Is diagnosis enough to guide interventions in mental Drugs and drug policy: What everyone needs to know. This is to ensure that the client understand any reason for change from what was originally agreed. An investigation of stigma in individuals receiving treatment for substance abuse. Cognitive therapy in practice: A case formulation approach. Unemployment and substance use: A review of the literature (19902010). https://www.samhsa.gov/data/report/results-2016-national-survey-drug-use-and-health-detailed-tables 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. https://doi.org/10.1097/NCM.0b013e318253f029 Registered office: Creative Tower, Fujairah, PO Box 4422, UAE. It is important to remember that not everything will fit neatly into each box. There are several approaches to managing client substance use and misuse that have demonstrated effectiveness. I can state that formulations of everyone must be taken with care, since they are hypothesis and not statements of facts as pointed out by Butler (G Butler 2009). Substance use and misuse has been correlated with both higher rates of absenteeism and workplace injuries (Bush & Lipari 2015). Cognitive Behavior Therapy (CBT) case conceptions have follows a 5p's model. Journal of Substance Abuse Treatment, 26(3), 151158. Liao, J.-Y., Huang, C.-M., Lee, C. T.-C., Hsu, H.-P., Chang, C.-C., Chuang, C.-J., & Guo, J.-L. (2018). Studies utilizing the Five Ps with mandated clients may demonstrate its efficacy, notably with agencies that require substance-related counseling. 0000241723 00000 n Plan: The Company must define and Plan its Goals and Milestones. 0000000016 00000 n Compton, W. M., Gfroerer, J., Conway, K. P., & Finger, M. S. (2014). He is also adamant that he does not have a problem with alcohol. Kleiman, M. A. R., Caulkins, J. P., & Hawken, A. https://doi.org/10.1016/j.cbpra.2013.03.004 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]. Plate, A. J., & Aldao, A. Previous studies using frameworks to formulate have often used cognitive behavioral therapy as the primary intervention (Chadwick et al., 2003; Persons et al., 2013). The goal here is to build Daxs competence in communicating, both in listening and expressing. Substance Abuse and Mental Health Services Administration. " [Formulation is] The lynch pin that holds theory and practice together" (Butler, 1998). Dax was quite upset, cursed at her, and then hung up the phone. startxref Therapy, 38(1), 5981. While being mandated to attend counseling, Dax shares concerns that he is afraid of what his daughters test results will show. Executive functioning in alcohol use studies: A brief review of findings and challenges in assessment. (2013). Dax, however, is hyper-focused on surgery and seems to dismiss Saras position. According to Read et. Published data on those incarcerated appears to be several years old. Behind bars II: Substance abuse and Americas prison population. 0000155834 00000 n 1189 0 obj <> endobj Do you have a 2:1 degree or higher? 0000200185 00000 n What are perpetuating factors? If your specific country is not listed, please select the UK version of the site, as this is best suited to international visitors. 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. 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. Protective factors are those that help to moderate actual or potential substance use and misuse impact. One of the strengths of this formulation is that it is not fixed. Substance use and misuse also has a negative impact on intimate partners, such as assuming increased responsibility and navigating unpredictability (Hussaarts et al., 2012). Perpetuating Factors More ominously, substance use and misuse has been correlated with intimate partner violence (Murphy & Ting, 2010). As shown above, there are numerous ways to examine and treat client substance use and misuse. Case Study 5P Model Example The Presenting Problem Predisposing factors 5P Model Question to Mac Environmental influences 5P Model: Precipitating factors History of Co-morbidity 5P Model: Perpetuating factors Risk assessment 5P Model: Protective factors Client's support network 5P Model: Appropriate intervention goals for the client, Treatment plan Testing case formulation hypotheses in psychotherapy: Two case examples. Like most things in medicine, there are multifactorial causes of diseases, illnesses, and disorders. Case Formulation with the Biopsychosocial Model The biopsychosocial model ensures that your case formulation will be holistic, and will capture biological, psychological and social factors. 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. Current Drug Abuse Reviews, 8(1), 2640. Ploy: The Strategy has to analyze What Tactics can be Implemented. Liese, B. S., & Esterline, K. M. (2015). 0000008644 00000 n Centers for Disease Control and Prevention. de Shazer, S. (1985). 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. 0000004805 00000 n Chiesa, A., & Serretti, A. 0000199672 00000 n 0000017180 00000 n https://www.ncbi.nlm.nih.gov/books/NBK343542 Narrative therapy to therapeutic ends. 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! Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. Health Affairs, 32(12), 22052215. One or more perpetuating psychological processes: Chronic marital/relationship discord, lack of empathy from family/friends, developmentally inappropriate expectations. 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. 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). Annual surveillance report of drug-related risks and outcomes. Clinical Pediatrics, 53(2), 111117. 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). (2017). The persons resilience and strengths that help maintain emotional health. Substance Abuse and Mental Health Services Administration. Addiction Science and Clinical Practice, 13(8), 115. 