Ps presents a framework in which counselors can examine and intervene with client substance use and misuse using a variety of approaches and strategies. An example formulation is available (see A case example: "Sandra")* as an example of the type of output you 0000017180 00000 n BMC Medicine, 10(111), 13. SAGE. The Diagnostic and Statistical Manual of Mental Disorders (5th ed. 160185). ), Cover every box in the 4 Ps just for the sake of doing it (not all boxes will always apply!). 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). If your specific country is not listed, please select the UK version of the site, as this is best suited to international visitors. Substance Use & Misuse, 49(5), 492512. low mood) Here the focus is on investigating resources and/or supports that may help prevent client substance use and misuse from further becoming problematic. Understanding how each factor contributes to a disease can better guide treatment decisions. (Ed.). - attachment theory, cognitive behavioural therapy, dialectical behavioural therapy, interpersonal therapy, psychodynamic therapy). For Dax, he shares that when he and his wife argue, it follows a very predictable pattern. 0000004501 00000 n Predisposing looks at a wider understanding of the issues, looking at it in more lengthily way. Do you have a 2:1 degree or higher? 0000245206 00000 n Precipitating factors are those that proximally bring about substance use and misuse and its resulting difficulties. Cognition and Emotion, 27(4), 753760. Barriers and facilitators affecting the implementation of substance use screenings in primary care clinics: A qualitative study of patients, providers, and staff. These beliefs are set off by occurrences in the client life, and once this belief is activated it can lead to automatic negative thinking. 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. She also drank 10 beers prior to arriving in the hospital. Participants: The leader of a meeting should carefully consider who he or she invites. 0000119448 00000 n 2004;2(6):576-582. doi:10.1370/afm.245. In Formulation in psychology and psychotherapy (pp. 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). Novice clinicians, who often have a more limited repertoire of strategies, may find the Five Ps valuable because of its systematic framework to clients. The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. However, an important skill that they should try to perform is to assess a situation before jumping to conclusions. https://www.ncbi.nlm.nih.gov/books/NBK343542 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. Clinical problem solving: the case of Matthew, part 1. Health Affairs, 32(12), 22052215. 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 B., Twohig, M. P., Waltz, T., Hayes, S. C., Roget, N., Padilla, M., & Fisher, G. (2007). Winters, N. C., Hanson, G., & Stoyanova, V. (2007). Let's do a simplified formulation for the patient (Jane Doe) below. This has further exacerbated her alcohol use disorder. 0000155834 00000 n This area explores significant occurrences that preceded or triggered the presenting problem and its consequences. Liao, J.-Y., Huang, C.-M., Lee, C. T.-C., Hsu, H.-P., Chang, C.-C., Chuang, C.-J., & Guo, J.-L. (2018). Johnstone, L. and Dallos, R., 2013. Cognitive Behavior Therapy (CBT) case conceptions have follows a 5p's model. 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 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. Mintzberg's 5 Ps of Strategy with Examples 1. Protective factors are those that help to moderate actual or potential substance use and misuse impact. Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: A meta-analysis. Kendler, K. S. (2012). Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. There was a parental divorce at age 5. Sample #1: Conceptualization for CBT case This is a 35-year-old Caucasian man referred by his physician for treatment of generalized anxiety. Narrative therapy to therapeutic ends. Journal of Marital and Family Therapy, 38(1), 122144. 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). As Chadwick et al. All rights reserved. Research on the success of family-based interventions has methodological challenges, such as small sample sizes and the difficulty of examining long-term outcomes (Rowe, 2012). Case formulation in process-experiential therapy. (2013). This inspires the development of a longitudinal understanding of a persons problems. The officers evaluated him, detained him, and subsequently arrested him for driving while intoxicated. One versus many: Capturing the use of multiple emotion regulation strategies in response to an emotion-eliciting stimulus. Following formulation, there should be an identification of the prioritised areas of focus for care - to inform the Care Plan. https://doi.org/10.1093/oxfordhb/9780199935291.013.57 0000014949 00000 n Routledge. The 4 Ps formulation table can be a very rigid and systematized way of presenting a formulation. Fig. 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. 0000012481 00000 n 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). Some different presentation styles are suggested here. What we understand today is shaped by what we believe and what we have experienced in our life. Tarrier, N., Wells, A. Acknowledging that his reticence is due to being obligated to attend counseling may assist in relationship building (Tahan & Sminkey, 2012). Most learners will use this method as it is the most simple. It is usually presented as Predisposing Precipitating Perpetuating Protective factors. +O1\lp#\ Current Psychiatry Reports, 15(11), 211. 0000239180 00000 n These symptoms have been maintained by [psychological factors/personality factors], and [social/environmental factors]. Journal of Mental Health Counseling, 30(1), 6794. Karriker-Jaffe, K. J., Klinger, J. L., Witbrodt, J., & Kaskutas, L. A. Psychological Assessment, 9(4), 334348. However, patient has the following [protective factors], which may be a good prognostic factor. Johnstone, L., & Dallos, R. apply to your case. Patterns: Study what Worked in the Past and What can be Replicated. Cognitive behavioral therapists use individually tailored formulations as a framework with which to understand their patients' difficulties and to plan effective treatment. Those who engage in substance use and misuse often have higher rates of unemployment (Compton et al., 2014; Dieter, 2011). Bacon, M. 