They may also present in the form of family, friends, or hobbies. Clinical Psychology 5 P Case Formulation (Macneil et al., 2012) Your mindset for intervention should be geared towards CBT - in NHS IAPT services this would be 'your' approach along with assessment as part of your case formulation. 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. Some of these evidence-based approaches will be demonstrated later in a case illustration. 0000003178 00000 n Experienced counselors, even with competence in a variety of approaches, can also benefit from using a framework to help address anticipated challenges (Macneil et al., 2012). However, like with anything, the more you practice, the better you will become at formulating. 0000200610 00000 n All rights reserved. Dax drinks two to three times a week, usually having one or two shots of whiskey and two to three draft beers. ), Essentials of clinical social work (pp. No plagiarism, guaranteed! (2017). 5 Ps Formulation Example. The Five Ps can be used in a variety of settings such as a community mental health agency, primary care clinic, and inpatient or residential treatment centers. It has been said that the experiences, incidents and or events in our life has an affect on both how we feel and behave. 0000180123 00000 n These psychological symptoms/factors are then observed by the clinician to give a psychiatric diagnosis. Substance Use & Misuse, 49(5), 492512. 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. Addressing client substance use and misuse can be quite complicated, and as mentioned previously, substance use and misuse impacts users and society in a variety of ways beyond substance intake. https://www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdf This can be both positive or negative but they have a direct correlation to how the person is today. The narrative formulation of the patient is a less rigid presentation structure where you may not choose to present everything in the 4 Ps table, and instead focus on the key factors that you think are relevant: A much more advanced and nuanced presentation might be using a more comprehensive formulation that integrates the 4Ps formulation through multiple lenses (e.g. Mental health professionals evaluations of the Integral Intake, a metatheory-based, idiographic intake instrument. https://doi.org/10.1111/j.1752-0606.2011.00242.x & Haddock, G. (1990). 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. It is important to remember that not everything will fit neatly into each box. 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. Correspondence may be addressed to Scott Peters, One University Way, San Antonio, TX 78224, scott.peters@tamusa.edu. Diagram of Ray's 5Ps formulation (Johnstone & Dallos, 2014) and core beliefs Source publication Integrating CBT and CFT within a case formulation approach to reduce depression and anxiety in. (2008). 0000156091 00000 n 0000002964 00000 n Implementing the Five Ps: The Case of Dax. Due to her history of abuse at age 12, she may have struggled with identity versus role confusion during that Eriksonian stage of psychosocial development. 0000186690 00000 n hA 4-`76>m{dKs. Client substance use and misuse can be quite challenging for counselors, both novice and experienced. Her mood was stable prior to this job loss, and she had no self-harm or suicidal thoughts in the past 1 year. Episodic future thinking in generalized anxiety disorder. Five additional elements are often added to this (referred to as 'the five Ps'): presenting problem (s) predisposing factors precipitating factors perpetuating factors protective factors. Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. British Journal of Clinical Psychology, 37(3), pp.269-284. What can be done, realistically speaking. (Rachman & de Silva 1978, Salkovskis & Harrison 1984, sited in Tarrier et al. 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). Plan: The Company must define and Plan its Goals and Milestones. https://doi.org/10.1186/s13722-018-0110-8 Predisposing looks at a wider understanding of the issues, looking at it in more lengthily way. This condition did not develop six months ago but developed during childhood when he failed to meet his father's expectations. 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! Current Drug Abuse Reviews, 4(1), 427. It's useful to employ the 5 Ps throughout the planning process. - Eriksonian developmental stages, psychodynamic defenses, and dialectical behavioural): Yet another way to present a formulation is in chronological order, starting from birth until present time: Having certain common phrases to use can be helpful to structure your presentation. Walsh, F. (2014). This essay may contain factual inaccuracies or out of date material. 0000156014 00000 n Journal of Anxiety Disorders, 36, 18. We would anticipate when engaging in treatment, the patient may have [resistance/transference/countertransference]. As Chadwick et al. https://www.ncbi.nlm.nih.gov/books/NBK343542 1189 76 Kendler, K. S. (2012). 0 Professional Case Management, 17(4), 164172. All work is written to order. 0000119626 00000 n Academic Press. The internal and external factors that maintain the current problems. 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. Cognition and Emotion, 27(4), 753760. Routledge. Keys to solution in brief therapy. As you get better and more expert at formulating, you may not need to use this rigid structured format, and instead, will be able to present a more intuitive and organic formulation of the patient instead (see other methods below). %PDF-1.4 % 0000239180 00000 n However, the patient has protective factors including psychological mindedness and previous response to therapy, which is a good prognostic factor. Dax is a 33-year-old married father of two children: a 9-year-old son, Cam, and a 7-year-old daughter, Zoe. The Canadian Journal of Psychiatry, 38(5), 351-358. 