5 ps formulation example

Additionally, Dax often struggles with strong and painful emotions, and alcohol helps to address them. Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. https://doi.org/10.3389/fpsyt.2013.00173 https://doi.org/10.1037/a0038618 Compton, W. M., Gfroerer, J., Conway, K. P., & Finger, M. S. (2014). Current Drug Abuse Reviews, 4(1), 427. 1. https://www.centeronaddiction.org/addiction-research/reports/behind-bars-ii-substance-abuse-and-americas-prison-population Twelve-step attendance is most beneficial with inpatient substance use and misuse treatment (Karriker-Jaffe et al., 2018). PREDISPOSING FACTORS: What led to the problem starting? It has been documented that 90% of the population at some point have intrusive thoughts, or feel paranoid and feel people are doing things on purpose towards them. Han, B., Hedden, S. L., Lipari, R., Copello, E. A. P., & Kroutil, L. A. These are historical psychological, biological, developmental, and socio-cultural factors that increased the person's vulnerability to their current problems. apply to your case. 0000006666 00000 n Early attachment experience and recovery from psychosis. Australasian Psychiatry, 22(4), 397-401. 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. Following a discussion of the Five Ps, a brief case illustration will demonstrate the framework. Substance Use & Misuse, 49(5), 492512. The more you formulate, it can be helpful to have a rough template of different formulations for different diagnoses (e.g. 0000241121 00000 n (2012). American Psychiatric Association. Oftentimes, when the topic of protective factors is used in substance use and misuse, it is related to deterrence of substance use, notably with adolescents (Liao et al., 2018). Client substance use and misuse is a significant problem in the United States, and it continues to cause difficulty for individuals, families, and society. The emphasis here is on features that continue the presenting problem. Behaviour research and therapy, 16(4), pp.233-248. Here the clinician may incorporate a solution-focused strategy exploring a time with Dax when he and his wife have disagreed, but he did not interrupt and the outcome was positive (de Shazer, 1985). Scott W. Peters, PhD, LPC-S, is an associate professor at Texas A&M University San Antonio. Published data on those incarcerated appears to be several years old. and her being fired from her job is connected to her underlying struggles in the following way: After being fired from her job, she experienced strong feelings of rejection, and was unable to cope with this major stressor. Study for free with our range of university lectures! Here the focus is on investigating resources and/or supports that may help prevent client substance use and misuse from further becoming problematic. Second, it also tends to shift the conversation toward what is present and going well in their lives and away from those areas that cause distress and suffering (de Shazer, 1985). 5 Ps narrative table, from Comprehensive Care Resource Guide For some, receiving substance use and misuse services can be stigmatizing. Centers for Disease Control and Prevention. 0000200610 00000 n Effects of treatment type on alcohol consumption partially mediated by Alcoholics Anonymous attendance. Additionally, as it is a continuous process it allows the therapist to revise any incorrect hypothesis about any underlying mechanism at any stage. health? This factor differs markedly from the first four. In addition, aspects of narrative therapy may provide an opportunity for Dax to re-author a unique outcome that gives meaning and provides a functional identity to him as a father and husband, thus building a sense of optimism (White & Epston, 1990). Wiley. 0000066425 00000 n He is also adamant that he does not have a problem with alcohol. Here you can choose which regional hub you wish to view, providing you with the most relevant information we have for your specific region. 0000200485 00000 n https://doi.org/10.1186/s13722-018-0110-8 https://doi.org/10.1016/j.cbpra.2013.03.004 Dax drinks two to three times a week, usually having one or two shots of whiskey and two to three draft beers. Additionally, he reports significant stress and conflict in his marriage as well as concerns over some upcoming diagnostic tests for their daughter related to a heart murmur. These factors all combine to cause the person to develop diabetes. 0000243959 00000 n ,"Sb.&;.+Y&&_{} G|ku!dKMwU*jMdDN The goals here are to both break the pattern and to facilitate healthy conversations. 0000013321 00000 n 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. This can result in lack of access to treatment services, contributing to increased stress. The authors reported no conflict of interest https://doi.org/10.2174/1874473711104010004 Like most things in medicine, there are multifactorial causes of diseases, illnesses, and disorders. We would anticipate when engaging in treatment, the patient may have [resistance/transference/countertransference]. The systematic but flexible nature of this framework affords clinicians numerous ways to address substance use and misuse. 