5 ps formulation example

If your specific country is not listed, please select the UK version of the site, as this is best suited to international visitors. As shown above, there are numerous ways to examine and treat client substance use and misuse. As she was unable to develop a sense of self and personal identity, these psychological factors are reflected in her adulthood with unstable relationships, and fears of abandonment. (2010, February). Han, B., Hedden, S. L., Lipari, R., Copello, E. A. P., & Kroutil, L. A. 0000186981 00000 n Macneil, C. A., Hasty, M. K., Conus, P., & Berk, M. (2012). Engel, G. L. (1977). Long-term, Jane might also benefit from a more in-depth understanding of how her past trauma affects her present self and symptoms. Their effectiveness has been well researched, and this paper does not propose a superior way to address substance use and misuse. (2014). Furthermore, the Five Ps helps clients and counselors explore relationships between each factor and the presenting problem. B., Twohig, M. P., Waltz, T., Hayes, S. C., Roget, N., Padilla, M., & Fisher, G. (2007). The goal here is to build Daxs competence in communicating, both in listening and expressing. The "5 Ps" we recommend include: Purpose: Every meeting should have a reason. https://www.samhsa.gov/treatment 0000241644 00000 n Additionally, Dax often struggles with strong and painful emotions, and alcohol helps to address them. Dax reports a strong paternal history of substance use and misuse. https://doi.org/10.1016/j.avb.2010.01.006 The 5 P's of Strategy is a planning process. (2017, September 7). Treating complex cases: The cognitive behavioural. 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. Moreover, the Five Ps align with SAMHSAs recommendation that clinicians tailor treatment to each client because no single treatment is particularly superior (SAMHSA, 2020). 0000003178 00000 n This can be both positive or negative but they have a direct correlation to how the person is today. (Persons, 1998). The need for a new medical model: a challenge for biomedicine. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. https://www.samhsa.gov/data/report/results-2016-national-survey-drug-use-and-health-detailed-tables https://doi.org/10.1177/0017896918763462 0000004344 00000 n 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. Many formulation models are administered within a cognitive behavioral grounding (Chadwick et al., 2003; Easden & Kazantzis, 2018; Persons et al., 2013). 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. In fact, this stigmatization can come from those who are treating them (Luoma et al., 2007). The Five Ps does not adhere to any particular theoretical orientation, thus allowing for a greater repertoire of strategies to draw from to help clients with substance use and misuse. 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. 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). This population often experiences stigma and suboptimal health care results (McNeely et al., 2018; van Boekel et al., 2013). 0000156014 00000 n This condition did not develop six months ago but developed during childhood when he failed to meet his father's expectations. Additionally, the lack of coping mechanisms leading to intense thoughts of suicide. Journal of Marital and Family For example, the clinician may ask Dax if they can share how genes are passed on and expressed, like genes for eye color or hypertension. 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. 0000238570 00000 n Addressing the potential genetic link to substance use and misuse may prove beneficial in raising Daxs awareness (Dick & Agrawal, 2008). This is where you'll need to be creative and also think more in-depth about your patient. After being told she was fired from her job, she went home and self-harmed to cope with the distress of this loss. Emotion regulation in cognitive-behavioral therapy: Bridging the gap between treatment studies and laboratory experiments. Positive relationships, supportive community, and/or extended family/friends? 1: A step-by-step way of filling out a Biopsychosocial Table. Even weekly status meetings or things of that nature should have a clearly defined purpose. 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. People with paranoia tend to avoid these situations which would lead to distress (Clark et al 2005). Facing addiction in America: The Surgeon Generals report on alcohol, drugs, and health. 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. 0000186690 00000 n Annual surveillance report of drug-related risks and outcomes. By examining and exploring clients use or misuse within the context of a multidimensional framework, interventions can be personalized, and areas of concern can be targeted. 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. One of the weakness of this formulation is identifying that the clients strength is not included the initial assessment and data collection. It can assist both novice and experienced clinicians working with clients who present for counseling with substance use and misuse. 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 . 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). 