6 Ps Formulation

Diagnosis is not the same as formulation! In mental health, if there is a group of constant symptoms observed in a population, these symptoms can be classified into a specific unit called diagnosis (this is what the DSM-5 does). For example, we diagnose a person with a major depressive episode if they meet 5 of the 9 symptomatic criteria. However, the wording tells us how the person became depressed due to their genetics, personality, psychological factors, biological factors, social circumstances (adverse events in childhood and social determinants of health) and their environment. As noted above, there are many ways to investigate and treat substance use and abuse among clients. For example, some interventions use an individual lens, such as cognitive behavioural therapy, which examines the links between thoughts, feelings, and behaviours (Morin et al., 2017). Other approaches look at substance use and abuse from a family or systemic perspective, looking at family patterns such as communication and normalization of substance use (Bacon, 2019). Offering mindfulness-based interventions can help cope with stressful events that have already triggered substance use (Garland et al., 2014). In addition, there are frameworks that use a formulation model that explores various aspects of clients (Johnstone & Dallos, 2013) such as causal, contributory, environmental and personal characteristics that offer a much broader view of client concerns. Now that you have filled in the simple parts of the story, the most difficult part is to conceptualize the predisposing social factors (step 3) and all the psychological factors (steps 4, 5, 6, 7). Here you need to be creative and also think more deeply about your patient. Ideally, each step should flow logically and intuitively into the next, depending on your setting, as you will see in our case of Jane Doe. A framework for understanding various psychological treatments and psychological theories can be helpful in letting your psychological formulation flow intuitively (e.g., the theory of.

B attachment, cognitive behavioural therapy, dialectical behaviour therapy, interpersonal therapy, psychodynamic therapy). However, this can be done intuitively even without a deep understanding of these frameworks (we don`t have to be Freud to do this). The more cases you go through (and more examples of formulations below), the more comfortable you will be with the formulation! The following readings are great resources to further develop your formulation skills: Good formulation should be integrative and allow you to understand how all the patient`s factors interact to lead to the current situation. This will give you an idea of their current level of functioning, prognosis and guide your orientation for treatment and management decisions. The “4 Ps” formulation table can be a very rigid and systematized way of representing a formulation. In the simplest way, you can present each box one after the other and describe each factor. Most learners will use this method because it is the “easiest”. It is generally presented as predisposing → precipitating → now → representing protective factors. As you become more and more experienced in formulation, you may not need to use this rigid structured format and instead present a more intuitive and organic formulation of the patient (see other methods below). For good measure, here`s another example of a formulation for someone with a diagnosis of schizophrenia.

Note that in this example, since the triggering cause of acute psychosis (also applies to manic episodes) is more “biological”, it may be more difficult to identify the underlying psychological factors (but this is not serious too – even the most “biological” psychiatric disorders can often be triggered by psychosocial stressors). First, let`s fill in the simplest parts of the table: Given the variations in substances, the extent of use, functional impairment, simultaneous onset with other mental disorders, and the inherent differences between clients, an idiographically sound framework seems particularly appropriate for this population. The five Ps allow consultants to evaluate and intervene at the same time. It allows the individualization of the client, the use of a variety of strategies, continuous evaluation and, if necessary, changes. In addition, the five Ps help clients and advisors explore the relationships between each factor and the issue at hand. This framework is idiographic in nature, as it examines clients individually and holistically (Marquis & Holden, 2008). The formulation of idiographic cases can be useful for complicated cases, for example, .B. among clients who use and abuse substances (Haynes et al., 1997).

It is systematic and at the same time allows flexibility and creativity. It can be used on an outpatient basis, in hospital and hospital settings and possibly as part of a follow-up program. The biopsychosocial model and case formulation (also known as biopsychosocial formulation) in psychiatry is a way of understanding a patient as more than a diagnostic label. Assumptions are made about the origins and causes of a patient`s symptoms. The most common and clinically feasible way to formulate is the biopsychosocial approach, first described by George Engel in 1980. [1] [2] Biopsychosocial formulation combines biological, psychological and social factors to understand a patient and uses them to control both treatment and prognosis. Your formulation of a patient grows and changes as you gather more information. Formulation is like cooking, and there is no “right” or “wrong” way to do it, but most improve over time with increasing clinical experience. Substance use and abuse among clients can be a major challenge for counselors, both beginners and experienced. Case formulation, also known as conceptualization, is a skill that new consultants often lack (Liese & Esterline, 2015). Using a framework to support case formulation can be useful for aspiring counsellors.

Experienced consultants, while having expertise in a variety of approaches, may also benefit from using a framework to address expected challenges (Macneil et al., 2012). Case formulations have been used in a number of areas such as psychosis, anxiety and trauma (Chadwick et al., 2003; Ingram, 2012; Persons et al., 2013). One of these frameworks is the five Ps (Macneil et al., 2012). Macneil and colleagues (2012) postulated that the diagnosis was inadequate and that it was crucial to include other factors such as causal factors, lifestyle, and personal factors in conceptualizing the case and formulating a plan. Applying this approach to clients who use and abuse substances would allow for more individual and flexible ways of intervening in substance use and abuse among clients. In addition, the collaborative nature of the Five Ps reinforces the concept of idiographic formulation. This corresponds to the inherent uniqueness of customers, their concerns and various factors. Previous studies using frameworks to formulate it have often used cognitive behavioural therapy as a primary intervention (Chadwick et al., 2003; Persons et al., 2013). Since clients` substance use and abuse can be quite complicated, using different approaches under the five Ps can lead to positive outcomes.

As Chadwick et al. (2003) noted, examining positive client experiences can be a way to learn how to increase client participation in addiction treatment. Another potential area of study could be to compare inexperienced consultants with more experienced consultants. As we have already mentioned, novice consultants often lack sufficient case formulation skills (Liese & Esterline, 2015). Examining the experiences of both groups with the Five Ps can provide ideas to support counsellor training programs related to substance use and the development of skills related to abuse. Implementing the five Ps in clients with mild substance use and abuse and those with greater substance use and abuse, perhaps using the DSM-5 diagnostic for SUD, may be another area of expertise. This research could point to populations for which the Five Ps are less and less effective. Studies using the Five Ps with mandated clients can prove their effectiveness, especially with organizations that need substance-related advice. You have now completed your spreadsheet. What else? How do you present all this information and data? Remember that there is no “right” or “wrong” way to present your formulation.

But the most important thing about the formulation is that it must be intuitive and logically fluid. Here are some different presentation styles suggested. You`re probably already formulating, but you just don`t know it. Like most things in medicine, there are multifactorial causes of diseases, diseases and disorders. For example, type II diabetes does not develop due to a single pathophysiological cause. The patient may have a strong family history of the disease, sedentary activity, environmental influences and/or poor nutritional diet. These factors all lead the person to develop diabetes. Understanding how each factor contributes to a disease can better guide treatment decisions. In psychiatry, the formulation seems more complicated because human behavior and the brain itself are extraordinarily complex.

As with everything, the more you practice, the better you improve in the formulation. One sentence tells us more about a young person, the context and the impact of their strengths and difficulties. Indeed, the way a young person describes their symptoms can be similar in many difficulties. .