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! 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). The 5 P's of Strategy is a planning process. Good interpersonal support from her best friend who brought her to hospital. Predisposing looks at a wider understanding of the issues, looking at it in more lengthily way. Sara is unequivocal in her confidence in Zoes cardiologist and his competence. She also appears to use alcohol as a way of managing distressing emotions, but does not have any psychological coping strategies. Dax can then share his and his wifes perspectives on their daughters care. For example, the clinician may ask Dax if they can share how genes are passed on and expressed, like genes for eye color or hypertension. (2003). Journal of Public Health, 38(3), e282e291. 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. Current stressors, plus salient developmental history, The patient presents at this time with [problem and symptoms], in the context of [situation and stressors], Genetics, temperament, medical history, substances, medications, The patient has the following [genetic vulnerabilities, medical history], The patient grew up in a family characterized by [factors], with a caregiver who was [distant/available/invalidating], Capacity for interaction, communication, empathy, and attachment, The patient may have had difficulty in [stage of development], and this is reflected in [examples from adult relationships], It appears that the patient may have struggled with conflicts in early life. Evidence-based approaches, such as cognitive behavioral therapy, tend to be nomothetic, assuming homogeneity and generally geared toward symptom amelioration (Robinson, 2011). Psychotherapy, 52(2), 190194. (Ed.). Harris, R. (2019). 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). As you do more formulation, you will notice that patients tend to present in templates, that is, certain diagnoses tend to follow a certain common theme of predisposing, precipitating, and perpetuating factors. Tahan, H. A., & Sminkey, P. V. (2012). 0000013350 00000 n Journal of Marital and Family Therapy, 38(1), 122144. The case formulation in child and adolescent psychiatry. (Johnstone & Dallos 2009). 0000186690 00000 n Worrell, M. (2015). Conflict of Interest and Funding Disclosure van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013). Poorolajal, J., Haghtalab, T., Farhadi, M., & Darvishi, N. (2016). The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. Case formulation, also referred to as conceptualization, is a skill new counselors often lack (Liese & Esterline, 2015). In addition, there are frameworks that use a formulation model examining various aspects of clients (Johnstone & Dallos, 2013) such as causal, contributing, environmental, and personal features, providing a much more expansive view of clients concerns. He then withdraws and becomes sullen for a few days. This can be both positive or negative but they have a direct correlation to how the person is today. Here, the clinician may use reality-based strategies that address choice and consequences (Wubbolding & Brickell, 2017). Predisposing factors include biological, environmental, or personality considerations that may put clients at risk of further substance use and misuse. Study for free with our range of university lectures! Note that in this example, since the precipitating cause for acute psychosis (also applies to manic episodes) is more biological, it may be harder to identify underlying psychological factors (but that's OK too even the most biological psychiatric disorders can often be precipitated by psychosocial stressors). This framework is idiographic in nature, as it looks at clients individually and holistically (Marquis & Holden, 2008). Twelve-step attendance is most beneficial with inpatient substance use and misuse treatment (Karriker-Jaffe et al., 2018). Predisposing Factors The five perspectives are: A strategy has a PLAN A strategy has a PLOY A strategy has a PATTERN A strategy has a POSITION A strategy has a PERSPECTIVE Let's examine each of the 5 Ps of Strategy in turn 1. 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. 0000006923 00000 n Free resources to assist you with your university studies! A review of CBT treatments for substance use disorders. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. Your formulation of a patient evolves and changes as you collect more information. The image (. Alcohol Research Current Reviews, 31(2), 111118. These factors all combine to cause the person to develop diabetes. The Five Ps does not adhere to any particular theoretical orientation, thus allowing for a greater repertoire of strategies to draw from to help clients with substance use and misuse. We would anticipate when engaging in treatment, the patient may have [resistance/transference/countertransference]. His father started out drinking occasionally and over the years slowly developed a dependency on alcohol. Treating substance use disorders in the criminal justice system. Type. Lack of adaptive coping mechanisms resulted in using self-harm to cope and avoid further emotional dysregulation. There could be a discussion of alcohol use disorder being a disease, not that different from any other passed-on trait or disease. Day, A. M., Kahler, C. W., Ahern, D. C., & Clark, U. S. (2015). Substance use and misuse is exceedingly common and has numerous implications, both individual and societal, impacting millions of Americans directly and indirectly every year. 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. 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. 