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. The American Journal on Addictions, 21(1), 3846. There are several approaches to managing client substance use and misuse that have demonstrated effectiveness. 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. https://www.samhsa.gov/treatment Han, B., Hedden, S. L., Lipari, R., Copello, E. A. P., & Kroutil, L. A. Client substance use and misuse is a significant problem in the United States, and it continues to cause difficulty for individuals, families, and society. Murphy, C. M., & Ting, L. (2010). The Five Ps is a systematic way to look at clients and their presentation, and its idiographic construction takes clients uniqueness into account. Some of these evidence-based approaches will be demonstrated later in a case illustration. 0000200185 00000 n Your formulation of a patient evolves and changes as you collect more information. Perpetuating Factors 300 words One or more perpetuating psychological processes: Chronic marital/relationship discord, lack of empathy from family/friends, developmentally inappropriate expectations. While being mandated to attend counseling, Dax shares concerns that he is afraid of what his daughters test results will show. Frontiers in Psychiatry, 9, 19. 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). Dax drinks two to three times a week, usually having one or two shots of whiskey and two to three draft beers. The clinician can provide a variety of potential spousal responses, allowing for more adaptability and flexibility in Daxs responses. (2016). Liese, B. S., & Esterline, K. M. (2015). What is a psychiatric case formulation? She has also previously responded well to psychotherapy and appears to be psychologically-minded. 0000238450 00000 n In addition, using these approaches may result in omitting the uniqueness of clients as a consideration in treatment. It is another way to address the multifaceted and complicated nature of client substance use and misuse. Compton, W. M., Gfroerer, J., Conway, K. P., & Finger, M. S. (2014). We would anticipate when engaging in treatment, the patient may have [resistance/transference/countertransference]. Perpetuating factors are those that sustain and possibly reinforce clients current substance use and misuse challenges. 0000200021 00000 n These factors all combine to cause the person to develop diabetes. Based on these factors, dialectical behavioural therapy would be the most helpful for this patient. (2018). Cognitive behaviour therapy for psychiatric problems: A practical guide. Plan A good strategy must have a plan. 0000241121 00000 n One way to do this is to use the "5 Ps.". Greg experiences feelings of stress and anxiety over the past six months. https://doi.org/10.1016/j.drugalcdep.2014.06.012 Aldao, A., & Nolen-Hoeksema, S. (2013). Oxford Handbooks Online, 149. Of course, the Mintzberg 5 P's of Strategy are part of an organisation's strategy, but it's also wise to look at the 5 P's as separate standpoints that all need to be considered for developing a strong and successful strategy. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. Testing case formulation hypotheses in psychotherapy: Two case examples. Substance use and misuse is exceedingly common and has numerous implications, both individual and societal, impacting millions of Americans directly and indirectly every year. As shown above, there are numerous ways to examine and treat client substance use and misuse. Kleiman, M. A. R., Caulkins, J. P., & Hawken, A. The image (. The Canadian Journal of Psychiatry, 38(5), 351-358. 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). A review of CBT treatments for substance use disorders. Alcohol Research Current Reviews, 31(2), 111118. Oxford University Press. - depression, self-harm, mania/psychosis, anxiety, etc.) Surgeon General Vivek Murthy reported that more than 20 million Americans have an SUD (U.S. Department of Health and Human Services, 2016). 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. The CBT formulation consists of 5 key stages which is known as the 5 Ps model. Currently, there are a variety of empirically based interventions for treating clients who engage in substance use and misuse. Professional Case Management, 17(4), 164172. 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). 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. 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 0000156014 00000 n Strategy as a Plan Planning comes naturally to many managers and as such, has become the default first step. It acknowledges your strengths and resources. 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. 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. New Harbinger. Easden, M. H., & Kazantzis, N. (2018). 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]. A, & Otto, M. W. (2010). However, the patient has protective factors including psychological mindedness and previous response to therapy, which is a good prognostic factor. Dax further reports his paternal grandfather died from liver failure. The case formulation in child and adolescent psychiatry. Journal of Public Health, 38(3), e282e291. 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). 0000199672 00000 n Use this table as a general guide, but don't memorize it for the sake of memorizing it! Frontiers in Psychiatry, 4(173), 115. Addictive Behaviors, 32(7), 13311346. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. Predisposing factors include biological, environmental, or personality considerations that may put clients at risk of further substance use and misuse. She also appears to use alcohol as a way of managing distressing emotions, but does not have any psychological coping strategies. 