2009). 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. This essay may contain factual inaccuracies or out of date material. 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. Child and Adolescent Psychiatric Clinics, 16(1), 111-132. The Five Ps permits counselors to both assess and intervene essentially simultaneously. Belenko, S., Hiller, M., & Hamilton, L. (2013). Henkel, D. (2011). Routledge.21-37). May, R. (1950). Treating substance use disorders in the criminal justice system. https://doi.org/10.1111/j.1521-0391.2011.00187.x The compass of pleasure: How our brains make fatty foods, orgasm, exercise, marijuana, generosity, vodka, learning, and gambling feel so good. Concept mapping: A supervision strategy for introducing case conceptualization skills to novice therapists. 0000016414 00000 n One versus many: Capturing the use of multiple emotion regulation strategies in response to an emotion-eliciting stimulus. Using a framework to assist in case formulation may prove useful to beginning counselors. Frontiers in Psychiatry, 4(173), 115. Ronald Press. https://doi.org/10.1186/1741-7015-10-111 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. Academic Press. Drug and Alcohol Dependence, 131(12), 2335. Those who engage in substance use and misuse often have higher rates of unemployment (Compton et al., 2014; Dieter, 2011). (2010, February). Johnstone & Dallos (2010) suggest a framework for CBT formulation which refers to the levels and process of formulation in regards to the five Ps; presenting issues, precipitating factors, perpetuating factors and protective factors presenting issues which define the current problems in term of emotions thoughts and . In the context of this article, the word abusable indicates substances that when taken are pleasurable enough to result in excessive dosing or increased frequency of intake (Linden, 2011). Marquis, A., & Holden, J. Some of these evidence-based approaches will be demonstrated later in a case illustration. Family therapy and the treatment of substance use disorders: The family matters model. Precipitating Factors Ploy: The Strategy has to analyze What Tactics can be Implemented. In fact, this stigmatization can come from those who are treating them (Luoma et al., 2007). 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. Journal of Addiction Medicine, 11(1), 39. Thus, there exists a need to concurrently examine and address the potentially complex nature of client substance use and misuse. Is diagnosis enough to guide interventions in mental Winters, N. C., Hanson, G., & Stoyanova, V. (2007). Dax can then share his and his wifes perspectives on their daughters care. 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). CBT has been found to not be effective in schizophrenia (Lynch et al. Alcohol Research Current Reviews, 31(2), 111118. Remember there is no right or wrong way to present your formulation. B., Twohig, M. P., Waltz, T., Hayes, S. C., Roget, N., Padilla, M., & Fisher, G. (2007). This research could point to populations for whom the Five Ps is more and less effective. What we understand today is shaped by what we believe and what we have experienced in our life. Wubbolding, R. E., & Brickell, J. The 4 Ps formulation table can be a very rigid and systematized way of presenting a formulation. 1. In addition, the collaborative nature of the Five Ps reinforces the concept of an idiographic formulation. A review of CBT treatments for substance use disorders. Family therapy: Systemic approaches to practice. It acknowledges your strengths and resources. University-educated. 0000004344 00000 n Another weakness is that sometimes the client might not want to disclose some information in their past which might assist the therapist in making the client understand that sometimes important part of their history in fluence the way they view the world. This framework is idiographic in nature, as it looks at clients individually and holistically (Marquis & Holden, 2008). 0 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. Worrell, M. (2015). There could be a discussion of alcohol use disorder being a disease, not that different from any other passed-on trait or disease. Kuyken, W., Padesky, C. A., & Dudley, R. (2009). https://doi.org/10.1007/s11920-013-0414-z She has several early developmental and pathogenic psychological factors, including growing up in a family characterized by invalidation, with parents who were distant and unavailable. Humphreys, K., Wing, S., McCarty, D., Chappel, J., Gallant, L., Haberle, B., Horvath, A. T., Kaskutas, L. A., Kirk, T., Kivlahan, D., Laudet, A., McCrady, B. S., McLellan, A. T., Morganstern, J., Townsend, M., & Weiss, R. (2004). Dax, however, is hyper-focused on surgery and seems to dismiss Saras position. %PDF-1.4 % 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). Hussaarts, P., Roozen, H. G., Meyers, R. J., van de Wetering, B. J. M., & McCrady, B. S. (2012). 