0000008363 00000 n Conflict of Interest and Funding Disclosure The essay will now look at the key ideas underpinning the process of CBT. W. W. Norton. Effects of treatment type on alcohol consumption partially mediated by Alcoholics Anonymous attendance. Sample #1: Conceptualization for CBT case This is a 35-year-old Caucasian man referred by his physician for treatment of generalized anxiety. Treating substance use disorders in the criminal justice system. One such framework is the Five Ps (Macneil et al., 2012). Substance use and misuse has significant impact on the occupational sector as well. 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! Schoen, C., Osborn, R., Squires, D., & Doty, M. M. (2013). Cognition and Emotion, 27(4), 753760. Those who engage in substance use and misuse often have higher rates of unemployment (Compton et al., 2014; Dieter, 2011). Liao, J.-Y., Huang, C.-M., Lee, C. T.-C., Hsu, H.-P., Chang, C.-C., Chuang, C.-J., & Guo, J.-L. (2018). Such a framework may enhance the effectiveness of the aforementioned interventions (Wormer & Davis, 2018). W. W. Norton. It is important to remember that not everything will fit neatly into each box. The compass of pleasure: How our brains make fatty foods, orgasm, exercise, marijuana, generosity, vodka, learning, and gambling feel so good. 0000199386 00000 n She also drank 10 beers prior to arriving in the hospital. Predisposing factors include biological, environmental, or personality considerations that may put clients at risk of further substance use and misuse. 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). In S. G. Hofmann & G. J. G. Asmundson (Eds. Please refer to an authoritative source if you require up-to-date information on any health or medical issue. Strategy as a Plan Planning comes naturally to many managers and as such, has become the default first step. Frontiers in Psychiatry, 4(173), 115. Day, A. M., Kahler, C. W., Ahern, D. C., & Clark, U. S. (2015). No plagiarism, guaranteed! https://doi.org/10.1186/1741-7015-10-111 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). This may open the door to a conversation regarding how his substance use and misuse may progress to alcohol use disorder and its definition as a pattern of alcohol use leading to clinically significant problems, including increase in use, failed attempts to stop, and use leading to an impaired ability to meet role obligations (American Psychiatric Association, 2013). (e.g. Formulation is like cooking, and there is no 'right' or 'wrong' way to do it, but most get better over time with increasing clinical experience. Example of the 5 P's of Marketing John is considering operating a jet ski shop catering to travelers and tourists. Johnstone, L., & Dallos, R. 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. 0000014220 00000 n (2008). What are the 5 Ps of case formulation? Goldman, R. and Greenberg, L.S., 1997. (2018). 0000012631 00000 n All rights reserved. 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. 1189 0 obj <> endobj CBT has been found to not be effective in schizophrenia (Lynch et al. In addition, the interventions demonstrated are not to be assumed the only ones that can be applied to Dax. Jane Doe presents with a diagnosis of borderline personality disorder and history of depression. 0000013321 00000 n Case conceptualization research in cognitive behavior therapy: A state of the science review. %PDF-1.4 % (Johnstone & Dallos 2009). 0000016414 00000 n https://doi.org/10.2174/1874473711104010004 Unemployment and substance use: A review of the literature (19902010). There are limitations to the Five Ps framework as a way to formulate and intervene with clients substance use and misuse. Sara is unequivocal in her confidence in Zoes cardiologist and his competence. Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. It is likely that other clinicians presented with Dax would use a different combination of approaches. 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). https://www.centeronaddiction.org/addiction-research/reports/behind-bars-ii-substance-abuse-and-americas-prison-population Protective Factors Substance use and misuse is exceedingly common and has numerous implications, both individual and societal, impacting millions of Americans directly and indirectly every year. 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. 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. 1264 0 obj <>stream 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 ACT made simple (2nd ed.). As mentioned previously, the Five Ps is not meant to replace any other substance use and misuse intervention. Mintzberg's 5 Ps of Strategy with Examples 1. " [Formulation is] The lynch pin that holds theory and practice together" (Butler, 1998). Kendler, K. S. (2012). Dick, D. M., & Agrawal, A. 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. or funding contributions for the development Client substance use and misuse can be quite challenging for counselors, both novice and experienced. She presents to hospital today with acute suicidal ideation and self-harm after being fired from her job. 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 . & Haddock, G. (1990). 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. (2017). 0000239964 00000 n However, an important skill that they should try to perform is to assess a situation before jumping to conclusions. In psychiatry, formulation appears more complicated because human behaviour and the brain itself is extraordinarily complex. https://doi.org/10.1186/s13722-018-0110-8 health? 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. 