Bahorik, A. L., Satre, D. D., Kline-Simon, A. H., Weisner, C. M., & Campbell, C. I. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860452/ Formulation for beginners. Karriker-Jaffe, K. J., Klinger, J. L., Witbrodt, J., & Kaskutas, L. A. 2009). Some of these evidence-based approaches will be demonstrated later in a case illustration. Case conceptualization research in cognitive behavior therapy: A state of the science review. The counselor may also assist Dax in emotional regulation, which may prevent the initiation of arguments (Aldao & Nolen-Hoeksema, 2013). Precipitating Factors https://doi.org/10.1097/ADM.0000000000000260 0000200185 00000 n These symptoms have been further perpetuated by the personality factors and traits described above, and her ongoing financial stressors. 0000066425 00000 n The CBHSQ report: Substance use and substance use disorder by industry. This may include a direct conversation about Daxs decision to drink, resulting in his becoming impaired, with the consequence of being detained, charged, and adjudicated. Twelve-step attendance is most beneficial with inpatient substance use and misuse treatment (Karriker-Jaffe et al., 2018). What it wants to Achieve. American Psychiatric Association. 0000015792 00000 n (2017). One way to do this is to use the "5 Ps.". What is a psychiatric case formulation? Here is an example of a set of treatment recommendations for Jane Doe: For good measure, here is another sample formulation for someone with a diagnosis of schizophrenia. Ingram, B. L. (2012). This framework is idiographic in nature, as it looks at clients individually and holistically (Marquis & Holden, 2008). 0000241723 00000 n (2013). 0000014949 00000 n https://doi.org/10.1007/s11920-013-0414-z (2017). There could be a discussion of alcohol use disorder being a disease, not that different from any other passed-on trait or disease. ), The science of cognitive behavioral therapy (pp. Frontiers in Psychiatry, 4(173), 115. Note that this table is extremely comprehensive and long, and not everything will (or should!) This likely led to an attachment style that was likely insecure and disorganized. Greg experiences feelings of stress and anxiety over the past six months. Marquis, A., & Holden, J. Substance Abuse and Mental Health Services Administration. (2018). 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. Case formulation, also referred to as conceptualization, is a skill new counselors often lack (Liese & Esterline, 2015). https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf ), Essentials of clinical social work (pp. It also provides opportunities for a variety of interventions and strategies targeted to clients and their substance use and misuse or contributing factors. This condition did not develop six months ago but developed during childhood when he failed to meet his father's expectations. Diagnostic and statistical manual of mental disorders (5th ed.). Predisposing looks at a wider understanding of the issues, looking at it in more lengthily way. Borrell-Carri F, Suchman AL, Epstein RM. Substance use and misuse has significant impact on the occupational sector as well. Surgeon General Vivek Murthy reported that more than 20 million Americans have an SUD (U.S. Department of Health and Human Services, 2016). Behaviour research and therapy, 16(4), pp.233-248. 0000200610 00000 n Journal of Anxiety Disorders, 36, 18. Molecular psychiatry, 17(4), 377-388. Liese, B. S., & Esterline, K. M. (2015). 0000200305 00000 n Client substance use and misuse at that level may need medical stabilization and detoxification prior to utilization of the Five Ps. In S. G. Hofmann & G. J. G. Asmundson (Eds. Example of the 5 P's of Marketing John is considering operating a jet ski shop catering to travelers and tourists. all (2004) it is essential to reduce stress and traumatic events for people recovering from Paranoid Schizophrenia, and start to contribute in social activities. 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). Client substance use and misuse is a significant problem in the United States, and it continues to cause difficulty for individuals, families, and society. Academic Press. 0000000016 00000 n Case formulations have been used in a number of areas such as those with psychosis, anxiety, and trauma (Chadwick et al., 2003; Ingram, 2012; Persons et al., 2013). Scott W. Peters, PhD, LPC-S, is an associate professor at Texas A&M University San Antonio. Studies utilizing the Five Ps with mandated clients may demonstrate its efficacy, notably with agencies that require substance-related counseling. 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. Substance use and misuse carries numerous potential repercussions. https://doi.org/10.1097/NCM.0b013e318253f029 Selzer, R., & Ellen, S. (2014). 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. Clinical Psychology 5 P Case Formulation (Macneil et al., 2012) Your mindset for intervention should be geared towards CBT - in NHS IAPT services this would be 'your' approach along with assessment as part of your case formulation. Long-term, Jane might also benefit from a more in-depth understanding of how her past trauma affects her present self and symptoms. https://www.samhsa.gov/data/report/results-2016-national-survey-drug-use-and-health-detailed-tables 0000012631 00000 n Given that client substance use and misuse can be quite complicated, using various approaches within the Five Ps framework may yield positive results. Most learners will use this method as it is the most simple. It is usually presented as Predisposing Precipitating Perpetuating Protective factors. How do you present all this information and data? Furthermore, the Five Ps helps clients and counselors explore relationships between each factor and the presenting problem. However, there are others who use substances to such an extent that it causes significant distress and impairment in their lives, a phenomenon clinically referred to as a substance use disorder (SUD). 