Precipitating factors are those that proximally bring about substance use and misuse and its resulting difficulties. 0000238491 00000 n
The choice of the above approaches is only meant as an illustration and not as definitive ways to address this particular client. Using case formulation in clinical practice. Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. https://doi.org/10.1016/j.cbpra.2013.03.004 Jane Doe presents with a diagnosis of borderline personality disorder and history of depression. " [Formulation is] The lynch pin that holds theory and practice together" (Butler, 1998). https://doi.org/10.1007/s11920-013-0414-z First and foremost, it should be emphasized that this particular framework has not been empirically tested with client substance use and misuse. A course of action you intend to take or a series of guidelines you intend to follow. Looking for a flexible role? 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). 0000006779 00000 n
One of the strengths of this formulation is that it is not fixed. https://www.samhsa.gov/treatment Effects of treatment type on alcohol consumption partially mediated by Alcoholics Anonymous attendance. There are limitations to the Five Ps framework as a way to formulate and intervene with clients substance use and misuse. Conflict of Interest and Funding Disclosure 0000187506 00000 n
Oxford University Press. As mentioned previously, novice counselors often lack sufficient case formulation skills (Liese & Esterline, 2015). However, patient has the following [protective factors], which may be a good prognostic factor. The clinician can intervene here by simply normalizing and validating his fears about the test results. Substance use and misuse in the United States is extremely common. This is where you'll need to be creative and also think more in-depth about your patient. 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. Client substance use and misuse is a significant problem in the United States, and it continues to cause difficulty for individuals, families, and society. low mood) 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. Compton, W. M., Gfroerer, J., Conway, K. P., & Finger, M. S. (2014). The officers evaluated him, detained him, and subsequently arrested him for driving while intoxicated. The compass of pleasure: How our brains make fatty foods, orgasm, exercise, marijuana, generosity, vodka, learning, and gambling feel so good. https://doi.org/10.3389/fpsyt.2013.00173 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. Concept mapping: A supervision strategy for introducing case conceptualization skills to novice therapists. It is important to remember that not everything will fit neatly into each box. Mindfulness-based strategies are not as effective when used alone as when used with other approaches (Sancho et al., 2018). Participants: The leader of a meeting should carefully consider who he or she invites. Dax is a 33-year-old married father of two children: a 9-year-old son, Cam, and a 7-year-old daughter, Zoe. Penguin. Previous studies using frameworks to formulate have often used cognitive behavioral therapy as the primary intervention (Chadwick et al., 2003; Persons et al., 2013). Dax was quite upset, cursed at her, and then hung up the phone. White, M., & Epston, D. (1990). The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. Drayton, M., Birchwood, M. and Trower, P., 1998. 0000004656 00000 n
Annals of Family Medicine. SAMHSAs recommendations fit well with a more holistic framework in that such a structure allows clinicians to develop a multidimensional picture of clients. Centers for Disease Control and Prevention. 0000004501 00000 n
BMC Medicine, 10(111), 13. Therapy, 38(1), 5981. Precipitating and perpetuating factors: the stressor of losing her job has reactivated these more primitive defense mechanisms and coping strategies. Journal of Substance Abuse Treatment, 26(3), 151158. Diagnostic and statistical manual of mental disorders (5th ed.). Child and Adolescent Psychiatric Clinics, 16(1), 111-132. Clinical problem solving: the case of Matthew, part 1. Client substance use and misuse can be quite challenging for counselors, both novice and experienced. They may also present in the form of family, friends, or hobbies. Family therapy: Systemic approaches to practice. 0000003215 00000 n
Using a framework to assist in case formulation may prove useful to beginning counselors. Even weekly status meetings or things of that nature should have a clearly defined purpose. ), The science of cognitive behavioral therapy (pp. The American Journal on Addictions, 21(1), 3846. 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. Cognitive therapy in practice: A case formulation approach. %%EOF
They are examples that the author chose to illustrate the Five Ps in practice. Liese, B. S., & Esterline, K. M. (2015). The image (. Routledge.
