Therapy, 38(1), 5981. 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. Dax was quite upset, cursed at her, and then hung up the phone. Cognitive behavioral therapists use individually tailored formulations as a framework with which to understand their patients' difficulties and to plan effective treatment. Cognition and Emotion, 27(4), 753760. Jane could benefit from accessing support from her company's HR department to understand what options she has after her job termination, Substance use groups such as Alcoholic's Anonymous, Increasing connections to her friends and social supports, Biopsychosocial Model and Case Formulation, The Parable of Panic: Suffocation, Social Attachment, and the Critical Role of an Integrative, Biopsychosocial Formulation, family act and what is the family structure, Childhood exposure to maternal depression, domestic violence, late adoption, temperament mismatch, or marital conflicts, Family history of mental disorders and substance use, Early parental divorce, unstable home life, history of trauma. 0000007444 00000 n People with paranoia tend to avoid these situations which would lead to distress (Clark et al 2005). Copyright 2023 National Board for Certified Counselors, Inc. and Affiliates. From a biological perspective, the patient is vulnerable because, The patient's early childhood and developmental history suggest, Used substances as a coping style in [the past], and now this is occurring again (or there is a relapse) due to [social factor]., Used substances as a coping style in [the past], and now this is occurring again (or there is a relapse) due to [psychological vulnerability]., I wonder if [psychological factor] is contributing to [current symptoms/struggles], Tell a story and narrative that is unique to your patient, Be specific and demonstrate your understanding of the patient as a, Use words like precipitating, protective, and perpetuating factors to anchor your listener, Focus on the most salient features and be concise, Try and use a psychological theory (but only if you understand it), Try to be perfect only to overwhelm yourself, Be generic (your formulation needs to be unique to your patient), Tell the patient's whole story all over again, Mention life events or trauma without an understanding of its meaning or impact, Try to formulate a grand unified theory of the patient and over-reach with your theory (if it doesnt fit, it doesnt fit! In addition, mindfulness strategies can assist in helping Dax to cognitively diffuse from present to future events (Harris, 2019). Patterns: Study what Worked in the Past and What can be Replicated. 0000004501 00000 n Garland, E. L., Froeliger, B., & Howard, M. O. 5 Ps Formulation Example. Dax is a 33-year-old married father of two children: a 9-year-old son, Cam, and a 7-year-old daughter, Zoe. If present categories are used, formulation can be limiting and dangerous. Unlike summary, it is a discussion about alternative ideas about diagnosis, aetiology, treatment and prognosis and of the arguments for and against each alternative. Substance use and misuse carries numerous potential repercussions. van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013). Unemployment and substance outcomes in the United States 20022010. Evidence-based approaches, such as cognitive behavioral therapy, tend to be nomothetic, assuming homogeneity and generally geared toward symptom amelioration (Robinson, 2011). However, each has some shortcomings. The patient has genetic vulnerabilities for mental illness in her family history, a history of anxious temperament, ongoing substance use, and subtherapeutic medication levels. SNACIy` iOUOb&U}+v$]MH"{8v%h= _ B., Twohig, M. P., Waltz, T., Hayes, S. C., Roget, N., Padilla, M., & Fisher, G. (2007). https://doi.org/10.1093/oxfordhb/9780199935291.013.57 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. This framework is idiographic in nature, as it looks at clients individually and holistically (Marquis & Holden, 2008). Perpetuating factors are those that sustain and possibly reinforce clients current substance use and misuse challenges. Currently, there are a variety of empirically based interventions for treating clients who engage in substance use and misuse. Another potential area of study might involve comparing novice counselors to more experienced counselors. What are the 5 Ps of case formulation? She experienced, Brief summarizing statement that includes demographic information, chief complaint, and presenting problems from patient's perspective and signs and symptoms (onset, severity, pattern), Integrative statement: how these factors interact to lead to the current situation and level of functioning, prognosis, and potential openings for intervention. 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. Furthermore, the Five Ps helps clients and counselors explore relationships between each factor and the presenting problem. https://doi.org/10.1111/j.1752-0606.2011.00280.x Mental health professionals evaluations of the Integral Intake, a metatheory-based, idiographic intake instrument. (2018). https://doi.org/10.1186/s13722-018-0110-8 low mood) It is likely that other clinicians presented with Dax would use a different combination of approaches. Child and Adolescent Psychiatric Clinics, 16(1), 111-132. 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]. What can be done, realistically speaking. 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. Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: A meta-analysis. Narrative therapy to therapeutic ends. Day, A. M., Kahler, C. W., Ahern, D. C., & Clark, U. S. (2015). As shown above, there are numerous ways to examine and treat client substance use and misuse. This is where you'll need to be creative and also think more in-depth about your patient. trailer (2017). This inspires the development of a longitudinal understanding of a persons problems. A review of CBT treatments for substance use disorders. - attachment theory, cognitive behavioural therapy, dialectical behavioural therapy, interpersonal therapy, psychodynamic therapy). Chadwick, P., Williams, C., & Mackenzie, J. 