Introduction

In health care, psychiatrists and psychologists use treatment plans for the treatment of their patients to achieve accurate and effective treatment and management of the health condition. A Psychological treatment plan is a versatile, multi-faceted document that allows the psychologist to design and monitor treatment. Such a plan is used to track progress, stay organized and keep a record of the patient care. When a psychologist comes up with a comprehensive treatment plan, it helps them to give the patient involved direction towards growth as well as healing.  In the development of a psychological treatment plan, it is required of the psychologist involved to outline the treatment goals. Both long term and short term goals. This aspect makes the treatment process well defined in its scope as well as in its application. As observed by &753$,  psychological treatment plans are vary depending on various factors. The most noted difference arises from the differences in the clinical setting where the treatment is being administered. It is therefore for psychiatrists as well as psychologists involved in patient care to have an understanding of how the various theoretical orientations can be used to provide the patient with the best treatment experience. In this regard, it calls for the psychologist involved in the treatment of Julia, a seventeen-year-old patient who has been diagnosed with anorexia nervosa to demystify the treatment plan based on the following subheadings.

Behaviorally Defined Symptoms

Presenting problems

An analysis of the case involving Julia points out that Julia has an eating mental. Through a critical analysis of her behavior, it is evident that Julia portrays different physical and comorbid psychological problems. These problems where group together illustrate that Julia is suffering from anorexia nervosa- a mental eating disorder. In essence, Julia indicates a likelihood in which her nutritional behavior is unusual. These leads to possibilities of psychiatric problems such as self-starvation and lack of appetite. As observed by anorexia nervosa is characterized by extremely body weight. The other problems that provide the diagnostic impression of anorexia nervosa include exhaustion, being ant sociable, stressed out. The diagnosis also reveals different behavioral symptoms which are all related to the diagnostic impression of anorexia nervosa. One of these behavioral symptoms is depression. Julia feels depressed by the fact that people feel her weight is extremely low. She feels that her friends have been treating her unfair since she is comfortable with her weight.  The other behavioral symptom is obsessive-compulsive disorder and borderline personality disorder.

How the problem(s) is/are evidenced in the client’s behavior

Although Julia is exceptionally underweight, she sees herself fat. While looking at the mirror, Julia does not see her poor weight; but relatively she sees herself as very fat. In a span, if a few years,  Julia has lost 105 pounds.  She started unhealthy dieting and lost 30 pounds in starting. Furthermore, it was not the end, and her health was more down because it lost 105 pounds. The reason for losing so much weight is that Julia did not take a nutritious diet because she was only taking diet sodas and crackers. Julia is extremely skinny, and in her opinion, she was very fat. She fears weight gain and looks skeletal, along with having a fear of eating around her friends and in public. In regards to her current condition, Julia appears depressed and has developed anxiety concerning her eating behavior and how people view it. In her words and as expressed in her behavior, Julia is obsessed with maintaining her weight. By maintain her weight, Julia hopes to participate in the athletic track games. Thus manifests obsessive-compulsive disorder which makes her deny Julia happiness. Eventually, this can lead to suicidal ideation. Though her constant fears of adding weight, Julia keeps watch of her diet. This aspect makes her health to deteriorate as a result of pathological issues.

Behavioral and cognitive symptoms

The development of Julia eating mental disorder is as a result of her current condition, that is, maintaining her weight so that she can participate in the athletic track games. She has therefore conditioned herself that she has to maintain her weight and keep watch on her nutrition to “keep fit.”  She has also developed restrictive conditioned behavior in the sense that she does not want to associate with her family members. She, therefore, feels comfortable in her world.

By the fact that he feels that her friends and family members regard her as extremely skinny, Julia develops a core belief that she is hopeless and has no meaning or purpose in life. These beliefs emanate from the mind and make her depressed. From the core knowledge, Julia extends an assumption that her life is health and she is poised to remain in this state. The core belief also makes Julia formulate automatic thoughts such as no one likes her and no one wants to motivate her in her current endeavors. Such thoughts as mentioned above results in a mental eating disorder- Anorexia nervosa.