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. Plan A good strategy must have a plan. 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 (2014). 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). 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. He was recently driving home from work in the evening and law enforcement stopped him because of erratic driving. The most common and clinically practical way to formulate is through the biopsychosocial approach, first described in 1980 by George Engel. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. The officers evaluated him, detained him, and subsequently arrested him for driving while intoxicated. ), Cover every box in the 4 Ps just for the sake of doing it (not all boxes will always apply!). Moreover, the Five Ps align with SAMHSAs recommendation that clinicians tailor treatment to each client because no single treatment is particularly superior (SAMHSA, 2020). What are the 5 Ps of case formulation? No plagiarism, guaranteed! The simplest format looks at just three key areas: thoughts, feelings (emotions and physical sensations) and behaviours. Cognitive therapy in practice: A case formulation approach. (2011). 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. Murphy, C. M., & Ting, L. (2010). startxref Engel, G. L. (1977). It has been said that the experiences, incidents and or events in our life has an affect on both how we feel and behave. Further, substance use and misuse is a significant risk factor for suicidality (Poorolajal et al., 2016). or funding contributions for the development Predisposing Factors Case formulation in process-experiential therapy. Treating complex cases: The cognitive behavioural. 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. Presenting Problem One such framework is the Five Ps (Macneil et al., 2012). Cognition and Emotion, 27(4), 753760. The Five Ps is a type of framework utilizing five factors developed by Macneil et al. The Five Ps framework promotes a very clear and systematic approach to case formulation or assessment that potentially provides a wealth of data. https://www.ncbi.nlm.nih.gov/books/NBK343542 Long-term, Jane might also benefit from a more in-depth understanding of how her past trauma affects her present self and symptoms. Current Psychiatry Reports, 15(11), 211. However, there are others who use substances to such an extent that it causes significant distress and impairment in their lives, a phenomenon clinically referred to as a substance use disorder (SUD). Based on these factors, dialectical behavioural therapy would be the most helpful for this patient. Poorolajal, J., Haghtalab, T., Farhadi, M., & Darvishi, N. (2016). Let's do a simplified formulation for the patient (Jane Doe) below. This is in keeping with the inherent uniqueness of clients, their concerns, and a variety of factors. 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). (2020, April 21). Dax is a 33-year-old married father of two children: a 9-year-old son, Cam, and a 7-year-old daughter, Zoe. Schoen, C., Osborn, R., Squires, D., & Doty, M. M. (2013). Additionally, the lack of coping mechanisms leading to intense thoughts of suicide. Tahan, H. A., & Sminkey, P. V. (2012). (2003). All work is written to order. He then withdraws and becomes sullen for a few days. The National Survey on Drug Use and Health asserted that close to 30% of respondents aged 12 and older reported use of illicit substances in the past month (Substance Abuse and Mental Health Services Administration [SAMHSA], 2017). More ominously, substance use and misuse has been correlated with intimate partner violence (Murphy & Ting, 2010). (2003) noted, examining positive client experiences may be one way to discover how to increase client participation in substance use and misuse treatment. The more cases you go through (and more of the sample formulations below) the more comfortable you will be with formulating! You are probably already formulating, but just don't know it. https://doi.org/10.1177/0009922813488653 Mental health professionals evaluations of the Integral Intake, a metatheory-based, idiographic intake instrument. This conversation can lead to investigating strategies for how each can be heard, including short role-plays with opportunities to practice (Worrell, 2015). Client substance use and misuse at that level may need medical stabilization and detoxification prior to utilization of the Five Ps. Rowe, C. L. (2012). <<6D17E8AF19023D4BAD06A1AFD23B08FB>]/Prev 415012/XRefStm 2760>> It should be noted that the strategies and interventions applied here are used as illustrations and are specific to Dax and his concerns. 