A reply posts, reflect on your peers' analyses. Were their perspectives relevant and supported by research findings? Build upon their points or offer an alternative viewpoint.

According to Sperry and Sperry (2020), biopsychosocial case formulations are foundational for understanding a client's presenting issues, guiding treatment, and achieving treatment goals effectively and efficiently. When formulating a biopsychosocial case, the PMHNP Is gathering information to understand the client's diagnosis, patterns of maladaptation, barriers to care in preparing for successful goal attainment. The eight P's method is a format that can be used to simplify the process of writing a case formulation.

1. Presentation Includes nature and severity of symptoms. 2. Predisposition Defines vulnerabilities to a particular clinical condition or conditions. Predispositions may be biological, psychological, sociological, and cultural in origin. 3. Precipitants may be causative or coincidental with the onset of symptoms. Precipitants may be physical, psychological, and/or socialogical stressors. 4. Protective factors or strengths are beneficial in attaining treatment objectives and goals. Coping skills, behavior management, strong family support system, and or medication adherence are examples of protective factors. 5. Patterns can be described as predictable behaviors based on history of the patient and would be considered baseline. Patterns may be physical, psychological, or sociological patterns may be maladaptive or adaptive in nature. 6. Perpetuants reinforce patterns and may originate from the individual or the environment of the individual. Physical, psychological, social, agonistic relationships among social systems, and may be habitual in nature. 7. Plan of treatment refers to the process of guiding the client to Wellness through interventions, strategy, methodology, and treatment goals. The plan must be ethical and best practice decision making ideally developed including the client, treatment team, and PMHNP. 8. Prognosis is defined by the client's likelihood to achieve wellness. Is based on client strengths, readiness to change, risk factors, therapeutic approach, client provider rapport, and expertise of psychotherapist and/or PMHNP.

For PMHNP to effectively treat human conditions we must understand an individual to the best of our diagnostic ability. We must be willing to collaborate with a therapeutic team including the client. The more that a provider knows about a patient and the circumstances that make them who they are the easier it is to meet them where they are to establish a therapeutic relationship that will lead them to their highest level of wellness. Care gaps can be avoided utilizing the biopsychosocial case formulation methodology according to Gilboa-Schechtman (2024).

An example of having a thorough biopsychosocial case formulation has aided my practice on many occasions. While working in primary care I had a client that came in for a sick visit every two to four weeks for about two months before I caught on to an underlying mental health crisis. The young lady was around 22 years old, living on her own, and in a physically and emotionally abusive relationship. Had I not been asked to and began to ask questions regarding her social history, physical symptoms, and psychosocial history I may have missed getting her the treatment that she needed. She did have physical symptoms that required treatment at times that required pharmaceutical management. However, most of the visits she was and for encouragement, someone to listen and hear her, and get her the mental health care that she so desperately needed. Once she was referred to psychotherapy and began attending cognitive therapy, EMDR, started psychotropic medication management, changed her environment, and refined her coping skills her physical symptoms resolved. I cannot say it enough, we must listen to our clients for what is not being said more intentionally, get to know them, their family and social situations to treat them holistically, (Clifton, 2022). Illnesses are not originated from a singular stimulus much of the time.

References:

Clifton, C. (2022, June 28). Case formulation and intervention: Application of the five PS Framework in substance use counseling - the professional counselor. The Professional Counselor - The official journal of the National Board for Certified Counselors, Inc. and Affiliates (NBCC). https://tpcjournal.nbcc.org/case-formulation-and-intervention-application-of-the-five-ps-framework-in-substance-use-counseling/

Gilboa-Schechtman, E. (2024, April 26). Case conceptualization in clinical practice and training. Clinical Psychology in Europe. https://pmc.ncbi.nlm.nih.gov/articles/PMC11303933/

Sperry, J., & Sperry, L. (2020, December). Case conceptualization: Key to highly effective counseling. www.counseling.org. https://www.counseling.org/publications/counseling-today-magazine/article-archive/article/legacy/case-conceptualization-key-to-highly-effective-counseling