NURS 6640 – Psychotherapy With Individuals Essay Paper

NURS 6640 – Psychotherapy With Individuals Essay Paper

The systemic approach is essentially a contextual approach to therapy. That is it views the presence of illness or dysfunction as being located within the family system rather than in one of its individual members (Asen, 2002). Practitioners use the term systemic rather than family therapy, because being at the receiving end of family therapy can have strong connotations of blame (Asen, 2002). Systemic ideas have led to major contributions to modern day psychological therapeutic practice, for example, the premise that multi-systems account for the problem and not just the individual experiencing difficulties, a commitment to positive connotation and a non-blaming approach. NURS 6640 – Psychotherapy With Individuals Essay Paper

Several different versions of systemic therapy have emerged over the years. It began with the initial concept of systems theory and cybernetics being applied to the study, and subsequently the treatment of families (Dallos & Urry, 1999). In the 1950’s Bateson and his colleagues studied the patterns of transaction and communication in individuals with schizophrenia. The group hypothesised that the family of the patient was forming his or her thought processes through the peculiar communication requirements imposed (Bateson et al, 1956). The family was seen as a system with homeostatic tendencies. Family members were considered as various parts of this system and seen as behaving according to a set of explicit and implicit rules that determine interpersonal behaviours and communications (Watzlawick et al; 1967). Systemic therapy developed on this view of the family as a system. It aimed to challenge and disrupt unhelpful interaction patterns and dysfunctional communications, subsequently, allowing new ways of communicating to emerge (Asen, 2002). NURS 6640 – Psychotherapy With Individuals Essay Paper

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In fact therapy based on systems theory presented itself as a radical breakthrough in the treatment of mental illness. The prevailing models of therapy at the time considered pathology as predominantly residing in the individual experiencing difficulties. With the introduction of systems theories, it came to be seen in terms of characteristics of the family system. Thus it presented an extremely diverse view of many conditions, such as depression anorexia, schizophrenia, phobias and anxieties. Dallos & Urry, (1999), provide the example of a child displaying a school phobia. Systemic ideas suggest that the child might be carrying conflicts on behalf of others in the family. “The child’s symptoms are seen as functional; possible functions could be to ensure a role for an otherwise isolated and lonely mother, to keep a disengaged father involved, and to distract attention from unresolved conflicts in the marriage” (Dallos & Urry, 1999 p.165). Importantly, this implied that individual treatments might not only be ineffective but could actually exacerbate the problem. To just treat the child in the above example, could serve to reinforce the erroneous view that the problem was residing in the child rather than tackling the causes, which could lie within the family system. It was this breakthrough of seeing the illness not solely as residing in the individual but in the persons family system that could indeed be regarded as one of systemic therapy’s greatest contributions to psychological therapeutic practice. Thus therapists began to examine the patterns within systems or the family surrounding the individual experiencing difficulties. This first wave of the application of systemic ideas became known as first-order cybernetics (Dallos & Urry, 1999) and are briefly outlined below. NURS 6640 – Psychotherapy With Individuals Essay Paper

FIRST-ORDER CYBERNETICS

Structural approach

Initially Minuchin and colleagues, (1974), proposed the structural approach. This approach assumes a normative family model, claiming families function particularly well when certain family structures prevail (Asen, 2002). Normative families were seen as those with embedded structures, such as hierarchies between generations within a family. It was considered important that these structures had semi-permeable boundaries permitting a sufficient flow of information up and down between hierarchies (Asen, 2002). The aim of structural family therapy is to make a particular family structure approximate the typical (normative) model. Challenging directly absent or rigid boundaries, unbalancing the equilibrium by temporarily joining with one family member against the others, or setting homework tasks designed to restore hierarchies, are some techniques used within a structural approach (Asen, 2002). As mentioned above seeing the problems as residing in the family system rather than the individual was the ground-breaking and somewhat revolutionary at the time and a major contribution to psychological therapeutic practice. NURS 6640 – Psychotherapy With Individuals Essay Paper

Strategic systemic therapy

Strategic systemic therapy, is founded on the hypothesis that the symptom is being maintained by behaviours that seek to suppress it (Haley, 1963; Watzlawick et al, 1974). Asen (2002) provides the example of a woman with depression and low self-esteem which may elicit her partner’s over-protectiveness, a solution that maintains the presenting problem. A strategic therapist may re-frame the problem. For example, suggesting that the woman’s depression is an unselfish act designed to protect her partner from his own problems. The therapist may then prescribe a ritual whereby for a week on uneven days, the partner needs to experiment with discussing his own concerns (Asen, 2002). It is argued, by strategic therapists that once some changes are achieved in relation to the presenting symptom, a domino effect sets in affecting other interactions and behaviours in the whole family system. (Asen, 2002). The pervading problem is put into a different meaning-frame that provides new perspectives and therefore potentially makes new behaviours possible (Asen, 2002). Once again this reframing of the problem was innovative at the time and led to subsequent developments in therapeutic practice. NURS 6640 – Psychotherapy With Individuals Essay Paper

SECOND ORDER CYBERNETICS

“Mental illnesses are indeed mental, in that they are at least 90% made up of blame, or casual attributions that are felt as blame.” (Hoffman, 1993: 391)

The shift towards what became known as second order cybernetics was broadly paralleled with a move in the social sciences towards constructivism and a departure from the mechanistic version of systems theory (Dallos & Urry, 1999). Observations of patterns within systems were still seen as the major starting point but the emphasis was moved to an exploration of how the particular patterns within a family were shaped by their beliefs, explanations and meanings. Therapists began to make no assumptions about how family life should be and what represented a ‘healthy’ family.

The basic premise of this ‘second wave’ of systems theories (Dallos & Urry, 1999) was that the therapist and supervision team were seen as formulating certain ideas about a particular family’s dynamics. These were regarded as no more than working hypothesis (Selvini Palazzoli, 1980) and it was believed there was no objective reality waiting to be discovered (Dallos & Urry, 1999). It was imperative that therapists worked in teams rather than individually because it was seen as essential that the therapists continually reflected on and questioned their perceptions. NURS 6640 – Psychotherapy With Individuals Essay Paper

The Milan systemic approach

The Milan systemic approach advocated by Selvini Palazzoli and colleagues, (1978), holds great emphasis on a particular style of interviewing – circular and reflexive questioning (Selvini Palazzoli et al, 1980). The approach focuses on questioning the various family members’ beliefs and perceptions regarding relationships. Asking each to comment and reflect on the answers given by the various other family members creates feedback that changes the fabric of family interactions (Asen, 2002). The Milan group’s commitment to positive connotation produced a non- blaming approach. Selvini Palazzoli, Boscolo, Cecchin & Prata ,(1980), succeeded in establishing three principles that they considered indispensible to interviewing the family correctly. They called these principles – Hypothesising , Circularity, Neutrality. NURS 6640 – Psychotherapy With Individuals Essay Paper

“By hypothesising we refer to the formulation by the therapist of a hypothesis based upon the information he possesses regarding the family he is interviewing. The hypothesis establishes a starting point for his investigation as well as his verification of the validity of this hypothesis based upon specific methods and skills. If the hypothesis is proven false, the therapist must form a second hypothesis based upon the information gathered during the testing of the first” (Selvini Palazzoli, et al, 1980; p.1) NURS 6640 – Psychotherapy With Individuals Essay Paper

A fundamental point emphasized was that every hypothesis had to be systemic, therefore, include all components of the family. The hypothesis was seen as neither true or false but more or less useful. That is, it was used by the Milan group as more of an investigative tool. By investigating proposed hypotheses of the problem, whether they proved true or false, the hypothesis served its essential function of providing the team of therapists with new information.

The second principle proposed by Milan systemic therapy was that of circularity.

“By circularity we mean the capacity of the therapist to conduct his investigation on the basis of feedback from the family in response to the information he solicits about relationships and, therefore, about difference and change” (Selvini Palazzoli et al, 1980,p.4). NURS 6640 – Psychotherapy With Individuals Essay Paper

The acquisition of such an ability demands that therapists free themselves from the linguistic and cultural condition that make them believe they are capable of thinking in terms of “things” so that they may rediscover “the deeper truth that we still think only in terms of relationships” (Bateson, 1968;p.173). Circular questioning has subsequently been described as both an information-gathering and a change-inducing procedure. According to Tomm “the purpose of a systemic interview is not so much the removal of a problem but the discovery of its systemic connectedness and hence its temporal necessity (Tomm, 1985; p.44). The recognition of this necessity makes the need for alternatives self-evident and may result in a problem resolution that appears to be spontaneous (Tomm, 1985).

The third principle was termed by the Milan group as “neutrality”: NURS 6640 – Psychotherapy With Individuals Essay Paper

“By neutrality of the therapist we mean a specific pragmatic effect that his total behaviour during the session exerts on the family (and not his intrapsychic disposition).” (Selvini Palazzoli et al, 1980; p.6). Ideally if the principle of neutrality is maintained throughout a family session, the family members should feel that the therapist had not sided or supported any one family member in particular. Instead the Milan- systemic therapist builds successive alliances, the end result of which is that the therapist is allied with everyone and no one at the same time. The therapist works to provoke feedback and collects information, the more the therapist does this the less apt to make moral judgements of any kind. It is also the responsibility of the therapist to observe and neutralize as early as possible any attempt towards coalition, seduction, or privileged relationships with the therapist made by any member or subgroup of the family (Selvini Palazzoli et al, 1980). NURS 6640 – Psychotherapy With Individuals Essay Paper

Social Constructionist approach

The Social Constructionist approach is based on the reality that the therapist observes is created, with perceptions being shaped by the therapist’s own cultures and his/her ingrained assumptions and beliefs. This approach is influencing many systemic therapists and has led to an examination of how language shapes problem perceptions and definitions ( Asen, 2002). Family therapists are interested in the active process of meaning-making and the greater variation of possibilities – the inherent ideas in particular discourses and the ideas that had been excluded (Boston, 2000). If the narratives in which clients describe their experience- or have their experience reported by mental health professionals- do not fit these experiences, then significant aspects of their lived experience will contradict the dominant narrative (White & Epston, 1990: cited in Asen, 2002) and be experienced as problematic. NURS 6640 – Psychotherapy With Individuals Essay Paper

Narrative Therapy

Systemic narrative therapy proposes to help families to produce and evolve new stories and ways of understanding events to make sense of their experiences. Family and therapist together co-construct new ways of describing the individual and related family issues so that they no longer need to be viewed or experienced as problematic (Asen, 2002).