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). Belenko, S., Hiller, M., & Hamilton, L. (2013). 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). (e.g. 3. 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. Risk and protective factors for adolescents illicit drug use: A population-based study. Henkel, D. (2011). We're here to answer any questions you have about our services. Oxford University Press. Social isolation and withdrawn from family members, Ongoing social isolation due to psychosis causing him to be fearful of others, Followed by an early intervention in psychosis team, History of immigration (increases risk for psychosis), Long-standing feelings of isolation and insecurity since childhood, Joined a gang, entering a stressful lifestyle, led to increased hyper-vigilance and paranoia in the past few months, Ongoing delusions leading patient become suspicious of healthcare workers/family, Previously responded well to CBT for psychosis, Family history of psychosis and schizophrenia. Ingram, B. L. (2012). This is where you'll need to be creative and also think more in-depth about your patient. Kendler, K. S. (2012). (Eds.). The therapist provides a route easiest for the client by identifying methods that build on the clients current resilience and strengths. Further, substance use and misuse is a significant risk factor for suicidality (Poorolajal et al., 2016). 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 . Addressing client substance use and misuse can be quite complicated, and as mentioned previously, substance use and misuse impacts users and society in a variety of ways beyond substance intake. Dax drinks two to three times a week, usually having one or two shots of whiskey and two to three draft beers. She subsequently planned to overdose on her medications. Additionally, the lack of coping mechanisms leading to intense thoughts of suicide. 0000200735 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). 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). Chadwick, P., Williams, C., & Mackenzie, J. Fundamental Changes in DSM-5 Dimensional Approach The conundrum with categories 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. The patient has genetic vulnerabilities for mental illness in her family history, a history of anxious temperament, ongoing substance use, and subtherapeutic medication levels. The CBHSQ report: Substance use and substance use disorder by industry. It can be used in outpatient, inpatient, and residential settings and possibly as part of an aftercare program. They are. %%EOF 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. https://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014.htm (2003) noted, examining positive client experiences may be one way to discover how to increase client participation in substance use and misuse treatment. In Formulation in psychology and psychotherapy (pp. Cognitive behavioral therapists use individually tailored formulations as a framework with which to understand their patients' difficulties and to plan effective treatment. https://doi.org/10.3109/10826084.2013.770027 Based on these factors, the following [treatment and management] would be the most helpful for this patient. 0000017296 00000 n https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638323/pdf/nihms734766.pdf Journal of Anxiety Disorders, 36, 18. https://doi.org/10.1037/a0038618 Family therapy and the treatment of substance use disorders: The family matters model. But the most important thing about formulation is that it should be intuitive and flow logically. Substance Use & Misuse, 49(5), 492512. Incorporating the Five Ps, with its holistic framework, may prove attractive to clients and counselors, thus potentially increasing the numbers of clients engaged in substance use and misuse treatment. Oxford University Press. 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). Here the focus is on investigating resources and/or supports that may help prevent client substance use and misuse from further becoming problematic. Dax presents as extremely frustrated and embarrassed at being mandated to attend counseling sessions. Dax shares that he and his wife are conflicted about how to proceed with their daughters medical care. Additionally, Dax often struggles with strong and painful emotions, and alcohol helps to address them. Johnstone, L., & Dallos, R. This factor has generally been underutilized despite being shown as beneficial to clients (Kuyken et al., 2009). However, the Five Ps presents a framework in which counselors can examine and intervene with client substance use and misuse using a variety of approaches and strategies. After being told she was fired from her job, she went home and self-harmed to cope with the distress of this loss. Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy. Wiley. https://doi.org/10.17744/mehc.30.1.j40256207h0581t1 0000241644 00000 n Sample #1: Conceptualization for CBT case This is a 35-year-old Caucasian man referred by his physician for treatment of generalized anxiety. health? 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. Novice clinicians, who often have a more limited repertoire of strategies, may find the Five Ps valuable because of its systematic framework to clients. (Persons, 1998). In addition, mindfulness strategies can assist in helping Dax to cognitively diffuse from present to future events (Harris, 2019). https://doi.org/10.1186/s13722-018-0110-8 https://doi.org/10.2174/1874473711104010004 0000186981 00000 n Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. The choice of the above approaches is only meant as an illustration and not as definitive ways to address this particular client. What we understand today is shaped by what we believe and what we have experienced in our life. ), Cover every box in the 4 Ps just for the sake of doing it (not all boxes will always apply!). Psychological Assessment, 9(4), 334348. However, the patient has protective factors including psychological mindedness and previous response to therapy, which is a good prognostic factor. 