5 ps formulation example

https://doi.org/10.1377/hlthaff.2013.0879 The essay will now look at the key ideas underpinning the process of CBT. There was a parental divorce at age 5. Journal of Public Health, 38(3), e282e291. It can be changed and reviewed as the treatment is in progress if any new information come to light. 5 P's of Marketing - Corporate Finance Institute J Am Acad Child Adolesc Psychiatry 2002;41(1):927. Use this table as a general guide, but don't memorize it for the sake of memorizing it! https://doi.org/10.1093/oxfordhb/9780199935291.013.57 B., Twohig, M. P., Waltz, T., Hayes, S. C., Roget, N., Padilla, M., & Fisher, G. (2007). 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. https://doi.org/10.1016/j.janxdis.2015.09.005 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). 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). B., Lemle Becker, V., & Tompkins, M. A. He then stopped at a local pub and had several drinks. https://doi.org/10.1186/s13722-018-0110-8 Rowe, C. L. (2012). What we understand today is shaped by what we believe and what we have experienced in our life. (2019). These symptoms have been maintained by [psychological factors/personality factors], and [social/environmental factors]. This essay may contain factual inaccuracies or out of date material. 0000240043 00000 n A good biopsychosocial formulation allows you to come up with a comprehensive and holistic treatment plan for your patient. There could be a discussion of alcohol use disorder being a disease, not that different from any other passed-on trait or disease. 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). Here's what the completed table would look like with the psychological factors incorporated. 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. Formulation: A multiperspective model. These symptoms have been further perpetuated by the personality factors and traits described above, and her ongoing financial stressors. I will go into further detail of the 5 Ps Model below. 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! Drayton, M., Birchwood, M. and Trower, P., 1998. https://doi.org/10.1111/j.1521-0391.2011.00187.x In addition, mindfulness strategies can assist in helping Dax to cognitively diffuse from present to future events (Harris, 2019). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860452/ Patterns: Study what Worked in the Past and What can be Replicated. This is to ensure that the client understand any reason for change from what was originally agreed. Like most things in medicine, there are multifactorial causes of diseases, illnesses, and disorders. 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). The approach that is highlighted in the 5Ps includes presenting, predisposing, precipitating, perpetuating, and protective factors. 0000011422 00000 n https//doi.org/10.1016/j.drugalcdep.2013.02.018 Following a discussion of the Five Ps, a brief case illustration will demonstrate the framework. 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. (Eds.). Abnormal and normal obsessions. Working systemically with families: Formulation, intervention and evaluation. endstream endobj 1263 0 obj <>/Filter/FlateDecode/Index[262 927]/Length 50/Size 1189/Type/XRef/W[1 1 1]>>stream A, & Otto, M. W. (2010). Liao, J.-Y., Huang, C.-M., Lee, C. T.-C., Hsu, H.-P., Chang, C.-C., Chuang, C.-J., & Guo, J.-L. (2018). 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. Unemployment and substance use: A review of the literature (19902010). (Goldman & Greenberg 1997). Born in Canada. Substance use and misuse is exceedingly common and has numerous implications, both individual and societal, impacting millions of Americans directly and indirectly every year. 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. 0000016414 00000 n Oxford University Press. Finally, the number of U.S. adults with a comorbid SUD and mental illness has been shown to be almost 8 million, with only about 5% receiving treatment for both (SAMHSA, 2017). The internal and external factors that maintain the current problems. Liese, B. S., & Esterline, K. M. (2015). 0000006105 00000 n 0000200485 00000 n 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. Biopsychosocial Model and Case Formulation - PsychDB Easden, M. H., & Kazantzis, N. (2018). The authors reported no conflict of interest https://doi.org/10.1016/j.drugalcdep.2014.06.012 The Five Ps is a systematic way to look at clients and their presentation, and its idiographic construction takes clients uniqueness into account. Surgeon General Vivek Murthy reported that more than 20 million Americans have an SUD (U.S. Department of Health and Human Services, 2016). 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. Clinical case formulations: Matching the integrative treatment plan to the client (2nd ed.). (2015). *sbJ&KcO0gfk1/G0isFuHe/Mcmf&*=QMh[pN[-.jzJ{g).k!1 M{[RSXn.+LhWi*z@-pMOcF52zZ#f!CSn^X&hN>nRu-w&7g5{P2C*.Es7@,IR35qHfwKxgGeK4QVBa?%(72e]7_/y!>$=Lx3ljHlGZL6eai7@*T!'HX)cE 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). Precipitating Factors (2013). 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. She presents to hospital today with acute suicidal ideation and self-harm after being fired from her job. https://doi.org/10.1177/0009922813488653 https://www.samhsa.gov/treatment The more cases you go through (and more of the sample formulations below) the more comfortable you will be with formulating! McHugh, R. K., Hearon, B. However, each has some shortcomings. University-educated. From simple essay plans, through to full dissertations, you can guarantee we have a service perfectly matched to your needs. It is likely that other clinicians presented with Dax would use a different combination of approaches. 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. 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. 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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638323/pdf/nihms734766.pdf How do you present all this information and data? Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: A meta-analysis. Hawton, K.E., Salkovskis, P.M., Kirk, J.E. - attachment theory, cognitive behavioural therapy, dialectical behavioural therapy, interpersonal therapy, psychodynamic therapy). One such framework is the Five Ps (Macneil et al., 2012). Molecular psychiatry, 17(4), 377-388. PDF Peters Case Formulation and Intervention Application of the Five PS (2012). " [Formulation is] The lynch pin that holds theory and practice together" (Butler, 1998). Case Formulation Counselling Tutor The Oxford Textbook of Psychiatry[7] states that 'formulation is a concise statement of the case. SAMHSAs recommendations fit well with a more holistic framework in that such a structure allows clinicians to develop a multidimensional picture of clients. (Rachman & de Silva 1978, Salkovskis & Harrison 1984, sited in Tarrier et al. Family therapy and the treatment of substance use disorders: The family matters model. Haynes, S. N., Leisen, M. B., & Blaine, D. D. (1997). ; DSM-5) bases an SUD on a pathological pattern related to the use of a substance (American Psychiatric Association, 2013, p. 483). Chapter 5 - Psychological Models for Case Formulation 0000187506 00000 n You've got your table all filled out now. Wu, J. Q., Szpunar, K. K., Godovich, S. A., Schacter, D. L., & Hofmann, S. G. (2015). 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). PDF Using DSM-5 in Case Formulation and Treatment Planning At its most basic, you could present each box sequentially and describe each factor. 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. U.S. Department of Health and Human Services. Routledge.21-37). Mindfulness-based interventions for the treatment of substance and behavioral addictions: A systematic review. 0000013321 00000 n 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. (2013). The goals here are to both break the pattern and to facilitate healthy conversations. Case conceptualization research in cognitive behavior therapy: A state of the science review. 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. The clinician can intervene here by simply normalizing and validating his fears about the test results. Published data on those incarcerated appears to be several years old. Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. Weerasekera, P. (1993). 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 also allows clinicians to target specific areas of concern (Macneil et al., 2012) and may be used in a variety of clinical settings. What Are The 5 P's Of Case Formulation? - IosFuzhu 0000004344 00000 n Substance use and misuse carries numerous potential repercussions. 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. 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. 0000006923 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). No plagiarism, guaranteed! Thus, there exists a need to concurrently examine and address the potentially complex nature of client substance use and misuse. The Biopsychosocial Model and Case Formulation (also known as the Biopsychosocial Formulation) in psychiatry is a way of understanding a patient as more than a diagnostic label. 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). (2017, September 7). What can be done, realistically speaking. Is diagnosis enough to guide interventions in mental (2017). Fig. The following pages describe two approaches to documenting the formulation using the 5Ps structure, including a narrative and flowchart. This factor has generally been underutilized despite being shown as beneficial to clients (Kuyken et al., 2009). Wubbolding, R. E., & Brickell, J. The effects of treatment for substance use problems on intimate partner violence: A review of empirical data. Cognition and Emotion, 27(4), 753760. 0000014949 00000 n Dax shares that he and his wife are conflicted about how to proceed with their daughters medical care. 0000238570 00000 n Another weakness is that sometimes the client might not want to disclose some information in their past which might assist the therapist in making the client understand that sometimes important part of their history in fluence the way they view the world. van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013). Case formulation in process-experiential therapy. In fact, this stigmatization can come from those who are treating them (Luoma et al., 2007). Poorolajal, J., Haghtalab, T., Farhadi, M., & Darvishi, N. (2016). Annals of Family Medicine. It allows for client individualization, use of a variety of strategies, ongoing assessment, and modifications as needed. 0000200610 00000 n https://doi.org/10.1016/j.cbpra.2013.03.004 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, 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). Copyright 2003 - 2023 - UKEssays is a trading name of Business Bliss Consultants FZE, a company registered in United Arab Emirates. 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. 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! Given that client substance use and misuse can be quite complicated, using various approaches within the Five Ps framework may yield positive results. People with paranoia tend to avoid these situations which would lead to distress (Clark et al 2005). Plate, A. J., & Aldao, A. 0000008644 00000 n 0000199672 00000 n According to Read et. Unlike summary, it is a discussion about alternative ideas about diagnosis, aetiology, treatment and prognosis and of the arguments for and against each alternative. The dappled nature of causes of psychiatric illness: Replacing the organicfunctional/hardwaresoftware dichotomy with empirically based pluralism. Cengage. In S. G. Hofmann & G. J. G. Asmundson (Eds. Karriker-Jaffe, K. J., Klinger, J. L., Witbrodt, J., & Kaskutas, L. A. It can assist both novice and experienced clinicians working with clients who present for counseling with substance use and misuse. 0000004501 00000 n Johnstone, L., & Dallos, R. She has also previously responded well to psychotherapy and appears to be psychologically-minded. Harris, R. (2019). 