Mental Health Nursing

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