There could be a discussion of alcohol use disorder being a disease, not that different from any other passed-on trait or disease. 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). 0000199386 00000 n
Copyright 2003 - 2023 - UKEssays is a trading name of Business Bliss Consultants FZE, a company registered in United Arab Emirates. Receipt of services for behavioral health problems: Results from the 2014 National Survey on Drug Use and Health. (2018, August 31). A logical analysis using gentle Socratic dialogue may help to challenge his emotional reactions to his daughters heart murmur (Etoom & Ratnapalan, 2014). 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. https://www.samhsa.gov/treatment Macneil, C. A., Hasty, M. K., Conus, P., & Berk, M. (2012). The more you formulate, it can be helpful to have a rough template of different formulations for different diagnoses (e.g. 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. Worrell, M. (2015). Journal of Mental Health Counseling, 30(1), 6794. startxref
Case formulation, also referred to as conceptualization, is a skill new counselors often lack (Liese & Esterline, 2015). The essay will describe Greg's case study using 5P's model. https://doi.org/10.1093/pubmed/fdv148 0000200610 00000 n
(2008). Effects of treatment type on alcohol consumption partially mediated by Alcoholics Anonymous attendance. 0000011818 00000 n
New York: WW Norton. 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). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. 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 and Case Formulation (also known as the Biopsychosocial Formulation) in psychiatry is a way of understanding a patient as more than a diagnostic label. [Patient] presents with a [diagnosis]. https://doi.org/10.1016/j.addbeh.2006.09.008 Using a framework to assist in case formulation may prove useful to beginning counselors. 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. Dax reports a strong paternal history of substance use and misuse. The Five Ps is a systematic way to look at clients and their presentation, and its idiographic construction takes clients uniqueness into account. 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). However, an important skill that they should try to perform is to assess a situation before jumping to conclusions. 2008). But the most important thing about formulation is that it should be intuitive and flow logically. low mood) The five Ps allow consultants to evaluate and intervene at . 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!). 1189 76
This may have reactivated/exacerbated her emotional dysregulation, and resulted in negative coping styles such as her self-harming and suicidal ideation. His father started out drinking occasionally and over the years slowly developed a dependency on alcohol. They are. This gives you a sense of their current level of functioning, prognosis, and guides your direction for treatment and management decisions. https://doi.org/10.1016/S0005-7967(02)00033-5 Science, 196(4286), 129-136. Cognitive behavioral therapists use individually tailored formulations as a framework with which to understand their patients' difficulties and to plan effective treatment. 0000156014 00000 n
A concerned best friend called and talked to her this evening, and brought her to the hospital. There are several approaches to managing client substance use and misuse that have demonstrated effectiveness. 0000008644 00000 n
Presenting problems are concerns that clients find difficult to manage. Lack of adaptive coping mechanisms resulted in using self-harm to cope and avoid further emotional dysregulation. Patterns: Study what Worked in the Past and What can be Replicated. Psychological Assessment, 9(4), 334348. There are limitations to the Five Ps framework as a way to formulate and intervene with clients substance use and misuse. One such framework is the Five Ps (Macneil et al., 2012). Substance Abuse and Mental Health Services Administration. Substance use and misuse in the United States is extremely common. 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). PREDISPOSING FACTORS: What led to the problem starting? Dallos, R. and Vetere, A., 2018. Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: A meta-analysis. Henkel, D. (2011). Fundamental Changes in DSM-5 Dimensional Approach The conundrum with categories Participants: The leader of a meeting should carefully consider who he or she invites. 0000155309 00000 n
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. Karriker-Jaffe, K. J., Klinger, J. L., Witbrodt, J., & Kaskutas, L. A. Disclaimer: This is an example of a student written essay.Click here for sample essays written by our professional writers. What it wants to Achieve. More ominously, substance use and misuse has been correlated with intimate partner violence (Murphy & Ting, 2010). In addition, the interventions demonstrated are not to be assumed the only ones that can be applied to Dax. Hussaarts, P., Roozen, H. G., Meyers, R. J., van de Wetering, B. J. M., & McCrady, B. S. (2012). 0000200021 00000 n
This conversation can lead to investigating strategies for how each can be heard, including short role-plays with opportunities to practice (Worrell, 2015). She also drank 10 beers prior to arriving in the hospital. Please refer to an authoritative source if you require up-to-date information on any health or medical issue. 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. Experienced clinicians understandably have a larger catalogue of strategies to choose from. 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. The Oxford Textbook of Psychiatry[7] states that 'formulation is a concise statement of the case. Guilford. Oxford University Press. (2017). Kendler, K. S. (2012). Journal of Marital and Family 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). Example of the 5 P's of Marketing John is considering operating a jet ski shop catering to travelers and tourists. Drug and Alcohol Dependence, 142(1), 350353. We've received widespread press coverage since 2003, Your UKEssays purchase is secure and we're rated 4.4/5 on reviews.co.uk. Most learners will use this method as it is the most simple. It is usually presented as Predisposing Precipitating Perpetuating Protective factors. Even weekly status meetings or things of that nature should have a clearly defined purpose. Australasian Psychiatry, 22(4), 397-401. 0000006923 00000 n