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). Journal of Marital and Family Therapy, 38(1), 122144. Kendler, K. S. (2012). 0000000016 00000 n https://doi.org/10.1016/j.janxdis.2015.09.005 Protective factors are those that help to moderate actual or potential substance use and misuse impact. 0000238570 00000 n 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. It can be changed and reviewed as the treatment is in progress if any new information come to light. hTILSQ=HC@K(`$*P2C 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). 0000004306 00000 n This is an essential step. 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). https://doi.org/10.1016/j.avb.2010.01.006 For example, many precipitating and perpetuating factors may overlap and fit in other boxes. (2013). 0000014949 00000 n J Am Acad Child Adolesc Psychiatry 2002;41(1):927. Sample #1: Conceptualization for CBT case This is a 35-year-old Caucasian man referred by his physician for treatment of generalized anxiety. 0000004656 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. %%EOF (2019). Impact of case formulation in cognitive behaviour [Patient] presents with a [diagnosis]. Current dose of sertraline is subtherapeutic, Ongoing discord in her romantic relationship, Good interpersonal support from her best friend who brought her to hospital, Re-experienced these feelings of abandonment after being fired from work. 0000241723 00000 n Substance Abuse and Mental Health Services Administration. 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. Participants: The leader of a meeting should carefully consider who he or she invites. Facing addiction in America: The Surgeon Generals report on alcohol, drugs, and health. 0000238491 00000 n Novice clinicians, who often have a more limited repertoire of strategies, may find the Five Ps valuable because of its systematic framework to clients. The American Journal on Addictions, 21(1), 3846. To help treat the client with psychosis maintaining specific behaviour can be beneficial and help avoid frustration and upsetting experiences (Johnstone 2009). The Canadian Journal of Psychiatry, 38(5), 351-358. 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. The following pages describe two approaches to documenting the formulation using the 5Ps structure, including a narrative and flowchart. Motivational interviewing: Building rapport with clients to encourage desirable behavioral and lifestyle changes. https://doi.org/10.1016/j.addbeh.2006.09.008 There was a parental divorce at age 5. 0000006923 00000 n Dax presents as extremely frustrated and embarrassed at being mandated to attend counseling sessions. Professional Case Management, 17(4), 164172. W. W. Norton. (Ed.). A good biopsychosocial formulation allows you to come up with a comprehensive and holistic treatment plan for your patient. Morin, J.-F. G., Harris, M., & Conrod, P. J. Van Wormer, K., & Davis, D. R. (2018). You've got your table all filled out now. Oxford University Press. Positive relationships, supportive community, and/or extended family/friends? The biopsychosocial model considers the 4 Ps for each of the biological, psychological, and social factors: The 4 Ps can be laid out in a 3 x 4 table to systematically do formulation and identity factors. 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. " [Formulation is] The lynch pin that holds theory and practice together" (Butler, 1998). 107127). CBT case formulations often have 5 ingredients: Presenting problem (s) Predisposing factors which made the individual vulnerable to the problem Precipitating factors which triggered the problem Perpetuating factors such as mechanisms which keep a problem going or unintended consequences of an attempt to cope with the problem Protective factors Clinical case formulations: Matching the integrative treatment plan to the client (2nd ed.). However, as mentioned previously, case formulations have been used across a variety of client concerns (Chadwick et al., 2003; Ingram, 2012; Persons et al., 2013). Penguin. Aldao, A., & Nolen-Hoeksema, S. (2013). In S. G. Hofmann & G. J. G. Asmundson (Eds. 0000002964 00000 n The case formulation in child and adolescent psychiatry. However, each has some shortcomings. According to Read et. Even weekly status meetings or things of that nature should have a clearly defined purpose. 0000118792 00000 n Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: A meta-analysis. It's useful to employ the 5 Ps throughout the planning process. 0000245206 00000 n People with paranoia tend to avoid these situations which would lead to distress (Clark et al 2005). https://doi.org/10.1080/02699931.2012.739998 0000014220 00000 n They may also present in the form of family, friends, or hobbies. 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. Ingram, B. L. (2012). 