Clinical Pediatrics, 53(2), 111117. Addressing the potential genetic link to substance use and misuse may prove beneficial in raising Daxs awareness (Dick & Agrawal, 2008). Client substance use and misuse is a significant problem in the United States, and it continues to cause difficulty for individuals, families, and society. For the year 2016, the Centers for Disease Control and Prevention (CDC) found that 18% of the U.S. population aged 12 and older had used illicit substances or misused prescription medications (CDC, 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. This framework is idiographic in nature, as it looks at clients individually and holistically (Marquis & Holden, 2008). Patterns: Study what Worked in the Past and What can be Replicated. 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. The following pages describe two approaches to documenting the formulation using the 5Ps structure, including a narrative and flowchart. 0000239964 00000 n 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). Cognitive behaviour therapy for psychiatric problems: A practical guide. 0000004656 00000 n One of the weakness of this formulation is identifying that the clients strength is not included the initial assessment and data collection. First and foremost, it should be emphasized that this particular framework has not been empirically tested with client substance use and misuse. (2018). https://doi.org/10.1080/10826084.2017.1349800 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). https://www.centeronaddiction.org/addiction-research/reports/behind-bars-ii-substance-abuse-and-americas-prison-population Studies utilizing the Five Ps with mandated clients may demonstrate its efficacy, notably with agencies that require substance-related counseling. 0000006894 00000 n These beliefs are set off by occurrences in the client life, and once this belief is activated it can lead to automatic negative thinking. Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: A meta-analysis. How do you present all this information and data? Mindfulness-based strategies are not as effective when used alone as when used with other approaches (Sancho et al., 2018). 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 is an example of a set of treatment recommendations for Jane Doe: For good measure, here is another sample formulation for someone with a diagnosis of schizophrenia. Results from the 2016 National Survey on Drug Use and Health: Detailed tables. Dax, however, is hyper-focused on surgery and seems to dismiss Saras position. Diagnosis is not the same as formulation! In addition, mindfulness strategies can assist in helping Dax to cognitively diffuse from present to future events (Harris, 2019). As mentioned previously, the Five Ps is not meant to replace any other substance use and misuse intervention. Molecular psychiatry, 17(4), 377-388. Current Psychiatry Reports, 15(11), 211. Testing case formulation hypotheses in psychotherapy: Two case examples. (2017). The CBT formulation consists of 5 key stages which is known as the 5 Ps model. The internal and external factors that maintain the current problems. Clinical problem solving: the case of Matthew, part 1. It also provides opportunities for a variety of interventions and strategies targeted to clients and their substance use and misuse or contributing factors. In addition, the collaborative nature of the Five Ps reinforces the concept of an idiographic formulation. Family therapy: Systemic approaches to practice. Weerasekera, P. (1993). 1. Mindfulness-based interventions for the treatment of substance and behavioral addictions: A systematic review. Easden, M. H., & Kazantzis, N. (2018). Substance use and misuse also has a negative impact on intimate partners, such as assuming increased responsibility and navigating unpredictability (Hussaarts et al., 2012). (2017, September 7). https://doi.org/10.1016/j.cbpra.2013.03.004 https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf The more cases you go through (and more of the sample formulations below) the more comfortable you will be with formulating! Current dose of sertraline is subtherapeutic, Ongoing discord in her romantic relationship, Good interpersonal support from her best friend who brought her to hospital, Re-experienced these feelings of abandonment after being fired from work. Substance Abuse and Mental Health Services Administration. Substance use and misuse carries numerous potential repercussions. 0000014949 00000 n 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). Research on the success of family-based interventions has methodological challenges, such as small sample sizes and the difficulty of examining long-term outcomes (Rowe, 2012). 0000008363 00000 n As shown above, there are numerous ways to examine and treat client substance use and misuse. This population often experiences stigma and suboptimal health care results (McNeely et al., 2018; van Boekel et al., 2013). Kleiman, M. A. R., Caulkins, J. P., & Hawken, A. Plate, A. J., & Aldao, A. Here you can choose which regional hub you wish to view, providing you with the most relevant information we have for your specific region. (e.g. Barriers and facilitators affecting the implementation of substance use screenings in primary care clinics: A qualitative study of patients, providers, and staff. What level of care is required (outpatient or inpatient)? Therapy, 38(1), 5981. It has been said that the experiences, incidents and or events in our life has an affect on both how we feel and behave. Routledge. Predisposing looks at a wider understanding of the issues, looking at it in more lengthily way. Use this table as a general guide, but don't memorize it for the sake of memorizing it! 0 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. Long-term, Jane might also benefit from a more in-depth understanding of how her past trauma affects her present self and symptoms. (2013). Further, substance use and misuse is a significant risk factor for suicidality (Poorolajal et al., 2016). Although these statistics are significant, it should be noted that Most people who use abusable drugs, even most people who use them nonmedically, do so in a reasonably controlled fashion and without much harm to themselves or anyone else (Kleiman et al., 2011, p. 2). 