0000017109 00000 n https://www.samhsa.gov/treatment 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. Frontiers in Psychiatry, 9, 19. He was recently driving home from work in the evening and law enforcement stopped him because of erratic driving. 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 therapist provides a route easiest for the client by identifying methods that build on the clients current resilience and strengths. From simple essay plans, through to full dissertations, you can guarantee we have a service perfectly matched to your needs. 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). Hussaarts, P., Roozen, H. G., Meyers, R. J., van de Wetering, B. J. M., & McCrady, B. S. (2012). https://doi.org/10.3389/fpsyt.2018.00095 Cognitive behavioral therapy for substance use disorders. In this article, we'll explore the 5 Ps in more detail and the tools that you can use in each area. 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. Easden, M. H., & Kazantzis, N. (2018). He denies any significant increase in alcohol use or any other substance use. OFarrell, T. J., & Clements, K. (2012). Good interpersonal support from her best friend who brought her to hospital. More ominously, substance use and misuse has been correlated with intimate partner violence (Murphy & Ting, 2010). 0000180123 00000 n 0000187506 00000 n Additionally, the lack of coping mechanisms leading to intense thoughts of suicide. 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. Child and Adolescent Psychiatric Clinics, 16(1), 111-132. She was suddenly fired from her job today due to conflicts at work with co-workers and being late at work several times from sleeping in. https://www.samhsa.gov/data/report/results-2016-national-survey-drug-use-and-health-detailed-tables Journal of Anxiety Disorders, 36, 18. Henkel, D. (2011). This factor differs markedly from the first four. 0000017180 00000 n What are the 5 Ps of case formulation? 0000245206 00000 n (Johnstone & Dallos 2009). 1. xref 5 Ps Formulation Example. (2019). Bush, D. M., & Lipari, R. N. (2015, April 16). Selzer, R., & Ellen, S. (2014). It may include past difficulties and experiences if these are relevant to the present. This condition did not develop six months ago but developed during childhood when he failed to meet his father's expectations. - Eriksonian developmental stages, psychodynamic defenses, and dialectical behavioural): Yet another way to present a formulation is in chronological order, starting from birth until present time: Having certain common phrases to use can be helpful to structure your presentation. 0000238450 00000 n The systematic but flexible nature of this framework affords clinicians numerous ways to address substance use and misuse. Client substance use and misuse at that level may need medical stabilization and detoxification prior to utilization of the Five Ps. 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. 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 Factors (Ed.). American Psychiatric Association. 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). She has the following protective factors, including a supportive psychiatrist and friend. Concurrently treating both is very complex, challenging, and expensive. The approach that is highlighted in the 5Ps includes presenting, predisposing, precipitating, perpetuating, and protective factors. 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. Here, the clinician may use reality-based strategies that address choice and consequences (Wubbolding & Brickell, 2017). The Essay Writing ExpertsUK Essay Experts. Emotion regulation in cognitive-behavioral therapy: Bridging the gap between treatment studies and laboratory experiments. ACT made simple (2nd ed.). Cengage. Dax denies any other negative consequences from his alcohol use. (Persons, 1998). Counselling with reality therapy (2nd ed.). 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! The officers evaluated him, detained him, and subsequently arrested him for driving while intoxicated. https://doi.org/10.1016/j.drugalcdep.2014.06.012 In spite of these limitations, there may be several potential areas of inquiry. The compass of pleasure: How our brains make fatty foods, orgasm, exercise, marijuana, generosity, vodka, learning, and gambling feel so good. Precipitating factors are those that proximally bring about substance use and misuse and its resulting difficulties. Clinical problem solving: the case of Matthew, part 1. Annual surveillance report of drug-related risks and outcomes. Introduction to formulation. Risk and protective factors for adolescents illicit drug use: A population-based study. This gives you a sense of their current level of functioning, prognosis, and guides your direction for treatment and management decisions. https://doi.org/10.1186/s13722-018-0110-8 0000009229 00000 n Routledge. Van Wormer, K., & Davis, D. R. (2018). Jane Doe is a 30-year-old female who presents with acute suicidal ideation in the context of a job loss. 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. (2017). All work is written to order. 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. 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). Predisposing looks at a wider understanding of the issues, looking at it in more lengthily way. 1. These are historical psychological, biological, developmental, and socio-cultural factors that increased the person's vulnerability to their current problems. The following pages describe two approaches to documenting the formulation using the 5Ps structure, including a narrative and flowchart. Is diagnosis enough to guide interventions in mental van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013). A logical analysis using gentle Socratic dialogue may help to challenge his emotional reactions to his daughters heart murmur (Etoom & Ratnapalan, 2014). There are several approaches to managing client substance use and misuse that have demonstrated effectiveness. 