Managing Therapeutic Approaches And Facilitating Therapeutic Interventions

Introduction Of Managing Therapeutic Approaches And Facilitating Therapeutic Interventions

All societies throughout the world have a large number of individuals who are affected by different mental health conditions. Managing these overwhelming conditions require adequate support from capable dedicated mental health care-giving systems and other sections of society. A study on the case of an adolescent greatly affected by the mental health condition of "anorexia nervosa" receiving therapeutic interventions provides the opportunity to understand the roles of various elements from multiple perspectives.

New Assignment Help is your one-stop destination for impeccable academic support. Our online assignment help in the UK caters to diverse subjects and topics, guaranteeing thorough assistance for every student. Explore our Free Assignment Samples to kick-start your assignments with confidence.

Role of Effective Communication Skills to Assess Jane’s and Significant Others’ Needs

A large part of the UK’s population suffers from various eating disorders and the adolescent population is the worst affected social group. And according to “The National Institute for Care and Excellence”, in the UK, almost 90% of the people suffering from these disorders are female. According to Statista, in 2020/21, “the most affected age group” by “anorexia nervosa” was adolescents aged 15-19, as observed in terms of the number of hospital admissions. Jane, a 15-year-old female belongs to this highly susceptible age group. The need for effective communication is prime in the diagnosis, assessment, and management of therapeutic interventions to tackle this mental health disorder successfully (Treasure et al., 2021). “NICE” mentions that AN has a “higher mortality rate” than “any other mental health disorders” and 20% of those are by suicides. Therefore, timely diagnosis and intervention to manage this become crucial. Effective communication is a must to properly manage therapeutic approaches for Jane. Revelation of the thought processes involving the motivation of Jane’s habit of self-starving, and the family dynamics with influencing factors is possible through communication (Leonidas et al., 2019). Patients like Jane find it hard to believe that their thought processes and habits need corrective measures. Even when they are diagnosed, they show a lack of compliance with the treatment programs. This can be overcome by establishing “good therapeutic communication”.

The “Multi-Disciplinary Team” focus on Jane’s “biological factors” including her current health, “social elements” like peer influence, and family dynamics, and “psychological status” including her low self-esteem, distorted body image, and lack of social skills to engage in the therapeutic relationship. This enables a coordinated and comprehensive mapping of the therapy procedure. Well-informed valid consent reduces resistance from the adolescent patient. Lower levels of frustration make patients like Jane focus on the progress and not feel overwhelmed by the details of the advice. When patients are aware of the importance of the parts of their “diet routine” and other actions advised by the therapists, they can believe and follow the advice regularly. Verbal communication skills can promote a good therapeutic relationship. These include greeting the individual with her preferred name, and a friendly introduction from the professionals conducting the therapy (Terache et al., 2023). The patient has to be properly informed about the expected activities regarding the upcoming interventions to decrease anxiety. Explaining the assessment procedure with “no jargon” and more “simple terms” can put her at ease. Highlighting the successes and the reasons for not being “embarrassed” are beneficial in achieving a better response. The use of respectful language and being cautious with using humour is necessary to avoid inadvertently “hurting” the patient. Patients like Jane with hearing impairment or other diminished senses need extra time to communicate (Wonderlich et al., 2020). Additional time must be allocated if necessary. Otherwise, the whole process becomes mostly ineffective due to a web of misunderstandings. Speaking slowly, occasionally repeating, and the use of simple terms is necessary. Active listening and paraphrasing of the words can easily confirm whether she is being misunderstood or not.

Non-verbal elements like using a positive tone and encouraging progress in terms of understanding and compliance are crucial. Maintaining eye contact and the careful use of facial expressions are important. Looking repeatedly at the clock, and reacting negatively to various bad habits of the patient are to be avoided. Focusing on the non-verbal cues and their modulation exerted by the patient can unravel the thoughts and feelings. Their confusion, inquisitiveness, and difficulties in understanding can be detected using these cues. A potential barrier in the therapeutic relationship could be the rise of conflicts. Differences in goals and expectations of the therapists and of the patient can harm the relationship. Undesirable interactions may include “limp” handshakes, making irrelevant small talk, not providing adequate information, asking personal questions, not initiating questions, disrespecting personal boundaries, not using simple terms, and even standing uncomfortably close (Bulik et al., 2019).

