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 meager. 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, i.e., 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.

Long term goals

In to put Julia on a path towards long term recovery, she will have to maintain an adequately nutritious diet to enable her to obtain weight commensurate to her age, height, and gender.

Short term Objectives

The most immediate objective is to enable Julia to open up on her fears and thoughts concerning weight gain through emotional support and assistance with redeveloping a normal eating behavior.

Intervention

The primary intervention in handling anorexia nervosa is to offer emotional assistance. This way the patient will be able to open up about their struggles and feelings towards weight gain. This, in turn, opens avenues to pursue different treatment options. Encouraging Julia to seek feedback from medical practitioners and other knowledgeable individuals from within her cycles about her views and perceptions about weight gain will enable her to open up about her struggles and have any arising misconceptions adequately addressed.

Emphasis on the need for a behavioral contract for Julia and explaining the benefit of such steps would be a significant step going forward. The benefit with such a contract is it allows the patient gain weight slowly and steadily hence able to have some control over the situation. Identifying and addressing of Julia’s concerns and educating her on the same would significantly influence the success of the primary treatment step. Since anorexia nervosa is in most a projection of underlying symptoms that the patient finds beyond her control, it is essential that these fears be addressed first.

Upon unearthing the underlying problems the next step is to help the patient back to healthy eating behavior. This should enable her to gain an average of 2 lb. Per week. This would involve; collaboration with nutritional healthcare experts to design diets based on the patients caloric needs to enable her to preclude adversely life-threatening phase. Once this is put in place, adhering to the previously formulated behavioral contract is crucial to the achievement of success in this stage. Giving Julia the room of choice on meals she would prefer as well as providing structured support during meals would enable her to appreciate the care being extended to her and as a result be more encouraged to follow the behavioral contract through.

Monitoring of progress is of importance. The patient’s health must at all remain the priority. In case of weight loss and malnutrition, the caregiver should in consultation with the nutritional health expert consider pursuing other options such as the provision of nutritional supplements and tube feeding.

Depending on the progress made from the first two stages, an evaluation of the patient’s current dependency levels and ability to progress towards self-reliance. This begins with identification and acknowledgment by the patient on the areas she still struggles with. Through such intervention, treatment plans can be adjusted to enable the patient to accepts personal responsibility and become more independent. Once the patient has demonstrated progress towards self-dependence, it is essential that her family is adequately equipped to assist and support her during her journey. Through family therapy and general education of people in their circles to understand her condition better enables them to show support when they struggle to cushion against relapse.

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 a connection 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 modality 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.

Evaluation

The efficiency of Evidence-Based Interventions

Cognitive simulation intervention is one of the most used interventions involving anorexia nervosa (Fahey, 2016). A study on the effects of cognitive simulation found that patient is treated through this intervention developed self-confidence by believing about themselves. The patients were observed as being able to approach life and challenging situations with calmness and peace. Keeping in mind that Beatrice problems emanate from past experiences, the intervention will thus help her be able to handle situations by being more relaxed and less anxious. Another observation from study Jongsma, Peterson and Bruce (2014) is that patients who were treated through the cognitive simulation intervention were able to cope well with challenging situations like the death of their loved ones and financial crisis.

When psychologists researched the effectiveness of the behavior therapy intervention, they conclude that it is equally effective as the cognitive simulation intervention. A study conducted by Gorenstein and Comer (2015) on the effectiveness of the behavior therapy intervention had the following deductions: it prevents addiction relapse; useful in anger management, effective in coping with grief and loss and helps in the management of chronic pain.  Another study by Gastaud, Padoan, and Eizirik (2014) found that this intervention is effective in overcoming obsessive-compulsive disorder and borderline personality disorder. Boyd (2018) after researching the effectiveness of the intervention concluded that it is essential in resolving relationship difficulties.

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.

References

Boyd, J. (2018).  Practice Planners: The Co-Occurring Disorders Treatment Planner.  Issues in Mental Health Nursing, 29(2), 205-206.

Fahey, W. E. (2016).  The complete psychotherapy treatment planner.  Journal of Child and Family Studies, 5(2), 245-246.

Farley, Y. (2012).  The couple’s psychotherapy treatment planner.  Sexual and Relationship Therapy, 27(1), 80-82.

Gastaud, M. B., Padoan, C. S., & Eizirik, C. L. (2014).  Initial Improvement in Adult Psychodynamic Psychotherapy.  British Journal of Psychotherapy, 30(2), 243-262.

Jongsma, A. E., Peterson, L. M., & Bruce, T. J. (2014).  The complete adult psychotherapy treatment planner.

Brenninkmeijer, V., Lagerveld, S. E., Blonk, R. W., Schaufeli, W. B., &Wijngaards-de Meij, L.  D. (2018). Predicting the effectiveness of work-focused CBT for common mental disorders:  The influence of baseline self-efficacy, depression and anxiety. Journal of  occupational rehabilitation, 1-11.

Brown, H. M., Lester, K. J., Jassi, A., Heyman, I., & Krebs, G. (2015). Pediatric obsessive-compulsive disorder and depressive symptoms: Clinical correlates and CBT treatment outcomes. Journal of abnormal child psychology, 43(5), 933-942.

Gorenstein, E., & Comer, J. (2015).  Case studies in abnormal psychology (2nd ed.). New York, NY: Worth Publishers. ISBN: 9780716772736

Nyer, M. B., Cassiello-Robbins, C., Nock, M. K., Petrie, S. R., Holt, D. J., Fisher, L. B., … &       Farabaugh, A. (2015). A case series of individual six-week cognitive behavioral therapy    with individually tailored manual-based treatment delivery for depressed college students     with or without suicidal ideation. Journal of Rational-Emotive & Cognitive-Behavior             Therapy, 33(2), 134-147.