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). Karriker-Jaffe, K. J., Klinger, J. L., Witbrodt, J., & Kaskutas, L. A. 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. ; DSM-5) bases an SUD on a pathological pattern related to the use of a substance (American Psychiatric Association, 2013, p. 483). 0000008644 00000 n (2018). https://doi.org/10.1016/j.addbeh.2006.09.008 0000200485 00000 n Example of the 5 P's of Marketing John is considering operating a jet ski shop catering to travelers and tourists. 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. Case formulation in process-experiential therapy. (2015). Like most things in medicine, there are multifactorial causes of diseases, illnesses, and disorders. First and foremost, it should be emphasized that this particular framework has not been empirically tested with client substance use and misuse. 0000186690 00000 n The Five Ps permits counselors to both assess and intervene essentially simultaneously. As mentioned previously, novice counselors often lack sufficient case formulation skills (Liese & Esterline, 2015). It can be changed and reviewed as the treatment is in progress if any new information come to light. 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. The idiographic/nomothetic dichotomy: Tracing historical origins of contemporary confusions. 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). https://doi.org/10.17744/mehc.30.1.j40256207h0581t1 Surgeon General Vivek Murthy reported that more than 20 million Americans have an SUD (U.S. Department of Health and Human Services, 2016). Protective factors are those that help to moderate actual or potential substance use and misuse impact. Addressing the potential genetic link to substance use and misuse may prove beneficial in raising Daxs awareness (Dick & Agrawal, 2008). Case formulation, also referred to as conceptualization, is a skill new counselors often lack (Liese & Esterline, 2015). One such framework is the Five Ps (Macneil et al., 2012). Dax reports a strong paternal history of substance use and misuse. We've received widespread press coverage since 2003, Your UKEssays purchase is secure and we're rated 4.4/5 on reviews.co.uk. Acknowledging that his reticence is due to being obligated to attend counseling may assist in relationship building (Tahan & Sminkey, 2012). de Shazer, S. (1985). McHugh, R. K., Hearon, B. Predisposing factors include biological, environmental, or personality considerations that may put clients at risk of further substance use and misuse. Facing addiction in America: The Surgeon Generals report on alcohol, drugs, and health. Centers for Disease Control and Prevention. 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). 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!). Wu, J. Q., Szpunar, K. K., Godovich, S. A., Schacter, D. L., & Hofmann, S. G. (2015). For example, type II diabetes does not develop because of a single pathophysiological cause. This population often experiences stigma and suboptimal health care results (McNeely et al., 2018; van Boekel et al., 2013). This essay may contain factual inaccuracies or out of date material. She also drank 10 beers prior to arriving in the hospital. 2009). Concept mapping: A supervision strategy for introducing case conceptualization skills to novice therapists. 0000200185 00000 n The clinician may also seek more information on the cause of the reported stress between him and his wife. However, the patient has protective factors including psychological mindedness and previous response to therapy, which is a good prognostic factor. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860452/ He fears that she will need open-heart surgery and that she may die. The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. The image (. Client substance use and misuse is a significant problem in the United States, and it continues to cause difficulty for individuals, families, and society. 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. Drug and Alcohol Dependence, 142(1), 350353. Twelve-step attendance is most beneficial with inpatient substance use and misuse treatment (Karriker-Jaffe et al., 2018). Examining the two groups experiences using the Five Ps may provide insight to assist counselor training programs related to substance use and misuse skill development. Wiley. The meaning of anxiety. or funding contributions for the development This is where you'll need to be creative and also think more in-depth about your patient. 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). However, patient has the following [protective factors], which may be a good prognostic factor. The clinician can provide a variety of potential spousal responses, allowing for more adaptability and flexibility in Daxs responses. Addiction Science and Clinical Practice, 13(8), 115. However, like with anything, the more you practice, the better you will become at formulating. Hypotheses are generated about the origins and causes of a patient's symptoms. Here you can choose which regional hub you wish to view, providing you with the most relevant information we have for your specific region. Now what? Delivery of mindfulness-based interventions may help to address stressful events that previously triggered substance use (Garland et al., 2014). (2017). The Five P's approach provides a structured way of constructing this formulation. 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).