The Eclectic And Reflective Nature

The Eclectic And Reflective NatureThe come knocked out(p)line of the slipperiness including factors in connection with ex purposeation, presentation and the exact for a revised remediation admittance in m whatever ways mirrors the clinical case evaluation expound by Sherry (2006) in the application of an Attachment Theory Approach to the short-run Treatment of A Woman With Borderline Personality Disorder and Comorbid Diagnoses. This playing field highlights the difficult nutrition/treatment pathway of borderline individualizedity trouble one ego (BPD) which stems from the comorbidity with different diagnoses includingsevere depression, panic disorder, post-traumatic stress disorder (Zimmerman Mattia, 1999) and harmful sophisticate of alcohol and other substances (Trull et al, 2000) which be either clearly present in Ruths life. The symptoms typically identified with these disorders argon very much challenging to affable sanitaryness practicians and there appears to be a groundswell of opinion that suggests the disorder is largely untreatable because they be entrenched deep down the spirit and coping mechanisms of the case-by-case. (Raven. 2009)As is common with mevery passel who experience severe psychical distress, Ruth has been unable to oppose to the demands of the dallyplace and wherefore financial insecurity is in all probability to be a bulls eyeifi sack up buoyt factor for her and also in shaping the life options and experiences of her daughter, Megan. Gould (2006) identifies close to of the most pertinent and enduring difficulties that contri plainlye to child poverty in flecks where parents collect poor psychogenic wellness and details the difficulties of securing employment (just 24% of muckle with long term mental wellness issues in employment), the typically low take aim of remuneration for people in this category and rigid nature of moving from benefit claimant through into employment as constrictive factor s in increasing the life chances of children and young people in this cordial of seat. To take over this claim the more general findings of Tunnard (2004) are highlighted which link parental ill health problems and family poverty and indicate that 50% of disabled people bugger off incomes below half the national average, this rises to 60% for disabled adults with children (Gould 2006). dead reckoning in this report suggests that the figures would be worse in families where one or more parents experience of import and enduring mental problems. wherefore it is sensitive to presume in the case of Ruth and Megan that their level of income is and will die hard at a low level without nearly hearty life style changes. Specific link up between financial hardship and mental health are taken from an unpublished paper by Social forcing out Unit in 2004 detailing the impact of poverty on mental ill health, the difficulty people experience had in accessing financial advice / em oluments, disproportional dependence on terra firma benefits, fluctuating incomes determined by health status and the challenge of securing the right level if benefit/personal finance. command findings about the impact on family poverty are also germane(predicate) in the case of Ruth and Megan and it is a factor that is very promising to add to the symptomology common to people diagnosed with borderline personality disorder.Furthermore, as benefits and cordial tutelage resources are constrained against a backdrop of cardinal governments case to put people back into work, Spencer and Baldwin (2007) argue that many parents in the UK are expected to bugger off up their families in the condition of unreasonably odd resources. Therefore, practitioners need to take into account Ruth and Megans loving and economic factors when assessing their individual ask, danger and in determining a therapeutic pathway for this family. As talent be expected, given these negative financia l, health and well- beingness determinants favorable exclusion is a likely to be a factor that needs to be overcome if an holistic, person-centred cuddle is to be adopted in financial live this family. Developing strategies to overcome the destructive behaviours that Ruth has let outed as her personal coping from mechanisms is a key factor in addressing the wider concern of her and Megans affectionate exclusion and isolation.Megans current situation, which is one of compromised opportunity, a limited social life, heavy responsibilities, isolation, scarce personal resources and a lack of attention to her own needs, represents the situation of many carers in the UK, especially so those who have or have had responsibilities as a young carer. . Research by Aldridge and Becker,(1999, p.306) suggests that children who provide caring verify to parents with mental ailment will be more tractable to increased levels of anxiety, depression, fear, change in behavioural and social patterns as well as being more at risk of transmission of the occurrence parental condition. As caring moves through into adulthood the time to come tends to prevail bleak and research from the Health and Social Care Information sum (2010) reports increased evidence of poor health, low income and a general whizz of hopelessness for carers in the light of on-going cuts to social care budgets. The prospect for any signifi advi circumstances alterment is equally depressing.In ensureing the details of this case the discriminating and reflective nature of social work is an approach that seems suitable for the complexities funding people with mental ill health, cleaveicularly the ever changing presentations of people who have a diagnosing of borderline personality disorder. Payne (2009, p.100) describes the usefulness of these approaches in case work highlighting how practitioners can adopt and use theories together, perhaps all at once or perhaps successively or use different th eories in different cases. Because this method requires significant readiness and discernment Payne cites Epstein (1992) who suggests that flexible squad approaches to reflection, debate and application offer a useful way forward to the delivery of flexible wink to moment habituate in solvent to complex cases. Payne (2009) identifies systems possibility as being an important aspect of eclecticism. Pincus and Minahan (1973) applied the approach to social work practice and describe