Brief solution-focused therapy

In brief solution-focused therapy, the problem drenched ways of talking are deliberately ignored, with the focus instead on the patterns of previous attempted solutions (De Shazer, 1985). The approach is based on the observation that symptoms and problems have a tendency to ebb and flow. During times when a symptom is less or not present, the therapist designs therapeutic strategies around the exceptions, as they form the basis of the solution. “The theory postulates that by encouraging families to amplify the solution patterns of their lives, the problem patterns can be driven into the background” (Asen, 2002; 231). NURS 6640 – Psychotherapy With Individuals Essay Paper

Psychoeducational approaches

Psychoeducational approaches (Leff et al, 1982; Anderson, 1983) combine behavioural interventions with structural approaches. Family members are educated about the causes and the course of the individual’s mental health problem. The general aim of therapy is to reduce the emotional intensity in the family as well as the degree of physical proximity (Asen, 2002). One of the main important aspects of this approach are regular relatives’ groups- to share experiences and solutions- and family sessions (Kuipers et al, 2002) (Asen, 2002). NURS 6640 – Psychotherapy With Individuals Essay Paper

Behavioural family and couple therapy

Behavioural family and couple therapy views the family as a major health-enhancing resource, with each member doing his/her very best to maximise pleasant and minimise unpleasant events in the family unit and the immediate social environment (Asen, 2002). Therapists in this framework employ such things as contingency contracting or operant conditioning to illicit behavioural change. After observation and analysis of recounted family or couple interactions, concrete goals for change are targeted by both family and therapist. The therapists and families work together on behaviours which can be easily modified and changed. Initially the focus is on positive feelings, ideas and plans and once some progress has been made, the focus shifts to the expression of negative feelings, in a constructive manner so that problem resolution can be facilitated (Asen, 2002). The therapist then adopts a structured- problem solving stance to encourage family members to agree on the problems and goals, discuss solutions and to highlight advantages and disadvantages of each proposed solution. Finally an implementation plan is put in place and the family and therapist continually review the efforts and results (Falloon, 1988). NURS 6640 – Psychotherapy With Individuals Essay Paper

Summary

In summary there are extremely diverse systemic approaches which have developed since the initial application of systems theories to therapy in the 1950’s. In its very conception, systemic therapy challenged the psychiatric/medical prevailing attitudes of the time and offered an alternative to the oppressive practices of stigmatization, isolation, confinement and enforced treatments. The innovative idea of externalising the problem to the individual’s wider systems and a fierce commitment to positive connotation has had a major impact on current therapeutic interventions. In addition to this, the premise of enlisting family members or ‘system’ members as therapeutic agents, surrounds the individual experiencing difficulties with an invaluable support system. The next section of this paper highlights the impact and contribution of systemic idea’s to therapeutic practice by discussing the evidence base for anorexia, schizophrenia and child-focused problems. NURS 6640 – Psychotherapy With Individuals Essay Paper

ANOREXIA NERVOSA

Over the past two decades family therapy has gradually established itself as an important treatment approach in eating disorders. It has been found to be particularly effective in adolescent anorexia nervosa. Its impact to the treatment of anorexia nervosa, particularly in adolescent sufferers could be considered to be one of Family therapy’s greatest contributions in a clinical setting.

There is a consistent body of empirical evidence for the effectiveness of family -based treatments which adds significant weight to the earlier clinical and theoretical accounts of some of the pioneers of family therapy such as Minuchin (Minuchin et al. 1975) and the Milan group (Selvini Palazzoli et al. 1974) and has undoubtedly been one of the important factors in the major changes in the treatment of eating disorders that the field has witnessed in the past 20 years (Eisler, 2002). NURS 6640 – Psychotherapy With Individuals Essay Paper

However in contradiction, alongside the evidence for the effectiveness of family therapy, there has also been growing evidence that the theoretical foundations from which this treatment has evolved are flawed. The ‘psychosomatic family’ model proposed by Minuchin et al (1978) suggested that there was a specific family context within which the eating disorder developed. It was suggested that a particular family process evolved around the symptomatic behaviour in interaction with vulnerability in the child and the child’s role as mediator in cross generational alliances (Minuchin et al. 1975) (cited in Eisler, 2002). Minuchin et al. (1975) emphasised the evolving and interactive nature of the process and saw the resulting ‘psychosomatic family’ as a necessary condition for the development of the eating disorder. The evidence for the psychosomatic family is weak and more recent findings have indicated that families in which an eating disorder sufferer is present are heterogenous group. This heterogeneity is not only with respect to socio-demographic characteristics but also in terms of the nature of the relationships within the family and the emotional climate and patterns of interactions (Eisler 1995). NURS 6640 – Psychotherapy With Individuals Essay Paper

Regardless of whether the family has an impact on the aetiology of the eating disorder, the major impact of an eating disorder, on family life, cannot be denied. ” As time goes on food, eating behaviours and the concerns that they give rise to begin to permeate the entire family fabric, every relationship in the family, influencing daily family routines, coping and problem solving behaviours.”(Eisler, 2002, p.292). Due to the monumental impact of the disorder on the entire family, an intervention that includes the entire family seems logical.

The most important facet of systemic therapy is that the family is seen as resource. It is important to explore with the family where things have got stuck and to help them to re-discover some of the resources that they have as a family so that they can become ‘unstuck’ and start looking for new solutions to the problems (Eisler, 2002).

As mentioned previously there is a growing body of evidence for the effectiveness of systemic family therapy in the treatment of anorexia, in particular adolescent anorexia nervosa. The initial studies were uncontrolled follow up studies. The first study of family therapy with patients with a diagnosis of anorexia nervosa was conducted by Minuchin and colleagues (1975). Their study involved 53 anorexic patients, just over half of whom started receiving inpatient treatment in conjunction with family therapy. Some patients were also seen individually. The results were extremely positive, the researchers reported a recovery rate of 86%, however the study has been heavily criticised for its methodological weaknesses (the evaluations were conducted by members of the clinical team, there was no comparison treatment and the length of follow-up varied from 18 months to 7 years ) (Eisler, 2002). NURS 6640 – Psychotherapy With Individuals Essay Paper

A similar study conducted by Martin (1985) showed positive results comparable to that of Minuchin and colleagues’ study. The research was a five year follow up of 25 adolescent anorexia nervosa patients (mean age 14.9 years), with a short duration of illness (8.1 months). At the end of the treatment period there had been significant improvements, although only 23% would have met the Morgan/Russel criteria for good outcome, 45% for intermediate outcome and 32% poor outcome. The results at follow-up were 80% having good outcome, 4% intermediate and the remaining patients either still in treatment (12%) or relapsed (4%).

Two other studies (Dare, 1983; Mayer, 1994) used family therapy as the only treatment intervention and found that 90% of patients had made significant improvements or were recovered at follow up. However, both of these studies were small (12 and 11 patients).

A third lager study, conducted by Stierlin & weber, (1987, 1989), took place with families seen at the Heidelberg Centre over a period of 10 years and adds to the evidence that adolescents and probably also young adults, do well in family therapy (Eisler, 2002). NURS 6640 – Psychotherapy With Individuals Essay Paper

To date there has not been very many randomized clinical trials in anorexia nervosa and the few that there is having been relatively small. Russell and colleagues (1987), compared family therapy and individual therapy and found that adolescent patients with a short duration faired significantly better with family therapy than the control treatment (individual therapy). The findings were however, inconclusive for those with duration of illness of more than three years who mostly had a poor outcome. Eisler (1997), conducted a five-year follow up of this study and showed that in the adolescent subgroup who had a short history of illness, those who received family therapy continued to do well with 90% having a good outcome. In comparison while those that had received the individual therapy also improved, nearly half still had significant eating disorder symptoms. This finding suggests that the benefits of family therapy can still be detected, 5 years after the end of treatment (Eisler, 2002).

Several other important studies have compared different types of family therapy. Two such studies were Eisler et al (2000), and LeGrange and colleagues (1992). Both researchers compared Conjoint Family Therapy (CFT) and Separated Family Therapy (SFT) in which the adolescent was seen on their own and the parents were seen in a separate session with the same therapist. Overall, the results of both studies showed improvements in both the CFT group and the SFT group. The study by Eisler and colleagues, suggested that on individual psychological measures and measures of family functioning there was significantly more change in the CFT group. NURS 6640 – Psychotherapy With Individuals Essay Paper

Similarly, a study by Robin et al (1999), also investigated the differences between two forms of family therapy. Researchers compared conjoint family therapy, which they described as behavioural family systems therapy – BFST, with ego-orientated individual therapy – EOIT. The EOIT consisted of individual therapy for the patient on a weekly basis, combined with fortnightly meetings with the parents. Robin and colleagues, (1999) found that by the end of treatment, both the BFST (similar to the Eisler, CFT group ) and the EOIT group patients had significantly improved, with 67% reaching target weight by the end of treatment. A one year follow up found that 75% had reached their target weight. The research found that BFST led to significantly greater weight gain than EOIT both at the end of treatment and at follow-up (Robin et al. 1999). Both groups produced comparably large improvements in eating attitudes, depression and self-reported eating-related family conflict. Furthermore a decrease in maternal negative communication and an increase in positive communication was found in the BFST group but not the EOIT group. NURS 6640 – Psychotherapy With Individuals Essay Paper

In summary, the overall consistent findings of these studies is that adolescents with anorexia appear to respond better to systemic family therapy, and often without the need for inpatient treatment (Eisler, 2002). Conclusions about the comparisons between different kinds of family therapy have to be examined more carefully. This is mainly due to the small size and small number of comparative studies (Eisler, 2002). It seems apparent that those treatments which encourage the parents to take an active role in tackling the adolescents anorexia are the most effective. According to Eisler, 2002, these therapies may have some advantages by over involving the parents in a way that is supportive and understanding of the adolescent, but encourages them to step back from the eating problem. Furthermore it has been suggested that not involving the parents in the treatment at all, leads to the worst outcome and may considerably delay recovery of the patient. However it should be noted that seeing whole families in which there are high levels of hostility or criticism, may be disadvantageous to the individual with anorexia. According to Szmuckler and colleagues, 1985, such families may be difficult to engage with and this may be even more salient when the whole family is seen together. During family sessions feelings of guilt and blame may be increased as a consequence of criticisms or confrontations brought up during the family therapy session (Squire-Dehouck, 1993). NURS 6640 – Psychotherapy With Individuals Essay Paper

SCHIZOPHRENIA

Providing family intervention therapy for individuals with schizophrenia is widely accepted as being beneficial to the both to the individual with schizophrenia and their families. Both the NICE (2003) and PORT (Lehman et al., 1998) guidelines recommend some kind of ‘family work’ or ‘family intervention’ for schizophrenia (Bertrando, 2006). It’s efficacy with treating individuals with Schizophrenia could also be considered one of systemic family therapies major contributions to clinical practice. Although there is considerable variability in the format of systemic-family based interventions, they tend to share a common set of assumptions. Firstly schizophrenia is regarded as an illness; secondly, the family environment is not implicated in the etiology of the illness. Third, support is provided and families are enlisted as therapeutic agents and lastly the interventions are part of a treatment package used in conjunction with routine drug treatment and outpatient clinical management (Lam, 1991; Dixon & Lehman, 1995). The elements of family interventions most frequently used in differing combinations are psycho-education, behavioural problem solving, family support, and crisis management (Dixon & Lehman, 1995). It is clear that effective family treatments involve at least some conjoint family meetings which include symptomatic and non-symptomatic family members. Emphasis is placed on blame reduction, the positive role which family members can play in the rehabilitation on the person experiencing difficulties and the degree to which family intervention will alleviate the family’s burden of care (Carr, 2000). One helpful aspect of systemic -family intervention is that it provides family members with an ‘explanation’ or ‘framing’ of the condition which provides “a rationale for reducing family stress, increasing family support and active coping and arranging for the person with schizophrenia to adhere to the prescribed medication regime” (Carr, 2000; 284). NURS 6640 – Psychotherapy With Individuals Essay Paper

Initially a study by Brown (1972) found that people with schizophrenia from families that expressed high levels of criticism, hostility, or, over-involvement have more frequent relapses than individuals with similar problems from families that tended to be less expressive of their emotions. There are now several interventions available to families involving education, support and management to reduce expressed emotion etc. (Pharoah et al, 2006). The aim of such family interventions is to reduce stress within the families and subsequently by doing so reduce the levels of relapse. Interventions are proposed to accompany drug treatments rather than to be used as an alternative (Pharoah et al, 2006). NURS 6640 – Psychotherapy With Individuals Essay Paper

A review by Mari, (1996), found that family interventions in Schizophrenia significantly reduced hospital admissions at one year follow up. Further to this, the most recent review carried out by Pharoah and colleagues, (2006) lends support to Mari’s, (1996) original finding and up to date evidence suggests that family intervention does statistically and significantly reduce hospital admissions at one year (Pharoah et al, 2006). In addition, at 18 month follow up, family intervention was still found to significantly reduce levels of admission to hospital. A study lending support to this hypothesis, reported that total number of days spent in hospital at 3 months was significantly lower for individuals that had received family interventions. Another study by Xiong (1994) cited by Pharoah (2006), favoured family intervention. The authors reported that 33 individuals receiving family intervention , spent on average 7.9 days in hospital by the end of 1 year follow up period, compared to 28 controls who spent on average 24 days in hospital.