Jane’s impaired hearing, generally shy nature, and an initial reluctance to accept her mental condition to be real are major challenges in establishing a good therapeutic relationship. The lack of confidence in the effectiveness of the therapy exhibited by her family is another challenge. These are mitigated using effective communication with a focus on building “partnership” through one-on-one and group sessions, uninterrupted support guiding them, avoiding assumptions or judgements to build rapport, use of empathy, having the cultural competence to respect beliefs and culture, giving time and effort for explanations and trust-forming successfully (Moudatsou et al., 2020). Her perceptual distortions of the desirable body image were detected to be influenced by the pop-culture role models with unnatural body stats. Helping her understand the reality by citing examples of sportspersons, athletes, and various successful people from all walks of life with different ideal body weights was possible through successful trust formation and effective communication.

Patient-centred Collaborative Approaches for Better Service Delivery

Collaboration is the key to achieving the necessary effect of the therapy to help a patient manage his/her condition. Jane here is receiving therapeutic interventions to manage “AN”, which has fatality risks. It is prevalent among adolescents and various factors make her susceptible. Appropriate knowledge to tackle this, awareness of Jane’s condition and its severity, and a well-informed multidisciplinary approach to facilitate the interventions is achievable through the collaboration of all the stakeholders. A healthcare service user may feel overwhelmed by the program, and not feel to be a partner. This can happen due to a failure to establish an engaging relationship.

If the service user is not motivated to actively “work” towards recovery and the effort becomes one-sided, it becomes ineffective. Patients like Jane, who are shy, do not express their difficulties vividly. The reluctance to accept her reality makes the service unacceptable to her. The therapeutic interventions seem “embarrassing” and “forced” in nature. Communicating effectively, involving her family, citing realistic body weight examples, and explaining scientific diet habits are parts of the process. The intervention is primarily sought by her family at first, suggested and developed by the professionals (Yao et al., 2021). This may create a perception that the therapy disregards the patient’s will and concerns. This is what is observed in Jane’s case in which she believes that she is being forced to take part in the sessions and these are questioning her judgements in an embarrassing manner.

This in addition to her hearing impairment makes communication more challenging. Understanding her thought process requires the revelation of it at first. Jane is motivated to reveal her beliefs regarding an “ideal body weight” to look “beautiful like the pop stars”, and “good dietary practices” only after she is made to feel a part of the team, working together to achieve a common goal. Encouraging Jane to express and ask questions, and not reacting negatively with judgements or biases has a positive effect on forming trust. With repeated interactive sessions including the one-on-one sessions and family sessions, she was encouraged to open up in a safe environment which actively listens to her without passing judgements. Paraphrasing her words to confirm her thoughts conveyed, using simple terms, and a friendly yet professional tone of voice were helpful in enabling her to engage more easily.

Asking no irrelevant personal questions is a part of respecting the patient-caregiver professional boundaries mandated in the legal frameworks. “Sectioning” or compulsory treatment under the “Mental Health Act” is possible. Ethical concerns regarding the violation of the patient and the patient’s family’s right to proceed with the advised actions after being informed properly are mitigated with discussions. A multidisciplinary and objective-oriented approach with no lapses ensures the ethical requirement of the proper utilisation of the resources (Yilmaz et al., 2022). Taking the patient on board with willful participation ensures the legal requirements of service delivery which are aimed at preventing negative reactions from the patients feeling forced and disrespected. Prescribing necessary medications and deciding the dose have to be aligned with ethical medical practices which ensures the risks of overdosing through proper communication and assessment of the patient’s physical and mental status (Rønning and Bjørkly, 2019).

The service user, Jane, initially attempts to skip the therapy sessions with various excuses. Patients like her also avoid eye contact and respond vaguely with very brief answers to the questions asked by the professionals. Her distorted body image and a peer pressure-driven motivation to stand out as “beautiful” by looking like pop stars with unrealistic body standards were major challenges and sources of conflict. Later she found it difficult to follow a scientific routine of a nutrition-packed diet which according to her, includes “fattening foods”. The “multidisciplinary team’s” careful interventions to communicate with her, giving encouragement, and giving proper explanations were helpful in the gradual orientation of her thought patterns.

As a collaborative member of the team, she readily shares her experiences, the difficulties, and even her interest in accelerated recovery. She shows interest in this topic by looking up “facts” on the internet and mentioning “inspirational recovery cases” she finds on “YouTube”. These, in addition to compliance, indicate that the service user understands and trusts the service being delivered (Woodruff et al., 2023). Progress in terms of her body weight and self-esteem, and improved social participations also indicate the mutual success of this collaborative effort.