5 Ps narrative table, from Comprehensive Care Resource Guide The more you formulate, it can be helpful to have a rough template of different formulations for different diagnoses (e.g. (2008). Behavioral health treatments and services. 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. We then move onto Perpetuating which looks at what factors are contributing to the remain of the problems the person is facing. 0000199672 00000 n 0000238450 00000 n Impact of case formulation in cognitive behaviour More ominously, substance use and misuse has been correlated with intimate partner violence (Murphy & Ting, 2010). Client substance use and misuse can be quite challenging for counselors, both novice and experienced. The image (. Remember there is no right or wrong way to present your formulation. 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). 0000017296 00000 n 0000155834 00000 n She notably has a past history of childhood trauma and abuse. It may include past difficulties and experiences if these are relevant to the present. Cognitive behavioral therapy for substance use disorders. 0 A logical analysis using gentle Socratic dialogue may help to challenge his emotional reactions to his daughters heart murmur (Etoom & Ratnapalan, 2014). Aggression and Violent Behavior, 15(5), 325333. https://doi.org/10.1111/j.1521-0391.2011.00187.x (2003) noted, examining positive client experiences may be one way to discover how to increase client participation in substance use and misuse treatment. We've received widespread press coverage since 2003, Your UKEssays purchase is secure and we're rated 4.4/5 on reviews.co.uk. She also appears to use alcohol as a way of managing distressing emotions, but does not have any psychological coping strategies. 2. 0000003215 00000 n As I stated above this factor looks to get a wider understanding of what the issues is. To help treat the client with psychosis maintaining specific behaviour can be beneficial and help avoid frustration and upsetting experiences (Johnstone 2009). The Five P's approach provides a structured way of constructing this formulation. Worrell, M. (2015). Cognitive Behavior Therapy (CBT) case conceptions have follows a 5p's model. The simplest format looks at just three key areas: thoughts, feelings (emotions and physical sensations) and behaviours. 0000004805 00000 n This has led to her adulthood self-perception of being unworthy of being loved, a constant fear of rejection, and increased rejection sensitivity. According to Dr Oliver James (Hussain 2009) CBT is over praised; what CBT achieves any other therapy can achieve to. 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. 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. hA 4-`76>m{dKs. Routledge.21-37). Other approaches observe substance use and misuse from a family or systems perspective, looking at familial patterns such as communication and normalization of substance use (Bacon, 2019). 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. Substance use and misuse has been correlated with both higher rates of absenteeism and workplace injuries (Bush & Lipari 2015). This population often experiences stigma and suboptimal health care results (McNeely et al., 2018; van Boekel et al., 2013). 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. 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 essay will describe Greg's case study using 5P's model. This is often the opportunity for the client to share what may help them move forward, what their assets are, who can support them, and any other self-identified skills (de Shazer, 1985). 300 words The formulation can be used by the psychiatrist, therapist, treating team and patient, and when constructed, at times it can be similar to a piece of art or poetry - capturing the essence of the patient's difficulties and providing a deep insight in a condensed form. Compton, W. M., Gfroerer, J., Conway, K. P., & Finger, M. S. (2014). It also allows clinicians to target specific areas of concern (Macneil et al., 2012) and may be used in a variety of clinical settings. I will go into further detail of the 5 Ps Model below. For Dax, he shares that when he and his wife argue, it follows a very predictable pattern. As Chadwick et al. https://doi.org/10.1177/0017896918763462 Executive functioning in alcohol use studies: A brief review of findings and challenges in assessment. Aldao, A., & Nolen-Hoeksema, S. (2013). Dax denies any other negative consequences from his alcohol use. The choice of the above approaches is only meant as an illustration and not as definitive ways to address this particular client. National Center on Addiction and Substance Abuse at Columbia University. 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 . 0000006666 00000 n The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. 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). 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! Etoom, Y., & Ratnapalan, S. (2014). Haynes, S. N., Leisen, M. B., & Blaine, D. D. (1997). )jB' */NNM;2=Kc.w}9XXtj+%]{IF UA_ 0000199386 00000 n Protective factors are those that help to moderate actual or potential substance use and misuse impact. Routledge. Perpetuating Factors Formulation in psychology and psychotherapy: Making sense of peoples problems (2nd ed.). This is to ensure that the client understand any reason for change from what was originally agreed. (2011). They are examples that the author chose to illustrate the Five Ps in practice. People with paranoia tend to avoid these situations which would lead to distress (Clark et al 2005). For example, some interventions use an individual lens, such as cognitive behavioral therapy, which examines connections between thoughts, feelings, and behaviors (Morin et al., 2017). Wiley. 