In terms of effect of family intervention on the families or relatives of the individual with schizophrenia, a study by Bloch, (1995), pointed that family’s ability to cope with the illness was not clearly increased by family intervention. However, the study did report that the families understanding of the patients’ needs were statistically increased by family intervention. In contrast Szmuckler, (2003), reported on continuous measures of coping by the carers and found ambiguous results with no benefit been shown for those in intervention group compared to controls. However studies have proven that family intervention decreases significantly the levels of criticism and hostility compared to groups not receiving family therapy (Tarrier, 1988). Increased understanding of an individual’s difficulties with schizophrenia, coupled with decreased levels of hostility and criticism towards that person, can be viewed a significant and important contribution of systemic therapy to dealing with this condition. NURS 6640 – Psychotherapy With Individuals Essay Paper

There is also evidence to suggest that family intervention is favourable when compared to standard care. A study by Chen, (2002; cited in Pharoah, 2006), reported that at the end of 1 year follow up, family therapy intervention did significantly reduce relapse rates of patients. Zhao, (2000), found that at 2 year follow up rates were again significantly lower in the family intervention groups. Furthermore studies looking at relapse rates at 3 year follow up also favoured family therapy (cited in Pharoah, 2006).

In their review, Pharoah and colleagues, (2006), concluded that people receiving family therapy may relapse less than standard care groups. However it is noted by the authors that unpublished and inaccessible smaller negative studies that could not be included in the current review, and may weaken the overall findings (Pharoah, 2006). But at the moment the best available evidence suggests that approximate number of families needed to be given Family Intervention in order to avoid the relapse of 1 patient at the end of 1 year, is 8. The impression of better overall global improvement in family intervention groups is supported by several other studies (Xiang, 1994; Ran, 2003; cited in Pharoah, 2006).

Family intervention was not shown to either hinder or promote the completion of one year of therapy , however findings do suggest that family therapy does promote compliance of individuals with schizophrenia and medication (Pharoah, 2006). The authors propose that it can be speculated that this is the reason that family Intervention has its main effect. Hogart, (1997), suggests that although compliance with medication was indeed improved by family. NURS 6640 – Psychotherapy With Individuals Essay Paper

According to World Health Organisation (WHO) ‘mental health is defined as a state of well-being in which every individual realize his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community’ (World Health Organization 2014).

What is Schizophrenia?

Schizophrenia is a long-term mental health condition that causes a range of different psychological symptoms which is caused by a mixture of genetic and environmental factors such as changes in the brain chemicals and stressful life experiences such as: a bereavement, abuse or losing job or home (leaflet reference) which can be disruptive and have an impact on the person’s ability to carry daily tasks such as going to work or maintain relationships with others (Psych Central 2014). Antipsychotic drug regimens for schizophrenia are used in order to limit the frequency and severity of relapses, maximise the beneficial effects of treatment for persistent symptoms and enhance adherence to recommend regimens. Also psychosocial interventions are required in order to manage the disability that results from negative symptoms and cognitive dysfunction (Barry, S. Gaughan, T and Hunter, R. (2012). NURS 6640 – Psychotherapy With Individuals Essay Paper

There are five types of schizophrenia and they are:

Paranoid subtype; this is one of the main subtypes of schizophrenia characterized by an intense fear which is often accompanied by delusions and hallucination, for example individuals who suffer from this condition have a fear of being threatened and being killed by certain individuals and therefore they will spend the majority of their time protecting themselves from these certain individuals (Mental Health Daily 2014). NURS 6640 – Psychotherapy With Individuals Essay Paper
Disorganised subtype; disorganisation of thoughts processes, difficulty in communicating properly, absence of hallucinations and delusions. People with this type of schizophrenia sometimes face difficulties in doing their daily tasks or activities. (Taylor V 2011).
Catatonic Subtype; this is a very rare subtype which includes extremes of behaviour and causes the patient to not have the ability to speak, move or respond. The symptoms of catatonic subtype include the patient to stare and hold their body in a fixed position. Appear unaware of their surroundings. The patient might repeat someone else movement or gestures (MNT 2004-2014).
Undifferentiated Subtype; this is when the patient experience the positive and negative symptoms of all the above but is not enough to be defined as another type of schizophrenia (Goldberg J 2005-2014). Residual Subtype; this subtype involves experiencing minimal positive symptoms of the illness, with more negative symptoms, and in some cases, more cognitive symptoms (Mental Health Daily 2014). NURS 6640 – Psychotherapy With Individuals Essay Paper

According to psycho central there are around 1 in 100 people suffer an episode of schizophrenia, which usually appears in people in their late teenagers or during their twenties. It is more common in men than women, due to the fact that men engage in physical sports, which increases the risk or them to suffer from brain injuries or damage their brain. Also it is considered to be a lifelong condition which is rarely cured but can be treated (Psych Central).

Causes of Schizophrenia

According to the National Health Choices schizophrenia is caused by a combination of genetic, physical, environmental and psychological factors that contribute with developing schizophrenia.

Genetics

It is recognised that 85% of vulnerability to schizophrenia is genetic. However, the amount of genetic vulnerability is not known as no single gene has been identified as a risk for schizophrenia (Lee Fontaine, K. (2009) Pg. 345).The biological approach believes that the person’s genes control his/her behaviour. It proves that illnesses such as schizophrenia are inherited because of the person’s genes, which can be controlled using antipsychotic Medicines. Schizophrenia can be genetically inherited from a close family member condition such as brother, parents; sister of someone with schizophrenia has 1 in 10 chance of developing schizophrenia. Also a child born with both parents having schizophrenia has a 1 in 2 chance of developing the condition (Patient.co.uk 2014). Furthermore, in identical twins if one of the twins develops schizophrenia, then the other twin has a 1 in 2 chance of developing it as well, even if they are raised separately, as they share the same genes. However in non-identical twins the chance of the other twin in developing schizophrenia when the first one develops it is 1 in 7, due to the different genetic make-ups (NHS Choices 2014). The majority of the population have no risk for schizophrenia, as the more protective factors people have, the less likely their chance of developing the disorder (Lee Fontaine, K. (2009) Pg. 346). NURS 6640 – Psychotherapy With Individuals Essay Paper

Drug Misuse

Studies have shown that drug misuse increases the risk of developing schizophrenia or a similar illness. Certain drugs such as cannabis, LSD, cocaine or amphetamines can cause symptoms of schizophrenia in people who are vulnerable. Three major studies (who down the studies) have shown that teenagers under the age of 15 who use cannabis are up to four times more likely to develop schizophrenia by the age of 26 (NHS Choices 2014). As the brain is still developing in the teenage years and using any substance that affects the developing process can cause long term psychological effects (West London Mental Health (NHS) 2014. NURS 6640 – Psychotherapy With Individuals Essay Paper

Neurotransmitters

Neurotransmitters are the chemicals that carry messages between the brain cells and are known to relieve some of the symptoms of schizophrenia. Research suggests that schizophrenia can be caused by the level of two neurotransmitters, dopamine and serotonin (NHS Choices (2014).

Biomedical model

Biomedical model is a theoretical model of illness that ignores psychological and social factors and includes only biologic factors in an attempt to understand a person’s medical illness or disorder (Medical Dictionary 2004-2014). It ignores the soul spirit, without realising that it affects the physical health and fails to deal with illnesses and diseases that have no obvious physical symptoms, such as schizophrenia, as it only looks at the physical aspect of the illness. It treats illnesses by using medical knowledge.  NURS 6640 – Psychotherapy With Individuals Essay Paper

Treatments for schizophrenia

Schizophrenia can be treated by Antipsychotic and antidepressants medications in order to reduce the psychotic symptoms and allow the person to function more appropriately (Rogers, A and Pilgrim, D. (2014) Pg. 129).

Antipsychotic medicines are used to helps control the biochemical imbalances that cause schizophrenia and they are the main medicines that are used to treat schizophrenia. It works best to ease positive symptoms, however antipsychotic medications does not work very well to ease negative symptoms (Patient.co.uk 2014). It treats particular symptoms of schizophrenia, i.e., positive such as delusions, hallucinations, disorganized thoughts and negative such as blunt affect and social withdrawal (Sumiyoshi, T. (2013).

Antipsychotic medicines are divided into two groups which are: traditional antipsychotic and atypical antipsychotic (Patient.co.uk 2014).
The first generation of antipsychotics which is known as traditional antipsychotic were first introduced in the 1950s and the second generation which known as atypical antipsychotics were developed and introduced into clinical practice in the 1970s (Rogers, A and Pilgrim, D. (2014) Pg. 129). Examples of antipsychotic medications include: chlorpromazine (Thorazine), Haloperidol (Haldol), perphenazine (generic only), Fluphenazine (generic only) etc. (National Institute of Mental Health (NIH) 2008) Antipsychotics medications work by blocking the effect of the chemical dopamine on the brain, in order to reduce the feeling of anxiety or aggression within a few hours of use, however it may take days or weeks in order to reduce other symptoms such as hallucinations or delusions thoughts (Drugs.com 2000-2014). The second generation of antipsychotics reduce positive symptoms more effectively compared to the first generation of antipsychotic drugs (Barry, S. Gaughan, T and Hunter, R. (2012). However there are many common negative effects from the antipsychotic medications including: weight gain, white and red blood cell disorder (e.g. agranulocytosis), tardive dyskinesia and tardive akathisia (movement and feeling disorders) and neuroleptic induced psychoses, which may increase the person’s risk of getting high cholesterol and diabetes (Rogers, A and Pilgrim, D. (2014) Pg. 129). However psychiatrists saw side effects as significantly less bothersome than symptoms when considering costs to society. This means that the needs of the patients are ignored in favour of the political needs of their treating psychiatrists (Rogers, A and Pilgrim, D. 2014 Pg. 130). NURS 6640 – Psychotherapy With Individuals Essay Paper
Atypical antipsychotics are considered as first-line treatments in international clinical guidelines. There has been an increase use of pharmacotherapy in children with mental and behavioral disorder in the past two decades and an increase in the availability of different medications that are labeled as atypical antipsychotics, which followed an increase in the prescription to patients across the life span, including children and adolescents, for symptoms of other illnesses, as well. There is also an increase in the volume of pediatric patients presenting for treatment of mental disorder in emergency departments due to the unavailability of or limited access of mental health services. The three antipsychotics that are approved for use in children are: Haloperidol, Thioridazine and Pimozide. Between 1996 and 2001 the percentage of new prescriptions for antipsychotics in children increased from 6.8% to 95.9% and the biggest increase in use was in white teenager male patient (Rasimas, J and Erica, L. (2012).
Around one in two individuals with schizophrenia have a history of drug abuse or addiction. As the vulnerability to psychosis and drug abuse share overlapping neural substrates and is more likely to co-occur in the same person. However, the phenotypic heterogeneity in schizophrenia makes it unlikely that a single neurobiological shortage causes the illness. Chronic antipsychotic treatment might alter reward function by inducing dopamine receptor supersentivity within dopamine pathways, and this is supported by pre-clinical evidence (Bedard, A. Maheux, J. Levesque, D and Samaha, A. (2011).NURS 6640 – Psychotherapy With Individuals Essay Paper

