Factors in the 5 P's Model of Formulation

5 P’s Model   

The CBT formulation consists of 5 key stages which is known as the 5 P’s model. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors.  Within the ‘Presenting issues stage’ its about looking at the current problems or issues the person is facing, to get a clear understanding of what they are and then set goals or targets based around this. 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 then move onto ‘Perpetuating’ which looks at what factors are contributing to the remain of the problems the person is facing. ‘Predisposing’ looks at a wider understanding of the issues, looking at it in more lengthily way. The last P looked at is ‘Protective’ which as the name suggest looks at ways to prepare the client so that relapse is unlikely, this is done by looking at the strengths of the client as a platform to build on. I will go into further detail of the ‘5 Ps Model’ below. (Johnstone & Dallos 2009)

Predisposing factors

As I stated above this factor looks to get a wider understanding of what the issues is. It looks at situations both past and present which can be both experiences and distresses that lead to symptoms of a psychotic nature can lead to resolving the psychosis. This is an essential step.

This inspires the development of a longitudinal understanding of a person’s problems. This is intended to inspire the identification of more in-depth interventions that aim to sustain change and prevent relapse (i.e., promote long-term behavioural adjustment). 

It has been said that the experiences, incidents and or events in our life has an affect on both how we feel and behave. This can be both positive or negative but they have a direct correlation to how the person is today. What we understand today is shaped by what we believe and what we have experienced in our life.

Precipitating Factors

This stage of “formulation involves articulating the external and internal factors that can activate presenting problems” (Johnstone & Dallos, 2010). 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). These beliefs are set off by occurrences in the client life, and once this belief is activated it can lead to automatic negative thinking. 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.

Perpetuating factors

The internal and external factors that maintain the current problems. To help treat the client with psychosis maintaining specific behaviour can be beneficial and help avoid frustration and upsetting experiences (Johnstone 2009). People with paranoia tend to avoid these situations which would lead to distress (Clark et al 2005). 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. (Rachman & de Silva 1978, Salkovskis & Harrison 1984, sited in Tarrier et al. 2008).

Bentall (2004) had stated that obsessed person is highly sensitive to any threats to their self-esteem, therefore it is important to the individual to sustain the behaviour that they believe is protecting them from hurt to their self-esteem.

Protective Factors

The person’s resilience and strengths that help maintain emotional health. The therapist provides a route easiest for the client by identifying methods that build on the client’s current resilience and strengths. According to Read et. all (2004) it is essential to reduce stress and traumatic events for people recovering from Paranoid Schizophrenia, and start to contribute in social activities. However, an important skill that they should try to perform is to assess a situation before jumping to conclusions.

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One of the strengths of this formulation is that it is not fixed. It can be changed and reviewed as the treatment is in progress if any new information come to light. It is open to modification any time during the treatment period and any new evidence that crop up at any time will be discussed with the client. This is to ensure that the client understand any reason for change from what was originally agreed. Additionally, as it is a continuous process it allows the therapist to revise any incorrect hypothesis about any underlying mechanism at any stage. (Persons, 1998).

One of the weakness of this formulation is identifying that the client’s strength is not included the initial assessment and data collection. 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.

Equally if there is lack of collaboration, this can be as a result of expectations from either client or the therapist for example if the client have expectations from the therapist because he sees him as the expert and should be able to provide all the answers to his problems without him the client having an input.

Conclusion

Based on what I have reviewed in this essay. 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). It would be difficult to say which formulation is correct, and if there is such a thing as a correct one, since everyone has an individual view of what is right or wrong. What must be looked at in every formulation is if the particular formulation seems to be the right one and benefit for the person with the psychosis. It is believed that CBT receives government support and funding because it is cheap and quick, even though the empirical evidence for it is weak (Hussain 2009). CBT has been found to not be effective in schizophrenia (Lynch et al. 2009). According to Dr Oliver James (Hussain 2009) CBT is over praised; what CBT achieves any other therapy can achieve to. 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 doesn’t have a particular structure that everyone follows. If present categories are used, formulation can be limiting and dangerous. (Goldman & Greenberg 1997)

Reference

• Dallos, R. and Vetere, A., 2018. Working systemically with families: Formulation, intervention and evaluation. Routledge.21-37). Routledge.
• Drayton, M., Birchwood, M. and Trower, P., 1998. Early attachment experience and recovery from psychosis. British Journal of Clinical Psychology, 37(3), pp.269-284.
• Goldman, R. and Greenberg, L.S., 1997. Case formulation in process-experiential therapy.
• Hawton, K.E., Salkovskis, P.M., Kirk, J.E. and Clark, D.M., 1989. Cognitive behaviour therapy for psychiatric problems: A practical guide. Oxford University Press.
• Johnstone, L. and Dallos, R., 2013. Introduction to formulation. In Formulation in psychology and psychotherapy (pp
• Persons, J.B., 1989. Cognitive therapy in practice: A case formulation approach. New York: WW Norton.
• Rachman, S. and de Silva, P., 1978. Abnormal and normal obsessions. Behaviour research and therapy, 16(4), pp.233-248.
• Tarrier, N., Wells, A. & Haddock, G. (1990). Treating complex cases: The cognitive behavioural