(2017). 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. Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. 0000006779 00000 n
Science, 196(4286), 129-136. This is to ensure that the client understand any reason for change from what was originally agreed. 5 Ps narrative table, from Comprehensive Care Resource Guide: 4 : The Integrated Formulation : The Integrated formulation builds on the familiarity of the '5Ps', with the aim of specifically integrating that . For example, we diagnose someone with a major depressive episode if they meet 5 of the 9 symptomatic criteria. 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). New York: WW Norton. She has also previously responded well to psychotherapy and appears to be psychologically-minded. 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. 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). (2018). Social isolation and withdrawn from family members, Ongoing social isolation due to psychosis causing him to be fearful of others, Followed by an early intervention in psychosis team,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. Executive functioning in alcohol use studies: A brief review of findings and challenges in assessment. https://doi.org/10.1016/j.cbpra.2013.03.004 In addition, mindfulness strategies can assist in helping Dax to cognitively diffuse from present to future events (Harris, 2019). People with paranoia tend to avoid these situations which would lead to distress (Clark et al 2005). Emotion regulation in cognitive-behavioral therapy: Bridging the gap between treatment studies and laboratory experiments. 0000186981 00000 n
Good interpersonal support from her best friend who brought her to hospital. (2014). (2013). 0000199386 00000 n
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. The therapist provides a route easiest for the client by identifying methods that build on the clients current resilience and strengths. All rights reserved. https://doi.org/10.1016/j.psc.2010.04.012 Remember there is no right or wrong way to present your formulation. This area explores significant occurrences that preceded or triggered the presenting problem and its consequences. She also drank 10 beers prior to arriving in the hospital. 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. The simplest format looks at just three key areas: thoughts, feelings (emotions and physical sensations) and behaviours. 0000241121 00000 n
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. 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. The idiographic/nomothetic dichotomy: Tracing historical origins of contemporary confusions. Here you can choose which regional hub you wish to view, providing you with the most relevant information we have for your specific region. Behaviour research and therapy, 16(4), pp.233-248. https://doi.org/10.1377/hlthaff.2013.0879 Testing case formulation hypotheses in psychotherapy: Two case examples. 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). SAGE. Client substance use and misuse can be quite challenging for counselors, both novice and experienced. Biopsychosocial Model and Case Formulation - PsychDB Current Drug Abuse Reviews, 8(1), 2640. Perpetuating factors are those that sustain and possibly reinforce clients current substance use and misuse challenges. Alcohol Research Current Reviews, 31(2), 111118. The genetics of alcohol and other drug dependence. (Rachman & de Silva 1978, Salkovskis & Harrison 1984, sited in Tarrier et al. She describes an invalidating childhood, where parents did not acknowledge or praise her. As you get better and more expert at formulating, you may not need to use this rigid structured format, and instead, will be able to present a more intuitive and organic formulation of the patient instead (see other methods below). https://doi.org/10.17744/mehc.30.1.j40256207h0581t1 Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy. 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). Disclaimer: This is an example of a student written essay.Click here for sample essays written by our professional writers. The five Ps allow consultants to evaluate and intervene at . Precipitating and perpetuating factors: the stressor of losing her job has reactivated these more primitive defense mechanisms and coping strategies. Behaviour and Research Therapy, 41(6), 671680. (2015). Your formulation of a patient evolves and changes as you collect more information. 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. Journal of Substance Abuse Treatment, 26(3), 151158. Using case formulation in clinical practice. Copyright 2023 National Board for Certified Counselors, Inc. and Affiliates. 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). 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). 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. It is another way to address the multifaceted and complicated nature of client substance use and misuse. 0000017180 00000 n
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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. Precipitating factors are those that proximally bring about substance use and misuse and its resulting difficulties. BMC Medicine, 10(111), 13. 160185). McHugh, R. K., Hearon, B. Dax can then share his and his wifes perspectives on their daughters care. Drug and Alcohol Dependence, 131(12), 2335. or funding contributions for the development The counselor may also assist Dax in emotional regulation, which may prevent the initiation of arguments (Aldao & Nolen-Hoeksema, 2013). Alcohol, cannabis, and opioid use disorders, and disease burden in an integrated healthcare system. Sample #1: Conceptualization for CBT case This is a 35-year-old Caucasian man referred by his physician for treatment of generalized anxiety. Dax presents as extremely frustrated and embarrassed at being mandated to attend counseling sessions. https://doi.org/10.3389/fpsyt.2018.00095 This is an essential step. 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. Seminars in the Psychotherapies , pp. Mindfulness-based interventions for the treatment of substance and behavioral addictions: A systematic review. Episodic future thinking in generalized anxiety disorder. Kuyken, W., Padesky, C. A., & Dudley, R. (2009). 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). https://doi.org/10.1111/j.1521-0391.2011.00187.x It can be changed and reviewed as the treatment is in progress if any new information come to light. Many formulation models are administered within a cognitive behavioral grounding (Chadwick et al., 2003; Easden & Kazantzis, 2018; Persons et al., 2013). Oxford University Press. Bush, D. M., & Lipari, R. N. (2015, April 16). Rowe, C. L. (2012). Substance Abuse and Mental Health Services Administration. Presenting problems are concerns that clients find difficult to manage. There are limitations to the Five Ps framework as a way to formulate and intervene with clients substance use and misuse. National Center on Addiction and Substance Abuse at Columbia University. (2011). 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. It can be used in outpatient, inpatient, and residential settings and possibly as part of an aftercare program. Morin, J.-F. G., Harris, M., & Conrod, P. J. Persons, J.B., 1989. ; DSM-5) bases an SUD on a pathological pattern related to the use of a substance (American Psychiatric Association, 2013, p. 483). Formulation - headspace There are numerous methods and combinations of methods to address substance use and misuse, such as family therapy, cognitive behavioral therapy, and self-help groups. The patient appears to have adopted self-harming as a primitive coping strategy by early adulthood, and these have continued on in adulthood. To position his business, John may consult the 5 Ps of marketing in the following manner: Product: By-the-hour jet ski rentals for people who are in the city for a short duration of time. Additionally, Dax often struggles with strong and painful emotions, and alcohol helps to address them. Chapter 5 - Psychological Models for Case Formulation We're here to answer any questions you have about our services. Therapy, 38(1), 5981. 0000238450 00000 n
The systematic but flexible nature of this framework affords clinicians numerous ways to address substance use and misuse. 2008). Cognitive and Behavioral Practice, 20(4), 399409. Drug and Alcohol Dependence, 142(1), 350353. How to Write a Case Conceptualization: 10 Examples (+ PDF) 0000155834 00000 n
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He then withdraws and becomes sullen for a few days. Journal of Anxiety Disorders, 36, 18. 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).