Antidepressants are a natural and common choice for the treatment of negative symptoms of chronic Schizophrenia (Singh, S. Singh, V. Kar, N and Chan K. 2010). It works by increasing serotonin and norepinephrine concentrations. However increasing serotonin can cause side effects such as: nausea, sexual dysfunction and changes in appetite. Antidepressants are very effective however it could take some people at least 4-8 weeks of treatments to show positive response. Unfortunately, side effects appear before the benefits of antidepressant medications take effects (Tung, A and Procyshyn, M. 2007). Antidepressants along with antipsychotics work more effectively in treating the negative symptoms of schizophrenia than antipsychotic by itself (Singh, S. Singh, V. Kar, N and Chan K. 2010). NURS 6640 – Psychotherapy With Individuals Essay Paper
Social models of mental health
The Social models of mental health ‘refers to an emphasis on the social as the primary source of causes and meanings in relation to mental health and mental disorder’ (Pilgrim, D. (2014) pg. 184, 185).Social models of mental health concluded that mental health problems can be understood and rectified by paying attention to the stressors linked with poverty, race, gender and age (Pilgrim, D. (2014) pg. 184, 185).
Social class plays a major role in mental health as people from lower social class are more likely to be diagnosed with mental health problems such as: anxiety states, depression, anti-social personality disorder and schizophrenia than the middle or higher social class. This is due to the fact that people from the lower social class are chronically outside the labour market, poorly educated, living in poverty and are vulnerable to different social problems, such as substance abuse and criminality (Pilgrim, D. (2014) Pg. 194). The greatest difference was in the diagnosis of schizophrenia which is seven times the rate for people from poor inner city districts compared with middle-class suburban areas. This is due to the combination of poverty and a lack of social cohesion in areas (Rogers, A and Pilgrim, D. (2014) Pg. 25).
However, class is considerate when people with mental health problems engage with professional services. As patients from poorer social class are more likely to receive biological treatments than psychological treatments. Poorer patients are less likely to be referred for psychotherapy, are more often rejected on assessment by specialists and drop out of treatment earlier. Also poorer patients are more likely to be treated coercively than voluntarily (Rogers, A and Pilgrim, D. (2014) Pg. 32). Race also plays an important role in mental health as Afro-Caribbean people have higher rates of diagnosis for schizophrenia but lower rates for depression and suicide than indigenous whites, due to higher rates of cannabis use (grow cannabies) and culture (Pilgrim, D. (2014) pg. 197).
Treatments
Psychological treatments is needed In order to help a person with schizophrenia to cope better with the symptoms of hallucinations or delusions, and treat negative symptoms including lack of enjoyment. Psychological treatments include: cognitive behaviour therapy, Arts therapy and family therapy (NHS Choices 2014).
Cognitive behaviour therapy (CBT) is a talking therapy which was first mentioned in 1952, it became as routine treatment in 2002. The aim of this therapy is to help people identify what is causing the person to have unwanted feelings and behaviour and replaces this thinking with realistic thoughts. This is done by encouraging people to express their emotions, beliefs and their experiences with a therapist, in order to help the person develop ways to challenge, cope and manage unhelpful thoughts and problem behaviour. It focuses on the person’s interest, assets and strengths. As people with schizophrenia have difficulties with concentration, attention and motivation (Jones, C. Hacker, D. Cormac, I. Meaden, A and Irving, C. 2012). Cognitive behaviour therapy can be used alongside most biological models of schizophrenia. As a cognitive behavioural approach does not contradict a biologic point of view in a patient whose personal explanation fits that models or insist on it for patients who prefer other explanations (Douglas, T. David, K and Peter, W. (2006).
Arts therapist allows people to express their experiences with schizophrenia creatively in a non-verbal way through art by working in a small group or individually. It encourages people to be creative and to participate in group activities in order to express themselves in a sensible manner which helps to release pressures that have been built up from stresses that people have faced (NHS Choices 2014).NURS 6640 – Psychotherapy With Individuals Essay Paper
Family therapy is also called family work or family intervention. The role of it is to help to recover psychosis symptoms and help family members and close friends support someone who has a mental illness. It helps relatives and members of the extended family look after themselves emotionally and give them the skills to work more collaboratively with health professionals. Taking care of someone with schizophrenia can be very difficult as relatives may feel shame, anger, anxiety sadness or guilt and also feeling somehow responsible for the illness. This will make them feel irritated by the person who is unwell and blaming the person for the problems. Which will be difficult for the person with schizophrenia to handle and will make him/her feel more anxious and depressed. Therefore family therapy can help family members discuss these issues and come up with plans to overcome these issues (Mental health care 2014).
Overall, psychotherapy cannot give good results without biological treatments, as biological treatments play a major role in managing schizophrenia. Whereas group therapies and cognitive-behaviour therapy help the person suffering from schizophrenia, with social adaption, coping strategies and cooperativeness (Dogan, S. Dogan, O. Havva, T and Coke, F. (2004).
It is very important for the multi-disciplinary team to work together in order to make decisions about the level of care that the person with schizophrenia would need. Before making any decision the multi-disciplinary team would look at the person’s holistic approach in order to get information about their physical, social, emotional and intellectual aspects, in order to provide the person with the right help/support that he/she would need. The multi-disciplinary team would work together as they would be aware of the person’s problems and would come out with plans to help support the person and his/her family’s needs, by doing this the person’s family would be getting on with their everyday life. The multi-disciplinary team would promote the persons independence by allowing his/her to try things themselves. They would not interfere in everything the person would do. Whereas if they do interfere with everything, the person would feel useless and this would lower his/her confidence and he/she would depend on them with everything. Also the multi-disciplinary team should have an updated record on how the person is getting on and how the patient have improved.
The patience would benefit from the multi-disciplinary workers as they work together with the service user to make sure that their plans are going on well, that they are finding use from each professional. The more professionals know about the person’s holistic approach the better services and support they will provide, as it will enable the person with schizophrenia to take advantage from those services and benefit from the results the person will gain.NURS 6640 – Psychotherapy With Individuals Essay Paper

Overall schizophrenia still exist in the society
Not all treatments work for everyone
People react to it differently.

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Massage therapy is the manipulation of the soft tissue on the body by a practitioner through the movement of their hands and arms as well as advanced techniques. Massage has been used to help people relax as well as a way to help treat minor ailments as a complement to other medication or treatment. As A Whirlwind Tour through the entire History of Massage webpage states ‘Massage is a universal instinct. From the day they descended from the trees, humans have known that it helps to rub a sore limb and that to touch is beneficial.’ So since then we have used and developed the skills and techniques through the years into the massage routines we see and use today. NURS 6640 – Psychotherapy With Individuals Essay Paper

History of Massage;

Throughout ancient history many different countries have been using massage and developing their skills as well as passing these down through the years. They have been borrowed, stolen and shared through different times as well as different places geographically around the world, many of the different types of massages resemble each other as techniques have been copied, borrowed and shared.

Pre-historic people used to practise some forms of therapeutic touch or massage as there has been evidence to suggest that they used to massage their muscles and rub herbs and oils onto their bodies to help with healing or to protect as this has been found in caveman paintings and drawings showing the giving and receiving of massage.

After then the next stage that has been recorded in history to show the major use of massage where the Chinese in around 3000BC in a book called ‘Con Fou of the Tao-Tse.’ As mentioned in the eBook History of Massage, Therapies & Rules in China ‘for years, blind people where the main masseurs.’ According to A Whirlwind Tour Through the entire history of Massage ‘Chinese writing dates from around 1400BC, near the start of the Shang dynasty, and it from around this time that we can reliably date massage.’ It was in China that the first exam in massage was sat about fifteen hundred years later as an addition to the occult studies schools. Around the same times as China the Egyptians also used massage and this has been depicted in tomb paintings of individuals being ‘Kneaded’ by others. The Japanese’s received their knowledge from China through the study of Buddhism and soon customised the techniques which became known as anma, which later became Japanese Shiatsu. According to The history of Massage: Learn How Massage Dates Back over 5,000 Years Ago ‘The primary goal of Shiatsu is to raise the energy level in the patient. In turn, this increased energy level regulates and fortifies the functioning of the organs and stimulates natural resistance to illnesses.’ The practitioners use a variety of techniques to pressure points on the body to balance the energies and work without needles or other equipment to do so. NURS 6640 – Psychotherapy With Individuals Essay Paper

However, some sources believe India was practicing massage before the Egyptians and the Chinese while others believe they might have acquired it from China a little later so the dates of when India first started to use any forms of massage range from around 3000BC to between 1.800-500BC. NURS 6640 – Psychotherapy With Individuals Essay Paper

‘Massage in India is referred to in ancient Hindu books such as ‘Ayurveda’ (Art of Life) which was written around 1800BC. It describes how movements such as shampooing and rubbing were used to relieve tiredness, increase energy levels and improve general health.’ Francesca Gould in Body Massage for Holistic Therapists (2004).

After this stage in history the next step in the time line is around 2000BC when the Greeks and Romans first started to use massage in the early foundations of their civilisations. The ancient Greeks used the knowledge from the Egyptians massage techniques, and it was given to the athletes’, women and soldiers as described in History of Massage, Therapies & Rules. The Greeks wrote many books on massage including some written by Homer, Aesculapius, Herodotus and Hippocrates who was the ‘Father ‘of Medicine. It was the Greeks who used to rub up the body towards the heart to help the venous and lymph in that direction, they also used this technique to move sickness towards the centre of the body to where is can be expelled with the waste materials. NURS 6640 – Psychotherapy With Individuals Essay Paper

The Romans however used massage as more of an indulgence than as a medical therapy; it was saved for those who could pay for it. The Romans received massage from the Greeks and enjoyed bathing before a full body massage and it was said that even Julius Caesar was pinched every day. The Roman gladiators were vigorously massaged before fights to make sure their muscles where warmed up and supple. Galen was the main figure in Rome for massage but he was actually Greek, according to A Whirlwind Tour through the History of Massage he lived from 130AD to 201AD and he acquired his knowledge of anatomy and physiology through working with the gladiators. Massage then was used as an alternative for exercise to help relive their excessive eating and drinking.

Massage was used throughout the different tribes in North America before the Europeans arrived, some tribes would massage/rub down their warriors before and after battle or rub ointments into ailing joints or muscles. Massage has also been seen through a variety of different countries through history including those such as Persia, Kurdistan, Thailand, Tibet, Indonesia and Hawaii.