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 . 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!). Substance use and misuse in the United States is extremely common. Frontiers in Psychiatry, 4(173), 115. 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. The internal and external factors that maintain the current problems. In addition, the interventions demonstrated are not to be assumed the only ones that can be applied to Dax. The approach that is highlighted in the 5Ps includes presenting, predisposing, precipitating, perpetuating, and protective factors. Substance Abuse and Mental Health Services Administration. It may include past difficulties and experiences if these are relevant to the present. Keywords: substance use and misuse, Five Ps, idiographic, systematic, flexible. Tahan, H. A., & Sminkey, P. V. (2012). Psychological Assessment, 9(4), 334348. University-educated. 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. 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. (2011). For example, we diagnose someone with a major depressive episode if they meet 5 of the 9 symptomatic criteria. He then withdraws and becomes sullen for a few days. Jane Doe presents with a diagnosis of borderline personality disorder and history of depression. 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). Addiction Science and Clinical Practice, 13(8), 115. Family therapy and the treatment of substance use disorders: The family matters model. The American Journal on Addictions, 21(1), 3846. Idiographic case formulation can be useful for complicated cases, such as those encountered with clients engaged in substance use and misuse (Haynes et al., 1997). The Five Ps is a systematic way to look at clients and their presentation, and its idiographic construction takes clients uniqueness into account. A logical analysis using gentle Socratic dialogue may help to challenge his emotional reactions to his daughters heart murmur (Etoom & Ratnapalan, 2014). 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 his report on alcohol, drugs, and health, the U.S. Fundamental Changes in DSM-5 Dimensional Approach The conundrum with categories All rights reserved. McHugh, R. K., Hearon, B. Participants: The leader of a meeting should carefully consider who he or she invites. The 5 P's of Strategy is a planning process. Oftentimes, when the topic of protective factors is used in substance use and misuse, it is related to deterrence of substance use, notably with adolescents (Liao et al., 2018). https://doi.org/10.3389/fpsyt.2013.00173 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). This gives you a sense of their current level of functioning, prognosis, and guides your direction for treatment and management decisions. One such framework is the Five Ps (Macneil et al., 2012). 0000241121 00000 n Effects of treatment type on alcohol consumption partially mediated by Alcoholics Anonymous attendance. Case formulation, also referred to as conceptualization, is a skill new counselors often lack (Liese & Esterline, 2015). 2004;2(6):576-582. doi:10.1370/afm.245. https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf 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. Centers for Disease Control and Prevention. This is an essential step. 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 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. Journal of Addiction Medicine, 11(1), 39. They are examples that the author chose to illustrate the Five Ps in practice. National Center on Addiction and Substance Abuse at Columbia University. 1. Thus, there exists a need to concurrently examine and address the potentially complex nature of client substance use and misuse. This has further exacerbated her alcohol use disorder. What level of care is required (outpatient or inpatient)? Current Drug Abuse Reviews, 8(1), 2640. A, & Otto, M. W. (2010). Dax denies any other negative consequences from his alcohol use. Cognitive Behavior Therapy (CBT) case conceptions have follows a 5p's model. We would anticipate when engaging in treatment, the patient may have difficulties with using primitive defense mechanisms. 2009). As I stated above this factor looks to get a wider understanding of what the issues is. It also provides opportunities for a variety of interventions and strategies targeted to clients and their substance use and misuse or contributing factors. 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! https//doi.org/10.1016/j.drugalcdep.2013.02.018 Mintzberg's 5 Ps of Strategy with Examples 1. Cognitive therapy in practice: A case formulation approach. 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. Having a framework for understanding of different psychological treatments and psychological theories can be helpful in making your psychological formulation flow intuitively (e.g. https://doi.org/10.1016/j.cbpra.2013.03.004 This research could point to populations for whom the Five Ps is more and less effective. Good interpersonal support from her best friend who brought her to hospital. At the end of his workday, he and his wife got into an argument over the phone about an upcoming diagnostic test and the possible results. 0000180123 00000 n 0000003178 00000 n Routledge.21-37). Bahorik, A. L., Satre, D. D., Kline-Simon, A. H., Weisner, C. M., & Campbell, C. I. (2010, February). Karriker-Jaffe, K. J., Klinger, J. L., Witbrodt, J., & Kaskutas, L. A. Johnstone, L. and Dallos, R., 2013. The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. Morin, J.-F. G., Harris, M., & Conrod, P. J. The dappled nature of causes of psychiatric illness: Replacing the organicfunctional/hardwaresoftware dichotomy with empirically based pluralism. 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). (2017). 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).