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). Dax drinks two to three times a week, usually having one or two shots of whiskey and two to three draft beers. This framework is idiographic in nature, as it looks at clients individually and holistically (Marquis & Holden, 2008). We then move onto Perpetuating which looks at what factors are contributing to the remain of the problems the person is facing. Some of these evidence-based approaches will be demonstrated later in a case illustration. This may have reactivated/exacerbated her emotional dysregulation, and resulted in negative coping styles such as her self-harming and suicidal ideation. But the most important thing about formulation is that it should be intuitive and flow logically. 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. 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 . 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. It can be changed and reviewed as the treatment is in progress if any new information come to light. [Patient] presents with a [diagnosis]. 0000000016 00000 n 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. Frontiers in Psychiatry, 9, 19. 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! https://www.ncbi.nlm.nih.gov/books/NBK343542 While being mandated to attend counseling, Dax shares concerns that he is afraid of what his daughters test results will show. Dax is a 33-year-old married father of two children: a 9-year-old son, Cam, and a 7-year-old daughter, Zoe. Routledge. If your specific country is not listed, please select the UK version of the site, as this is best suited to international visitors. A course of action you intend to take or a series of guidelines you intend to follow. 0000008363 00000 n In Formulation in psychology and psychotherapy (pp. The Essay Writing ExpertsUK Essay Experts. Dax presents as extremely frustrated and embarrassed at being mandated to attend counseling sessions. The case formulation in child and adolescent psychiatry. 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). The Five Ps permits counselors to both assess and intervene essentially simultaneously. Ploy: The Strategy has to analyze What Tactics can be Implemented. We've received widespread press coverage since 2003, Your UKEssays purchase is secure and we're rated 4.4/5 on reviews.co.uk. In addition, mindfulness strategies can assist in helping Dax to cognitively diffuse from present to future events (Harris, 2019). Formulation and the Biopsychosocial Model: Introduction for Psychiatry Dax reports a strong paternal history of substance use and misuse. New York: WW Norton. [1][2] Biopsychosocial formulation combines biological, psychological, and social factors to understand a patient, and uses this to guide both treatment and prognosis. Australasian Psychiatry, 22(4), 397-401. Early attachment experience and recovery from psychosis. <<6D17E8AF19023D4BAD06A1AFD23B08FB>]/Prev 415012/XRefStm 2760>> Precipitating Factors Protective Factors The Diagnostic and Statistical Manual of Mental Disorders (5th ed. McHugh, R. K., Hearon, B. Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. What level of care is required (outpatient or inpatient)? Morin, J.-F. G., Harris, M., & Conrod, P. J. Concurrently treating both is very complex, challenging, and expensive. 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]. Oxford Handbooks Online, 149. 0 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638323/pdf/nihms734766.pdf What it wants to Achieve. https://doi.org/10.1080/02699931.2012.739998 https://doi.org/10.1111/j.1521-0391.2011.00187.x all (2004) it is essential to reduce stress and traumatic events for people recovering from Paranoid Schizophrenia, and start to contribute in social activities. It acknowledges your strengths and resources. Mindfulness-based strategies are not as effective when used alone as when used with other approaches (Sancho et al., 2018). 0000003215 00000 n It can assist both novice and experienced clinicians working with clients who present for counseling with substance use and misuse. An example formulation is available (see A case example: "Sandra")* as an example of the type of output you 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). 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. Family therapy: Systemic approaches to practice. Planning is an essential part of the strategy formulation process, so take time to Brainstorm new opportunities. Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust 0000239101 00000 n https://doi.org/10.1016/j.avb.2010.01.006 (2014). Scott W. Peters, PhD, LPC-S, is an associate professor at Texas A&M University San Antonio. ), The science of cognitive behavioral therapy (pp. Sample #1: Conceptualization for CBT case This is a 35-year-old Caucasian man referred by his physician for treatment of generalized anxiety. Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy. People with paranoia tend to avoid these situations which would lead to distress (Clark et al 2005). %PDF-1.4 % According to Dr Oliver James (Hussain 2009) CBT is over praised; what CBT achieves any other therapy can achieve to. Psychological Assessment, 9(4), 334348. Let's do a simplified formulation for the patient (Jane Doe) below. 