The most recent history of massage can be seen is western civilisation. The earliest record was written by Ambroise Pare (1510-1590) but he was ridiculed for his publication. However by the time Henrik Ling (1776-1839) became the father of modern western massage it had become less of a ridicule. As the History of Massage, Therapies & rules tell us Henrik Ling once put. “We ought not to consider the organs of the body as the lifeless forms of a mechanical mass,” he wrote, “but as the living, active instruments of the soul.” And through this he finally developed the system known as Swedish massage. NURS 6640 – Psychotherapy With Individuals Essay Paper

Massage has now moved back towards the old holistic attributes instead of the physiological attributes so we are back to seeing massage in the same way as the ancient Chinese, Egyptians and Greeks once saw the therapy. As reported by The Massage Bible, ‘during the first World War injured soldiers were treated with massage, while the Californian bodywork movement in the 1960s combined massage with personal growth.’ There are many different kinds of massage practiced today all over the world and many of them can be received by almost anyone unless they have a specific reason that it cannot be preformed. There are a few different people who have been in the forefront of massage in modern history and those are Cornelius E. Who is the ‘Father’ of massage in the USA, David Palmer, the ‘Father’ of chair massage, Dr Tiffany Fields, the ‘Mother’ of massage research and Jack Meagher the ‘Father’ of sports massage. In figure I. In the appendices is a time line of the history of massage along with the creation and history of other therapies this has been take from the eBook History of Massage, Therapies & Rules. NURS 6640 – Psychotherapy With Individuals Essay Paper

Massage Principles and Holistic Experience:

To decide if massage is a holistic therapy first of all we need to know what holistic means and according to thefreedictionary.com Holistic means ‘Concerned with wholes rather than analysis or separation into parts.’ And with this definition we shall determine whether or not massage is a holistic experience. NURS 6640 – Psychotherapy With Individuals Essay Paper

A massage whether it is a Swedish, Shiatsu or any other form of massage moves across the whole surface of the skin missing only a few vital places which are left for either health and safety reasons or due to the intimacy of the area. Most massages that even just incorporate one certain area such as an Indian head massage or even reflexology they all use different points of that area to correspond with different areas or energies upon the body. With different energies running throughout in specific channels which move around the entire body, when a massage is preformed to the whole body or even just a small portion of the body such as the hands, feet or head all the energies are involved which in turn incorporates the body as a whole. With this in mind a massage can be believed to be Holistic as this matches with the definition of holistic in taking the body as a whole instead of a separation of its individual parts. NURS 6640 – Psychotherapy With Individuals Essay Paper

There is only one reason as to not treat a certain part of the body and that is due to a contra-indication such as pregnancy where you would not touch or massage the abdominal area or is say someone had a fungal infection upon their feet you would not massage their feet and would move onto the next step of the massage itself. These contra-indications could be on a temporary basis or they could be permanent and therefore this client would not be able to receive a treatment. There are some contra-indications such as cancer, epilepsy and a few others which would need a doctor’s approval before a treatment could be carried out upon the client for insurance reasons. For example for epilepsy if you do not know the trigger for a seizure and you had not received a doctors approval for the treatment and the client unfortunately had a seizure upon your table then the client might decide to sue the practitioner for causing this, this is why doctors approval is sought.

Due to the Health and Safety at work act 1974 all employers and employees must maintain a high standard of health and safety in the work place as described in F. Gould’s Body Massage for Holistic Therapists. NURS 6640 – Psychotherapy With Individuals Essay Paper

‘Employers are responsible for the health and safety of anyone who enters their premises. If an employer has more than five employees, the work place must have a health and safety policy, of which all staff must be aware.’

There are many different procedures in the work place that all employees must adhere to such as the first aid and fire procedures, all employees should know where the first aid kits and fire extinguishers/ exits are located within the building for the safely of themselves and the clients, It is advisable however, that all practitioners are first aid qualified themselves in the event of an emergency. From the clients point of view the practitioner should know these things as well as have a basic understanding of personal hygiene in the sense of washing their hands properly, being of a clean and presentable appearance and be dressed appropriately for the treatment. This is due to the intimate nature of the massage with the close skin to skin contact as strong smelling perfumes or strong body odour can be very unpleasant for the client. A general knowledge of health and safety is beneficial for the example to clean up spillages as and when they happen as to avoid trips, slips and falls of either the client or yourself. A good general idea of protecting your equipment is ideal as oils and creams can become a hazard if left un-cleaned from the treatment table as this could cause a slip or the degrading of your equipment such as the vinyl of the table tops. NURS 6640 – Psychotherapy With Individuals Essay Paper

For insurance purposes the practitioner must ensure that they do not perform a massage while they are unwell or when the client is contagious due to the spread of infection and should always wear gloves if they have any open areas upon their hands. This is for their own protection and that of the client as to not pass anything between them or onto any other client from the previous client. However it is also important to know if the client is well enough to receive the treatment, for this the practitioner must refer to the contraindication lists to see whether or not the client is acceptable to treat. The client should also be aware that at any point the practitioner is legally allowed to refuse treatment for withholding information or for unacceptable behaviour. The practitioner must also get the permission off the client at all times before a treatment if they can touch the client themselves, and they must ensure the client understands this and what is going to happen during the treatment for insurance purposes for the protection of both the client and practitioner. NURS 6640 – Psychotherapy With Individuals Essay Paper

Personal safety for the practitioner is also important; these include the correct posture and the compression of the wrists. If either of these are incorrect then the practitioner later in their career could cause themselves more pain due to repetitive strain on the joints and could cause more damage if continued. To help prevent this the right table height should be selected for the practitioner as well as the correct foot wear to help with posture, also the right hand movements should be followed to help prevent the compression of the wrists. The most important piece of safety a practitioner should adhere to is their own safety when working with a client on their own such as a residential call or even in their own rooms at their treatment centre. If doing a residential call then the practitioner should only really perform these on clients that already know, they have a personal phone number for and they should always make sure someone knows where they are at which times and check in after the appointment with either a family member or work colleague to show they are safe. If they get a new client after a residential call they should always follow the rules of asking for the residential phone number and insist upon phoning the day before the treatment to see if they still wish to receive the treatment. NURS 6640 – Psychotherapy With Individuals Essay Paper

Making the treatment of a client a positive experience is one of the most important parts of making a massage holistic, the practitioner should look after their clients making sure they are comfortable with what is going on whether they are new or long term clients. To be a massage practitioner you should have excellent customer service skills, client care should be the most important thing to remember and should always be used every day with every client, the client should believe that the practitioner cares. The practitioner should always consult with the client and devise a treatment plan to suite the clients and stick to this plan unless anything changes in the circumstances with the client as well as receiving permission from the client for the practitioner to touch them during the treatment. During the treatment the discussion should be at a comfortable level for the client but also low enough for the client to relax and enjoy the treatment. After care should always be adhered to and offered to the client with a small encouragement of lifestyle changes if needed for the client’s needs. NURS 6640 – Psychotherapy With Individuals Essay Paper

Effects of Massage including the Physiological and psychological effects upon the client:

Massage even though it is a holistic experience has been seen to have an effect of other areas of the human body and not just as a way to relax; a massage has been seen to show that it has both physiological and psychological effect upon the clients. Physiological effects are those which are shown upon the body itself and its function whereas psychological effects are those which manifest themselves in the mind and the emotions of the client. There are many different outcomes which could manifest for both on the anatomy and the body systems. In two different clinical trials that have been preformed independently of each other there is a show of the two different effects received after a massage treatment, one for the Physiological effects and one for the psychological effects.

In the first trial the objective was to see if the early intervention with massage in children with Down syndrome would help with the motor skills and muscle tone. So parents with children suffering from Down syndrome where asked to attend one of two early intervention classes, one class was a body massage session and the other a reading session after a base line had been assessed upon their severity of the syndrome, some children were not used if sever mobility where involved or they had emotional problems as this might interfere with the trial. NURS 6640 – Psychotherapy With Individuals Essay Paper

Twelve of the children were assigned to the massage sessions and eleven to the control reading session, so in overall there where twenty one children involved in this trial. Each session was scheduled for the same times each week and specific times of the day for both classes, and each session was on an individual basis, the sessions lasted for half an hour each, twice a week for two months, while the reading session was conducted the same way with the therapist holding the child while reading for the half an hour.

This was the treatment that the children received in the following sequence:

‘The 30-minute massage therapy session started with the child lying on a small mat

on the floor. The therapist conducted the following sequence three times with the

child in a supine position: Legs and feet-(a) while forming hands like a letter ‘C’ and

wrapping the fingers around the child’s leg, long, milking and twisting strokes from

the thigh to the ankles; (b) massaging foot by gliding thumbs across bottom of foot

followed by squeezing and tugging each toe; (c) massaging across top of foot by gliding thumbs from ankle to toes; (d) flexing and extending the foot; (e) massaging from ankle to foot and back to ankle; (f) stroking from the ankle up towards the thigh; and (g) back and forth rolling movements (as if making a rope from dough) from the

ankle to the thigh. Stomach-(a) slow, circular, rubbing movements to stomach area

with one hand; (b) using the palms, hand over hand down the stomach in a paddlewheel fashion; (c) starting with thumbs together at the umbilicus, stroking horizontally to sides of body and then twice above and twice below the umbilicus; (d) using fingertips and starting below the umbilicus on the child’s right side, small circular upward movements until even with the umbilicus, then continuing across to the left side, and then down on the left side to below the umbilicus; (e) with one hand. NURS 6640 – Psychotherapy With Individuals Essay Paper

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following the other, short upward stroking from right side below the umbilicus, then

Massage and Down syndrome 401 across the umbilicus to the left side of the body, and then down on the left side to below the umbilicus; and (f) cupping or holding sides of knees, bending both knees simultaneously towards the stomach and holding for three to five seconds. Chest-(a) with palms of hands on child’s sternum, stroking outward across chest; (b) starting at sternum, stroking upwards and over tops of shoulders and down the sides of the ribs; and (c) starting at the right thigh, stroking diagonally through the chest to the opposite shoulder and back down to the same thigh; repeat starting at the left thigh; Arms and hands-same as legs and feet (i.e. replace ‘legs’ with ‘arms’ and ‘feet’ with ‘hands’). Face-(a) making small circles to entire scalp (as if shampooing hair); (b) with flats of thumbs together on midline of forehead, stroking outward towards the temples; (c) stroking gently over the eyes and brows; (d) starting at the bridge of the nose, stroking across the cheekbones to the ears; and (e) making circular movements under the chin, around the jaw line, around the ears, to the back of the neck and the rest of the scalp. The following sequences were done after placing the children on their stomach (in a prone position). Back-applying oil to the hands: (a) starting at the top of the spine, alternating hand strokes across the back working down towards the tail bone (never

pressing the spine) and reaching over to include the sides; (b) hand over hand movements from upper back to hips with flats of hands and then continuing to feet; (c) using circular motion with fingertips, from neck to hips stroking over the long muscles next to the spine and retracing on the other side of the spine; (d) making circular strokes with the palm of the hand to rub the tops of the shoulders; and (e) ending with long gliding strokes from the neck to the feet.’ As was described in the journal Children with Down syndrome improved in motor functioning and muscle tone following massage therapy (2006). NURS 6640 – Psychotherapy With Individuals Essay Paper

The trial was held at the children’s early intervention pre-school centres, while the test was run by the university of Miami school of medicine. The results of this trial show that there was a greater gain for the results of the children who where massaged in their sessions than to those who where read too. The improvements were shown in the gross motor skills and fine motor skills development of the children as well as a marginal effect in their language development. This then showed that through the early intervention with massage it could help children with Down syndrome enhance their motor development at a faster rate than if they were left to mature in their own way. NURS 6640 – Psychotherapy With Individuals Essay Paper

These results help to show that massage can have a physiological effect upon the body in helping to produce and enhance muscle tone. However, there is the argument that another control group could have been added into the trial to help show whether this is successful or not is a control group that uses light stokes instead of a pressure massage to help with the ethical problems of withholding the intervention from those in the reading session. This was all shown in the clinical trial journal of Children with Down syndrome improved in motor functioning and muscle tone following massage therapy (2006) which is located in the appendices.