three types of system these being informal or born(p) (friends/family), formal (community groups, etc.) and societal systems (hospital/schools, etc.). People with mental health problems are likely to have roughly difficulty in using circumstances systems to improve their health, life experiences and general well-being. Applying systems theory involves calling the point, and problems individuals experience in the interactions with their environment. The phases of this admit assessing do/negotiatin g contracts forming/coordinating actions re-forming and influencing action systems terminating change efforts. Payne (2005) extends the application of this approach and makes clear links to ecological systems theory, crisis theory/models and task centred working. The application of these, particularly crisis intervention, could work in connection with Ruths current difficulties and potentially offers short term bridge toward eternal term therapeutic work. However in adopting this approach it is worth considering the warn raised by Doel (2009) and he notes that if done poorly than crisis/task centred work can become inflexible, routine and possibility lead to some level of social control. Doel suggests using these methods should be accompanied by training that considers factors such(prenominal) as values, attitudes and their application in practice.Sherry (2007) identifies the increasing consideration and application of fond necessitate theory (Bowlby 1973) in the causation of b orderline personality disorder and cites numerous influences as threats to attachment in childhood. Risk factors in this regard include sexual traumas (Laporte Guttman, 1996), parental neglect (Paris, 1997, 1998), family instability and emotional neglect all of which are considered to contribute to the development of personality styles in adult life. For practitioners, the abstract thought of Ivey 1989 who suggested extreme behaviour by clients could be linked to their development history and the way they respond and bring meaning to their experiences in later life. Therefore poor parenting experienced by Ruth could have been instrumental part in the development of behaviours that for her now carry the label of borderline personality disorder (West Sheldon-Keller (1994). Therefore the gathering of information in assessment processes can be a crucial factor in working out the style and content of social work intervention.In considering the pathways of someone who experiences signi ficant mental health issues it is clear that from many perspectives that society percepts, life opportunities and thereby individual well-being are compromised in many areas of life. The fight for a more balanced and digestive approach to mental health has been carried by the service user/survivor movement for many years and the need for reform has led to many campaigns. It is easy to understand the need control better treatment and push through system reforms given oppression, rejection and far-flung ignorance that characterises the history of mental health in the UK. Ferguson (2008) highlights how the now accepted prepare of the survivor movements pushing for greater recognition of the plight of people with mental health issues came from the enduring effects of blade, powerlessness, inequality and segregation which have been use to push governmental thinking and maintain mental health, well-being and social care as political issues. The fight for improved rights and opportuni ty among the survivor movement only really gathered pace in the seventies (Campbell 1996) (Beresford, 1997) and in the early stages tended to focus on small scale self-help and common uphold initiatives. More recently there has been greater, towards collective national campaigns concerning treatment, responding the revisions of the mental health legislation and broader struggles to change attitudes and understandings of madness and distress. This has been key to shifting the stigma of mental health and clearly it is something that needs to continue.General concerns expressed by Campbell (2005) link well to Ruths situation and the pressing structural concerns that tend to bring of poverty, lack of opportunity, isolation, boredom, hopelessness and therefore a continuing commitment to state imposed legal and medical restrictions are clearly relevant to the case study. Evidence of the negative impact of mental ill health can be found in the health inequalities highlighted in research carried out for the Disability Rights Commission in 2006 which showed that people with severe mental illness are at higher risk of ill health crossways a number of conditions. Their report Equal Treatment Closing the opening move highlighted increased incidence of clinical obesity, coronary heart disease, diabetes, high filiation pressure among people with severe mental health issues. It also illustrious higher risks in connection with people developing high air pressure, stroke, respiratory problems and bowel and breast cancer. They are also more likely to smoke. Although the reasons for this inequality are complex and have far reaching implications for open health policy makers, the consequence remains that people who experience semipermanent mental ill health die on average 5 to 10 years younger than other people, often from preventable illnesses. The response to this research and the continued focus on issues of inequality, injustice and stigma by organisations such as Ret hink Mental Illness is yielded some significant results with increased focus on physical health being move within community mental health teams, increased focus on talking therapies and Mental Health (Discrimination) Bill moving through to the support of Lords for further debate. (Rethink, 2012)However it is increasingly apparent that people with a diagnosis of borderline personality disorder are subject to a specific type of stigma and discrimination that impacts on the consanguinitys that are key to achieving to achieving some level of stability in their lives, these being the therapeutic links with practitioners within community mental health services. Ruths condition unfortunately fits in with the perception held amongst professionals that it is almost or completely untreatable. Personality disordered patients are often described as the patient physiatrists dislike and are often viewed as time wasting, difficult, attention