Although the adolescent individual needed prolonged therapeutic intervention and yet had mental reservations against it, the presence of an ideal power dynamic in the patient-caregiver relationship was instrumental in overpowering those reservations. The inherent design of the therapy includes respect at its core, avoids judgemental reactions, and attempts to make it a well-informed joint effort involving the patient and other relevant stakeholders including her family to be contributors to the collaborative endeavour (Peterson and Fuller, 2019). Here the therapists maintain a professional boundary which helps avoid power imbalances. The therapists are in the “position of authority” and they lead the recovery process with their expertise. The projection of their enhanced understanding, successes, and capability to effectively help the patient is key to keeping the patient motivated and trusting in the process (Bargiacchi et al., 2019). When the patient’s socio-economic status, cultural beliefs and behaviours are acknowledged positively, the therapeutic relationship becomes strong.

Evaluation of Caregiving-related Legal and Ethical Principles within Nursing Practice

The common ethical dilemmas in the case of mental health nursing need to be carefully considered to avoid any violation of human rights. Failure to conduct the duties with ethical practices, and in line with legal principles can lead to counter-productive damages. The mental health condition makes a patient like Jane vulnerable to multiple physical and mental health risks. Forceful and coercive practices may result in negative reactions and cause irreversible damage (DavyRomano, 2022). Misunderstanding stemming from communication gaps, inadequate interactions, and a lack of compassion exhibited by the service delivery team are the common risk factors giving rise to conflicts. Being able to respect the patient and her family’s autonomy in terms of the decision-making process is a must. Justification of coercive measures citing short and long-term patient benefits must be avoided. The lack of resources and the insufficient number of mental healthcare nurses in the UK is a major challenge. These by no means should be used as excuses for unethical practices of misguiding the patients, coercing them, misinforming the family, wrongly suggesting medication doses, and other malpractices (Brennan et al., 2020). The four key principles in mental health nursing care are “autonomy”, “justice”, “beneficence”, and “nonmaleficence”. The agency over the patient’s physical and mental health and the ability to take rational and independent decisions regarding these must not be violated by coercing a patient like Jane.

Even though Jane is not an adult yet, she has distorted perceptions, and is at risk of further damage if untreated, she has the right to autonomy with her family having a level of control over her decision-making. The capability to influence her to collaborate willingly is a part of the skill set of a mental healthcare nursing professional. Equal access to therapeutic interventions which are free from direct and indirect discrimination is necessary (Tah?ll?o?lu et al., 2020). Customising the accessibility to care to deliver services to the marginalised is a part of this “principle of justice”. Treating patients like this with the equitable distribution of the caregiving capacity, and maintaining fairness is necessary. The ethical obligation to employ all the effort and resources to benefit the patients, helping them recover and alleviation of suffering is known as “beneficence” which should guide the actions and continuously fuel the morale of the caregivers (Holmes et al., 2021). While pursuing treatment, a patient like Jane who is prone to suffer further damages needs to be meticulously monitored, all actions must be well-informed based on the observations and in alignment with the principle of “not inflicting harm” or “maleficence”.

In the nursing practice involving facilitating therapeutic interventions to help mental health patients like Jane recover from eating disorders like “anorexia nervosa”, the ethical and legal guidelines are highly useful. The noble purpose of dedicating the life and efforts of a caregiver to the mental health-related needs of society can be tarnished and become failed if patients like Jane do not show signs of improvement at a desired pace. The application of a defined and structured approach to conducting the activities is helpful in maintaining the ethical and legal duties of causing benefits, avoiding harm, and avoiding any violation of rights to autonomy (Buchanan et al., 2022). A “coordination”-centric compassionate approach ensures higher levels of participation, satisfaction, lower risk of damages, and recovery at a desired pace. Jane’s improved body weight, increased social activity and her wish to “help others recover from AN” are the promising results of this multi-stakeholder approach.

The impact of these ethical and legally aligned nursing practices has multiple benefits including the mental and associated physical health-related improvements exhibited by Jane. This has been a case of success which has boosted the morale of the caregivers involved in facilitating the therapeutic interventions including the nursing staff members. Jane’s improvement is an example of the possibility of success achievable through a coordinated effort. Effective nursing interventions involving “family therapy”, and successful compliance with “weight management plans” are exemplary and thereby boost the confidence and skill sets for future interventions (Radden, 2021).