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. (2003). This stage of formulation involves articulating the external and internal factors that can activate presenting problems (Johnstone & Dallos, 2010). https://doi.org/10.1002/jclp.22516 B., Lemle Becker, V., & Tompkins, M. A. 5Ps Formulation | PDF | Substance Abuse | Mental Disorder Karriker-Jaffe, K. J., Klinger, J. L., Witbrodt, J., & Kaskutas, L. A. Presenting problems are concerns that clients find difficult to manage. One or more perpetuating psychological processes: Chronic marital/relationship discord, lack of empathy from family/friends, developmentally inappropriate expectations. The clinician can intervene here by simply normalizing and validating his fears about the test results. Second, it also tends to shift the conversation toward what is present and going well in their lives and away from those areas that cause distress and suffering (de Shazer, 1985). 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. https://doi.org/10.1016/j.cbpra.2013.03.004 How do you present all this information and data? Note that this table is extremely comprehensive and long, and not everything will (or should!) Social isolation and withdrawn from family members, Ongoing social isolation due to psychosis causing him to be fearful of others, Followed by an early intervention in psychosis team, History of immigration (increases risk for psychosis), Long-standing feelings of isolation and insecurity since childhood, Joined a gang, entering a stressful lifestyle, led to increased hyper-vigilance and paranoia in the past few months, Ongoing delusions leading patient become suspicious of healthcare workers/family, Previously responded well to CBT for psychosis, Family history of psychosis and schizophrenia. (2018, August 31). Cognitive Behavior Therapy (CBT) case conceptions have follows a 5p's model. Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. Psychology Essay Example: Case Study Using 5P's Model - speedypaper Chapter. He denies any significant increase in alcohol use or any other substance use. The essay will describe Greg's case study using 5P's model. For some, receiving substance use and misuse services can be stigmatizing. Wubbolding, R. E., & Brickell, J. Clinical Psychology 5 P Case Formulation - StuDocu Haynes, S. N., Leisen, M. B., & Blaine, D. D. (1997). Johnstone, L., & Dallos, R. Free resources to assist you with your university studies! She also drank 10 beers prior to arriving in the hospital. These psychological symptoms/factors are then observed by the clinician to give a psychiatric diagnosis. 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. In spite of these limitations, there may be several potential areas of inquiry. First and foremost, it should be emphasized that this particular framework has not been empirically tested with client substance use and misuse. This area explores significant occurrences that preceded or triggered the presenting problem and its consequences. Hawton, K.E., Salkovskis, P.M., Kirk, J.E. 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). One versus many: Capturing the use of multiple emotion regulation strategies in response to an emotion-eliciting stimulus. Born in Canada. low mood) The officers evaluated him, detained him, and subsequently arrested him for driving while intoxicated. The clinician may also seek more information on the cause of the reported stress between him and his wife. (2017). It is important to remember that not everything will fit neatly into each box. 1. https://doi.org/10.3389/fpsyt.2018.00095 0000004306 00000 n 0000011818 00000 n Therapy, 38(1), 5981. It can be used in outpatient, inpatient, and residential settings and possibly as part of an aftercare program. It is another way to address the multifaceted and complicated nature of client substance use and misuse. What are the 5 Ps in psychology? - Alqatirat Counselling with reality therapy (2nd ed.). Robinson, O. C. (2011). Cognitive behaviour therapy for psychiatric problems: A practical guide. 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. 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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860452/ Those who engage in substance use and misuse often have higher rates of unemployment (Compton et al., 2014; Dieter, 2011). Nurcombe B, Drell M, Leonard H, et al. Journal of Anxiety Disorders, 36, 18. Fig. Correspondence may be addressed to Scott Peters, One University Way, San Antonio, TX 78224, scott.peters@tamusa.edu. Her mood was stable prior to this job loss, and she had no self-harm or suicidal thoughts in the past 1 year. 5 Ps Formulation Handout.docx - PSYC212: Abnormal 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 Weerasekera, P. (1993). 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). She subsequently planned to overdose on her medications. The compass of pleasure: How our brains make fatty foods, orgasm, exercise, marijuana, generosity, vodka, learning, and gambling feel so good. Is diagnosis enough to guide interventions in mental B., Twohig, M. P., Waltz, T., Hayes, S. C., Roget, N., Padilla, M., & Fisher, G. (2007). Guilford. Rowe, C. L. (2012). 0000238450 00000 n However, the patient has protective factors including psychological mindedness and previous response to therapy, which is a good prognostic factor. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. Dax further reports his paternal grandfather died from liver failure. She has also previously responded well to psychotherapy and appears to be psychologically-minded. The meaning of anxiety. Lack of adaptive coping mechanisms resulted in using self-harm to cope and avoid further emotional dysregulation. Substance Use & Misuse, 49(5), 492512. +O1\lp#\ What are the 5 Ps of case formulation? Drug and Alcohol Dependence, 131(12), 2335. 