(Johnstone & Dallos 2009). Family therapy and the treatment of substance use disorders: The family matters model. Easden, M. H., & Kazantzis, N. (2018). Here's what the completed table would look like with the psychological factors incorporated. 0000239101 00000 n
(2015). 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. However, each has some shortcomings. (2003) noted, examining positive client experiences may be one way to discover how to increase client participation in substance use and misuse treatment. The need for a new medical model: a challenge for biomedicine. https://doi.org/10.1080/10826084.2017.1349800 *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 The goal here is to build Daxs competence in communicating, both in listening and expressing. 0000002760 00000 n
The simplest format looks at just three key areas: thoughts, feelings (emotions and physical sensations) and behaviours. (2016). According to Read et. xref
Rowe, C. L. (2012). Another potential area of study might involve comparing novice counselors to more experienced counselors. Sample #1: Conceptualization for CBT case This is a 35-year-old Caucasian man referred by his physician for treatment of generalized anxiety. ), Essentials of clinical social work (pp. Hypotheses are generated about the origins and causes of a patient's symptoms. 0000004344 00000 n
Child and Adolescent Psychiatric Clinics, 16(1), 111-132. https://www.centeronaddiction.org/addiction-research/reports/behind-bars-ii-substance-abuse-and-americas-prison-population 0000014949 00000 n
Garland, E. L., Froeliger, B., & Howard, M. O. She has the following protective factors, including a supportive psychiatrist and friend. For some, receiving substance use and misuse services can be stigmatizing. Behind bars II: Substance abuse and Americas prison population. Having a framework for understanding of different psychological treatments and psychological theories can be helpful in making your psychological formulation flow intuitively (e.g. (Persons, 1998). In addition, the vast majority of those with an SUD never receive treatment (Han et al., 2015). apply to your case. 0000119085 00000 n
To help treat the client with psychosis maintaining specific behaviour can be beneficial and help avoid frustration and upsetting experiences (Johnstone 2009). 160185). Cognitive behavioural couple therapy. What are the 5 Ps in psychology? He denies any significant increase in alcohol use or any other substance use. therapy for psychosis. The Five P's approach provides a structured way of constructing this formulation. 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. 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! 0000119267 00000 n
hTILSQ=HC@K(`$*P2C It is important to remember that not everything will fit neatly into each box. He fears that she will need open-heart surgery and that she may die. The Essay Writing ExpertsUK Essay Experts. 0000186981 00000 n
Predisposing factors include biological, environmental, or personality considerations that may put clients at risk of further substance use and misuse. 0000180256 00000 n
University-educated. In Formulation in psychology and psychotherapy (pp. May, R. (1950). The Five Ps permits counselors to both assess and intervene essentially simultaneously. https://doi.org/10.3109/10826084.2013.770027 Barriers and facilitators affecting the implementation of substance use screenings in primary care clinics: A qualitative study of patients, providers, and staff. It would be difficult to say which formulation is correct, and if there is such a thing as a correct one, since everyone has an individual view of what is right or wrong. As part of his adjudication, Dax was required to attend five counseling sessions and have a clinicians report provided to the court. Bush, D. M., & Lipari, R. N. (2015, April 16). 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). of this manuscript. Here are some examples: A good formulation should be integrative, and let you understand how all of the patient's factors interact to lead to the current situation. 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). All work is written to order. 5 Ps narrative table, from Comprehensive Care Resource Guide 58 - 65. The persons resilience and strengths that help maintain emotional health. ), Cover every box in the 4 Ps just for the sake of doing it (not all boxes will always apply!). 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. The clinician can provide a variety of potential spousal responses, allowing for more adaptability and flexibility in Daxs responses. Equally if there is lack of collaboration, this can be as a result of expectations from either client or the therapist for example if the client have expectations from the therapist because he sees him as the expert and should be able to provide all the answers to his problems without him the client having an input. Evaluation of children with heart murmurs. 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! Frontiers in Psychiatry, 4(173), 115. The approach that is highlighted in the 5Ps includes presenting, predisposing, precipitating, perpetuating, and protective factors. The systematic but flexible nature of this framework affords clinicians numerous ways to address substance use and misuse. Etoom, Y., & Ratnapalan, S. (2014). As I stated above this factor looks to get a wider understanding of what the issues is. Studies utilizing the Five Ps with mandated clients may demonstrate its efficacy, notably with agencies that require substance-related counseling. Another potential limitation is that the Five Ps may not be particularly beneficial for substance use and misuse in which there is clinical evidence of an SUD that includes significant withdrawal symptoms. 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 Therapy, 38(1), 122144. Rachman, S. and de Silva, P., 1978. 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). They disagree, interrupt one another, yell, and he calms down by having several beers. Such a framework may enhance the effectiveness of the aforementioned interventions (Wormer & Davis, 2018). Current Drug Abuse Reviews, 8(1), 2640.