0000238570 00000 n Journal of Substance Abuse Treatment, 26(3), 151158. https://doi.org/10.1111/j.1752-0606.2011.00280.x (2017, September 7). (2003). The CBHSQ report: Substance use and substance use disorder by industry. This conversation can lead to investigating strategies for how each can be heard, including short role-plays with opportunities to practice (Worrell, 2015). 0000155905 00000 n Substance Use & Misuse, 53(4), 596605. https://doi.org/10.2174/1874473711104010004 The authors reported no conflict of interest 1189 76 Example of the 5 P's of Marketing John is considering operating a jet ski shop catering to travelers and tourists. 0000013350 00000 n 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. Note that this table is extremely comprehensive and long, and not everything will (or should!) 0000006105 00000 n It also provides opportunities for a variety of interventions and strategies targeted to clients and their substance use and misuse or contributing factors. To help treat the client with psychosis maintaining specific behaviour can be beneficial and help avoid frustration and upsetting experiences (Johnstone 2009). 0000007722 00000 n 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. U.S. Department of Health and Human Services. Additionally, as it is a continuous process it allows the therapist to revise any incorrect hypothesis about any underlying mechanism at any stage. Clinical Pediatrics, 53(2), 111117. Day, A. M., Kahler, C. W., Ahern, D. C., & Clark, U. S. (2015). Penguin. 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. https://www.samhsa.gov/data/report/results-2016-national-survey-drug-use-and-health-detailed-tables Dax presents as extremely frustrated and embarrassed at being mandated to attend counseling sessions. Walsh, F. (2014). Emotion regulation in cognitive-behavioral therapy: Bridging the gap between treatment studies and laboratory experiments. https://doi.org/10.1007/s11920-013-0414-z 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. Wiley. Routledge. Therapy, 38(1), 5981. 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. Clients who engage in substance use and misuse can present with a variety of issues beyond use (Bahorik et al., 2017; Compton et al., 2014; Poorolajal et al., 2016). She has the following protective factors, including a supportive psychiatrist and friend. startxref Dax is a 33-year-old married father of two children: a 9-year-old son, Cam, and a 7-year-old daughter, Zoe. Australasian Psychiatry, 22(4), 397-401. Routledge. https://doi.org/10.1111/j.1521-0391.2011.00187.x There could be a discussion of alcohol use disorder being a disease, not that different from any other passed-on trait or disease. Concurrently treating both is very complex, challenging, and expensive. We would anticipate when engaging in treatment, the patient may have difficulties with using primitive defense mechanisms. 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. He was recently driving home from work in the evening and law enforcement stopped him because of erratic driving. Journal of Addiction Medicine, 11(1), 39. 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! Twelve-step attendance is most beneficial with inpatient substance use and misuse treatment (Karriker-Jaffe et al., 2018). They are. Annual surveillance report of drug-related risks and outcomes. Mindfulness-based interventions for the treatment of substance and behavioral addictions: A systematic review. 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. https://doi.org/10.1016/j.psc.2010.04.012 One such framework is the Five Ps (Macneil et al., 2012). Tahan, H. A., & Sminkey, P. V. (2012). https://doi.org/10.1080/02699931.2012.739998 For example, type II diabetes does not develop because of a single pathophysiological cause. 0000016414 00000 n Predisposing Factors Harris, R. (2019). Evidence-based approaches, such as cognitive behavioral therapy, tend to be nomothetic, assuming homogeneity and generally geared toward symptom amelioration (Robinson, 2011). CBT has been found to not be effective in schizophrenia (Lynch et al. Conflict of Interest and Funding Disclosure Her ongoing alcohol use is another example of a maladaptive coping strategy. 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. Many formulation models are administered within a cognitive behavioral grounding (Chadwick et al., 2003; Easden & Kazantzis, 2018; Persons et al., 2013). The internal and external factors that maintain the current problems. 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. https://doi.org/10.1016/j.cbpra.2013.03.004 Unlike summary, it is a discussion about alternative ideas about diagnosis, aetiology, treatment and prognosis and of the arguments for and against each alternative. 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). The dappled nature of causes of psychiatric illness: Replacing the organicfunctional/hardwaresoftware dichotomy with empirically based pluralism. Risk and protective factors for adolescents illicit drug use: A population-based study. https://doi.org/10.1016/j.addbeh.2006.09.008 The counselor may also assist Dax in emotional regulation, which may prevent the initiation of arguments (Aldao & Nolen-Hoeksema, 2013). The clinician may also seek more information on the cause of the reported stress between him and his wife. Cognitive behavioral therapy for substance use disorders. (2003) noted, examining positive client experiences may be one way to discover how to increase client participation in substance use and misuse treatment. Fundamental Changes in DSM-5 Dimensional Approach The conundrum with categories 0000239964 00000 n Dax, however, is hyper-focused on surgery and seems to dismiss Saras position. 0000009229 00000 n https://doi.org/10.1186/s13722-018-0110-8 0000005575 00000 n 0000006666 00000 n 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). Addressing the potential genetic link to substance use and misuse may prove beneficial in raising Daxs awareness (Dick & Agrawal, 2008).