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). The goal here is to build Daxs competence in communicating, both in listening and expressing. 0000017109 00000 n Additionally, as it is a continuous process it allows the therapist to revise any incorrect hypothesis about any underlying mechanism at any stage. (Eds.). Following formulation, there should be an identification of the prioritised areas of focus for care - to inform the Care Plan. B., Twohig, M. P., Waltz, T., Hayes, S. C., Roget, N., Padilla, M., & Fisher, G. (2007). https//doi.org/10.1016/j.drugalcdep.2013.02.018 https://doi.org/10.1016/j.psc.2010.04.012 0000156014 00000 n https://doi.org/10.1016/S0005-7967(02)00033-5 hA 4-`76>m{dKs. https://doi.org/10.1186/s13722-018-0110-8 His father started out drinking occasionally and over the years slowly developed a dependency on alcohol. Plate, A. J., & Aldao, A. 0000004805 00000 n Based on these factors, dialectical behavioural therapy would be the most helpful for this patient. 0000239964 00000 n The approach that is highlighted in the 5Ps includes presenting, predisposing, precipitating, perpetuating, and protective factors. It is likely that other clinicians presented with Dax would use a different combination of approaches. 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. https://doi.org/10.1177/0009922813488653 (2020, April 21). There are limitations to the Five Ps framework as a way to formulate and intervene with clients substance use and misuse. 0000187506 00000 n Aggression and Violent Behavior, 15(5), 325333. To help treat the client with psychosis maintaining specific behaviour can be beneficial and help avoid frustration and upsetting experiences (Johnstone 2009). 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). A review of CBT treatments for substance use disorders. He then stopped at a local pub and had several drinks. The genetics of alcohol and other drug dependence. Planning is an essential part of the strategy formulation process, so take time to Brainstorm new opportunities. Diagnostic and statistical manual of mental disorders (5th ed.). Dax, however, is hyper-focused on surgery and seems to dismiss Saras position. The Essay Writing ExpertsUK Essay Experts. Liese, B. S., & Esterline, K. M. (2015). 1. Addiction Science and Clinical Practice, 13(8), 115. Scott W. Peters, PhD, LPC-S, is an associate professor at Texas A&M University San Antonio. 0000011818 00000 n (Persons, 1998). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860452/ Easden, M. H., & Kazantzis, N. (2018). Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. 0000245206 00000 n or funding contributions for the development An investigation of stigma in individuals receiving treatment for substance abuse. Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: A meta-analysis. 0000003215 00000 n 0000199672 00000 n The last P looked at is Protective which as the name suggest looks at ways to prepare the client so that relapse is unlikely, this is done by looking at the strengths of the client as a platform to build on. )jB' */NNM;2=Kc.w}9XXtj+%]{IF UA_ 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). Frontiers in Psychiatry, 9, 19. Counselling with reality therapy (2nd ed.). 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. This condition did not develop six months ago but developed during childhood when he failed to meet his father's expectations. 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. In spite of these limitations, there may be several potential areas of inquiry. Let's do a simplified formulation for the patient (Jane Doe) below. Chadwick, P., Williams, C., & Mackenzie, J. Do you have a 2:1 degree or higher? Note that in this example, since the precipitating cause for acute psychosis (also applies to manic episodes) is more biological, it may be harder to identify underlying psychological factors (but that's OK too even the most biological psychiatric disorders can often be precipitated by psychosocial stressors). Hawton, K.E., Salkovskis, P.M., Kirk, J.E. Such a framework may enhance the effectiveness of the aforementioned interventions (Wormer & Davis, 2018). It also provides opportunities for a variety of interventions and strategies targeted to clients and their substance use and misuse or contributing factors. The patient has genetic vulnerabilities for mental illness in her family history, a history of anxious temperament, ongoing substance use, and subtherapeutic medication levels. Presenting Problem This is to ensure that the client understand any reason for change from what was originally agreed. Abnormal and normal obsessions. It can be used in outpatient, inpatient, and residential settings and possibly as part of an aftercare program. Free resources to assist you with your university studies! (Ed.). 