0000243959 00000 n 0000007722 00000 n He was recently driving home from work in the evening and law enforcement stopped him because of erratic driving. (2019). Diagnosis is not the same as formulation! She experienced, Brief summarizing statement that includes demographic information, chief complaint, and presenting problems from patient's perspective and signs and symptoms (onset, severity, pattern), Integrative statement: how these factors interact to lead to the current situation and level of functioning, prognosis, and potential openings for intervention. 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). We're here to answer any questions you have about our services. 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. Based on these factors, the following [treatment and management] would be the most helpful for this patient. Facing addiction in America: The Surgeon Generals report on alcohol, drugs, and health. Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: A meta-analysis. Precipitating factors are those that proximally bring about substance use and misuse and its resulting difficulties. Schoen, C., Osborn, R., Squires, D., & Doty, M. M. (2013). This conversation can lead to investigating strategies for how each can be heard, including short role-plays with opportunities to practice (Worrell, 2015). 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). Alcohol, cannabis, and opioid use disorders, and disease burden in an integrated healthcare system. Therapy, 38(1), 5981. 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. Johnstone, L. and Dallos, R., 2013. 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. 0000241200 00000 n Fig. 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. Presenting Issue(s) - please use the DSM-What assessment tools. Substance Use & Misuse, 53(4), 596605. Easden, M. H., & Kazantzis, N. (2018). Free resources to assist you with your university studies! Sample #1: Conceptualization for CBT case This is a 35-year-old Caucasian man referred by his physician for treatment of generalized anxiety. The approach that is highlighted in the 5Ps includes presenting, predisposing, precipitating, perpetuating, and protective factors. 0000245206 00000 n https://doi.org/10.1002/jclp.22516 Strategy as a Plan Planning comes naturally to many managers and as such, has become the default first step. Regrettably, most do not receive treatment while incarcerated (Belenko et al., 2013). (Eds.). (2003) noted, examining positive client experiences may be one way to discover how to increase client participation in substance use and misuse treatment. 0000006105 00000 n New Harbinger. Sancho, M., De Gracia, M., Rodrguez, R. C., Mallorqu-Bagu, N., Snchez-Gonzlez, J., Trujols, J., Snchez, I., Jimnez-Murcia, S., & Menchn, J. M. (2018). She has the following protective factors, including a supportive psychiatrist and friend. - depression, self-harm, mania/psychosis, anxiety, etc.) New York: WW Norton. W. W. Norton. Drug and Alcohol Dependence, 142(1), 350353. [1][2] Biopsychosocial formulation combines biological, psychological, and social factors to understand a patient, and uses this to guide both treatment and prognosis. It can be used in outpatient, inpatient, and residential settings and possibly as part of an aftercare program. 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. Here is an example of a set of treatment recommendations for Jane Doe: For good measure, here is another sample formulation for someone with a diagnosis of schizophrenia. Liao, J.-Y., Huang, C.-M., Lee, C. T.-C., Hsu, H.-P., Chang, C.-C., Chuang, C.-J., & Guo, J.-L. (2018). 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). One such framework is the Five Ps (Macneil et al., 2012). Additionally, the lack of coping mechanisms leading to intense thoughts of suicide. Dax was quite upset, cursed at her, and then hung up the phone. Substance use and misuse also has a negative impact on intimate partners, such as assuming increased responsibility and navigating unpredictability (Hussaarts et al., 2012). Formulation for beginners. Compton, W. M., Gfroerer, J., Conway, K. P., & Finger, M. S. (2014). What we understand today is shaped by what we believe and what we have experienced in our life. 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. He denies any significant increase in alcohol use or any other substance use. Furthermore, the Five Ps helps clients and counselors explore relationships between each factor and the presenting problem. To help treat the client with psychosis maintaining specific behaviour can be beneficial and help avoid frustration and upsetting experiences (Johnstone 2009). 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/10.2174/1874473711104010004 Garland, E. L., Froeliger, B., & Howard, M. O. The genetics of alcohol and other drug dependence. 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. https://doi.org/10.1037/a0038618 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. Bahorik, A. L., Satre, D. D., Kline-Simon, A. H., Weisner, C. M., & Campbell, C. I. This may open the door to a conversation regarding how his substance use and misuse may progress to alcohol use disorder and its definition as a pattern of alcohol use leading to clinically significant problems, including increase in use, failed attempts to stop, and use leading to an impaired ability to meet role obligations (American Psychiatric Association, 2013). Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. Health Affairs, 32(12), 22052215. In his report on alcohol, drugs, and health, the U.S. 0000119448 00000 n Han, B., Hedden, S. L., Lipari, R., Copello, E. A. P., & Kroutil, L. A. Dax can then share his and his wifes perspectives on their daughters care. https//doi.org/10.1016/j.drugalcdep.2013.02.018 Effects of treatment type on alcohol consumption partially mediated by Alcoholics Anonymous attendance. Study for free with our range of university lectures! There are limitations to the Five Ps framework as a way to formulate and intervene with clients substance use and misuse. Precipitating Factors 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 more cases you go through (and more of the sample formulations below) the more comfortable you will be with formulating! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860452/ A logical analysis using gentle Socratic dialogue may help to challenge his emotional reactions to his daughters heart murmur (Etoom & Ratnapalan, 2014). https://doi.org/10.1111/j.1521-0391.2011.00187.x Journal of Substance Abuse Treatment, 26(3), 151158. Given that client substance use and misuse can be quite complicated, using various approaches within the Five Ps framework may yield positive results. Presenting problems are concerns that clients find difficult to manage. 0000180034 00000 n May, R. (1950). 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. 0000002760 00000 n Weerasekera, P. (1993). The CBT formulation consists of 5 key stages which is known as the 5 Ps model. Frontiers in Psychiatry, 9, 19. We've received widespread press coverage since 2003, Your UKEssays purchase is secure and we're rated 4.4/5 on reviews.co.uk. A course of action you intend to take or a series of guidelines you intend to follow. This area explores significant occurrences that preceded or triggered the presenting problem and its consequences. Treating complex cases: The cognitive behavioural. According to Dr Oliver James (Hussain 2009) CBT is over praised; what CBT achieves any other therapy can achieve to. 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. " [Formulation is] The lynch pin that holds theory and practice together" (Butler, 1998). 0000200021 00000 n 0000010086 00000 n Here, a conversation about what counseling entails as well as psychoeducation related to the effects of alcohol on executive functioning may prove beneficial (Day et al., 2015). Aldao, A., & Nolen-Hoeksema, S. (2013). Unemployment and substance outcomes in the United States 20022010. These are historical psychological, biological, developmental, and socio-cultural factors that increased the person's vulnerability to their current problems. Etoom, Y., & Ratnapalan, S. (2014). Twelve-step attendance is most beneficial with inpatient substance use and misuse treatment (Karriker-Jaffe et al., 2018). 1. Conflict of Interest and Funding Disclosure He then withdraws and becomes sullen for a few days. The officers evaluated him, detained him, and subsequently arrested him for driving while intoxicated. 0000003215 00000 n In addition, using these approaches may result in omitting the uniqueness of clients as a consideration in treatment. The counselor may also assist Dax in emotional regulation, which may prevent the initiation of arguments (Aldao & Nolen-Hoeksema, 2013). Such a framework may enhance the effectiveness of the aforementioned interventions (Wormer & Davis, 2018). Our academic experts are ready and waiting to assist with any writing project you may have. The more you formulate, it can be helpful to have a rough template of different formulations for different diagnoses (e.g. ; DSM-5) bases an SUD on a pathological pattern related to the use of a substance (American Psychiatric Association, 2013, p. 483). What are the 5 Ps of case formulation? However, each has some shortcomings. These beliefs are set off by occurrences in the client life, and once this belief is activated it can lead to automatic negative thinking. Ploy: The Strategy has to analyze What Tactics can be Implemented. Plan A good strategy must have a plan. Societally, substance use and misuse consequences exceed $400 billion in crime, health, and lost productivity (U.S. Department of Health and Human Services, 2016, p. 2). 107127). 2009). Tarrier, N., Wells, A. 5 Ps narrative table, from Comprehensive Care Resource Guide Furthermore, clients like Dax who are mandated to attend substance-related counseling may have service plans that are not congruent with the Five Ps framework. 0000180256 00000 n 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. However, this can be done intuitively even without an in-depth understanding of these frameworks (we don't need to be Freud to do this). Delivery of mindfulness-based interventions may help to address stressful events that previously triggered substance use (Garland et al., 2014). The CBHSQ report: Substance use and substance use disorder by industry. 0000006894 00000 n 0000017180 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. 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). 0000186981 00000 n Protective Factors Results from the 2016 National Survey on Drug Use and Health: Detailed tables. It should be noted that the strategies and interventions applied here are used as illustrations and are specific to Dax and his concerns. One or more perpetuating psychological processes: Chronic marital/relationship discord, lack of empathy from family/friends, developmentally inappropriate expectations. Substance Abuse and Mental Health Services Administration. A, & Otto, M. W. (2010). 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). Motivational interviewing: Building rapport with clients to encourage desirable behavioral and lifestyle changes. 