Week 4: Care in the Context of mental health interventions (non-harm)

Question 1

milieu

Answer 1

physical and social environment in which client is receiving treatment

Question 2

milieu therapy

Answer 2

uses a safe environment that is actively supporting the client to achieve their goals

Question 3

goals of milieu therapy

Answer 3

• empower client to set and achieve goals
• develop purposeful relationships with team members to assist in meeting goals
• learn adaptive coping and interpersonal skills in controlled environment that can be generalized to other aspects of client’s like
• build community (both ourselves and peers)

Question 4

safe environment for milieu therapy

Answer 4

• safety is priority for client & staff
• enact behaviour risk assessment and interventions (no hoodies & strings for staff)
• following up on all breaches of safety promptly (if u see a co-worker acting unsafely and it is not followed up by staff this will break down the milieu and positive goals)

Question 5

limit setting for milieu therapy

Answer 5

• set clear, enforceable limits
• enacting behaviour risk assessment and interventions appropriately (no hoodies, strings for staff)
• following up on safety breaches (if you see another co-worker acting unsafely and it is not followed up than milieu will start to break down)

Question 6

trusting relationship in milieu therapy

Answer 6

• follow through with words, boundaries, expectations
• consistency
• modelling the behaviour of a therapeutic behaviour

Question 7

building self-esteem in milieu therapy

Answer 7

• structured purposeful set-up for clients to carry out tasks and meet expectations
• provide options whenever possible
• accept client for whom they are (don’t set expectations for clients that they won’t be able to achieve, enact SBC, seeing opportunities for clients to achieve goals and take them
• strengths based!

Question 8

psychotherapy (talk therapy)

Answer 8

intense client-therapist relationships which often involves examination of deeply emotional experiences, destructive behaviour patterns and serious mental health issues

Question 9

is psychotherapy considered a controlled act?

Answer 9

• yes and it can be access by nurses under certain circumstances

Question 10

circumstances for psychotherapy use as a controlled act (by nurse)

Answer 10

• treating a patient
• applying psychotherapy technique
• therapeutic relationship with client
• patient has serious thought, cognition, mood, emotional regulation, perception or memory
• this disorder may seriously impair patient’s judgment, insight, behaviour, communication or social functioning
• NEED an order to provide psychotherapy as a controlled act under these circumstances

Question 11

therapeutic technique vs. controlled act of psychotherapy

Answer 11

a nurse with further education in a technique is providing couples therapy, but clients are not having serious disorder of thought, then this would not be psychotherapy

Question 12

types of psychotherapy

Answer 12

• cognitive behavioural therapy (CBT)
• Interpersonal therapy (IPT)
• Dialectical behavioural therapy (DBT)

Question 13

CBT focus (3)

Answer 13

• anxiety & depression focus
• relationship between cognition & behaviours
• cognition involves conscious thoughts, automatic thoughts and schemas

Question 14

CBT focus (3)

Answer 14

• anxiety & depression focus
• relationship between cognition & behaviours
• cognition involves conscious thoughts, automatic thoughts and schemas

Question 15

CBT focus (3)

Answer 15

• anxiety & depression focus
• relationship between cognition & behaviours
• cognition involves conscious thoughts, automatic thoughts and schemas

Question 16

CBT format

Answer 16

• structured and time limited (6-20 sessions)
• problem focused and goal oriented
• exploration of clients lived experience and set goals around those specific problems
• involves the clinician teaching specific strategies and skills that the client would use to shift cognition and re-write there mental schema in order to change behaviours
• strategies and skills
• based on pro-active, shared therapeutic relationship between therapist and client

Question 17

Interpersonal therapy (IPT) focus

Answer 17

• depression
• focused on current challenges and relationships with other’s in clients life

Question 18

IPT format

Answer 18

• structured
• time limit (6-20 sessions), can initiate another structure session
• here and now relationships and aims to improve impersonal functioning and social support

Question 19

Dialectical behaviour therapy (DBT) focus

Answer 19

• borderline personality disorder, PTSD, depression
• focused on acceptance (validating current thoughts and feelings) and change of thoughts behaviour

Question 20

DBT format

Answer 20

• structured
• year long commitment
• skills development; psychotherapy; coaching; case management

Question 21

motivational interviewing

Answer 21

• therapeutic communication technique with goal of patient led lasting behaviour change
• when change is motivated by autonomy more likely to last (guiding client to make those changes for themselves

Question 22

Principles of motivational interviewing

Answer 22

• express empathy (reflective listening)
• develop discrepancy (don’t give tone of compliments for something good & then nothing when behaviour not achieved)
• roll with resistance (new perspectives without imposing)
• support self-efficacy (strengths)
• assess confidence (scale 1-10)

Question 23

change readiness

Answer 23

• pre contemplation (not thinking of change)
• contemplation (ambivalent about making changes)
• preparation (taking steps towards change)
• action (actively involved in change process)
• maintenance (sustaining target behaviour)