Case Formulation

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https://www.psychdb.com/teaching/biopsychosocial-case-formulation#the-formulation-table Case Formulation People are more than a diagnosis! De’An Roper, PhD, LCSW-S

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https://www.psychdb.com/teaching/biopsychosocial-case-formulation#the-formulation-table 4 P’s P redisposing, P recipitating, P erpetuating, P rotective Helpful in organizing our thoughts and helping us to figure out where to target our interventions. Provides historical influences at all levels of the person in environment Helps identify presenting factors Identifies barriers Includes strengths that are available to help support interventions Is a dynamic document Case Formulation paints a picture of how the client came to be who they are.

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Table 1. Formulation matrix Article Copyright © 2014 Authors, Source DOI: 10.1177/1039856214536240 . See content reuse guidelines at: sagepub.com/journals-permissions Chart for Case Formulation

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https://www.psychdb.com/teaching/biopsychosocial-case-formulation#the-formulation-table Predisposing factors – Risk factors that may influence the client, historical in nature Precipitating factors – Stressors or issues that have influence over what is going on with the client as they present to you for services Perpetuating factors – Barriers that prevent movement, change or growth Protective factors – Strengths or resiliencies that exist, these could be internally or within the environment The 4 P’s

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What was their temperament at birth? Is there a family psychiatric history? Are there toxic exposures in utero, birth complications, or developmental disorders? Is there a history of concussions or traumatic brain injuries? Neurodevelopmental history Predisposing   ( risks or historical influences ) Biological https://www.psychdb.com/teaching/biopsychosocial-case-formulation#the-formulation-table What is their attachment style? What is the family structure and how did they respond to family structure? Do they have problems with affect regulation? Psychological Social Poverty, teen parenthood, or poor access to health care? Childhood exposure to parental depression, domestic violence, or marital conflicts? Immigration history, marginalization, discrimination, or racism? Macro system influences

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https://www.psychdb.com/teaching/biopsychosocial-case-formulation#the-formulation-table Precipitating ( current and recent stressors)   Biological Serious medical illness or injury? Increasing use of alcohol or drugs? Medication non-adherence? Pregnancy or hormonal changes? Sleep deprivation? Psychological Stressor that activate one or more psychological processes: Cognitive: core beliefs and cognitive distortions Dialectical: emotional dysregulation and dysfunction Interpersonal: grief, loss, disagreement, change/transitions Psychodynamic: unconscious conflicts/defenses Interpersonal trauma Social Loss of or separation from close family, partner, or friends Interpersonal trauma Work/academic/financial stressors Recent immigration, loss of home, loss of a supportive service (e.g. - respite services, appropriate school placement)

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https://www.psychdb.com/teaching/biopsychosocial-case-formulation#the-formulation-table Biological Chronic illness/pain, functional impairment caused by cognitive deficits, or a learning disorder, TBI? Lack of medication optimization/ compliance or (suboptimal doses)? Current substance misuse? What are the degree of the MH symptoms right now? Sleep disturbance? Psychological Cognitive: core beliefs and cognitive distortions Emotional dysregulation and dysfunction Interpersonal: grief, loss, disagreement, change/transitions Psychodynamic: unconscious conflicts/defenses Self harm, poor coping skills, limited or lack of insight Social Lived experiences of racism Structural stigma Loss of or separation from close family, partner, or friends Isolation, unsafe environment Work/academic/financial stressors Recent immigration, loss of home, loss of a supportive service (e.g. - respite services, appropriate school placement) Perpetuating  ( chronic stressors or barriers to change)  

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https://www.psychdb.com/teaching/biopsychosocial-case-formulation#the-formulation-table Biological Good health Absence of familial psychiatric history Positive medication response No history of substance misuse Psychological Self reflection skills Self regulation and coping skills Capacity to be flexible in thinking Previous positive responses to treatment or behavior changes Identity exploration in love, work, and world view Subjective sense of self-sufficiency, making independent decisions Sense of identity Social Ability to make friends and get along with others Family and extended family support Safe neighborhoods and housing Opportunities for exploration in work and school Protective (strengths and resiliencies)  

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https://www.psychdb.com/teaching/biopsychosocial-case-formulation#the-formulation-table Multiple theories and frameworks can used to conceptualize Gregory’s case. Using  a social learning  lens Gregory’s alcohol use could be indicative of  modeling  as well as a  biological  link through  genetics . Gregory’s father abused alcohol while he was in his care, which he witnessed and thereby  modeled  the maladaptive behavior. Additionally, as his mother diagnosed with Borderline personality disorder diagnosis, genetics could explain his later development of the disorder which has a strong genetic component. From a  systems  perspective it is clear Gregory’s early experiences and interactions within his home and low SES community (victim of domestic violence, witness to interpersonal violence, murder, “ghetto”) presented him with a wide range of maladaptive adult interactions. The extended roots of  Psychodynamic  theory informs us that Gregory’s early childhood neglect and home discord would most likely result in a  disorganized/disoriented attachment style . Janet has biological factors related to genetic vulnerabilities for mental illness from her family history, her grandfather was diagnosed with schizophrenia and her mother suffered from major depression. She also has trouble with medication compliance because of structural barriers to employment with a living wage, and she resides in a rural area that does not have a near by pharmacy. These social factors greatly reduce her ability to take her medications on a consistent basis. Narrative Example: Using your chart, write the case report underscoring the application of the theory that supports your observations.

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PowerPoint Presentation Roper, De'An O Roper, De'An O 2 2021-02-23T15:42:24Z 2021-02-25T21:49:50Z

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