Case Formulation: The Five Ps
A clinician formulation template using the five Ps: presenting problems, predisposing factors, precipitating factors, perpetuating factors and protective factors, with a final section drawing them into a maintaining cycle and a treatment focus.
About this resource
The five Ps framework is one of the most widely taught structures for case formulation across psychiatry and psychology. It organises what is known about a client into five headings: the presenting problems, the predisposing factors that made the person vulnerable, the precipitating events that triggered the current episode, the perpetuating factors that keep it going, and the protective factors and strengths that can be built on. The structure is theory-neutral enough to hold biological, psychological and social information, and specific enough to point toward treatment.
Its value in CBT comes from the emphasis on perpetuating factors. Predisposing and precipitating factors explain how the problem arose, but they are largely in the past; perpetuating factors are the processes operating now, and they are what treatment can change. A five Ps formulation that lists many historical factors and few maintaining ones will not generate a treatment plan. This template therefore gives the most space to perpetuating factors and asks you to describe how they interact as a cycle, before naming the treatment focus that follows.
The professional version includes prompts for each P, guidance on avoiding the common error of a formulation that is a list rather than an explanation, notes on sharing the formulation with the client in accessible language, and a worked illustration.
How to use it
- Complete the template after assessment, drawing on the history, the client's own account, and any measures. It is a working document; expect to revise it as therapy proceeds.
- Write presenting problems in the client's words, and be concrete about frequency, severity and impact. A formulation of a vague problem will itself be vague.
- For predisposing and precipitating factors, include only what has a plausible link to the presenting problems. A long list of biographical detail without a stated link is a history, not a formulation.
- Give the perpetuating factors the most attention. For each one, ask what it does: how it prevents disconfirmation, removes reward, increases threat, or reduces the person's resources. Then describe how they connect.
- Do not skip protective factors. They shape the treatment plan (what can be built on, who can help) and they matter to the client, who often hears only the problems reflected back.
- Share the formulation with the client, translated into plain language, and ask what fits and what does not. Their corrections improve it and their agreement makes treatment collaborative.
References
- Weerasekera, P. (1996). Multiperspective Case Formulation: A Step Towards Treatment Integration. Krieger Publishing.
- Macneil, C. A., Hasty, M. K., Conus, P., & Berk, M. (2012). Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice. BMC Medicine, 10, 111.
- Johnstone, L., & Dallos, R. (Eds.). (2014). Formulation in Psychology and Psychotherapy: Making Sense of People's Problems (2nd ed.). Routledge.