(2011). 0000119626 00000 n
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). Morin, J.-F. G., Harris, M., & Conrod, P. J. We would anticipate when engaging in treatment, the patient may have [resistance/transference/countertransference]. 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). Journal of Clinical Psychology, 74(3), 356384. Mindfulness-based interventions for the treatment of substance and behavioral addictions: A systematic review. BMC Medicine, 10(111), 13. 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. This inspires the development of a longitudinal understanding of a persons problems. Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. https://doi.org/10.1002/jclp.22516 Conflict of Interest and Funding Disclosure Concept mapping: A supervision strategy for introducing case conceptualization skills to novice therapists. Haynes, S. N., Leisen, M. B., & Blaine, D. D. (1997). Predisposing Factors 0000012481 00000 n
You've got your table all filled out now. 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. Surgeon General Vivek Murthy reported that more than 20 million Americans have an SUD (U.S. Department of Health and Human Services, 2016). She has also previously responded well to psychotherapy and appears to be psychologically-minded. However, patient has the following [protective factors], which may be a good prognostic factor. Predisposing looks at a wider understanding of the issues, looking at it in more lengthily way. The Five Ps is a type of framework utilizing five factors developed by Macneil et al. 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. (2017). What are perpetuating factors? In addition, mindfulness strategies can assist in helping Dax to cognitively diffuse from present to future events (Harris, 2019). 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). 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. 0000009229 00000 n
*You can also browse our support articles here >. In this article, we'll explore the 5 Ps in more detail and the tools that you can use in each area. Precipitating factors are those that proximally bring about substance use and misuse and its resulting difficulties. The CBT formulation consists of 5 key stages which is known as the 5 P's model. https://doi.org/10.1007/s11920-013-0414-z 0000066425 00000 n
https://doi.org/10.1080/02699931.2012.739998 https://doi.org/10.1093/oxfordhb/9780199935291.013.57 If present categories are used, formulation can be limiting and dangerous. It is another way to address the multifaceted and complicated nature of client substance use and misuse. OFarrell, T. J., & Clements, K. (2012). What are the 5 Ps of case formulation? J Am Acad Child Adolesc Psychiatry 2002;41(1):927. 0
Winters, N. C., Hanson, G., & Stoyanova, V. (2007). Borrell-Carri F, Suchman AL, Epstein RM. The internal and external factors that maintain the current problems. Macneil and his colleagues (2012) posited that diagnosing was insufficient and it was critical to include other factors such as causal, lifestyle, and personal factors in conceptualizing the case and formulating a plan. Kuyken, W., Padesky, C. A., & Dudley, R. (2009). (2014). The clinician may also discuss strategies to help Dax regulate his reactions using emotion-focused interventions such as positive reframing to ameliorate the stress of his daughters cardiac condition (Plate & Aldao, 2017). 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. +O1\lp#\ American Psychiatric Association. (2012). 0000238570 00000 n
(2020, April 21). 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. 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. This has further exacerbated her alcohol use disorder. 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. Cognitive behaviour therapy for psychiatric problems: A practical guide. Clinical case formulations: Matching the integrative treatment plan to the client (2nd ed.). In fact, this stigmatization can come from those who are treating them (Luoma et al., 2007). Like most things in medicine, there are multifactorial causes of diseases, illnesses, and disorders. https://doi.org/10.2174/1874473711104010004 Concurrently treating both is very complex, challenging, and expensive. 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). Cognitive behavioral therapy for substance use disorders. 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 . Study for free with our range of university lectures! %PDF-1.4
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Clinical problem solving: the case of Matthew, part 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638323/pdf/nihms734766.pdf What is a psychiatric case formulation? He is also adamant that he does not have a problem with alcohol. Remember there is no right or wrong way to present your formulation. Moreover, the Five Ps align with SAMHSAs recommendation that clinicians tailor treatment to each client because no single treatment is particularly superior (SAMHSA, 2020). Twelve-step attendance is most beneficial with inpatient substance use and misuse treatment (Karriker-Jaffe et al., 2018). (2013). The patient appears to have adopted self-harming as a primitive coping strategy by early adulthood, and these have continued on in adulthood. " [Formulation is] The lynch pin that holds theory and practice together" (Butler, 1998). Routledge. One versus many: Capturing the use of multiple emotion regulation strategies in response to an emotion-eliciting stimulus. 0000155905 00000 n
- attachment theory, cognitive behavioural therapy, dialectical behavioural therapy, interpersonal therapy, psychodynamic therapy). 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. This research could point to populations for whom the Five Ps is more and less effective. Given the variations of substances, the level of use, the functional impairment, co-occurrence with other mental disorders, and inherent client differences, an idiographically based framework seems particularly appropriate with this population.
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