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The Use of Cbt in Treating Eating Disorders

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In this assignment I will start off by outlining the importance of Patient Confidentiality, and then briefly describe my role as a Social Prescribing Health Trainer. I will then introduce cognitive therapy and theory and outline the generic cognitive model that has informed the development of psychological treatments for emotional disorders. I present a rationale for the application of CBT skills and why I believe it is an appropriate intervention for my case study with the specific difficulties that concern her. I define the therapeutic alliance, emphasizing its importance, and highlighting that it has been identified as a major factor crucial to the change process. I explain how I have endeavoured to create a positive bond between the patient and myself by showing a high degree of empathy, congruence and interpersonal contact. I describe the initial assessment, case history and detail the information gathered in subsequent sessions. Predisposing and precipitating causes, as well as maintaining factors relating to the patient's problems are discussed through the use of Socratic questioning and guided discovery. The initial assessment, case history, problem list, case formulation, and behavioural experiment are attached in the Appendix as evidence in Practice. Finally I conclude by being critically reflective of myself in practice, enlisting feedback from my patient, and considering the appropriateness & applicability of CBT based interventions with my patient's particular difficulties in my practice setting. I also evaluate and critically appraise the articles, research, evidence and theory I found surrounding the treatments and therapeutic models used to treat my patient's particular difficulty.

A patient who knows that the personal, private and intimate information he/she shares with a counsellor or psychotherapist is held in confidence is more likely to feel at ease about self-disclosure. The patient will also feel more able to trust their counsellor, and will want to open up and discuss their issues, concerns and difficulties more readily. Without this level of patient confidentiality the client-counsellor relationship has no firm foundation. I asked for my patient's consent to use her as my case study in this assignment and have maintained her confidentiality throughout by using the pseudonym Helen rather than her actual name. Any identifying information has been removed/changed and I have also not disclosed the location and name of my practice setting.

Patient confidentiality also means maintaining private information about a patient, and ensuring that no unauthorised person has access to this. Patient information may be stored in a variety of different ways. Information stored in electronic records, on a computer for instance, must be strictly maintained to avoid the violation of a client's privacy and confidentiality. In my case I use SystemOne which is a single unified database available to all healthcare professionals. My notes are securely held and managed at a remote centralised location. I also input patient information on The Data Collection & Reporting System (DCRS). This is a growing body of data that demonstrates the effectiveness of the Health Trainer service. The data collected by the system is analysed on behalf of the Health Trainer programme by the Birmingham Primary Care Shared Services Agency and is published in a national report.

There is, however, one instance where a patient's confidentiality might be breached, and that is when their personal safety, or the safety of others comes into question in some way. At my first session with any patient I explain this and ask for their signature confirming that they understand this (see highlighted section in Appendix 1). Before the confidential information is shared with another counselling professional, I would inform the patient of my intention and would ensure that harm to the patient is minimised, and ethics and institutional laws are correctly adhered to.

My role as a Social Prescribing Health Trainer is to increase the capacity of the GP practices I work in to meet the non-medical needs of their patients and to work closely with those patients, supporting them where necessary, to access appropriate local voluntary and community sector services. In my post I contribute to tackling inequalities in health through promoting and supporting people to develop healthier behaviours and lifestyles in the context of their own local communities. I deliver effective brief low intensity facilitated self help interventions with particular emphasis on Cognitive Behavioural principles. My patients present with a wide variety of mental health issues which include depression, stress, anxiety, panic attacks, addictive life controlling issues, eating disorders and self harm.

Cognitive-behavioural therapy (CBT) is collaborative, goal-orientated, structured, and present focussed. It is described by Beck et al.(1979) as "an active, directive, time-limited, structured approach used to treat a variety of psychiatric disorders (for example, depression, anxiety, phobias, pain problems, etc)". CBT is the psychological approach with the most evidence for efficacy across a range of mental health conditions including depression, anxiety and some eating disorders (Department of Health, 2001). This psycho-educational approach adheres to three fundamental principles based on the cognitive model of depression. The critical, first assumption is that depressive affect and behaviour are influenced by cognitive interpretation of situational experiences. The second assumption presumes that, with practice, cognitions can be identified, monitored, and evaluated. Finally, it is assumed that modifying distorted cognitions influences affect and behaviour (Beck et al., 1979; Sacco & Beck, 1995). CBT emphasizes Socratic self-help, so the word 'client' (meaning one who uses the services of another) would be preferable to 'patient' ('one who receives treatment'). However, in the GP Practices within which I work the word patient is used so that is the term I have used when referring to my case study.

In selecting a patient to undertake the case study with, I considered both Safran and Segal's suitability criteria and diagnosis. Regarding the former, research has found that the better a patient's intrapersonal resources (eg "psychological mindedness" and motivation: Roth & Fonagy, 1996) and interpersonal facility (eg positive marital and social relationships: Horvarth, 1991) the better able they are to form a good therapy relationship. 'Helen' (a pseudonym) presented with the diagnosis of anorexia with bulimic tendencies. Some researchers have suggested that anorexia and bulimia should be thought of as two manifestations of a single disorder with



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