The second trial is to determine whether or not massage can have a psychological effect on the client and for this the trial was preformed for the Association of Paediatric Haematology/Oncology Nurses (2009). The aim of this trial was to reduce symptoms of children with cancer and to reduce the anxiety of their parents. NURS 6640 – Psychotherapy With Individuals Essay Paper

‘Children with cancer, ages 1 to 18 years, received at least 2 identical cycles of

Chemotherapy, and one parent, participated in the 2- period crossover design in which 4 weekly massage sessions alternated with 4 weekly quiet-time control

Sessions.’ As described in the article Massage Therapy for Children with Cancer (2009). NURS 6640 – Psychotherapy With Individuals Essay Paper

To determine if the massage was helping to relieve the psychological symptoms of anxiety in the parents and the symptoms of the children while the trial was progressing they measured everyone’s heart and respiratory rates, blood pressure, and salivary cortisol level as well as their pain, nausea, anxiety, and fatigue levels.

According to the results of this trial the massage was more effective in reducing heart rate than quiet time in the children, the anxiety in the children aged fourteen and older and the anxiety in the adults. The clients all commented upon how the massage rather than the quiet time helped with their anxiety and helped them feel better. So due to their result it is feasible to massage children with cancer and their parents to help relieve their anxiety. Therefore this result helps to show that massage to the body can have a psychological effect upon the client in this sense it has reduced the anxiety of the both the children and the parents although in the younger babies the results did vary a little more than the other ages, but the results of the older children and the adults help to prove that just a massage on its own can have a psychological effect upon the human body. The trial that this assessment was based upon is located in the appendices as clinical trial 2. NURS 6640 – Psychotherapy With Individuals Essay Paper

So both of these trials show that massage can had a successful outcome on the physiological and psychological effects portrayed on the body, they both proved that through a short massage the body can manifest its effects through muscle tone or motor function progression as well as to reduce anxiety in both children and adults. Neither of these two trials have a negative out come and therefore both are a success but there shall be a few trials where massage has not appeared to be successful at all or shows that it is a little less successful than anticipated, these however are normal and show both sides to an ongoing argument about whether massage is actually good for the body, mind and spirit on a whole or if it just theoretically works on the body. NURS 6640 – Psychotherapy With Individuals Essay Paper

The main objective of any academic course is to ensure that the learners gain vital information that aims at enhancing their knowledge while at the same time promoting their judge mental and decision makes skills. This course has faired pretty well in as improving my judgmental skills.

Having cleanly studied the United Parcel Services company, (UPS), a company operating in the transport and logistic company has enabled me see how firms can utilize various methods to improve their sales despite the fact that they already have well established brand names (UPS, 2010). NURS 6640 – Psychotherapy With Individuals Essay Paper

The course has allowed me to gain vital information concerning specific attribute start makes a monopolistic firm gain the status of being a competitive firm. Central to gaining this competition is advertisement which is useful to increase the consumption of its products hence further locking up its consumers while at the same time, gaining more loyalty to its brand.

The course therefore has been of vital importance as it has allowed me realize the how advertising can be used as a source of strategy. However, despite the importance of advertising, the course has been instrumental in letting the facts concerning its pros and cons be well articulated to me. This therefore means that any firm must learn how to balance its resources between advertising and other issues that must be well met.

This means that advertising when taken to ist overboard shall result to negative effects as opposed to leading the efforts taken towards advertising to relies greater sales and revenue. The course has therefore been of great importance as it has really expounded my knowledge. Reference UPS (2010). About US. Retrieved July 24, 2010, from http://www. ups. com/content/us/en/about/history/index. html. NURS 6640 – Psychotherapy With Individuals Essay Paper

In order to overcome behavioral problems such as anxiety, depression or fear, individuals usually communicate their problems or anxieties with their trusted friends or family members. In case of somewhat complicated problem, a counselor is consulted. These are a relatively simple form of psychotherapies that individuals have been practicing for centuries. However, with the development of modern science and advancements in the field of Psychology, theorists have identified some more effective approaches for psychoanalysis. One of these approaches is cognitive behavioral treatment or therapy (CBT). CBT of depression is a psychotherapeutic treatment approach that involves the application of specific, empirically supported strategies focused on changing negative thinking patterns and altering behavior. Cognitive therapy teaches a client the connection between thought patterns, emotional state, and behavior. This therapy encourages the client to change irrational and negative thinking patterns in order to alleviate the emotional symptoms that are caused by the thoughts. These approaches were developed as a result of modern psychological research and are therefore based on scientific principles. NURS 6640 – Psychotherapy With Individuals Essay Paper

Introduction
Cognitive Behavioral Therapy (CBT) represents a combination of behavioral and cognitive theories of human behavior, psychopathology, and a melding of emotional, familial, and peer influences. There are several subclasses of the psychotherapy CBT some of these include, Rational Emotional Behavior, Cognitive, Rational Living, and Dialectical Behavioral Therapy among others. CBT builds a set of skills that enables an individual to be aware of thoughts and emotions; identify how situations, thoughts, and behaviors influence emotions; and improve feelings by changing dysfunctional thoughts and behaviors (Cully,J., Teten, A.,2008). This topic/theory is chosen because it targets multiple areas of potential vulnerability (e.g., cognitive, behavioral, affective) with developmentally-guided strategies and traverses multiple intervention pathways. The target group or populations in which this research will address include psychological disorders in youth and adolescents. This paper will discuss the framework and review why this practice is a staple for therapeutic practices. The application of CBT within the mental health field will be reviewed and rationalized as to why this particular theory is chosen for future practice. NURS 6640 – Psychotherapy With Individuals Essay Paper

History of CBT
True to its name, cognitive-behavioral therapy (CBT) emerged as a rational amalgam of behavioral and cognitive theories of human behavior, causal and maintaining forces in psychopathology, and targets for intervention (Kendall & Hollon, 1979). CBT was originally developed to treat depression, and has since been adapted to the treatment of anxiety disorders, substance use disorders, personality disorders, eating disorders, bipolar disorder, and schizophrenia (Wenzel, A., Brown, G. K., & Karlin, B. E. (2011). CBT was developed by Aaron Beck in the 1960’s, this began with development that blended the elements of behavioral therapy with cognitive therapy. Thus, although behavioral therapies and cognitive approaches seemed to develop in parallel paths, over time the two approaches merged into what is now called cognitive-behavioral therapy ( Milkman,H., Wanberg,K.(2007). It stems from the initial approach of Rational Emotive Therapy (RET). Assumptions of cognitive behavioral therapy were initially developed by Albert Ellis in Rational-Emotive Behavior Therapy (REBT) and, then, later altered by Aaron Beck with Cognitive Therapy (CT) and Donald Meichenbaum with Cognitive Behavioral Modification.(CBM) (Spicer, A.2005).Within REBT is a directive, persuasive, and confrontational form of therapy in which the therapist fulfills the role of a teacher. Clients have negative ‘irrational’ thoughts when faced with an activating event. When or if clients confront these thoughts and change them, the theory is wanted changes in behaviors/reactions will follow. Cognitive therapy incorporates open ended questions to allow reflection, to address and resolve a person’s issues themselves. NURS 6640 – Psychotherapy With Individuals Essay Paper
The numerous strategies that comprise CBT reflect its complex and integrative history. Following from early respondent conditioning theories (Bandura, 1977), CBT incorporates concepts such as extinction and habituation. CBT went on to integrate modeling and cognitive restructuring strategies from social learning and cognitive theories. In addition, focus on self-talk and problem solving are each evident in CBT’s general focus on fostering the development of personal coping strategies and mastery of emotional and cognitive processes. Consistent with a tripartite view (cognition, behavior, emotion) of psychopathology (Barlow, 2000), CBT targets these multiple areas of vulnerability and avenues of intervention.
Research provides a history of CBT as applied to youth psychopathology. This history can be traced back to the 1960’s when the value and effectiveness of the prevailing psychodynamic perspective was questioned (Levitt, 1963) and found to be lacking. Behavior therapy consequently gained distinction but, in the 1960s, these therapies were initially controversial and primarily relegated to the treatment of behavior dysfunction in severely disordered children. It was not until the mid to late 1970’s that the continuing expansion of behavioral therapies reached higher functioning clients, integrated the role of cognitive processing, and incorporated a focus on emotions. The transition did not happen at once. In the end, social cognitive processing, psychology of self-control, and emotion regulation were blended into behavioral interventions and,emerged as CBT of the present day.
Before there was CBT, there was behavioral therapy which initially was controversial and underestimated however ultimately paved the way for empirically-supported treatments for mental health disorders of youth. For example, the Mowrers’ ‘bell-and-pad’ procedure for the treatment of enuresis is an often-cited example of an early behavioral intervention. Though clinical applications of behavioral strategies did not begin in seriousness until the 1960’s,initial work set the stage by targeting and addressing observable behavior and by measuring outcomes for later child cognitive-behavioral interventions. NURS 6640 – Psychotherapy With Individuals Essay Paper
Chosen Theory
Respondent conditioning explanations of behavior influenced early behavior therapy, particularly for the treatment of anxiety. In respondent conditioning, a conditioned stimulus (CS) closely follows an unconditioned stimulus (UCS) that elicits an unconditioned response (UCR) of fear. After repeated pairings, the CS alone will elicit the conditioned response (CR) of fear. Respondent conditioning was historically important in birthing notions of exposure tasks for the treatment of anxiety, now a well-established example, if not hallmark, of modern CBT for child anxiety (Barrios, O’Dell, 1998). Children often try a number of behaviors and then learn from consequences. One example of this is smoking, if you try smoking and you are accepted within the crowd of peers this is a positive reinforcement and a child will likely repeat the behavior. If the same child is caught and disciplined the likelihood of continuing the behavior is minimized and less likely to be repeated (McLeod,S. 2007).These possibilities play a major role in the shaping of behavior over time. Environments low in predictable and preferred contingencies may lead to decreased self-efficacy and maladjustment. NURS 6640 – Psychotherapy With Individuals Essay Paper