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. Journal of Mental Health Counseling, 30(1), 6794. For some, receiving substance use and misuse services can be stigmatizing. Penguin. Case conceptualization research in cognitive behavior therapy: A state of the science review. Among those are 12-step programs (Humphreys et al., 2004), mindfulness-based interventions (Chiesa & Serretti, 2014), evidence-based approaches such as cognitive behavioral therapy (McHugh et al., 2010), and family counseling (OFarrell & Clements, 2012). W. W. Norton. Van Wormer, K., & Davis, D. R. (2018). 0000002760 00000 n 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). 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. 58 - 65. The persons resilience and strengths that help maintain emotional health. https://doi.org/10.1097/ADM.0000000000000260 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). They are examples that the author chose to illustrate the Five Ps in practice. J Am Acad Child Adolesc Psychiatry 2002;41(1):927. 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. Correspondence may be addressed to Scott Peters, One University Way, San Antonio, TX 78224, scott.peters@tamusa.edu. What it wants to Achieve. Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust Journal of Marital and Family 0000014220 00000 n British Journal of Clinical Psychology, 37(3), pp.269-284. 0000004501 00000 n 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. (2012). Type. Design of individualized behavioral treatment programs using functional analytic clinical case models. People with paranoia tend to avoid these situations which would lead to distress (Clark et al 2005). Dax was quite upset, cursed at her, and then hung up the phone. Dax can then share his and his wifes perspectives on their daughters care. The Five Ps is a type of framework utilizing five factors developed by Macneil et al. Day, A. M., Kahler, C. W., Ahern, D. C., & Clark, U. S. (2015). Chapter. 0000239180 00000 n Here the focus is on investigating resources and/or supports that may help prevent client substance use and misuse from further becoming problematic. The patient may have a strong family history of the disease, a sedentary job, environmental exposures, and/or a nutritionally-poor diet. [Patient] presents with a [diagnosis]. 0000119267 00000 n 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. Our academic experts are ready and waiting to assist with any writing project you may have. 0000006666 00000 n 0000016414 00000 n Routledge. Borrell-Carri F, Suchman AL, Epstein RM. Routledge.21-37). Centers for Disease Control and Prevention. Journal of Clinical Psychology, 74(3), 356384. The essay will now look at the key ideas underpinning the process of CBT. Remember there is no right or wrong way to present your formulation. Facing addiction in America: The Surgeon Generals report on alcohol, drugs, and health. If present categories are used, formulation can be limiting and dangerous. 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!). Ingram, B. L. (2012). 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. 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). Greg experiences feelings of stress and anxiety over the past six months. Born in Canada. From simple essay plans, through to full dissertations, you can guarantee we have a service perfectly matched to your needs. There are several approaches to managing client substance use and misuse that have demonstrated effectiveness. Journal of Marital and Family Therapy, 38(1), 122144. 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. (2008). Cognitive Behavior Therapy (CBT) case conceptions have follows a 5p's model. Effects of treatment type on alcohol consumption partially mediated by Alcoholics Anonymous attendance. 2008). Currently, there are a variety of empirically based interventions for treating clients who engage in substance use and misuse. 0000006923 00000 n In addition, the vast majority of those with an SUD never receive treatment (Han et al., 2015). We would anticipate when engaging in treatment, the patient may have [resistance/transference/countertransference]. Here you can choose which regional hub you wish to view, providing you with the most relevant information we have for your specific region. 