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. Journal of Addiction Medicine, 11(1), 39. These can be in the form of personal characteristics such as tenacity, intellect, or insight. The dappled nature of causes of psychiatric illness: Replacing the organicfunctional/hardwaresoftware dichotomy with empirically based pluralism. 3. In the context of this article, the word abusable indicates substances that when taken are pleasurable enough to result in excessive dosing or increased frequency of intake (Linden, 2011). all (2004) it is essential to reduce stress and traumatic events for people recovering from Paranoid Schizophrenia, and start to contribute in social activities. The emphasis here is on features that continue the presenting problem. Family therapy for drug abuse: Review and updates 20032010. Cengage. 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. The patient may have a strong family history of the disease, a sedentary job, environmental exposures, and/or a nutritionally-poor diet. One such framework is the Five Ps (Macneil et al., 2012). Annals of Family Medicine. What must be looked at in every formulation is if the particular formulation seems to be the right one and benefit for the person with the psychosis. 0000200021 00000 n Delivery of mindfulness-based interventions may help to address stressful events that previously triggered substance use (Garland et al., 2014). 1. Psychological Assessment, 9(4), 334348. This likely led to an attachment style that was likely insecure and disorganized. The patient has genetic vulnerabilities for mental illness in her family history, a history of anxious temperament, ongoing substance use, and subtherapeutic medication levels. What is the purpose of formulation? and Clark, D.M., 1989. 0000066425 00000 n This may have reactivated/exacerbated her emotional dysregulation, and resulted in negative coping styles such as her self-harming and suicidal ideation. 0000200735 00000 n 0000119448 00000 n Surgeon General Vivek Murthy reported that more than 20 million Americans have an SUD (U.S. Department of Health and Human Services, 2016). 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. Winters, N. C., Hanson, G., & Stoyanova, V. (2007). Client substance use and misuse at that level may need medical stabilization and detoxification prior to utilization of the Five Ps. People with paranoia tend to avoid these situations which would lead to distress (Clark et al 2005). Ingram, B. L. (2012). In his report on alcohol, drugs, and health, the U.S. Behavioral health treatments and services. 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. 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. Rowe, C. L. (2012). Narrative therapy to therapeutic ends. More ominously, substance use and misuse has been correlated with intimate partner violence (Murphy & Ting, 2010). (2008). The CBHSQ report: Substance use and substance use disorder by industry. The case formulation in child and adolescent psychiatry. What is a psychiatric case formulation? (2017). Keywords: substance use and misuse, Five Ps, idiographic, systematic, flexible. These symptoms have been maintained by [psychological factors/personality factors], and [social/environmental factors]. 2. https://doi.org/10.1007/s11920-013-0414-z 0000243959 00000 n A systematic review of the evidence. Dax is a 33-year-old married father of two children: a 9-year-old son, Cam, and a 7-year-old daughter, Zoe. Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. For example, many precipitating and perpetuating factors may overlap and fit in other boxes. 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. Additionally, the lack of coping mechanisms leading to intense thoughts of suicide. Evidence-based approaches, such as cognitive behavioral therapy, tend to be nomothetic, assuming homogeneity and generally geared toward symptom amelioration (Robinson, 2011). 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. 0000156091 00000 n [1][2] Biopsychosocial formulation combines biological, psychological, and social factors to understand a patient, and uses this to guide both treatment and prognosis. In addition, aspects of narrative therapy may provide an opportunity for Dax to re-author a unique outcome that gives meaning and provides a functional identity to him as a father and husband, thus building a sense of optimism (White & Epston, 1990). 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. Formulation for beginners. 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. He is confident that he does not have a problem and that counseling should be reserved for those who cannot stop drinking. Their effectiveness has been well researched, and this paper does not propose a superior way to address substance use and misuse. Rachman, S. and de Silva, P., 1978. Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. 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. Precipitating factors are those that proximally bring about substance use and misuse and its resulting difficulties. 0000015792 00000 n https://doi.org/10.1097/NCM.0b013e318253f029 The image (. 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). 0000013321 00000 n Cognitive therapy in practice: A case formulation approach. The systematic but flexible nature of this framework affords clinicians numerous ways to address substance use and misuse. University-educated. Health Affairs, 32(12), 22052215. ), Essentials of clinical social work (pp. The 4 Ps formulation table can be a very rigid and systematized way of presenting a formulation. Addictive Behaviors, 32(7), 13311346. The genetics of alcohol and other drug dependence. If your specific country is not listed, please select the UK version of the site, as this is best suited to international visitors. Etoom, Y., & Ratnapalan, S. (2014). 0000013350 00000 n 0000005575 00000 n He fears that she will need open-heart surgery and that she may die. https://doi.org/10.1016/S0005-7967(02)00033-5 Regrettably, most do not receive treatment while incarcerated (Belenko et al., 2013). Her ongoing alcohol use is another example of a maladaptive coping strategy. 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). Implementing the Five Ps: The Case of Dax. Working systemically with families: Formulation, intervention and evaluation. The CBT formulation consists of 5 key stages which is known as the 5 P's model. 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. Thus, there exists a need to concurrently examine and address the potentially complex nature of client substance use and misuse. Unemployment and substance use: A review of the literature (19902010). Drug and Alcohol Dependence, 131(12), 2335. What we understand today is shaped by what we believe and what we have experienced in our life. We've received widespread press coverage since 2003, Your UKEssays purchase is secure and we're rated 4.4/5 on reviews.co.uk. Compton, W. M., Gfroerer, J., Conway, K. P., & Finger, M. S. (2014). Henkel, D. (2011). For example, type II diabetes does not develop because of a single pathophysiological cause. 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). Haynes, S. N., Leisen, M. B., & Blaine, D. D. (1997). This inspires the development of a longitudinal understanding of a persons problems. This is where you'll need to be creative and also think more in-depth about your patient. One of the strengths of this formulation is that it is not fixed. In implementing the Five Ps framework with Dax, the clinician chose to use psychoeducation and strategies borrowed from acceptance and commitment, reality, Bowenian family systems, and solution-focused brief therapies to assist Dax with his substance use and misuse. Based on these factors, the following [treatment and management] would be the most helpful for this patient. British Journal of Clinical Psychology, 37(3), pp.269-284. As mentioned previously, novice counselors often lack sufficient case formulation skills (Liese & Esterline, 2015). It is likely that other clinicians presented with Dax would use a different combination of approaches. Substance Abuse and Mental Health Services Administration. 0000119085 00000 n Motivational interviewing: Building rapport with clients to encourage desirable behavioral and lifestyle changes. 0000011422 00000 n Aggression and Violent Behavior, 15(5), 325333. 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. 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). %PDF-1.4 % However, patient has the following [protective factors], which may be a good prognostic factor. 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. (Rachman & de Silva 1978, Salkovskis & Harrison 1984, sited in Tarrier et al. Disclaimer: This is an example of a student written essay.Click here for sample essays written by our professional writers. 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! 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. https://doi.org/10.3389/fpsyt.2013.00173 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). The clinician can intervene here by simply normalizing and validating his fears about the test results. (2015). 1: A step-by-step way of filling out a Biopsychosocial Table. In psychiatry, formulation appears more complicated because human behaviour and the brain itself is extraordinarily complex. Using case formulation in clinical practice. From simple essay plans, through to full dissertations, you can guarantee we have a service perfectly matched to your needs. https://doi.org/10.1016/j.psc.2010.04.012 Routledge. The ball in the pool metaphor (i.e., holding a beach ball under the water works temporarily, but eventually it pops back up) can be compared to alcohol temporarily holding those painful emotions down, eventually to resurface. Robinson, O. C. (2011). What are the 5 Ps in psychology? low mood) 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). https://www.apa.org/pubs/journals/pas/index https://www.samhsa.gov/data/report/results-2016-national-survey-drug-use-and-health-detailed-tables Goldman, R. and Greenberg, L.S., 1997. 