Many behavioral processes continue to be used within CBT. Over time, behavioral therapy began to address the thought processes and cognitive skills that were seen as involved in the implementation and receipt of contingency management and came to be implemented among less severe populations. This change to higher-functioning youth and to an increased awareness of the role of cognition was an important part of the conversion to CBT. Many behavioral interventions, and cognitive-behavioral interventions, were initiated and researched with children in mind. They were not borrowed adult treatments, or downward extensions of adult treatments applied with children. To its credit, cognitive-behavioral therapies with youth were intentionally developmentally-sensitive and research-informed interventions.
With CBT the approach is rooted in fundamental principle that one’s cognitions play a significant role in development and maintenance of emotional and behavioral response to life situations. Case in point Post Traumatic Stress Disorder (PTSD). PTSD is a type of anxiety disorder, this can occur after experiencing extreme emotional trauma with a perceived threat of death or serious injury. CBT approach to treatment typically incorporates two theoretical orientations as to why the fear is developed. The first of these is the Learning Theory. Learning Theory focuses on how the mechanisms of fear and avoidance of the trauma are conditioned, activated and reinforced. The second is Emotional-Processing Theory. This is the meaning attached to the memory prevents the individual from confronting the traumatic memory and then processing the information. The goal of CBT for PTSD patients is to teach cognitive-reframing techniques. These may include a form of exposure to the traumatic memory, such as repeated exposure to images or a written description of the trauma. This allows the patient to construct a detailed account of the event and discuss feelings and cognitions associated. Thought process strategy allows understanding patients to see how pushing the memory further away in the mind actually reinforces the impact of the memory. The memory instead is dealt with and accepted as a memory. In a study of 92 assault victims trauma focused cognitive behavioral treatments/therapy, using virtual reality, imagery, or written exposure are effective treatments for PTSD(Prendes,A., & Resko, S.). Rates of exposure to violence and traumatic events for children and adolescents are exceedingly high. In a nationally representative sample of children and adolescents in the United States, 60.4% reported exposure in the past year, with lifetime rates nearly a half to one-third higher, depending on exposure type (Finkelhor, Turner, Omrod, & Hamby, 2009). Clearly with these statistics CBT will be beneficial in the treatment of children and adolescents. Cognitive-behavioral therapy is also used widely in treatment of borderline personality within youth. CBT with borderline patients because of their explicit focus on self-regulation use of Meichenbaum’s approach to teaching impulse control to impulsive children. Focus on the progressive internalization and reutilization of self-instructions to stop, look, listen, delay, plan, and implement an appropriate strategy. Cognitive techniques, directed against catastrophizing, black-and-white, or either-or thinking are appropriate for treating borderline patients. The therapist points out the way these cognitive patterns are activated under certain circumstances and helps the patient reality-test them when they emerge. Borderline patients are not easily ‘argued out of’ their distortions, and are seldom able when their emotions are aroused to engage in the kind of reality-oriented ‘collaborative empiricism’ of cognitive therapy(Westen,D.1991). NURS 6640 – Psychotherapy With Individuals Essay Paper

The shift forward
CBT is defined as a purposeful combination of the demonstrated efficiencies and methodological rigor of behavioral procedures with the cognitive-mediational processes that influence adjustment (Kendall, Hollon, 1979). In the 1970’s, internal thought processes (e.g., self-talk began to be viewed as both targets and mechanisms of change, with an importance on improving cognitive skills rather than modifying behavior. Two early reports of CBT with children were combinations of self-instructional training, with coping modeling and a response cost contingency. As promise was seen in efforts to incorporate children’s developing cognitive abilities into behavior modification to produce therapeutic change, cognitive processes became integrated with behavioral interventions. By integrating cognition, the behavioral model adopted a broader and effective behavior change strategies.
Meyers and Craighead (1984) identified several forces that led the shift toward interventions that were cognitive-behavioral in nature. One force, cognitive psychology, was a factor that impacted behavior therapy with children through (a) modeling, (b) self-instruction training, and (c) problem-solving. The cognitive information processing explanation of modeling, or observational learning, holds that even in the absence of respondent or operant contingencies, an individual can learn by viewing another person’s behavior. Although modeling was historically identified with behavior therapy, Bandura’s explanation of modeling effects highlighted attention and retention, which are cognitive processes drawn from an information-processing model of cognitive psychology, as among the major factors that influenced observational learning. Bandura’s account of modeling, which ushered in a cognitive explanation for a portion of behavior therapy, and his discussion of the role of symbolic cognitive processes in behavior change, were springboards for the theoretical advance of CBT (Meyers, Craighead, 1984). Indeed, various behavior therapy interventions began to be understood from both an information-processing and a more general cognitive viewpoint (Mahoney, 1974). NURS 6640 – Psychotherapy With Individuals Essay Paper
Self-instruction training was another avenue through which cognitive psychology impacted behavior therapy. Self-instruction emerged to teach impulsive children how to control their behavior. The program drew from the language-development sector of cognitive developmental psychology, particularly the work of Luria and Vygotsky, who suggested that children learn to control their own behavior by overt and eventually covert speech. Researchers and clinicians continue to draw from the cognitive developmental literature to incorporate cognitive strategies and enhance behavior therapy procedures. For example, the literature on social cognition has contributed to notions of self-talk and social skills training, and to our understanding of mechanisms of behavior change.
Problem solving, though once linked with behavioral learning, has a cognitive information-processing flavor. Problem solving within CBT for youth focuses on internal thought processes as one mechanism of change. Several early programs for youth employed problem solving. As evidence of its lasting impact, many current empirically-supported programs for youth have a problem-solving focus. The emphasis on modifying thought processes as a means for producing both behavioral and cognitive change illustrates the integration of CBT and cognitive developmental psychology.
Interventions that targeted self-control were described as a third force behind CBT for youth. Explanations of self-control procedures were progressively cognitive in nature, with influential papers supporting the role of internal factors in self-control. Main beliefs of self-control were being applied to work with children in the mid-1970’s, as theoretical advances (e. g., Bandura’s self-efficacy buttressed the relationship between overt and covert events. Studies of self-control and self-efficacy advanced the testing of private cognitive experiences in ways that could be integrated within behavioral paradigms. NURS 6640 – Psychotherapy With Individuals Essay Paper
Anxiety disorders in children are common with causative factors such as school, family relationships, and social functioning. Anxiety disorders in childhood remain under recognized and under treated. It is speculated that as much as 12-20%of children seen in mental health settings suffer from extremes of anxious-nervous manifestations (Knell & Dasari,2006, Schafer,2009). Behavioral problems resulting from anxious reactions to their world, cause disruption, in the child, families, and community. Parents often misunderstand the source of the problem being anxiety and rather describe it as attitude, being spoiled, or attention seeking behavior. A study of children from 7-17who had separation or generalized anxiety disorder were treated with CBT over a years’ time span. CBT was a 60 minute session which included various child anxiety assessment tools for data. Medication was introduced to a portion of the group and a combination was used for the remaining group participants. The end results show CBT as an effective treatment. This is rewarding news and will increase parents approach to treatments as well as open the door to increased diagnosis and treatment for children (Walkup,J., Albano,A., Piacentini, J. & Birmaher, B. (2008).
The emerging successes of cognitive therapy for adult disorders influenced the psychological treatment of children. A core assumption of cognitive therapy is that maladaptive cognitive processes produce psychological disorders, which can be improved by modifying these cognitive processes. Ellis’ irrational thinking and Beck’s cognitive distortions are examples of the key concepts that influenced CBT. Specifically, Ellis and Harper proposed that people engage in maladaptive behavior and/or experience negative mood states because they engage in irrational thought processes. Thus, they argued that the focus in therapy is changing maladaptive ways of thinking. Beck similarly maintained that maladaptive cognitions are associated with psychological disturbance. Many research evaluations have supported cognitive therapy with adults, and clinical work with children has been influenced by, and frequently refers to, the work of Beck and Ellis. NURS 6640 – Psychotherapy With Individuals Essay Paper
Given the increasing number of studies supporting therapeutic benefit for cognitive therapy, the focus was placed on assessing and understanding cognition despite traditional difficulties with isolating and measuring such phenomena. Some of the early cognitive therapy with adults relied on persuasion and reason, though later efforts underscored the benefit of prospective hypothesis testing and behavioral tasks.
The integration of the strategies of cognitive and behavioral therapy thrived due to the desirability and viability of this combination to produce clinically meaningful outcomes. Indeed, without the favorable research evaluations, the approach would not have gained interest from practitioners nor maintained itself among researchers. Simply put, the use of contingencies to facilitate a child’s engagement in exercises that produce cognitive change was both data-supported and clinically appealing.
Though its initial impetus was the wedding and integrating of cognitive (e.g., thoughts influence behavior and emotion) and behavioral (e.g., research evaluation, contingencies) traditions, CBT rapidly evolved and emerged as a treatment informed by a wider set of models. CBT grew and materialized to address salient disorders in youth, as well as developmental vulnerabilities toward psychopathology. Just as the role of cognition has, in its pioneering fashion, come to be incorporated into behavioral therapy, so too have forces related to social environments, genetic vulnerabilities, therapeutic processes, and familial and peer relationships.
As an illustration of expanding models, consider Clark and Watson’s] tripartite model as an explanation for the extensive overlap of the otherwise-seen-as-separate disorders, anxiety and depression. The tripartite model describes how anxiety and depression share a common component, negative affect, which accounts for symptom overlap. Negative affect is the sense of high objective distress and includes a variety of affective states such as being angry, afraid, sad, worried, and guilty. The model suggests that negative affect is a shared dispositional vulnerability for emotional psychopathology, specifically anxiety and depression. By contrast, low positive affect is a factor specific to depression and autonomic arousal is a factor specific to anxiety. CBT for addressing emotional disorders, in sync with the tripartite model, also targets overlapping features. However, Barlow suggested that anxiety is different from autonomic arousal. He proposed that negative affect is a pure manifestation of the emotion of anxiety, while autonomic arousal is a manifestation of the emotion of fear. Despite small differences, autonomic arousal, high levels of general distress and negative affect, and low positive affect are seen as important predisposing traits of emotional psychopathology. Targeting and treating these salient factors across disorders is a strategic approach that has been accepted within CBT. NURS 6640 – Psychotherapy With Individuals Essay Paper
Barlow described a triple-vulnerability model of emotional disorders: (1) a general genetic vulnerability, (2) a general psychological vulnerability characterized by a diminished sense of control, and (3) a specific psychological vulnerability resulting from early learned experiences]. This diathesis-stress model is consistent with how children may develop a sense of diminished control through experiences with both their own highly reactive arousal system and high negative affectivity and with uncontrollable life events. Once a diminished sense of control is developed, a child is more likely to perceive other events as uncontrollable, even those for which the child could potentially manage. For example, over controlling, unresponsive, and unpredictable family environments can foster a sense of uncontrollability and an external locus of control, a major psychological vulnerability. A specific psychological vulnerability can arise from early socialization experiences with the family or peers, and can contribute to experiencing psychopathology in particular areas. In accordance with this vulnerability model, CBT approaches for youth incorporate parent training with an increased focus on contextual issues and the development of children’s mastery over their own environment. NURS 6640 – Psychotherapy With Individuals Essay Paper

