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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). Addiction Science and Clinical Practice, 13(8), 115. Predisposing Factors 0000180123 00000 n Dax shares that he and his wife are conflicted about how to proceed with their daughters medical care. 0000119085 00000 n (2008). Dax was quite upset, cursed at her, and then hung up the phone. SAMHSAs recommendations fit well with a more holistic framework in that such a structure allows clinicians to develop a multidimensional picture of clients. SAGE. What is a psychiatric case formulation? Sara is unequivocal in her confidence in Zoes cardiologist and his competence. 0000155905 00000 n Perpetuating factors are those that sustain and possibly reinforce clients current substance use and misuse challenges. https://doi.org/10.1377/hlthaff.2013.0879 0000007722 00000 n Once the protective factors are identified, the ensuing conversation provides opportunities to imagine future outcomes in which protective factors may come into play should situations occur that the client finds problematic. Working systemically with families: Formulation, intervention and evaluation. They are. Goldman, R. and Greenberg, L.S., 1997. low mood) https//doi.org/10.1016/j.drugalcdep.2013.02.018 British Journal of Clinical Psychology, 37(3), pp.269-284. & Haddock, G. (1990). Alcohol, cannabis, and opioid use disorders, and disease burden in an integrated healthcare system. Formulation in psychology and psychotherapy: Making sense of peoples problems (2nd ed.). Dax, however, is hyper-focused on surgery and seems to dismiss Saras position. (2003) noted, examining positive client experiences may be one way to discover how to increase client participation in substance use and misuse treatment. Jane is able to articulate a safe plan to stay with a friend, and is suitable for outpatient care, Jane might benefit from an increase of her, Jane might benefit from the use of anti-craving medications such as. 0000000016 00000 n Some different presentation styles are suggested here. Again let's fill out the easiest parts of the table first: Now here is one potential example of a predisposing social and psychological formulation of psychosis (again, there are no right or wrong ways to formulate, it depends on the patient you have in front of you!). The Five Ps framework promotes a very clear and systematic approach to case formulation or assessment that potentially provides a wealth of data. 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 dappled nature of causes of psychiatric illness: Replacing the organicfunctional/hardwaresoftware dichotomy with empirically based pluralism. This factor differs markedly from the first four. Evidence-based approaches, such as cognitive behavioral therapy, tend to be nomothetic, assuming homogeneity and generally geared toward symptom amelioration (Robinson, 2011). 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). However, an important skill that they should try to perform is to assess a situation before jumping to conclusions. Belenko, S., Hiller, M., & Hamilton, L. (2013). Morin, J.-F. G., Harris, M., & Conrod, P. J. Even weekly status meetings or things of that nature should have a clearly defined purpose. Substance use and misuse has been correlated with both higher rates of absenteeism and workplace injuries (Bush & Lipari 2015). Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. The emphasis here is on features that continue the presenting problem. 0000006779 00000 n In spite of these limitations, there may be several potential areas of inquiry. After being told she was fired from her job, she went home and self-harmed to cope with the distress of this loss. Your formulation of a patient evolves and changes as you collect more information. https://doi.org/10.1002/jclp.22516 It's useful to employ the 5 Ps throughout the planning process. Worrell, M. (2015). 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. Now that you've filled in the easy parts from the history, the hardest part is conceptualizing the predisposing social factors (Step 3), and all of the psychological factors (Steps 4, 5, 6, 7). Client substance use and misuse is a significant problem in the United States, and it continues to cause difficulty for individuals, families, and society. Client substance use and misuse can be quite challenging for counselors, both novice and experienced. The 4 Ps formulation table can be a very rigid and systematized way of presenting a formulation. Free resources to assist you with your university studies! Behind bars II: Substance abuse and Americas prison population. 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. (2012). And that's okay! https://doi.org/10.1080/02699931.2012.739998 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). 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. As mentioned previously, the Five Ps is not meant to replace any other substance use and misuse intervention. The effects of treatment for substance use problems on intimate partner violence: A review of empirical data. In addition, the collaborative nature of the Five Ps reinforces the concept of an idiographic formulation. Looking for a flexible role? (Ed.). All work is written to order. 0000004656 00000 n Presenting problems are concerns that clients find difficult to manage. Drayton, M., Birchwood, M. and Trower, P., 1998. Tarrier, N., Wells, A. - depression, self-harm, mania/psychosis, anxiety, etc.) Sample #1: Conceptualization for CBT case This is a 35-year-old Caucasian man referred by his physician for treatment of generalized anxiety. It should be noted that the strategies and interventions applied here are used as illustrations and are specific to Dax and his concerns. The American Journal on Addictions, 21(1), 3846. Dax is a 33-year-old married father of two children: a 9-year-old son, Cam, and a 7-year-old daughter, Zoe. Centers for Disease Control and Prevention. A good biopsychosocial formulation allows you to come up with a comprehensive and holistic treatment plan for your patient. https://doi.org/10.1016/j.psc.2010.04.012 Lack of adaptive coping mechanisms resulted in using self-harm to cope and avoid further emotional dysregulation. 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. https://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014.htm No plagiarism, guaranteed! This factor has generally been underutilized despite being shown as beneficial to clients (Kuyken et al., 2009). It is likely that other clinicians presented with Dax would use a different combination of approaches. Good interpersonal support from her best friend who brought her to hospital. 0000017180 00000 n apply to your case. 0000200021 00000 n 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. 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. (Rachman & de Silva 1978, Salkovskis & Harrison 1984, sited in Tarrier et al. Jane Doe presents with a diagnosis of borderline personality disorder and history of depression. Those who engage in substance use and misuse often have higher rates of unemployment (Compton et al., 2014; Dieter, 2011). https://doi.org/10.1186/s13722-018-0110-8 Here's what the completed table would look like with the psychological factors incorporated. 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. According to Read et. As mentioned previously, novice counselors often lack sufficient case formulation skills (Liese & Esterline, 2015). Presenting Issue(s) - please use the DSM-What assessment tools. For some, receiving substance use and misuse services can be stigmatizing. U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. Some of these evidence-based approaches will be demonstrated later in a case illustration. Perpetuating Factors The Five P's approach provides a structured way of constructing this formulation. Early attachment experience and recovery from psychosis. Garland, E. L., Froeliger, B., & Howard, M. O. (Persons, 1998). Remember there is no right or wrong way to present your formulation. 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. Risk and protective factors for adolescents illicit drug use: A population-based study. Keywords: substance use and misuse, Five Ps, idiographic, systematic, flexible. Based on these factors, the following [treatment and management] would be the most helpful for this patient. 0000010086 00000 n He is also adamant that he does not have a problem with alcohol. 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).