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. CBT has been found to not be effective in schizophrenia (Lynch et al. He was recently driving home from work in the evening and law enforcement stopped him because of erratic driving. Additionally, the lack of coping mechanisms leading to intense thoughts of suicide. 0000009229 00000 n Academic Press. 0000066425 00000 n Professional Case Management, 17(4), 164172. Societally, substance use and misuse consequences exceed $400 billion in crime, health, and lost productivity (U.S. Department of Health and Human Services, 2016, p. 2). Becks States that life experiences play a part in people dysfunctional beliefs and assumptions about themselves, others and the world around them (Beck 1967, 1979). Penguin. 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. 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). Concurrently treating both is very complex, challenging, and expensive. 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. 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. The officers evaluated him, detained him, and subsequently arrested him for driving while intoxicated. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. Acknowledging that his reticence is due to being obligated to attend counseling may assist in relationship building (Tahan & Sminkey, 2012). However, the patient has protective factors including psychological mindedness and previous response to therapy, which is a good prognostic factor. 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. Construct a psychological formulation of the case study - UKEssays.com 0000004656 00000 n 0000156091 00000 n https://doi.org/10.1111/j.1752-0606.2011.00242.x Compton, W. M., Gfroerer, J., Conway, K. P., & Finger, M. S. (2014). Precepting factors draw upon the ABC model (Burns, 1989; Ellis, 1977; Trower et al 1998) which refers to A- activating event, B Beliefs and C- consequences. Positive relationships, supportive community, and/or extended family/friends? https://doi.org/10.1007/s11920-013-0414-z 5 Ps of Strategy explained in a Practical way with Examples. - Consuunt Correspondence may be addressed to Scott Peters, One University Way, San Antonio, TX 78224, scott.peters@tamusa.edu. Selzer, R., & Ellen, S. (2014). (2017). This has further exacerbated her alcohol use disorder. The patient may have a strong family history of the disease, a sedentary job, environmental exposures, and/or a nutritionally-poor diet. As mentioned previously, the Five Ps is not meant to replace any other substance use and misuse intervention. Effects of treatment type on alcohol consumption partially mediated by Alcoholics Anonymous attendance. Predisposing factors include biological, environmental, or personality considerations that may put clients at risk of further substance use and misuse. For example, type II diabetes does not develop because of a single pathophysiological cause. Based on these factors, dialectical behavioural therapy would be the most helpful for this patient. 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 . Predisposing looks at a wider understanding of the issues, looking at it in more lengthily way. Episodic future thinking in generalized anxiety disorder. Lack of adaptive coping mechanisms resulted in using self-harm to cope and avoid further emotional dysregulation. The therapist provides a route easiest for the client by identifying methods that build on the clients current resilience and strengths. https://doi.org/10.1080/10826084.2017.1349800 Clinical Pediatrics, 53(2), 111117. Routledge. Day, A. M., Kahler, C. W., Ahern, D. C., & Clark, U. S. (2015). apply to your case. PDF Using DSM-5 in Case Formulation and Treatment Planning https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf 0000180034 00000 n His father started out drinking occasionally and over the years slowly developed a dependency on alcohol. Substance use and misuse has significant impact on the occupational sector as well. Now what? What is a psychiatric case formulation? 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). 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 . Guilford. Protective Factors There are numerous methods and combinations of methods to address substance use and misuse, such as family therapy, cognitive behavioral therapy, and self-help groups. He then withdraws and becomes sullen for a few days. One versus many: Capturing the use of multiple emotion regulation strategies in response to an emotion-eliciting stimulus. https://doi.org/10.3389/fpsyt.2013.00173 https://doi.org/10.2174/1874473711104010004 Predisposing Factors https://doi.org/10.3109/10826084.2013.770027 Furthermore, clients like Dax who are mandated to attend substance-related counseling may have service plans that are not congruent with the Five Ps framework. The Five Ps can be used in a variety of settings such as a community mental health agency, primary care clinic, and inpatient or residential treatment centers. He is also adamant that he does not have a problem with alcohol. Based on these factors, the following [treatment and management] would be the most helpful for this patient. 5P Model Case Formulation [Case Study Example] | KESSAYS.COM Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. 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). & Haddock, G. (1990). 1264 0 obj <>stream This is in keeping with the inherent uniqueness of clients, their concerns, and a variety of factors. 0000003178 00000 n The five perspectives are: A strategy has a PLAN A strategy has a PLOY A strategy has a PATTERN A strategy has a POSITION A strategy has a PERSPECTIVE Let's examine each of the 5 Ps of Strategy in turn 1. 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. https://doi.org/10.1177/0017896918763462 ), Essentials of clinical social work (pp. Client substance use and misuse at that level may need medical stabilization and detoxification prior to utilization of the Five Ps. 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 .

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