Therapeutic Interventions in Mental Healthcare, through A Bio-Psycho-Social Perspective

The broader "bio-psycho-social model" in therapeutic interventions replaces the older "biomedical" approach to dealing with conditions like AN. The mental health of patients like Jane is affected by the combination of "biological", "social", and "psychological" factors. The genetic makeup of an individual containing certain mutations, and the brain chemistry can make her or him susceptible (Smaji? and de la Fosse, 2019). Unmanaged childhood stresses and traumas, cultural influences, and media can act as social factors (Stein et al., 2021). Jane's childhood experience of being bullied for being overweight, and her pop culture idols with unrealistic body stats are such well-identified factors (Bowen et al., 2022). The psychological tendencies motivating an individual like Jane to be a perfectionist about body image, and biased beliefs regarding "healthy non-fattening foods", etc. can intensify the problem.

Drug treatment of anorexia includes the use of antipsychotics in combination with the therapies. Digestion-related issues, osteoporosis, weak immune system, and other issues emerging due to chronic starvation are sometimes managed with different drugs specific to those problems. Antidepressants like "fluoxetine" may be recommended. The risk of using these medications includes several side effects like nausea, insomnia, and diarrhoea observed in a few cases worsening the condition (Attia et al., 2019). Long-term side effects include hormonal imbalance. In extreme cases of AN-associated anxiety and depression, the benefits of using these drugs may outweigh the risks.

Adolescents like Jane are primarily recommended for psychotherapy and the use of antidepressants is rare (van den Berg et al., 2019). As per NHS recommendations, around 40 sessions throughout a period of 12 to 18 months are used to help them understand the need for recovery, the effects of starvation, and the root causes. This also develops ways to cope with fears of gaining weight, and "not looking perfect". Failure to conduct regular assessments of the effects of such sessions may render all efforts partially or totally ineffective. Accompanied by diet advice these one-on-one and family sessions have been proven beneficial for patients like Jane in accepting the reality and working on improving health.

The psychosocial impairments of AN patients like Jane including poor interpersonal relationships, and social isolation can be mitigated by making them take part in "family therapy" and giving them access to "social support networks" and engaging in "social eating" and other activities. The recovery process becomes accelerated by reinforcing constructive behaviours through these (Beykloo et al., 2019). The care afforded to Jane involved coordinated and standard ethical practices. Proper application of bio-psycho-social evidence-based comprehensive therapeutic interventions has been proven instrumental in an expedited recovery process. Minimal use of medications, and successfully engaging various stakeholders like Jane and her family in the well-coordinated interventions are highly satisfying.

Conclusion

The coordinated participation of an MDT of experts, the AN-affected adolescent named Jane, and her family has promoted recovery at a desired pace. The key areas of demonstration and a reinforced understating are the required "communication skills" to build a functional relationship, the effectiveness of collaboration, the realistic nature of the need for adhering to the legal and ethical principles, and the success of well-established interventions including psychotherapy. The identification of barriers like communication difficulties and lack of trust has been successfully overcome. Skilful future demonstrations inspired by this, and further studies to integrate innovations and other developments to improve the interventions are the next logical steps.

References

Attia, E., Steinglass, J.E., Walsh, B.T., Wang, Y., Wu, P., Schreyer, C., Wildes, J., Yilmaz, Z., Guarda, A.S., Kaplan, A.S. and Marcus, M.D., 2019. Olanzapine versus placebo in adult outpatients with anorexia nervosa: a randomized clinical trial. American Journal of Psychiatry, 176(6), pp.449-456.

Bargiacchi, A., Clarke, J., Paulsen, A. and Leger, J., 2019. Refeeding in anorexia nervosa. European journal of pediatrics, 178, pp.413-422.

Beykloo, M.Y., Nicholls, D., Wong, I., Simic, M., Mills, E. and Brauer, R., 2020. Incidence of anorexia nervosa and the prescribing of psychotropic medications from UK Primary Care, 1996-2016: A retrospective database study.

Bowen, M., Lovell, A. and Waller, R., 2022. Stigma: the representation of anorexia nervosa in UK newspaper Twitter feeds. Journal of Mental Health, 31(1), pp.131-138.

Brennan, C.R., Chapman, S. and Illingworth, S., 2020. Evaluation of Refeeding Outcomes Over 5-Years in A Specialist Adolescent Eating Disorder Center in The UK: A Retrospective Chart Review Study.

Buchanan, M., Blackburn, R. and Hayhurst, C., 2022. 1902 Children and adolescent mental health (CAMH) services in the emergency department: UK-wide online survey.

Bulik, C.M., Flatt, R., Abbaspour, A. and Carroll, I., 2019. Reconceptualizing anorexia nervosa. Psychiatry and clinical neurosciences, 73(9), pp.518-525.

