Stages of Developing a Psychiatric Treatment Care Plan

Stages of Developing a Psychiatric Treatment armorial bearing PlanA patient had been admitted to an A E unit after committing deliberate self-harm. He had attempted to commit suicide by overdosing on some headache tablets. When that hadnt worked he slashed himself in several places using a kitchen knife. He arrived at the A E unit in an extremely distressed state.Why the psychologist was called inAlthough the patient all the way had very severe physical injuries a comprehensive psychosocial assessment revealed he was suffering from severe psychological problems. His symptoms seemed to suggest clinical depression that was so established and severe it necessitated intensive and sustained psychotherapy. Thus, it was decided to immediately refer him to a clinical psychologist. This is consistent with professional guidelines, which recommend that self-harm patients are referred for psychological intervention if an initial psychosocial assessment reveals an underlying psychological pr oblem (NICE, 2004, p.32). A clinical psychologist is formally trained to channel with various forms of psychopathology, including clinical depression, based on psychological theories and interrogation (Davey, 2004, pp.713-714). In addition to carrying out in-depth psychological evaluations, to identify underlying psychopathology (using a wide variety of personality and neuropsychological tests, and clinical observation), the psychologist is trained to advert a formal diagnosis, using set criteria. Clinical psychologists and psychiatrists give way very similar training. However a clinical psychologist rather than psychiatrist was called in to deal with this case because the latter are originally medical doctors, and hence typically use the medical model for dealing with psychological disorders. Psychosocial assessment suggested that this patient primarily required intensive psychotherapy rather than medication.Theoretical conceptsThe clinical psychologist relied upon Sigmund Fre uds psychoanalytic theory in formulating a treatment plan (McMillan, 2001, pp.599-600). Freuds conceptualisations have had a massive impact on popular culture, and psychology and psychiatry in particular. Psychoanalytic theory posits that unconscious conflict, often emanating from childhood, and involving forbidden sexual and assertive desires causes psychopathology. A distinction is made between the conscious (awareness), preconscious (memories that are readily accessible), and unconscious (repressed memories of which a person may not even be aware). overlying against these levels of consciousness are three comp championnts of human personality the id (basic biological drives), the ego (restrictions imposed by external reality), and superego (conscience). The id operates at the subconscious level, while the ego and superego cash in ones chips at the preconscious and conscious levels. Perpetual and intense conflicts between the id and the other two components can generate gigant ic anxiety and, if unresolved, mental health problems. Psycho synopsis places considerable emphasis on the sex drive, or libido. Humans are thought to progress through several stages of psychosexual development. Fixation at any one stage results in various emotional problems.What the psychologist didDuring the initial session with the patient the clinical psychologist immediately set up a good rapport with the patient. The priority was to assess the patients problem, and develop a comprehensive treatment plan with clear goals for recovery. After an initial session the patient underwent numerous sessions involving free association, a therapeutic form of psychoanalysis (McMillan, 2001, pp.167-168). During this procedure, the psychologist encouraged the patient to verbalise whatever came to mind. Free association is considered to yield clues about the subconscious roots of a patients problem. The patient verbalise a lot about his childhood. From time to time the therapist probed with searching questions encouraging the patient to elaborate on particular statements made. During each session the psychotherapist maintained an empathic and non-judgemental demeanour, in order to facilitate a high degree of trust between himself and the patient. The patient attended weekly sessions over a six-month period. During the final month of therapy the clinician engaged in dream analysis, whereby the patient was asked to describe recent dreams in as much detail and with as much trueness as possible.How the psychologists input was assessedBy the end of therapy it had gradually become clear that the patient had been experiencing intense homosexual desires ever since puberty. These urges had been repressed for years, in order to adapt to social norms and his parents wishes for him to get married and have children. The patient wasnt conscious of these forbidden desires. The realisation made him feel much better, going a longsighted way to explain why he had been feeling patholog ically depressed, even suicidal. The impact of psychoanalytic therapy on this patient was assessed using a pre- and post-test experimental analysis (Coolican, 1994, pp.82-88). During his initial assessment of the patient the psychologist obtained baseline measures of psychiatric symptoms using the SCL-90-R (Derogatis, 1983), social functioning using the Social Adjustment Scale (Weissman, 1975), general adjustment in life, using the Global Assessment Scale (Endicott et al, 1976), and episodes of self-harm, using the Suicide and Self-Harm Inventory (Sansone et al, 1998) during the previous six months. At the end of therapy the therapist administered the same battery of tests to pretend any improvements in the patients mental health. Statistical analysis comparing pre- and post-test data, using a t-tested for repeated measures (Coolican, 1994, pp.281-286) showed significant improvements on all criteria psychiatric functioning, and social/ worldwide adjustment, and frequency of self-ha rm.BibliographyCoolican, H. (1994) Research Methods and Statistics in Psychology, London, HodderDavey, G. (ed) (2004) Complete Psychology . London Hodder and StoughtonDerogatis, L.R. (1983) SCL-90-R Administration, Scoring, and Procedures Manual,II. Towson, Md, Clinical Psychometric Research.Endicott, J., Spitzer, R.L., Fleiss, J.L. Cohen, J. (1976) The Global AssessmentScale a procedure for measuring general severity of psychiatric disturbance.Archives of General Psychiatry, 33, pp.766771.NICE (2004) Self-Harm The Short-Term Physical and Psychological Managementand Secondary Prevention of Self-Harm in Primary and Secondary CareClinical Guideline 16. London National Institute for Clinical Excellence.McMillan, M. (2001) The reliability and validity of Freuds methods of freeassociation and interpretation. Psychological Inquiry, 3, pp. 167-175.Sansone, R.A., Wiederman, M.W. Sansone, L.A. (1998) The Self-Harm Inventory(SHI) development of a scale for identifying self-destructive beha viors andborderline personality disorder. Journal of Clinical Psychology, 54, pp.973-983.Weissman, M.M. (1975) The assessment of social adjustment. Archives of GeneralPsychiatry, 32, pp.357365.