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. Journal of Marital and Family 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. hTILSQ=HC@K(`$*P2C Good interpersonal support from her best friend who brought her to hospital. Protective factors are those that help to moderate actual or potential substance use and misuse impact. The 5 P's of Strategy is a planning process. Drug and Alcohol Dependence, 142(1), 350353. Based on these factors, dialectical behavioural therapy would be the most helpful for this patient. Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy. Evaluation of children with heart murmurs. What can be done, realistically speaking. Here you can choose which regional hub you wish to view, providing you with the most relevant information we have for your specific region. 0000007722 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). Most learners will use this method as it is the most simple. It is usually presented as Predisposing Precipitating Perpetuating Protective factors. https://doi.org/10.1177/0009922813488653 - 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. The counselor may also assist Dax in emotional regulation, which may prevent the initiation of arguments (Aldao & Nolen-Hoeksema, 2013). https://doi.org/10.1080/02699931.2012.739998 trailer In S. G. Hofmann & G. J. G. Asmundson (Eds. Formulation in psychology and psychotherapy: Making sense of peoples problems (2nd ed.). 0000155309 00000 n A concerned best friend called and talked to her this evening, and brought her to the hospital. 0000156014 00000 n No plagiarism, guaranteed! 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. 0000241644 00000 n Harris, R. (2019). Study for free with our range of university lectures! This research could point to populations for whom the Five Ps is more and less effective. Even weekly status meetings or things of that nature should have a clearly defined purpose. Annual surveillance report of drug-related risks and outcomes. It will make your job of formulating much easier. Current Drug Abuse Reviews, 4(1), 427. 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). 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. Dallos, R. and Vetere, A., 2018. New Harbinger. 0000016707 00000 n She has also previously responded well to psychotherapy and appears to be psychologically-minded. endstream endobj 1263 0 obj <>/Filter/FlateDecode/Index[262 927]/Length 50/Size 1189/Type/XRef/W[1 1 1]>>stream Note that this table is extremely comprehensive and long, and not everything will (or should!) According to Dr Oliver James (Hussain 2009) CBT is over praised; what CBT achieves any other therapy can achieve to. Do they have ability to be reflective or modulate their affect? These are historical psychological, biological, developmental, and socio-cultural factors that increased the person's vulnerability to their current problems. Let's do a simplified formulation for the patient (Jane Doe) below. Perpetuating factors are those that sustain and possibly reinforce clients current substance use and misuse challenges. The essay will describe Greg's case study using 5P's model. 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). Book ReviewCollege Counseling and Student Development: Theory, Practice, and Campus Collaboration, Reflections on Power From Feminist Women Counselor Educators, Evaluating the Impact of Solution-Focused Brief Therapy on Hope and Clinical Symptoms With Latine Clients, Guidelines and Recommendations for Writing a Rigorous Quantitative Methods Section in Counseling and Related Fields. ACT made simple (2nd ed.). Journal of Public Health, 38(3), e282e291. & Haddock, G. (1990). We would anticipate when engaging in treatment, the patient may have [resistance/transference/countertransference]. 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. health? It is believed that CBT receives government support and funding because it is cheap and quick, even though the empirical evidence for it is weak (Hussain 2009). Some of these evidence-based approaches will be demonstrated later in a case illustration. The most common and clinically practical way to formulate is through the biopsychosocial approach, first described in 1980 by George Engel. You are probably already formulating, but just don't know it. 0000241121 00000 n However, the patient has protective factors including psychological mindedness and previous response to therapy, which is a good prognostic factor. Given that client substance use and misuse can be quite complicated, using various approaches within the Five Ps framework may yield positive results. 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). Day, A. M., Kahler, C. W., Ahern, D. C., & Clark, U. S. (2015). 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. To help treat the client with psychosis maintaining specific behaviour can be beneficial and help avoid frustration and upsetting experiences (Johnstone 2009). The meaning of anxiety. Bacon, M. All work is written to order. Case conceptualization research in cognitive behavior therapy: A state of the science review. Seminars in the Psychotherapies , pp. 0000017180 00000 n 0000002760 00000 n 0000200485 00000 n https://doi.org/10.1016/j.drugalcdep.2014.06.012 They are examples that the author chose to illustrate the Five Ps in practice. For example, we diagnose someone with a major depressive episode if they meet 5 of the 9 symptomatic criteria. Perpetuating Factors 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 . Cognition and Emotion, 27(4), 753760. Routledge. Stressor that activate one or more psychological processes: Loss of or separation from close family, partner, or friends, Do they have a chronic illness, functional impairment caused by. 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.