Good interpersonal support from her best friend who brought her to hospital. https://www.ncbi.nlm.nih.gov/books/NBK343542 Born in Canada. Most learners will use this method as it is the most simple. It is usually presented as Predisposing Precipitating Perpetuating Protective factors. In addition, the interventions demonstrated are not to be assumed the only ones that can be applied to Dax. In his report on alcohol, drugs, and health, the U.S. An example formulation is available (see A case example: "Sandra")* as an example of the type of output you For example, many precipitating and perpetuating factors may overlap and fit in other boxes. Here you can choose which regional hub you wish to view, providing you with the most relevant information we have for your specific region. trailer
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Participants should be people who can . It can be changed and reviewed as the treatment is in progress if any new information come to light. This has led to her adulthood self-perception of being unworthy of being loved, a constant fear of rejection, and increased rejection sensitivity. Oxford Handbooks Online, 149. Dax presents as extremely frustrated and embarrassed at being mandated to attend counseling sessions. As I stated above this factor looks to get a wider understanding of what the issues is. Henkel, D. (2011). 0000200305 00000 n
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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). Molecular psychiatry, 17(4), 377-388. No plagiarism, guaranteed! https://doi.org/10.17744/mehc.30.1.j40256207h0581t1 Hypotheses are generated about the origins and causes of a patient's symptoms. Addiction Science and Clinical Practice, 13(8), 115. Copyright 2003 - 2023 - UKEssays is a trading name of Business Bliss Consultants FZE, a company registered in United Arab Emirates. What are perpetuating factors? 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. This conversation can lead to investigating strategies for how each can be heard, including short role-plays with opportunities to practice (Worrell, 2015). Jane Doe is a 30-year-old female who presents with acute suicidal ideation in the context of a job loss. (2008). 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). Remember there is no right or wrong way to present your formulation. History & Philosophy of Psychology, 13(2), 3239. Fundamental Changes in DSM-5 Dimensional Approach The conundrum with categories might you consider? Persons, J. Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy. https://doi.org/10.1111/j.1752-0606.2011.00280.x Goldman, R. and Greenberg, L.S., 1997. Following formulation, there should be an identification of the prioritised areas of focus for care - to inform the Care Plan. 0000118792 00000 n
Family therapy and the treatment of substance use disorders: The family matters model. Regrettably, most do not receive treatment while incarcerated (Belenko et al., 2013). However, each has some shortcomings. It also appears they may have had difficulty with [drives], stemming from [psychoanalytic concept], These experiences impacted the patient's view of themselves as being [view of self], and this has continued into adulthood based on [experiences]., The patient appears to have adopted [defense mechanisms] as coping strategies by early adulthood, and these have continued on, The patient's interpersonal relationships appear to be [give examples of patterns of relationships], These underlying factors may have precipitated the patient's [current presentation]. Psychological Assessment, 9(4), 334348. As part of his adjudication, Dax was required to attend five counseling sessions and have a clinicians report provided to the court. Johnstone, L., & Dallos, R. Impact of case formulation in cognitive behaviour van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013). 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. It may include past difficulties and experiences if these are relevant to the present. Day, A. M., Kahler, C. W., Ahern, D. C., & Clark, U. S. (2015). 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). 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. By examining and exploring clients use or misuse within the context of a multidimensional framework, interventions can be personalized, and areas of concern can be targeted. Presenting problems are concerns that clients find difficult to manage. ), Cover every box in the 4 Ps just for the sake of doing it (not all boxes will always apply!). University-educated. 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. 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! therapy for psychosis. The goal here is to build Daxs competence in communicating, both in listening and expressing. ,"Sb.&;.+Y&&_{} G|ku!dKMwU*jMdDN The Five Ps is a systematic way to look at clients and their presentation, and its idiographic construction takes clients uniqueness into account. 1264 0 obj
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Having a framework for understanding of different psychological treatments and psychological theories can be helpful in making your psychological formulation flow intuitively (e.g. 1. 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. 0000180034 00000 n
