1189 0 obj <> endobj Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. New Harbinger. Jane could benefit from accessing support from her company's HR department to understand what options she has after her job termination, Substance use groups such as Alcoholic's Anonymous, Increasing connections to her friends and social supports, Biopsychosocial Model and Case Formulation, The Parable of Panic: Suffocation, Social Attachment, and the Critical Role of an Integrative, Biopsychosocial Formulation, family act and what is the family structure, Childhood exposure to maternal depression, domestic violence, late adoption, temperament mismatch, or marital conflicts, Family history of mental disorders and substance use, Early parental divorce, unstable home life, history of trauma. The goal here is to build Daxs competence in communicating, both in listening and expressing. To help treat the client with psychosis maintaining specific behaviour can be beneficial and help avoid frustration and upsetting experiences (Johnstone 2009). ACT made simple (2nd ed.). 0000013350 00000 n The case formulation in child and adolescent psychiatry. Luoma, J. Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: A meta-analysis. A systematic review of the evidence. Introduction to formulation. https://doi.org/10.1177/0009922813488653 One or more perpetuating psychological processes: Chronic marital/relationship discord, lack of empathy from family/friends, developmentally inappropriate expectations. https://www.samhsa.gov/data/report/results-2016-national-survey-drug-use-and-health-detailed-tables You've got your table all filled out now. startxref However, they may find this framework valuable as it provides one more way to address the often-encountered complex challenges of substance use and misuse. Having a framework for understanding of different psychological treatments and psychological theories can be helpful in making your psychological formulation flow intuitively (e.g. (Johnstone & Dallos 2009). Precipitating and perpetuating factors: the stressor of losing her job has reactivated these more primitive defense mechanisms and coping strategies. 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. 0000013321 00000 n 0000008363 00000 n This has led to her adulthood self-perception of being unworthy of being loved, a constant fear of rejection, and increased rejection sensitivity. )jB' */NNM;2=Kc.w}9XXtj+%]{IF UA_ This can result in lack of access to treatment services, contributing to increased stress. 0000017109 00000 n ; DSM-5) bases an SUD on a pathological pattern related to the use of a substance (American Psychiatric Association, 2013, p. 483). 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. She notably has a past history of childhood trauma and abuse. McNeely, J., Kumar, P. C., Rieckmann, T., Sedlander, E., Farkas, S., Chollak, C., Kannry, J. L., Vega, A., Waite, E. A., Peccoralo, L. A., Rosenthal, R. N., McCarty, D., & Rotrosen, J. Journal of Addiction Medicine, 11(1), 39. 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). 0000002964 00000 n Additionally, Dax often struggles with strong and painful emotions, and alcohol helps to address them. Looking for a flexible role? of this manuscript. Concept mapping: A supervision strategy for introducing case conceptualization skills to novice therapists. 1. Wubbolding, R. E., & Brickell, J. He is confident that he does not have a problem and that counseling should be reserved for those who cannot stop drinking. Counselling with reality therapy (2nd ed.). 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. Haynes, S. N., Leisen, M. B., & Blaine, D. D. (1997). Clinical problem solving: the case of Matthew, part 1. 0000238570 00000 n It is likely that other clinicians presented with Dax would use a different combination of approaches. Precipitating factors are those that proximally bring about substance use and misuse and its resulting difficulties. Effects of treatment type on alcohol consumption partially mediated by Alcoholics Anonymous attendance. One of the weakness of this formulation is identifying that the clients strength is not included the initial assessment and data collection. Here the clinician may incorporate a solution-focused strategy exploring a time with Dax when he and his wife have disagreed, but he did not interrupt and the outcome was positive (de Shazer, 1985). Drayton, M., Birchwood, M. and Trower, P., 1998. Implementing the Five Ps: The Case of Dax. 0000004805 00000 n The officers evaluated him, detained him, and subsequently arrested him for driving while intoxicated. Motivational interviewing: Building rapport with clients to encourage desirable behavioral and lifestyle changes. Currently, there are a variety of empirically based interventions for treating clients who engage in substance use and misuse. 0000238491 00000 n 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. (2016). The therapist provides a route easiest for the client by identifying methods that build on the clients current resilience and strengths. Case formulation in process-experiential therapy. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. 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. 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. Substance Abuse and Mental Health Services Administration. hA 4-`76>m{dKs. (2013). Information. Moreover, the Five Ps align with SAMHSAs recommendation that clinicians tailor treatment to each client because no single treatment is particularly superior (SAMHSA, 2020). 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). Furthermore, the patient's difficulties can be understood as arising from the following developmental processes: which has led to the following thinking patterns: and the [precipitating event] is connected to their underlying struggles in the following way: They have the following: [protective factors], Jane Doe presents with a diagnosis of borderline personality disorder and history of depression. 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. The Oxford Textbook of Psychiatry[7] states that 'formulation is a concise statement of the case. 0 Based on these factors, the following [treatment and management] would be the most helpful for this patient. The Five Ps is a systematic way to look at clients and their presentation, and its idiographic construction takes clients uniqueness into account. Harris, R. (2019). 107127). Dax reports a strong paternal history of substance use and misuse. It acknowledges your strengths and resources. She describes an invalidating childhood, where parents did not acknowledge or praise her. Rachman, S. and de Silva, P., 1978. 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! 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). The five Ps allow consultants to evaluate and intervene at . An example formulation is available (see A case example: "Sandra")* as an example of the type of output you 0000006923 00000 n 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). These factors all combine to cause the person to develop diabetes. 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. Now what? Participants should be people who can . 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). 0000004344 00000 n 0000239101 00000 n 0000014220 00000 n Hypotheses are generated about the origins and causes of a patient's symptoms. Client substance use and misuse is a significant problem in the United States, and it continues to cause difficulty for individuals, families, and society. 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. 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. This research could point to populations for whom the Five Ps is more and less effective. 0000187506 00000 n She also drank 10 beers prior to arriving in the hospital. Thus, there exists a need to concurrently examine and address the potentially complex nature of client substance use and misuse. First and foremost, it should be emphasized that this particular framework has not been empirically tested with client substance use and misuse. Is diagnosis enough to guide interventions in mental The most common and clinically practical way to formulate is through the biopsychosocial approach, first described in 1980 by George Engel.