Current and Future Directions
Disorder specific applications of CBT for children and adolescents have enjoyed widespread application. A search of key terms ‘cognitive behavioral therapy’ and ‘children’ on PsycInfo, an online database of psychological literature, revealed 1192 articles, 1156 of which were published since 1990. Increased interest in and research on CBT has firmly established its presence in the field of clinical child and adolescent psychology and psychiatry. The initial book on CBT with children and adolescents is now in its fourth edition, with numerous chapters describing CBT procedures for specific disorders (Kendall, 1991).
True to its ties with the empirical methods of behavior therapy, CBT with children and adolescents continues to be guided by empirical research. Studies of the nature of specific disorders inform treatment procedures, and evaluations of treatments applied to real cases inform dissemination and practice. To date, an impressive series of empirical research reports support the use of CBT for the treatment and prevention of various psychological disorders in youth. The American Psychological Association Task Force on Promotion and Dissemination of Psychological Procedures established criteria for use in determining whether treatments can be considered empirically-supported (see also Chambless & Hollon’s criteria (Chambless , Hollon, 1998). NURS 6640 – Psychotherapy With Individuals Essay Paper
Based on the criteria, treatments can be categorized as either ‘well established,’ ‘probably efficacious,’ ‘possibly efficacious,’ or ‘experimental.’ CBT has emerged as the treatment with the most empirical support for numerous internalizing disorders in youth. Specific modalities of CBT have been categorized as ‘well established,’ such as child-only groups and child groups plus a parent component for youth with depressive disorders. A specific CBT protocol for youth exposed to traumatic events, Trauma-Focused CBT, is also considered ‘well-established’. Many other CBT protocols have been categorized as ‘probably efficacious’ for the treatment of internalizing disorders, including the Coping Cat Program for anxiety and phobic disorders, school-based group CBT for exposure to traumatic events, and individual exposure-based CBT for obsessive-compulsive disorder.
Although less support has been found for the use of CBT for externalizing disorders in youth, group CBT is considered a ‘well established’ treatment for adolescent substance abuse and some CBT protocols, such as Anger Control Training and Rational-Emotive Mental Health Program, are considered ‘probably efficacious’ for the treatment of disruptive behaviors in youth (Eyberg, Nelson, Boggs, 2008). Overall, CBT is often considered the ‘first line of defense’ in the treatment of psychological disorders in youth. NURS 6640 – Psychotherapy With Individuals Essay Paper
Although additional work is necessary to strengthen the efficacy of CBT for youth, researchers have called for a shift toward examining the mediators, moderators, and predictors of treatment outcome. This call implores researchers to go beyond evaluating the degree to which treatment works and to move toward examining why and for whom it works]. Future research has many worthy candidates of investigations. Potential mediating variables worthy of exploration include the individual components of treatment protocols, therapeutic process variables such as therapeutic alliance and child involvement, and within-client change processes. Future work is also necessary to delineate whether certain pretreatment characteristics, comorbid conditions, and treatment formats moderate or predict outcome. Given the ever-increasing use of technology in society, a particular area ripe for research includes the use of computer technology in CBT protocols.
A pressing concern and an area requiring empirical support is how best to disseminate CBT to community practice (Beidas, Kendall, 2010). The growing empirical support of the efficacy of CBT does not guarantee its use. ‘Bridging the gap’ between research evidence and clinical practice is an endeavor requiring effort from all parties involved, including researchers, practitioners, policymakers, and mental health consumers (Tansella, Thornicroft, 2009). It can be argued that the pursuit of dissemination constitutes the next chapter in the history of CBT. Engagement in this endeavor will likely lead to global improvements in the mental health care of youth. NURS 6640 – Psychotherapy With Individuals Essay Paper

Conclusion
CBT represents an integration of behavioral, cognitive, and other (e.g., developmental, social) theories of human behavior and psychopathology. The numerous strategies that comprise CBT reflect its complex and integrative history and include conditioning, modeling, cognitive restructuring, problem solving, and the development of personal coping strategies, mastery, and a sense of self-control. CBT targets multiple areas of potential vulnerability (e.g., cognitive, behavioral or affective) and provides avenues of intervention. CBT is often considered the treatment of choice for mental health disorders in youth. Additional work is needed to understand the mediators, moderators, and predictors of treatment outcome, and to pursue the dissemination of efficacious CBT approaches. NURS 6640 – Psychotherapy With Individuals Essay Paper

References
1. Kendall PC, Hollon SD. Cognitive-behavioral interventions: Overview and current status. In: Kendall PC, Hollon SD, editors. Cognitive-behavioral interventions: Theory, research, and procedures. New York: Academic Press; 1979. pp. 1’9.
2. Wolpe J, Lazarus AA. Behavior therapy techniques. New York: Pergamon; 1966.
3. Bandura A. Social learning theory. Englewood Cliffs, NJ: Prentice Hall; 1977.
4. Beck AT. Theoretical perspectives on clinical anxiety. In: Tuma AH, Maser JD, editors. Anxiety and the anxiety disorders. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc; 1985. pp. 183’196.
5. Ellis A. Reason and emotion in psychotherapy. New York: Stuart; 1962.
6. Meichenbaum DH, Goodman J. Training impulsive children to talk to themselves: A means of developing self-control. J Abnorm Psychol. 1971;77:115’126. [PubMed]
7. D’Zurilla TJ, Goldfried MR. Problem solving and behavior modification. NURS 6640 – Psychotherapy With Individuals Essay Paper

Nurses today face many ethical dilemmas in the delivery of patient care. What can or should be done for the patient versus the wishes of the patient’s physician conflicting with the personal beliefs the nurse holds to be true. The client’s wishes may conflict with the institutional policies, physician professional opinion, the client’s family desires, or even the laws of the state. According to the nursing code of ethics, the nurse’s first allegiance is to the client (Blais & Hayes, 2011, pg. NURS 6640 – Psychotherapy With Individuals Essay Paper

60). The ethical ideals of each nurse must be weighed with the laws of the state along with providing the most ethical care for the patient. The advancements in medical technology make it possible to sustain a patient life where previously there was no hope of recovery. These advancements have put nurses in the forefront of decision making begging the question “just because we can, should we” to be answered. Nurses need to understand the legalities involved with these new technologies to practice safely and effectively. Scientific achievements have opened new ground for nursing exploration. In response to the need for nursing input into social and legal issues, nurses now find career opportunities as forensic nurses, legal nurse consultants, and nurse-attorneys (Blais & Hayes, 2011, pg. 75). This paper will explore the ethical and legal issues encountered by nurses in two case studies. NURS 6640 – Psychotherapy With Individuals Essay Paper

The American Nurses Association Code of Nursing Ethics could influence a final decision in each case study that was presented. The six caps study revealed family members to have conflict in their desires when it came time for a decision in going ahead with surgery (the father’s desire) and having a poor quality of life as the outcome (the adult children’s belief based on physicians prognosis). The adult children believe that their mother would not want to have the surgery and have a poor quality of life. The appropriate decision to involve the ethics committee shows the collaboration between health care professionals. Nurses should be aware of their own values and attitudes in order to recognize when a situation might affect the care they are able to provide (Blais & Hayes, 2011, p.52). The nurses primary commitment is to the patient, whether an individual, family, group, or community. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient (ANA Code of Ethics for Nurses, 2014). Given the information that the adult children believe, their mother would not want to undergo the surgery, it is implied that it was the patient’s wish. NURS 6640 – Psychotherapy With Individuals Essay Paper

Based on the above information the ANA code of ethics can influence the final decision in that the family members would come to realize that the outcome from surgery would not be what the patient desires. A good decision is one that is in the client’s best interest and at the same time preserves the integrity of all involved (Blais & Hayes, 2011, p. 61). The critical thinking exercise gives information that a nurse is a witness in a malpractice case. The negligence resulted in harm to the client and the case is against the healthcare institution and another nurse who was overtly negligent. The nurses primary commitment is to the patient, whether an individual, family, group, or community. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the values of the profession through individual and collective action (Blais & Hayes, 2011, p. 59). Given the above ethical codes the nurse failed to uphold and follow ethical practice which resulted in harm to the patient. It is reasonable to assume that the ANA code of nursing ethics would have a significant impact on the courts final decision, as codes of ethics are usually higher than legal standards, and they can never be less than the legal standards of the profession (Blais & Hayes, 2011, p. 58) NURS 6640 – Psychotherapy With Individuals Essay Paper

Registered Nurses (RN’s) are routinely faced with moral and ethical decisions concerning their patients and fellow employees. In healthcare these issues can be very complex and complicated. An R.N. must frequently challenge their own moral and ethical values when they tasked with supporting their patients and families through difficult end-of-life decision making. Additionally, they may be forced to face the ethical decisions surrounding a fellow co-worker that might be compromising patient care due to impairment, because of an addiction or sleep deprivation. As with other people, there are many issues that influence an RN’s moral and ethical decision making. According to Chitty & Black, an individual’s moral and ethical decision making process is affected by their value system which is largely influenced by their culture and life experiences (Chitty & Black, 2011). Additionally, literature states that ethical decisions are also affected by the social norm of a society or group (Chmielewski, 2013). Unfortunately, when the decision making process for moral and ethical decisions is made through this form of influence, the choices made for moral conduct may go awry. NURS 6640 – Psychotherapy With Individuals Essay Paper

An example of this might be a group of students that decide as a whole to cheat on an exam. In other words, if the social norm is used as moral compass, there must be an unbiased check and balance system in place. In a hospital setting, this process may involve an ethics committee, an organization’s corporate compliance, or a human resources department. For RN’s that are faced with ethical and moral dilemmas, it is also important to refer to the Code of Ethics for Nurses that has been established by American Nurses Association (ANA). The ANA has set very clear guidelines for RN’s concerning the professional ethical obligations that are expected of nurses when faced with moral decisions concerning patients, colleagues, and the organizations that they work in (American Nurses Association, 2014). NURS 6640 – Psychotherapy With Individuals Essay Paper

The nurse has a legal duty to assist justice as far as possible (Blais & Hayes, 2011). In the case study of the nurse who observed a nurse violating standards of care, and who was overtly negligent, the nurse has a legal duty to report the incident. The primary responsibility of a nurse is to the patient. It is vital for the nurse to report negligence on any level in order to protect the safety of patients. The nurse also has a legal responsibility to be truthful and honest when testifying as a witness in court (Blais & Hayes, 2011).

In the case study of Marianne, the responsibility of the nurse is to organize discussion between the patient and her family regarding end of life decisions. In this case, there is no advanced directive, which puts the family in a bind, not knowing exactly what to do. According to the American Nursing Association, the nurse should attempt to have the Advanced Directive signed during the admission process (“End of Life Issues”, 2014). Doing this will not only protect the patient, but will assist the family in
knowing what the patient wishes in the event that the patient cannot speak for herself. A nurse has a legal responsibility to put the patient’s needs first, protect the safety of every patient, and act as patient advocate with every patient encounter. NURS 6640 – Psychotherapy With Individuals Essay Paper

As stated above nurses are faced with many personal and professional dilemmas in their daily duties. The ANA Code of Ethics is intended as an aid to these difficult decisions. The danger, though, with any such “aid” is that it may be applied in an unthinking manner as simply a set of preexisting rules (Dahnke, 2014). Nurses must always keep the focus on delivering the highest quality of care to the patient.

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References
American Nurses Association, Code of Ethics for Nurses. (2014). Retrieved from http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf American Nurses Association, End of life issues. (2014). Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/End-of-Life Blais, K.K., Hayes, J.S. (2011). Professional Nursing Practice: Concepts & Perspectives. (6th ed., cpt. 6). Upper Saddle River, NJ: Pearson/Prentice-Hall. Chitty, K.K. & Black, B.P. (2011). Professional nursing: Concepts and challenges (6th ed.). St. Louis, MO: Elsevier Saunders Chmielewski, C. (2013). Values and culture in ethical decision making. The Global Community for Academic Advising. Retrieved from http://www.nacada.ksu.edu/Resources/Clearinghouse/View-Articles/Values-and-culture-in-ethical-decision-making.aspx Dahnke, M. D. (2014). Lippincott’s nursing center.com: The role of the American Nurses Association code in ethical decision making… Retrieved from http://www.nursingcenter.com/lnc/static?pageid=864590. NURS 6640 – Psychotherapy With Individuals Essay Paper

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