DavyRomano, E., 2022. From Treatment to Recovery: Family, Health, and Sociocultural Implications of Anorexia Nervosa. East Carolina University.

Holmes, S., Malson, H. and Semlyen, J., 2021. Regulating “untrustworthy patients”: Constructions of “trust” and “distrust” in accounts of inpatient treatment for anorexia. Feminism & Psychology, 31(1), pp.41-61.

Leonidas, C., Nazar, B.P., Munguía, L. and Santos, M.A., 2019. How do we target the factors that maintain anorexia nervosa? A behaviour change taxonomical analysis. International Review of Psychiatry, 31(4), pp.403-410.

Moudatsou, M., Stavropoulou, A., Philalithis, A. and Koukouli, S., 2020, January. The role of empathy in health and social care professionals. In Healthcare (Vol. 8, No. 1, p. 26). MDPI.

Peterson, K. and Fuller, R., 2019. Anorexia nervosa in adolescents: An overview. Nursing2021, 49(10), pp.24-30.

Radden, J.H., 2021. Food refusal, anorexia and soft paternalism: what's at stake?. Philosophy, Psychiatry, & Psychology, 28(2), pp.141-150.

Rønning, S.B. and Bjørkly, S., 2019. The use of clinical role-play and reflection in learning therapeutic communication skills in mental health education: an integrative review. Advances in medical education and practice, pp.415-425.

Smaji?, V.A. and de la Fosse, C., 2019. EMDR treatment for anorexia nervosa triggered by early traumatic experiences. Psychotherapy in Achieving Health and Well-being for Children and Young People, 2(2), pp.65-76.

Stein, K., Warne, N., Heron, J., Zucker, N. and Bould, H., 2021. Do children with recurrent abdominal pain grow up to become adolescents who control their weight by fasting? Results from a UK population?based cohort. International Journal of Eating Disorders, 54(6), pp.915-924.

Tah?ll?o?lu, A., Özcan, T., Yüksel, G., Majroh, N., Köse, S. and Özbaran, B., 2020. Is aripiprazole a key to unlock anorexia nervosa?: A case series. Clinical Case Reports, 8(12), pp.2826-2833.

Terache, J., Wollast, R., Simon, Y., Marot, M., Van der Linden, N., Franzen, A. and Klein, O., 2023. Promising effect of multi-family therapy on BMI, eating disorders and perceived family functioning in adolescent anorexia nervosa: an uncontrolled longitudinal study. Eating disorders, 31(1), pp.64-84.

Treasure, J., Parker, S., Oyeleye, O. and Harrison, A., 2021. The value of including families in the treatment of anorexia nervosa. European Eating Disorders Review, 29(3), pp.393-401.

van den Berg, E., Houtzager, L., de Vos, J., Daemen, I., Katsaragaki, G., Karyotaki, E., Cuijpers, P. and Dekker, J., 2019. Meta?analysis on the efficacy of psychological treatments for anorexia nervosa. European Eating Disorders Review, 27(4), pp.331-351.

Wonderlich, S.A., Bulik, C.M., Schmidt, U., Steiger, H. and Hoek, H.W., 2020. Severe and enduring anorexia nervosa: Update and observations about the current clinical reality. International Journal of Eating Disorders, 53(8), pp.1303-1312.

Woodruff, K., Joy, E., Burns, R.D., Summers, S.A., Metos, J.M. and Jordan, K.C., 2023. A Retrospective Chart Review Demonstrates that Coordinated, Multidisciplinary Treatment for Patients with Anorexia Nervosa Improves Odds of Weight Restoration.

Yao, S., Larsson, H., Norring, C., Birgegård, A., Lichtenstein, P., D?Onofrio, B.M., Almqvist, C., Thornton, L.M., Bulik, C.M. and Kuja-Halkola, R., 2021. Genetic and environmental contributions to diagnostic fluctuation in anorexia nervosa and bulimia nervosa. Psychological Medicine, 51(1), pp.62-69.

Yilmaz, Z., Schaumberg, K., Halvorsen, M., Goodman, E.L., Brosof, L.C., Crowley, J.J., Mathews, C.A., Mattheisen, M., Breen, G., Bulik, C.M. and Micali, N., 2022. Predicting eating disorder and anxiety symptoms using disorder-specific and transdiagnostic polygenic scores for anorexia nervosa and obsessive-compulsive disorder. Psychological Medicine, pp.1-15.