Intervening's OK. OK?

Mental Health Nursing,  Nov/Dec 2002  by Reeve, Thomas

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Speak Up!

In the July/August Speak Up!, Marjorie Lloyd criticised the 'confusing' range of interventions (anxiety and anger management for instance) available to mental health nurses, described it as a 'supermarket approach' and asked what had become of `self-management'? Thomas Reeve, however, sees the question from a different point of view

I would suggest self-management is inherent in the psychological interventions listed - in particular, anxiety management and anger management are interventions designed with the explicit intention of helping clients to understand their emotional responses to everyday life, teaching them techniques and strategies to manage their emotions.

CBT has developed from a well researched model and it specifically aims to help clients recognise their thinking processes and the emotional/behavioural consequences. DBT is a model of treatment which is used with borderline personality disorder. Self-management of emotions and self destructive behaviours are key to the treatment (Linehan M M, 1993).

It was implied that if nurses use psychological models to inform their practice then they do not recognise caring as an important quality in their work. To quote Beck (1979) the therapist `must possess necessary characteristics such as the human capacity to respond to the patient in the atmosphere of a human relationship with concern, acceptance and sympathy. No matter how proficient he [sic] is in the technical application of cognitive therapy strategies, he will be severely hampered if he is not adequately endowed with these essential interpersonal characteristics'. It has been well recognised in the field of psychological therapy that the therapeutic relationship is essential for successful treatment.

Psychological interventions do look at clients holistically Psychosocial interventions, for example, are an approach used to understand and treat psychosis using medical, psychological and social interventions such as CBT and family therapy Surely, as a profession, we should be exploring ways of understanding people's experiences of mental illness in a more flexible and patient centred manner?

A supermarket approach may not be such a bad thing. Supermarkets provide an opportunity to make choices and choice is what we should be providing to our clients.

As an RMN working as a cognitive behavioural therapist I am aware that psychological models are not a panacea. However, psychological models have developed through an empirical process of on-going research and development. In my opinion, caring is not enough: offering clients psychological therapy is very caring. The opportunity to make progress with their mental health in a clearly demonstrable manner rather than muddling along in an unfocussed, haphazard manner is surely more desirable.

References

Beck AT, Rush A J, Shaw B F and Emery G (1979) Cognitive Therapy of Depression. New York, Guilford Press

Linehan M M (1993) Skills training manual for treating borderline personality disorder. New York, Guilford Press

Thomas Reeve is a cognitive behavioural psychotherapist with South of Tyne and Wearside Mental Health NHS Trust

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