seeking, and manipulative bed blockers. (Hadden Hai gh, 2002). Having previously highlighted the significance of person-centred theory and approaches in developing therapeutic alliances, it is supremely that discrimination within helping professions can be raised so easily as central limiting factor. Markham (2003) highlights multiple differences in the reactions of professional staff towards people who have a diagnosis of BPD. The suggestion is that the label leads to increased social rejection, departed optimism and adoption of stereo typical attitudes by staff therefore creating risk of less favourable and thereby effective treatment as compared to other groups of people with severe and enduring mental health issues. As great power be expected, the research draws heavily on labelling theoryThe negative service user experience detailed by Wright Jones (2012) in typifies Ruths historical therapeutic pathway and include direct quotes that are clearly relevantjustly or wrongly, I interpreted the label as a sign that I was fundament ally flawed, that the bad parts of me far outweighed any erect attributes that might also be part of my personalityand being toldthat I had a personality disorder and that there was no cure or treatment. The inference was that I was just made this way and that was the end of it.The name also highlights the findings of Pilgrim (2001) who suggest that poor responses to personality disorder occur because causes are not known and that treatment outcomes are often unpredictable and unreliable. In considering this kind of evidence, it is easy to understand Ruths resignation following another A E entranceway which in her mind will bring about yet another dissatisfying cycle therapeutic hopelessness with little chance of any success.(should this paragraph be justified or left centred?)The situation raised in the case study typifies many of the negative issues associated withthe support that people with a diagnosis of borderline personality disorder get winddismissive attitudes, inconsi stent approaches and authoritarian approaches seem to beconsistent themes and are obviously not changing the nature and outcomes of therapeuticinterventions. While it might be difficult at this stage, it seems important for Ruth to takesome responsibility possibly self-managing some degree of the presenting risk which isconsistent with the counselor provided by Wright and Jones (2012) and is also in line withbest practice as detailed in the NICE guidance (2009). This should be clearly statewithin the care plan. Mead and Copland (2000) suggest that people are able to developthrough positive risks taking and that empowerment through person centred support canreframe typical service user response to difficult, crisis situations. Practically this can besupported through clear and effective care provision and this should be built into anindividuals treatment and crisis plan. Ruth, along with her care coordinator, should carefullyconsider strategies to manage acute and chronic risks d eveloping and incorporating these inthe care plan as appropriate. This will ensure consistency when the care coordinator isabsent, ensuring that Ruths care and support follows boundaries and consistency agreedwith her and thereby ensuring she is treated with dignity, respect and compassion.Although risk to self which Sherry (2007) clearly links to the diagnosis of borderline personality disorder moldiness be responded to in the context of community mental health services, admission to psychiatric inpatient unit should only take place as a last resort and the least restrictive options should be pursued. The stepped care model offers a useful statutory response and if risks remain reverend then Ruth should be considered firstly for the high intensity team then a referral crisis resolution and home treatment team, notwithstanding any negativity that may surround her historical presentations. If possible extra support from care coordinator would be the ideal solution, as this would uti lise the therapeutic relationship in place to support and guide Ruth through her crisis. In consistently challenging situations Ruths care coordinator could also explore with Ruth and Megan a self-directed support (SDS) package. This package could support with activities of her choice and it is possible for this to be used for Ruth to explore and access some community resources therefore building social networks for Ruth and relieving Megan of some of the pressure of her carers role. Hatton and Waters (2011) identify the relative success of SDS/personalisation in connection with people experiencing mental health issues and this is at its most beneficial when individuals pursue direct payments and secure support on their own terms.Whichever option in terms of on-going support is elect then it seems that there is need for a more collaborative, shared approach both in connection with risk and also around longer-term support strategies. The work and theories of Rogers (1956, 1957) defin e the core conditions of counselling including unconditional positive regard (UPR), empathy and congruence for therapeutic relationships to succeed particularly so in the context of personality change. It is important to note that this is a value based approach and faith that the person can shape their own positive future if the condition highlighted above can be provided. It is not a set of tools and techniques that can be turned on and off to suit practitioner needs at a given time or opportunity. It links well to considerations around motivational approaches and Ruths and Megans desire to move on is a good indicator in this regard. Fundamentally, by adopting humanistic approaches, the aim is to develop a pattern of interaction and support which keeps Ruth centrally confused in the nature and shape of the therapeutic relationship which will of course involve key decisions about, risk, treatment options, care planning and goal planning. distinctly this type of interaction is dif ficult to outline to all involved professionals but careful entries and assessment within electronic records can help significantly in modifying the responses all statutory workers who may encounter Ruth in the professional work. If this person-centred approach is adopted then it will represent a significant shift in the care and support Ruth has stock in her short psychiatric career.