58 - 65. This can be even more problematic given the lack of health care access for large numbers of Americans (Schoen, 2013). But the most important thing about formulation is that it should be intuitive and flow logically. She presents to hospital today with acute suicidal ideation and self-harm after being fired from her job. 0000012631 00000 n Day, A. M., Kahler, C. W., Ahern, D. C., & Clark, U. S. (2015). 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. An example formulation is available (see A case example: "Sandra")* as an example of the type of output you 0000008644 00000 n Let's do a simplified formulation for the patient (Jane Doe) below. If your specific country is not listed, please select the UK version of the site, as this is best suited to international visitors. The patient appears to have adopted self-harming as a primitive coping strategy by early adulthood, and these have continued on in adulthood. SAMHSAs recommendations fit well with a more holistic framework in that such a structure allows clinicians to develop a multidimensional picture of clients. Annual surveillance report of drug-related risks and outcomes. Centers for Disease Control and Prevention. 0000004805 00000 n Oxford University Press. National Center on Addiction and Substance Abuse at Columbia University. Kleiman, M. A. R., Caulkins, J. P., & Hawken, A. Introduction to formulation. Behavioral health treatments and services. The image (. 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). Persons, J. 0000238491 00000 n Example of the 5 P's of Marketing John is considering operating a jet ski shop catering to travelers and tourists. 0000199672 00000 n Dax denies any other negative consequences from his alcohol use. health? This population often experiences stigma and suboptimal health care results (McNeely et al., 2018; van Boekel et al., 2013). The "5 Ps" we recommend include: Purpose: Every meeting should have a reason. For example, we diagnose someone with a major depressive episode if they meet 5 of the 9 symptomatic criteria. (Persons, 1998). Perpetuating Factors In S. G. Hofmann & G. J. G. Asmundson (Eds. Family therapy: Systemic approaches to practice. 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. 0000014949 00000 n The Oxford Textbook of Psychiatry[7] states that 'formulation is a concise statement of the case. Abnormal and normal obsessions. This has further exacerbated her alcohol use disorder. https://www.apa.org/pubs/journals/pas/index He is also adamant that he does not have a problem with alcohol. (2013). Substance use and misuse carries numerous potential repercussions. However, they may find this framework valuable as it provides one more way to address the often-encountered complex challenges of substance use and misuse. What it wants to Achieve. 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). 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). Looking for a flexible role? Currently, there are a variety of empirically based interventions for treating clients who engage in substance use and misuse. 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 . (2020, April 21). headspace recommends a formulation framework using the five Ps, as follows: Presenting problem (s): Initial signs, symptoms or other difficulties that are clinically important for the young person. *You can also browse our support articles here >. In this article, we'll explore the 5 Ps in more detail and the tools that you can use in each area. Information. 1: A step-by-step way of filling out a Biopsychosocial Table. In addition, the collaborative nature of the Five Ps reinforces the concept of an idiographic formulation. 0000017109 00000 n Your formulation of a patient evolves and changes as you collect more information. As part of his adjudication, Dax was required to attend five counseling sessions and have a clinicians report provided to the court. 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). You've got your table all filled out now. Routledge. 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). He fears that she will need open-heart surgery and that she may die. One of the weakness of this formulation is identifying that the clients strength is not included the initial assessment and data collection. In addition, the vast majority of those with an SUD never receive treatment (Han et al., 2015). Robinson, O. C. (2011). 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. Rowe, C. L. (2012). )jB' */NNM;2=Kc.w}9XXtj+%]{IF UA_ Positive relationships, supportive community, and/or extended family/friends? Client substance use and misuse at that level may need medical stabilization and detoxification prior to utilization of the Five Ps. ), Cover every box in the 4 Ps just for the sake of doing it (not all boxes will always apply!). 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. Chapter. She also drank 10 beers prior to arriving in the hospital. The compass of pleasure: How our brains make fatty foods, orgasm, exercise, marijuana, generosity, vodka, learning, and gambling feel so good. Journal of Marital and Family Therapy, 38(1), 122144. Borrell-Carri F, Suchman AL, Epstein RM. She subsequently planned to overdose on her medications. These can be in the form of personal characteristics such as tenacity, intellect, or insight. 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! McHugh, R. K., Hearon, B. Working systemically with families: Formulation, intervention and evaluation. Health Education Journal, 77(7), 749761. Narrative therapy to therapeutic ends. I will go into further detail of the 5 Ps Model below. 0000200185 00000 n (2018, August 31).