Evidence-based theoretical orientations

Cognitive-Behavioral Therapy

According to Brown et al., (2015), the CBT model provides that beliefs and behaviors are responsible for the psychological problems of patients. Through individuals through the system, he or she can develop and get mental disorders. Cognitive behaviorists believe that mental disorders such as anorexia nervosa, and depression results as a result of faulty thought system. When a specific thought becomes a disturbance, such a person is likely to develop a mental disorder. Social learning is therefore emphasized as a way of developing an individual as well as the ideas of reinforcements. The CBT model is used in psychological treatment to change faulty thought systems. It also involves changing irrational behavior. This as observed by Brown et al., (2015) can be attained education where positive experiences are strengthened. In the end, the patient thinking is altered and enhances the way individuals cope.

Psychodynamic psychotherapy Theoretical Orientation

The focus of this orientation is on how the unconscious affects the behavior and thinking of patients with mental health conditions. When used as a form of psychotherapy, psychodynamic therapy encourages the understanding as well as the self-awareness of patients. This understanding is essential in helping patients to resolve their past experiences. As observed by Nyer, et al. (2015), in most cases an individual’s past experiences play a significant role in their present conditions.

The connection between the Theoretical Orientation and Corresponding Intervention

Research has it that a combination of skilled, focused approaches with cognitive-behavioral approaches is the most effective in treating anorexia nervosa. According to Brenninkmeijer, et al. (2018), both CBT and therapy provide extensive empirical support for treating depressive symptoms. The significant connection between the three theoretical orientations is based on the sense that the treatment of all the mental eating disorders requires the patient to accept herself as well as her condition. This basis makes the patient initiate the process of change in cognitive behavioral therapy. The DHT emphasizes on regulating the eating pattern as well as the behavior of the patient. It is therefore right to say that there is aconnection with the other two theoretical orientations – CBT and  FSAT.

The rationale for the Integration of Multiple Theoretical Orientations

Eating mental disorders and especially anorexia nervosa is complex to treat with only one intervention. By using multiple theoretical orientations, it becomes easier to understand the different interventions to be used in the treatment of the disorders.  It is therefore right to say that using multiple theoretical orientations provides the therapist or the psychologist with the best treatment method for the problems.

Treatment modalities

The treatment modalities that fits this case is individual therapy, family therapy, and group therapy. Individual therapy will involve the client going through different therapy sessions. With this therapy, the client will improve her cognitive functioning and will change her behavior towards eating patterns. Family therapy will involve the mother, the father, and the siblings. They will all be taught on how to relate well with the patient and help her in her overall recovery. Group therapy will involve patient suffering from anorexia nervosa and other related eating mental disorders.

Ethics

Potential Ethical Dilemmas

The possible ethical dilemma that may arise during the implementation of this is plan is the issue of dual relationship. In such a way the therapist may develop a second, significantly different relationship the client in addition to the traditional client-therapist one. In this case, it becomes a challenge for therapists to attend their duties professionally. The second ethical dilemma that can arise is when the client perceives the different interventions used as extra workload. If this happens to be the case, the therapist will have it rough trying to convince the client otherwise. The extra workload can be viewed by the client as psychological torture. The last ethical dilemma is that of the client losing the ability to make an independent decision. At this stage, the therapist may be required to decide on behalf of the client.

Ethical Principles

Some of the ethical principles that can be used to resolve the ethical dilemmas are respected for people’s rights and dignity and informed consent. Regarding the former, the therapist or the psychologist is required to respect the worth and dignity of the client. He or she is also responsible for protecting the client’s right to self-determination, privacy, and confidentiality (American Psychological Association 2010). Regarding the latter, it is required of the psychologist to seek informed consent from the client before making any decision that concerns her. The consent might be written or oral.

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