0000010825 00000 n Kendler, K. S. (2012). In addition, there may be clients who are simply not ready or able to address some or most of the dimensions of the Five Ps. This has led to her adulthood self-perception of being unworthy of being loved, a constant fear of rejection, and increased rejection sensitivity. At its most basic, you could present each box sequentially and describe each factor. all (2004) it is essential to reduce stress and traumatic events for people recovering from Paranoid Schizophrenia, and start to contribute in social activities. First and foremost, it should be emphasized that this particular framework has not been empirically tested with client substance use and misuse. Looking for a flexible role? Ideally, each step should flow logically and intuitively into the next based on your framework, as you'll see in our case of Jane Doe. In fact, this stigmatization can come from those who are treating them (Luoma et al., 2007). Dax further reports his paternal grandfather died from liver failure. 0000241723 00000 n Kuyken, W., Padesky, C. A., & Dudley, R. (2009). The authors reported no conflict of interest The Canadian Journal of Psychiatry, 38(5), 351-358. This is where you'll need to be creative and also think more in-depth about your patient. 2004;2(6):576-582. doi:10.1370/afm.245. She is, Her underlying history of experiencing trauma and sexual abuse at a young age, A history of invalidating experiences in childhood, That she is not deserving of love or close relationships, a core belief of her being unlovable, and that self-harm is the main way of coping with stressors, That others may leave or abandon her any time, increased rejection sensitivity, and a future fear of being rejected, That the world can be a fearful and scary place. %PDF-1.4 % 0000017180 00000 n 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). 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). 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 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. Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. Behind bars II: Substance abuse and Americas prison population. This conversation can lead to investigating strategies for how each can be heard, including short role-plays with opportunities to practice (Worrell, 2015). Dax presents as extremely frustrated and embarrassed at being mandated to attend counseling sessions. Emotion regulation in cognitive-behavioral therapy: Bridging the gap between treatment studies and laboratory experiments. Episodic future thinking in generalized anxiety disorder. 0000200185 00000 n 0000016707 00000 n (2015). 0000119626 00000 n 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). 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). If your specific country is not listed, please select the UK version of the site, as this is best suited to international visitors. New York: WW Norton. Humphreys, K., Wing, S., McCarty, D., Chappel, J., Gallant, L., Haberle, B., Horvath, A. T., Kaskutas, L. A., Kirk, T., Kivlahan, D., Laudet, A., McCrady, B. S., McLellan, A. T., Morganstern, J., Townsend, M., & Weiss, R. (2004). Additionally, he reports significant stress and conflict in his marriage as well as concerns over some upcoming diagnostic tests for their daughter related to a heart murmur. (2014). This gives you a sense of their current level of functioning, prognosis, and guides your direction for treatment and management decisions. Drug and Alcohol Dependence, 142(1), 350353. Garland, E. L., Froeliger, B., & Howard, M. O. It acknowledges your strengths and resources. More ominously, substance use and misuse has been correlated with intimate partner violence (Murphy & Ting, 2010). Results from the 2016 National Survey on Drug Use and Health: Detailed tables. Mental health professionals evaluations of the Integral Intake, a metatheory-based, idiographic intake instrument. 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 targets based around this. Fundamental Changes in DSM-5 Dimensional Approach The conundrum with categories The image (. The choice of the above approaches is only meant as an illustration and not as definitive ways to address this particular client. He denies any significant increase in alcohol use or any other substance use. Behaviour and Research Therapy, 41(6), 671680. Here's what the completed table would look like with the psychological factors incorporated. 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). Please refer to an authoritative source if you require up-to-date information on any health or medical issue. Social isolation and withdrawn from family members, Ongoing social isolation due to psychosis causing him to be fearful of others, Followed by an early intervention in psychosis team, History of immigration (increases risk for psychosis), Long-standing feelings of isolation and insecurity since childhood, Joined a gang, entering a stressful lifestyle, led to increased hyper-vigilance and paranoia in the past few months, Ongoing delusions leading patient become suspicious of healthcare workers/family, Previously responded well to CBT for psychosis, Family history of psychosis and schizophrenia. This area explores significant occurrences that preceded or triggered the presenting problem and its consequences. health? 