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. BMC Medicine, 10(111), 13. )jB' */NNM;2=Kc.w}9XXtj+%]{IF UA_ Precipitating and perpetuating factors: the stressor of losing her job has reactivated these more primitive defense mechanisms and coping strategies. May, R. (1950). This likely led to an attachment style that was likely insecure and disorganized. In addition, mindfulness strategies can assist in helping Dax to cognitively diffuse from present to future events (Harris, 2019). An example formulation is available (see A case example: "Sandra")* as an example of the type of output you For example, type II diabetes does not develop because of a single pathophysiological cause. 0000239101 00000 n 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. 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). Here the focus is on investigating resources and/or supports that may help prevent client substance use and misuse from further becoming problematic. Substance Abuse and Mental Health Services Administration. Professional Case Management, 17(4), 164172. We would anticipate when engaging in treatment, the patient may have [resistance/transference/countertransference]. Participants: The leader of a meeting should carefully consider who he or she invites. 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. Addiction Science and Clinical Practice, 13(8), 115. https://doi.org/10.1016/j.janxdis.2015.09.005 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. <<6D17E8AF19023D4BAD06A1AFD23B08FB>]/Prev 415012/XRefStm 2760>> Karriker-Jaffe, K. J., Klinger, J. L., Witbrodt, J., & Kaskutas, L. A. What we understand today is shaped by what we believe and what we have experienced in our life. Diagnosis is not the same as formulation! 0000238491 00000 n Studies utilizing the Five Ps with mandated clients may demonstrate its efficacy, notably with agencies that require substance-related counseling. From simple essay plans, through to full dissertations, you can guarantee we have a service perfectly matched to your needs. Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy. https://doi.org/10.1016/S0005-7967(02)00033-5 https://doi.org/10.1111/j.1521-0391.2011.00187.x These symptoms have been further perpetuated by the personality factors and traits described above, and her ongoing financial stressors. 0000007444 00000 n The persons resilience and strengths that help maintain emotional health. The National Survey on Drug Use and Health asserted that close to 30% of respondents aged 12 and older reported use of illicit substances in the past month (Substance Abuse and Mental Health Services Administration [SAMHSA], 2017). 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. Chiesa, A., & Serretti, A. Substance use and misuse in the United States is extremely common. Belenko, S., Hiller, M., & Hamilton, L. (2013). The authors reported no conflict of interest 0000013350 00000 n (2011). Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. Are mindfulness-based interventions effective for substance use disorders? Cognitive behavioral therapists use individually tailored formulations as a framework with which to understand their patients' difficulties and to plan effective treatment. Jane is able to articulate a safe plan to stay with a friend, and is suitable for outpatient care, Jane might benefit from an increase of her, Jane might benefit from the use of anti-craving medications such as. He fears that she will need open-heart surgery and that she may die. 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. The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. Child and Adolescent Psychiatric Clinics, 16(1), 111-132. He then stopped at a local pub and had several drinks. It also allows clinicians to target specific areas of concern (Macneil et al., 2012) and may be used in a variety of clinical settings. American Psychiatric Association. He is confident that he does not have a problem and that counseling should be reserved for those who cannot stop drinking. U.S. Department of Health and Human Services. It's useful to employ the 5 Ps throughout the planning process. Journal of Substance Abuse Treatment, 26(3), 151158. In this article, we'll explore the 5 Ps in more detail and the tools that you can use in each area. Substance Abuse and Mental Health Services Administration. (2018). The night he was pulled over, he had had two additional beers and one additional shot of whiskey on top of his usual consumption after a telephone argument with his wife, Sara. Frontiers in Psychiatry, 9, 19. Chapter. Tahan, H. A., & Sminkey, P. V. (2012). (Goldman & Greenberg 1997). This has further exacerbated her alcohol use disorder. You've got your table all filled out now. According to Read et. B., Lemle Becker, V., & Tompkins, M. A. (2019). 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). https://doi.org/10.3389/fpsyt.2013.00173 More ominously, substance use and misuse has been correlated with intimate partner violence (Murphy & Ting, 2010). https://doi.org/10.1093/pubmed/fdv148 University-educated. 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. Using a framework to assist in case formulation may prove useful to beginning counselors. Perpetuating factors are those that sustain and possibly reinforce clients current substance use and misuse challenges. https://doi.org/10.1016/S0740-5472(03)00212-5 0000012481 00000 n Delivery of mindfulness-based interventions may help to address stressful events that previously triggered substance use (Garland et al., 2014).

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