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). Macneil, C. A., Hasty, M. K., Conus, P., & Berk, M. (2012). 0000155834 00000 n She subsequently planned to overdose on her medications. (2013). (2011). Chiesa, A., & Serretti, A. Behind bars II: Substance abuse and Americas prison population. Liao, J.-Y., Huang, C.-M., Lee, C. T.-C., Hsu, H.-P., Chang, C.-C., Chuang, C.-J., & Guo, J.-L. (2018). Strategy as a Plan Planning comes naturally to many managers and as such, has become the default first step. If present categories are used, formulation can be limiting and dangerous. She has the following protective factors, including a supportive psychiatrist and friend. Do they have ability to be reflective or modulate their affect? Information. Linden, D. J. It can assist both novice and experienced clinicians working with clients who present for counseling with substance use and misuse. Introduction to formulation. U.S. Department of Health and Human Services. However, it does suggest that more than 60% had a substance use disorder and 20% were under the influence at the time of their offense (National Center on Addiction and Substance Abuse at Columbia University, 2010). Protective Factors (Persons, 1998). 0000239180 00000 n After being told she was fired from her job, she went home and self-harmed to cope with the distress of this loss. It is likely that other clinicians presented with Dax would use a different combination of approaches. 0000017296 00000 n For Dax, he shares that when he and his wife argue, it follows a very predictable pattern. Luoma, J. Bush, D. M., & Lipari, R. N. (2015, April 16). Barriers and facilitators affecting the implementation of substance use screenings in primary care clinics: A qualitative study of patients, providers, and staff. 0000186981 00000 n Annual surveillance report of drug-related risks and outcomes. Routledge. The patient may have a strong family history of the disease, a sedentary job, environmental exposures, and/or a nutritionally-poor diet. Predisposing looks at a wider understanding of the issues, looking at it in more lengthily way. (Johnstone & Dallos 2009). What can be done, realistically speaking. Frontiers in Psychiatry, 9, 19. 1189 76 It is important to remember that not everything will fit neatly into each box. She presents to hospital today with acute suicidal ideation and self-harm after being fired from her job. Acknowledging that his reticence is due to being obligated to attend counseling may assist in relationship building (Tahan & Sminkey, 2012). 0000239101 00000 n Delivery of mindfulness-based interventions may help to address stressful events that previously triggered substance use (Garland et al., 2014). Persons, J.B., 1989. 0000008363 00000 n (2016). )jB' */NNM;2=Kc.w}9XXtj+%]{IF UA_ 0000155905 00000 n OFarrell, T. J., & Clements, K. (2012). Based on what I have reviewed in this essay. Nothing gets resolved, and this cycle appears once again when they have conflict. 0000002760 00000 n Emotion regulation in cognitive-behavioral therapy: Bridging the gap between treatment studies and laboratory experiments. A course of action you intend to take or a series of guidelines you intend to follow. 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. Drug and Alcohol Dependence, 142(1), 350353. Case formulation, also referred to as conceptualization, is a skill new counselors often lack (Liese & Esterline, 2015). https://doi.org/10.1097/NCM.0b013e318253f029 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). 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. 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. 0000006779 00000 n 0000156091 00000 n This gives you a sense of their current level of functioning, prognosis, and guides your direction for treatment and management decisions. The Essay Writing ExpertsUK Essay Experts. Of course, the Mintzberg 5 P's of Strategy are part of an organisation's strategy, but it's also wise to look at the 5 P's as separate standpoints that all need to be considered for developing a strong and successful strategy. Easden, M. H., & Kazantzis, N. (2018). 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!). low mood) All rights reserved. 0000008644 00000 n They disagree, interrupt one another, yell, and he calms down by having several beers. As mentioned previously, the Five Ps is not meant to replace any other substance use and misuse intervention. These psychological symptoms/factors are then observed by the clinician to give a psychiatric diagnosis. 0000003178 00000 n Episodic future thinking in generalized anxiety disorder. - depression, self-harm, mania/psychosis, anxiety, etc.) Lack of adaptive coping mechanisms resulted in using self-harm to cope and avoid further emotional dysregulation. 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.

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