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. As I stated above this factor looks to get a wider understanding of what the issues is. Mintzberg's 5 Ps of Strategy with Examples 1. One way to do this is to use the "5 Ps.". For Dax, he shares that when he and his wife argue, it follows a very predictable pattern. 2. This factor has generally been underutilized despite being shown as beneficial to clients (Kuyken et al., 2009). Here, the clinician may use reality-based strategies that address choice and consequences (Wubbolding & Brickell, 2017). Using a framework to assist in case formulation may prove useful to beginning counselors. 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. 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. Journal of Public Health, 38(3), e282e291. All work is written to order. Like most things in medicine, there are multifactorial causes of diseases, illnesses, and disorders. Copyright 2003 - 2023 - UKEssays is a trading name of Business Bliss Consultants FZE, a company registered in United Arab Emirates. Some of these evidence-based approaches will be demonstrated later in a case illustration. 0000241200 00000 n 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. 0000004306 00000 n Many formulation models are administered within a cognitive behavioral grounding (Chadwick et al., 2003; Easden & Kazantzis, 2018; Persons et al., 2013). [1][2] Biopsychosocial formulation combines biological, psychological, and social factors to understand a patient, and uses this to guide both treatment and prognosis. (e.g. A logical analysis using gentle Socratic dialogue may help to challenge his emotional reactions to his daughters heart murmur (Etoom & Ratnapalan, 2014). This can be even more problematic given the lack of health care access for large numbers of Americans (Schoen, 2013). Seminars in the Psychotherapies , pp. Journal of Anxiety Disorders, 36, 18. https://doi.org/10.2174/1874473711104010004 We've received widespread press coverage since 2003, Your UKEssays purchase is secure and we're rated 4.4/5 on reviews.co.uk. https://www.samhsa.gov/treatment 3. Fig. https://doi.org/10.1111/j.1752-0606.2011.00242.x Family therapy for drug abuse: Review and updates 20032010. 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. 0000007722 00000 n Narrative therapy to therapeutic ends. One such framework is the Five Ps (Macneil et al., 2012). Sample #1: Conceptualization for CBT case This is a 35-year-old Caucasian man referred by his physician for treatment of generalized anxiety. SAGE. I will go into further detail of the 5 Ps Model below. 0000243959 00000 n <<6D17E8AF19023D4BAD06A1AFD23B08FB>]/Prev 415012/XRefStm 2760>> Another potential area of study might involve comparing novice counselors to more experienced counselors. Alcohol Research Current Reviews, 31(2), 111118. Journal of Addiction Medicine, 11(1), 39. You are probably already formulating, but just don't know it. The officers evaluated him, detained him, and subsequently arrested him for driving while intoxicated. Dax is a 33-year-old married father of two children: a 9-year-old son, Cam, and a 7-year-old daughter, Zoe. 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 . Psychotherapy, 52(2), 190194. Case formulation in process-experiential therapy. A good biopsychosocial formulation allows you to come up with a comprehensive and holistic treatment plan for your patient. Goldman, R. and Greenberg, L.S., 1997. The idiographic/nomothetic dichotomy: Tracing historical origins of contemporary confusions. However, patient has the following [protective factors], which may be a good prognostic factor. It has been documented that 90% of the population at some point have intrusive thoughts, or feel paranoid and feel people are doing things on purpose towards them. 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 Oxford University Press. The effects of treatment for substance use problems on intimate partner violence: A review of empirical data. 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. 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. She also drank 10 beers prior to arriving in the hospital. 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). Due to her history of abuse at age 12, she may have struggled with identity versus role confusion during that Eriksonian stage of psychosocial development. Cengage. After being told she was fired from her job, she went home and self-harmed to cope with the distress of this loss. Substance Abuse and Mental Health Services Administration. To position his business, John may consult the 5 Ps of marketing in the following manner: Product: By-the-hour jet ski rentals for people who are in the city for a short duration of time.