Academic Press. Haynes, S. N., Leisen, M. B., & Blaine, D. D. (1997). Behaviour research and therapy, 16(4), pp.233-248. 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). 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. The genetics of alcohol and other drug dependence. 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). Five additional elements are often added to this (referred to as 'the five Ps'): presenting problem (s) predisposing factors precipitating factors perpetuating factors protective factors. It is open to modification any time during the treatment period and any new evidence that crop up at any time will be discussed with the client. This can be both positive or negative but they have a direct correlation to how the person is today. 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. & Haddock, G. (1990). 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). He then stopped at a local pub and had several drinks. The internal and external factors that maintain the current problems. Example of the 5 P's of Marketing John is considering operating a jet ski shop catering to travelers and tourists. Presenting Problem Dallos, R. and Vetere, A., 2018. Kuyken, W., Padesky, C. A., & Dudley, R. (2009). ), Essentials of clinical social work (pp. More ominously, substance use and misuse has been correlated with intimate partner violence (Murphy & Ting, 2010). While being mandated to attend counseling, Dax shares concerns that he is afraid of what his daughters test results will show. of this manuscript. (Eds.). startxref
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. The Diagnostic and Statistical Manual of Mental Disorders (5th ed. 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. Concurrently treating both is very complex, challenging, and expensive. 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/10.1093/oxfordhb/9780199935291.013.57 Formulation in psychology and psychotherapy: Making sense of peoples problems (2nd ed.). 0000008644 00000 n
Oxford University Press. 58 - 65. Psychotherapy, 52(2), 190194. What it wants to Achieve. This gives you a sense of their current level of functioning, prognosis, and guides your direction for treatment and management decisions. The effects of treatment for substance use problems on intimate partner violence: A review of empirical data. Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. Bush, D. M., & Lipari, R. N. (2015, April 16). 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. Counselling with reality therapy (2nd ed.). https://doi.org/10.1002/jclp.22516 Based on these factors, dialectical behavioural therapy would be the most helpful for this patient. He denies any significant increase in alcohol use or any other substance use. Chadwick, P., Williams, C., & Mackenzie, J. 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. These are historical psychological, biological, developmental, and socio-cultural factors that increased the person's vulnerability to their current problems. Scott W. Peters, PhD, LPC-S, is an associate professor at Texas A&M University San Antonio. It should be noted that the strategies and interventions applied here are used as illustrations and are specific to Dax and his concerns. Another potential area of study might involve comparing novice counselors to more experienced counselors. This may have reactivated/exacerbated her emotional dysregulation, and resulted in negative coping styles such as her self-harming and suicidal ideation. Perpetuating factors are those that sustain and possibly reinforce clients current substance use and misuse challenges. In J. R. Brandell (Ed. (e.g. Acknowledging that his reticence is due to being obligated to attend counseling may assist in relationship building (Tahan & Sminkey, 2012). Planning is an essential part of the strategy formulation process, so take time to Brainstorm new opportunities. The 4 Ps formulation table can be a very rigid and systematized way of presenting a formulation. Given that client substance use and misuse can be quite complicated, using various approaches within the Five Ps framework may yield positive results. One versus many: Capturing the use of multiple emotion regulation strategies in response to an emotion-eliciting stimulus. The Five Ps is a type of framework utilizing five factors developed by Macneil et al. In spite of these limitations, there may be several potential areas of inquiry. 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). Such a framework may enhance the effectiveness of the aforementioned interventions (Wormer & Davis, 2018). The counselor may also assist Dax in emotional regulation, which may prevent the initiation of arguments (Aldao & Nolen-Hoeksema, 2013). Additionally, many individuals who engage in substance use and misuse have co-occurring major medical conditions, such as cancers, cardiovascular accidents (strokes), and respiratory and cardiac illnesses (Bahorik et al., 2017). 0000004306 00000 n
all (2004) it is essential to reduce stress and traumatic events for people recovering from Paranoid Schizophrenia, and start to contribute in social activities. 0000199386 00000 n
Their effectiveness has been well researched, and this paper does not propose a superior way to address substance use and misuse. (2017). 0000180123 00000 n
However, an important skill that they should try to perform is to assess a situation before jumping to conclusions. Plate, A. J., & Aldao, A. The CBT formulation consists of 5 key stages which is known as the 5 Ps model. (Goldman & Greenberg 1997). This is in keeping with the inherent uniqueness of clients, their concerns, and a variety of factors. Wubbolding, R. E., & Brickell, J. 0