0000017109 00000 n Addressing the potential genetic link to substance use and misuse may prove beneficial in raising Daxs awareness (Dick & Agrawal, 2008). 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. [Patient] presents with a [diagnosis]. SAGE. The goals here are to both break the pattern and to facilitate healthy conversations. He then stopped at a local pub and had several drinks. Wu, J. Q., Szpunar, K. K., Godovich, S. A., Schacter, D. L., & Hofmann, S. G. (2015). Van Wormer, K., & Davis, D. R. (2018). Diagnosis is not the same as formulation! Johnstone, L. and Dallos, R., 2013. 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. - depression, self-harm, mania/psychosis, anxiety, etc.) Journal of Clinical Psychology, 74(3), 356384. (2017). 107127). He fears that she will need open-heart surgery and that she may die. ACT made simple (2nd ed.). Remember there is no right or wrong way to present your formulation. ), Essentials of clinical social work (pp. 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. White, M., & Epston, D. (1990). Current Psychiatry Reports, 15(11), 211. Marquis, A., & Holden, J. 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). This factor differs markedly from the first four. The approach that is highlighted in the 5Ps includes presenting, predisposing, precipitating, perpetuating, and protective factors. What is a psychiatric case formulation? Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. The five Ps allow consultants to evaluate and intervene at . This research could point to populations for whom the Five Ps is more and less effective. Weerasekera, P. (1993). A logical analysis using gentle Socratic dialogue may help to challenge his emotional reactions to his daughters heart murmur (Etoom & Ratnapalan, 2014). Now what? Keys to solution in brief therapy. Family therapy for drug abuse: Review and updates 20032010. Nothing gets resolved, and this cycle appears once again when they have conflict. 0000180256 00000 n 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. Here you can choose which regional hub you wish to view, providing you with the most relevant information we have for your specific region. As Chadwick et al. What level of care is required (outpatient or inpatient)? Perpetuating factors are those that sustain and possibly reinforce clients current substance use and misuse challenges. Regrettably, most do not receive treatment while incarcerated (Belenko et al., 2013). Note that this table is extremely comprehensive and long, and not everything will (or should!) Seminars in the Psychotherapies , pp. 0000180123 00000 n This can result in lack of access to treatment services, contributing to increased stress. (2016). 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. Effects of treatment type on alcohol consumption partially mediated by Alcoholics Anonymous attendance. 5 Ps narrative table, from Comprehensive Care Resource Guide Client substance use and misuse can be quite challenging for counselors, both novice and experienced. We've received widespread press coverage since 2003, Your UKEssays purchase is secure and we're rated 4.4/5 on reviews.co.uk. B., Lemle Becker, V., & Tompkins, M. A. Rachman, S. and de Silva, P., 1978. of this manuscript. https://doi.org/10.1177/0017896918763462 0000239180 00000 n To help treat the client with psychosis maintaining specific behaviour can be beneficial and help avoid frustration and upsetting experiences (Johnstone 2009). 0000012631 00000 n They are examples that the author chose to illustrate the Five Ps in practice. 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). What it wants to Achieve. Here you can choose which regional hub you wish to view, providing you with the most relevant information we have for your specific region. all (2004) it is essential to reduce stress and traumatic events for people recovering from Paranoid Schizophrenia, and start to contribute in social activities. 0000009229 00000 n Many formulation models are administered within a cognitive behavioral grounding (Chadwick et al., 2003; Easden & Kazantzis, 2018; Persons et al., 2013). 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. Hussaarts, P., Roozen, H. G., Meyers, R. J., van de Wetering, B. J. M., & McCrady, B. S. (2012). Cognitive and Behavioral Practice, 20(4), 399409. Frontiers in Psychiatry, 9, 19. Frontiers in Psychiatry, 4(173), 115. As mentioned earlier different therapists have a different structure of formulations in CBT, this can be seen as a downside to the therapy, since it doesnt have a particular structure that everyone follows. Our academic experts are ready and waiting to assist with any writing project you may have. If he cannot identify a time, simple role-plays in which Dax does not interrupt or yell and instead experiences different outcomes may provide optimism to Dax. 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. Selzer, R., & Ellen, S. (2014). (2012). Formulation: A multiperspective model. Cengage. Jane Doe is a 30-year-old female who presents with acute suicidal ideation in the context of a job loss. (2013). Dick, D. M., & Agrawal, A. https://doi.org/10.1016/S0005-7967(02)00033-5 Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. In addition, the collaborative nature of the Five Ps reinforces the concept of an idiographic formulation. Jane has been working at a start up company for the past 2 years.