Mental Health Nursing
Mental Health Nursing
Mental Health Nursing
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Assessment of Need (Phelan et al., 1995) or the standardised psychiatric<br />
assessment for chronic psychotic patients (Krawiecka et al., 1977).<br />
Measurements should be taken using established, valid and reliable tools<br />
that examine various facets of the patient’s problem and identify improvement<br />
in some or all aspects. One may generally expect a patient with<br />
depression to recover to the extent that all measurable areas improve.<br />
However, with a patient with chronic schizophrenia, one may observe<br />
improvement only in some areas. Consequently, cognitive behavioural<br />
measures should include general measures such as social functioning.<br />
However, they must also include very specific measures of change.<br />
Experimentation<br />
Cognitive behaviour therapy in in-patient care 191<br />
Experimentation is a core characteristic of the cognitive behavioural approach.<br />
There is often a range of techniques which may be of benefit to patients<br />
with specific problems. For example, in depression, one might use cognitive<br />
techniques to help the patient change a particularly negative thought.<br />
However, in addition, the therapist will know that for some patients, specific<br />
exercises are important. Some patients may benefit from using a timetabling<br />
approach to structuring their activities while others benefit from training in<br />
improving assertive skills and others from the use of medication and so on.<br />
The cognitive behavioural approach requires the therapist to develop a programme<br />
of treatment, which incorporates the use of a number of techniques.<br />
However, as each patient responds in their own individual way, one needs<br />
to find the optimum technique or combination of techniques. This can only<br />
be done by actually trying the techniques (singularly or in combination) in<br />
real life. Thus, in a sense, each trial of treatment becomes an experiment in<br />
its own right. The therapist should use a range of measures before applying<br />
the techniques, and again after the application, in order to ascertain the<br />
effectiveness of these techniques. Then, once the therapist has had the<br />
opportunity to consider the results of the measures and to discuss the outcome<br />
with the patient, the techniques and strategies can be varied. This<br />
approach, combining measurement and experimentation with clinical practice,<br />
is often called the approach of the ‘scientist practitioner’.<br />
Finally, the cognitive behavioural approach relies on the application of<br />
evidence (obtained from research) to practice. The cognitive behavioural<br />
framework assumes that the person who delivers the cognitive behaviour<br />
approach has a broad knowledge of the scientific literature relating to<br />
research on the efficacy of various procedures and techniques. Thus, for<br />
example, the knowledgeable practitioner of cognitive behaviour therapy<br />
should know which approaches work and which approaches do not work<br />
for various problems. Although this seems rather obvious, it is worth<br />
noting that patients with mental health problems still receive many treatments