Unlike summary, it is a discussion about alternative ideas about diagnosis, aetiology, treatment and prognosis and of the arguments for and against each alternative. W. W. Norton. 0000241723 00000 n
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Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Selzer, R., & Ellen, S. (2014). It can assist both novice and experienced clinicians working with clients who present for counseling with substance use and misuse. - 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. 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! Mindfulness-based interventions for the treatment of substance and behavioral addictions: A systematic review. Disclaimer: This is an example of a student written essay.Click here for sample essays written by our professional writers. Is diagnosis enough to guide interventions in mental In the Five Ps context, protective factors are used to potentially prevent substance use and misuse from having more negative impact as well as to increase client resilience. Formulation for beginners. They are. ACT made simple (2nd ed.). Results from the 2016 National Survey on Drug Use and Health: Detailed tables. The Canadian Journal of Psychiatry, 38(5), 351-358. He fears that she will need open-heart surgery and that she may die. 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. The meaning of anxiety. 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). 1: A step-by-step way of filling out a Biopsychosocial Table. Journal of Addiction Medicine, 11(1), 39. A good biopsychosocial formulation allows you to come up with a comprehensive and holistic treatment plan for your patient. W. W. Norton. It also allows clinicians to target specific areas of concern (Macneil et al., 2012) and may be used in a variety of clinical settings. 0000241644 00000 n
This framework is idiographic in nature, as it looks at clients individually and holistically (Marquis & Holden, 2008). Here you can choose which regional hub you wish to view, providing you with the most relevant information we have for your specific region. The simplest format looks at just three key areas: thoughts, feelings (emotions and physical sensations) and behaviours. The idiographic/nomothetic dichotomy: Tracing historical origins of contemporary confusions. Poorolajal, J., Haghtalab, T., Farhadi, M., & Darvishi, N. (2016). Information. The dappled nature of causes of psychiatric illness: Replacing the organicfunctional/hardwaresoftware dichotomy with empirically based pluralism. 0000006105 00000 n
Protective factors are those that help to moderate actual or potential substance use and misuse impact. 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. [Patient] presents with a [diagnosis]. 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). These factors all combine to cause the person to develop diabetes. 0000000016 00000 n
Dax shares that he and his wife are conflicted about how to proceed with their daughters medical care. Belenko, S., Hiller, M., & Hamilton, L. (2013). (2008). 0000015792 00000 n
For example, we diagnose someone with a major depressive episode if they meet 5 of the 9 symptomatic criteria. Dax drinks two to three times a week, usually having one or two shots of whiskey and two to three draft beers. What level of care is required (outpatient or inpatient)? (2018). 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). Published data on those incarcerated appears to be several years old. https://doi.org/10.1097/NCM.0b013e318253f029 Do you have a 2:1 degree or higher? Macneil, C. A., Hasty, M. K., Conus, P., & Berk, M. (2012). We would anticipate when engaging in treatment, the patient may have difficulties with using primitive defense mechanisms. - attachment theory, cognitive behavioural therapy, dialectical behavioural therapy, interpersonal therapy, psychodynamic therapy). She also drank 10 beers prior to arriving in the hospital. The goals here are to both break the pattern and to facilitate healthy conversations. Journal of Mental Health Counseling, 30(1), 6794. Schoen, C., Osborn, R., Squires, D., & Doty, M. M. (2013). (2010, February). Behaviour and Research Therapy, 41(6), 671680. 0000200021 00000 n
Study for free with our range of university lectures! Unemployment and substance use: A review of the literature (19902010). This likely led to an attachment style that was likely insecure and disorganized. This inspires the development of a longitudinal understanding of a persons problems. It looks at situations both past and present which can be both experiences and distresses that lead to symptoms of a psychotic nature can lead to resolving the psychosis. (2015). People with paranoia tend to avoid these situations which would lead to distress (Clark et al 2005). 0000200735 00000 n
Morin, J.-F. G., Harris, M., & Conrod, P. J. hA 4-`76>m{dKs. 0000238450 00000 n
160185). However, like with anything, the more you practice, the better you will become at formulating. Routledge.21-37). Walsh, F. (2014). Presenting Issue(s) - please use the DSM-What assessment tools. Ingram, B. L. (2012). Science, 196(4286), 129-136. In addition, mindfulness strategies can assist in helping Dax to cognitively diffuse from present to future events (Harris, 2019). 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! Surgeon General Vivek Murthy reported that more than 20 million Americans have an SUD (U.S. Department of Health and Human Services, 2016). 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.