Dax further reports his paternal grandfather died from liver failure. 0000001856 00000 n
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. 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). Journal of Marital and Family This is where you'll need to be creative and also think more in-depth about your patient. Sample #1: Conceptualization for CBT case This is a 35-year-old Caucasian man referred by his physician for treatment of generalized anxiety. She subsequently planned to overdose on her medications. 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. (2013). This condition did not develop six months ago but developed during childhood when he failed to meet his father's expectations. https://www.ncbi.nlm.nih.gov/books/NBK343542 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. This factor has generally been underutilized despite being shown as beneficial to clients (Kuyken et al., 2009). The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. Karriker-Jaffe, K. J., Klinger, J. L., Witbrodt, J., & Kaskutas, L. A. (2008). Morin, J.-F. G., Harris, M., & Conrod, P. J. For example, we diagnose someone with a major depressive episode if they meet 5 of the 9 symptomatic criteria. It should be noted that the strategies and interventions applied here are used as illustrations and are specific to Dax and his concerns. https://doi.org/10.1093/pubmed/fdv148 The essay will describe Greg's case study using 5P's model. Behind bars II: Substance abuse and Americas prison population. https://doi.org/10.1080/10826084.2017.1349800 Dax reports a strong paternal history of substance use and misuse. The more cases you go through (and more of the sample formulations below) the more comfortable you will be with formulating! For example, type II diabetes does not develop because of a single pathophysiological cause. Additionally, as it is a continuous process it allows the therapist to revise any incorrect hypothesis about any underlying mechanism at any stage. However, each has some shortcomings. or funding contributions for the development 58 - 65. One way to do this is to use the "5 Ps.". 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. Schoen, C., Osborn, R., Squires, D., & Doty, M. M. (2013). 0000003178 00000 n
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). Do you have a 2:1 degree or higher? 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! 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). 1. 0000000016 00000 n
5 Ps narrative table, from Comprehensive Care Resource Guide The counselor may also assist Dax in emotional regulation, which may prevent the initiation of arguments (Aldao & Nolen-Hoeksema, 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 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]. Centers for Disease Control and Prevention. While being mandated to attend counseling, Dax shares concerns that he is afraid of what his daughters test results will show. SAGE. He fears that she will need open-heart surgery and that she may die. 0000013350 00000 n
2008). and Clark, D.M., 1989. If present categories are used, formulation can be limiting and dangerous. Diagnosis is not the same as formulation! Penguin. Journal of Anxiety Disorders, 36, 18. 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). 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. Her ongoing alcohol use is another example of a maladaptive coping strategy. Robinson, O. C. (2011). 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. In addition, the collaborative nature of the Five Ps reinforces the concept of an idiographic formulation. Patterns: Study what Worked in the Past and What can be Replicated. https://www.apa.org/pubs/journals/pas/index 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! What we understand today is shaped by what we believe and what we have experienced in our life. 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. 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. There are limitations to the Five Ps framework as a way to formulate and intervene with clients substance use and misuse. Drug and Alcohol Dependence, 142(1), 350353. It acknowledges your strengths and resources. However, the patient has protective factors including psychological mindedness and previous response to therapy, which is a good prognostic factor. [Patient] presents with a [diagnosis]. Fundamental Changes in DSM-5 Dimensional Approach The conundrum with categories Review of outcome research on marital and family therapy in treatment for alcoholism. 0000004344 00000 n
Journal of Clinical Psychology, 74(3), 356384. Keys to solution in brief therapy. Belenko, S., Hiller, M., & Hamilton, L. (2013). Substance Abuse and Mental Health Services Administration. After being told she was fired from her job, she went home and self-harmed to cope with the distress of this loss. 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. Bahorik, A. L., Satre, D. D., Kline-Simon, A. H., Weisner, C. M., & Campbell, C. I. New York: WW Norton. SAMHSAs recommendations fit well with a more holistic framework in that such a structure allows clinicians to develop a multidimensional picture of clients. 0000015792 00000 n
(2017). 2004;2(6):576-582. doi:10.1370/afm.245. In addition, the interventions demonstrated are not to be assumed the only ones that can be applied to Dax. Early attachment experience and recovery from psychosis. 160185). *You can also browse our support articles here >. (2017). As mentioned previously, novice counselors often lack sufficient case formulation skills (Liese & Esterline, 2015). For Dax, he shares that when he and his wife argue, it follows a very predictable pattern. There could be a discussion of alcohol use disorder being a disease, not that different from any other passed-on trait or disease. Hussaarts, P., Roozen, H. G., Meyers, R. J., van de Wetering, B. J. M., & McCrady, B. S. (2012). These are historical psychological, biological, developmental, and socio-cultural factors that increased the person's vulnerability to their current problems. https://doi.org/10.1097/ADM.0000000000000260 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. We would anticipate when engaging in treatment, the patient may have [resistance/transference/countertransference]. 0000119626 00000 n
Mental health professionals evaluations of the Integral Intake, a metatheory-based, idiographic intake instrument. Drugs and drug policy: What everyone needs to know. (2019). Wu, J. Q., Szpunar, K. K., Godovich, S. A., Schacter, D. L., & Hofmann, S. G. (2015). This is an essential step. 0000016707 00000 n
https://doi.org/10.1016/j.addbeh.2006.09.008 History & Philosophy of Psychology, 13(2), 3239. A review of CBT treatments for substance use disorders. Current Psychiatry Reports, 15(11), 211. (2010, February). https://doi.org/10.1016/j.janxdis.2015.09.005 From simple essay plans, through to full dissertations, you can guarantee we have a service perfectly matched to your needs. Cognition and Emotion, 27(4), 753760. 0000200610 00000 n
Seminars in the Psychotherapies , pp. As Chadwick et al. Keywords: substance use and misuse, Five Ps, idiographic, systematic, flexible. We then move onto Perpetuating which looks at what factors are contributing to the remain of the problems the person is facing. The Five P's approach provides a structured way of constructing this formulation. What is the purpose of formulation? Dax presents as extremely frustrated and embarrassed at being mandated to attend counseling sessions. Presenting Problem In addition, mindfulness strategies can assist in helping Dax to cognitively diffuse from present to future events (Harris, 2019). Greg experiences feelings of stress and anxiety over the past six months. Additionally, Dax often struggles with strong and painful emotions, and alcohol helps to address them. https://doi.org/10.1111/j.1521-0391.2011.00187.x The meaning of anxiety. Nothing gets resolved, and this cycle appears once again when they have conflict. Dax, however, is hyper-focused on surgery and seems to dismiss Saras position. Introduction to formulation. What it wants to Achieve. OFarrell, T. J., & Clements, K. (2012). Working systemically with families: Formulation, intervention and evaluation. The genetics of alcohol and other drug dependence. https://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014.htm Their effectiveness has been well researched, and this paper does not propose a superior way to address substance use and misuse. Australasian Psychiatry, 22(4), 397-401. 0000004306 00000 n
The image (. The Five Ps framework promotes a very clear and systematic approach to case formulation or assessment that potentially provides a wealth of data. PREDISPOSING FACTORS: What led to the problem starting? I will go into further detail of the 5 Ps Model below. The American Journal on Addictions, 21(1), 3846. 0000012481 00000 n
It can be changed and reviewed as the treatment is in progress if any new information come to light. Effects of treatment type on alcohol consumption partially mediated by Alcoholics Anonymous attendance. The essay will now look at the key ideas underpinning the process of CBT. 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.