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. (2010, February). Again let's fill out the easiest parts of the table first: Now here is one potential example of a predisposing social and psychological formulation of psychosis (again, there are no right or wrong ways to formulate, it depends on the patient you have in front of you!). Jane has been working at a start up company for the past 2 years. For example, type II diabetes does not develop because of a single pathophysiological cause. 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. The therapist provides a route easiest for the client by identifying methods that build on the clients current resilience and strengths. Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. Liao, J.-Y., Huang, C.-M., Lee, C. T.-C., Hsu, H.-P., Chang, C.-C., Chuang, C.-J., & Guo, J.-L. (2018). The Essay Writing ExpertsUK Essay Experts. There was a parental divorce at age 5. Schoen, C., Osborn, R., Squires, D., & Doty, M. M. (2013). Addressing the potential genetic link to substance use and misuse may prove beneficial in raising Daxs awareness (Dick & Agrawal, 2008). This has further exacerbated her alcohol use disorder. https://www.apa.org/pubs/journals/pas/index Australasian Psychiatry, 22(4), 397-401. The clinician can provide a variety of potential spousal responses, allowing for more adaptability and flexibility in Daxs responses. University-educated. 0000155905 00000 n Family therapy and the treatment of substance use disorders: The family matters model. Dick, D. M., & Agrawal, A. (2017, September 7). But the most important thing about formulation is that it should be intuitive and flow logically. Another potential area of study might involve comparing novice counselors to more experienced counselors. Drug and Alcohol Dependence, 142(1), 350353. Review of outcome research on marital and family therapy in treatment for alcoholism. It is important to remember that not everything will fit neatly into each box. The Five Ps is a systematic way to look at clients and their presentation, and its idiographic construction takes clients uniqueness into account. She subsequently planned to overdose on her medications. Journal of Substance Abuse Treatment, 26(3), 151158. 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. 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. The emphasis here is on features that continue the presenting problem. (Eds.). Facing addiction in America: The Surgeon Generals report on alcohol, drugs, and health. He then withdraws and becomes sullen for a few days. What are perpetuating factors? However, patient has the following [protective factors], which may be a good prognostic factor. Are mindfulness-based interventions effective for substance use disorders? Fig. Chiesa, A., & Serretti, A. 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). As mentioned previously, the Five Ps is not meant to replace any other substance use and misuse intervention. The goal here is to build Daxs competence in communicating, both in listening and expressing. ; DSM-5) bases an SUD on a pathological pattern related to the use of a substance (American Psychiatric Association, 2013, p. 483). The case formulation in child and adolescent psychiatry. In J. R. Brandell (Ed. Current Drug Abuse Reviews, 8(1), 2640. https://doi.org/10.1177/0009922813488653 Based on these factors, dialectical behavioural therapy would be the most helpful for this patient. One versus many: Capturing the use of multiple emotion regulation strategies in response to an emotion-eliciting stimulus. The idiographic/nomothetic dichotomy: Tracing historical origins of contemporary confusions. Currently, there are a variety of empirically based interventions for treating clients who engage in substance use and misuse. 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. Keywords: substance use and misuse, Five Ps, idiographic, systematic, flexible. This involves explaining that interactions can act as a kind of back-and-forth loop of actionreactionaction without any resolution, leaving both parties feeling unheard, misunderstood, and frustrated. Cengage. 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). A systematic review of the evidence. To explain your difficulties and make sense of them, you and the psychologist have to come up with a formula. Substance use and misuse also has a negative impact on intimate partners, such as assuming increased responsibility and navigating unpredictability (Hussaarts et al., 2012). or funding contributions for the development 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! Precipitating and perpetuating factors: the stressor of losing her job has reactivated these more primitive defense mechanisms and coping strategies. Those who engage in substance use and misuse often have higher rates of unemployment (Compton et al., 2014; Dieter, 2011). Understanding how each factor contributes to a disease can better guide treatment decisions. It can assist both novice and experienced clinicians working with clients who present for counseling with substance use and misuse. It looks at situations both past and present which can be both experiences and distresses that lead to symptoms of a psychotic nature can lead to resolving the psychosis. Diagram of Ray's 5Ps formulation (Johnstone & Dallos, 2014) and core beliefs Source publication Integrating CBT and CFT within a case formulation approach to reduce depression and anxiety in. The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. Persons, J. (2020, April 21). It will make your job of formulating much easier. Dax, however, is hyper-focused on surgery and seems to dismiss Saras position. Cognition and Emotion, 27(4), 753760. History & Philosophy of Psychology, 13(2), 3239. Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. 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. The effects of treatment for substance use problems on intimate partner violence: A review of empirical data. Current Psychiatry Reports, 15(11), 211. BMC Medicine, 10(111), 13. 1189 76 The more cases you go through (and more of the sample formulations below) the more comfortable you will be with formulating!
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