2. 0000186690 00000 n Psychotherapy, 52(2), 190194. or funding contributions for the development https://www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdf Moreover, the Five Ps align with SAMHSAs recommendation that clinicians tailor treatment to each client because no single treatment is particularly superior (SAMHSA, 2020). 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. Family therapy for drug abuse: Review and updates 20032010. 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 0000155905 00000 n Most learners will use this method as it is the most simple. It is usually presented as Predisposing Precipitating Perpetuating Protective factors. Additionally, the lack of coping mechanisms leading to intense thoughts of suicide. This can result in lack of access to treatment services, contributing to increased stress. He then stopped at a local pub and had several drinks. Chadwick, P., Williams, C., & Mackenzie, J. This has led to her adulthood self-perception of being unworthy of being loved, a constant fear of rejection, and increased rejection sensitivity. 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. endstream endobj 1263 0 obj <>/Filter/FlateDecode/Index[262 927]/Length 50/Size 1189/Type/XRef/W[1 1 1]>>stream 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. As Chadwick et al. Formulation for beginners. *You can also browse our support articles here >. This is an essential step. Perpetuating factors are those that sustain and possibly reinforce clients current substance use and misuse challenges. This factor differs markedly from the first four. 0000238570 00000 n 1264 0 obj <>stream 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). 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. Formulation in psychology and psychotherapy: Making sense of peoples problems (2nd ed.). The Oxford Textbook of Psychiatry[7] states that 'formulation is a concise statement of the case. History & Philosophy of Psychology, 13(2), 3239. Alcohol Research Current Reviews, 31(2), 111118. 0000200485 00000 n Presenting Issue(s) - please use the DSM-What assessment tools. (2017). Case Conceptualization - Psychology Tools Formulation - headspace 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. https://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014.htm 0000003178 00000 n Formulation: A multiperspective model. Motivational interviewing: Building rapport with clients to encourage desirable behavioral and lifestyle changes. Addiction treatment: A strengths perspective (4th ed.). Dax, however, is hyper-focused on surgery and seems to dismiss Saras position. Psychiatric Clinics of North America, 33(3), 511525. 0000007722 00000 n Some different presentation styles are suggested here. Health Education Journal, 77(7), 749761. (Johnstone & Dallos 2009). Behind bars II: Substance abuse and Americas prison population. After being told she was fired from her job, she went home and self-harmed to cope with the distress of this loss. Drayton, M., Birchwood, M. and Trower, P., 1998. Problem areas reported by substance abusing individuals and their concerned significant others. 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. If present categories are used, formulation can be limiting and dangerous. Using a framework to assist in case formulation may prove useful to beginning counselors. Bacon, M. Jane Doe presents with a diagnosis of borderline personality disorder and history of depression. Dallos, R. and Vetere, A., 2018. 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. Once the protective factors are identified, the ensuing conversation provides opportunities to imagine future outcomes in which protective factors may come into play should situations occur that the client finds problematic. They conceptualized a way to look at clients and their problems, systematically and holistically taking into consideration the (1) Presenting problem, (2) Predisposing factors, (3) Precipitating factors, (4) Perpetuating factors, and (5) Protective factors. The Five Ps framework promotes a very clear and systematic approach to case formulation or assessment that potentially provides a wealth of data. 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). From simple essay plans, through to full dissertations, you can guarantee we have a service perfectly matched to your needs. However, each has some shortcomings. 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). 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. 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. 0000239964 00000 n The 5 P's of Strategy is a planning process. May, R. (1950). (2013). (2015). 0000004501 00000 n In J. R. Brandell (Ed. https://www.apa.org/pubs/journals/pas/index 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). This has further exacerbated her alcohol use disorder. She has the following protective factors, including a supportive psychiatrist and friend. The Five Ps is a type of framework utilizing five factors developed by Macneil et al. 160185). They are examples that the author chose to illustrate the Five Ps in practice. 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. Do you have a 2:1 degree or higher? The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. Keywords: substance use and misuse, Five Ps, idiographic, systematic, flexible. This factor has generally been underutilized despite being shown as beneficial to clients (Kuyken et al., 2009). 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.