Case Analysis – Collaborating With Outside Providers Prior

Case Analysis – Collaborating with Outside Providers prior to beginning work on

Assess the evidence-based practices implemented in this case study. Explain the connection between each theoretical orientation used by Dr. Heston and the treatment intervention plans utilized. Describe the cognitive-behavioral model of the maintenance of bulimia nervosa. Explain why Rita was reluctant to participate in Dr. Heston’s request for her to keep a record of her eating behaviors, using information from the Halmi (2013) article “Perplexities of Treatment Resistance in Eating Disorders” to support your statements. Recommend outside providers (psychiatrists, medical doctors, nutritionists, social workers, holistic practitioners, etc.) to help Rita achieve her treatment goals, citing relevant literature. Describe some of the challenges and ethical issues Dr. Heston may face when working collaboratively with these outside providers and apply ethical principles and standards of psychology relevant to this collaboration. Evaluate the effectiveness of the treatment interventions used by Dr. Heston, supporting your assessment with information from the case and two to three peer-reviewed articles from the Ashford University Library. Recommend three additional treatment interventions appropriate for this case, justifying your choices based on case details and relevant literature. Ensure your paper is 4 to 5 double-spaced pages, formatted according to APA style, including a title page and references.

Paper For Above instruction

The case of Rita, a patient diagnosed with bulimia nervosa, provides a comprehensive opportunity to analyze evidence-based practices, theoretical orientations, and multidisciplinary collaboration within mental health treatment. Dr. Heston’s approach embodies a combination of cognitive-behavioral therapy (CBT) grounded in the cognitive-behavioral model of bulimia nervosa's maintenance, along with other psychological interventions. This paper evaluates the interventions implemented, explores collaboration challenges, and proposes additional strategies to enhance treatment outcomes.

Theoretical Foundations and Treatment Plans

Dr. Heston’s treatment strategies are primarily rooted in cognitive-behavioral therapy, which is considered the gold standard in bulimia nervosa treatment (Waller et al., 2014). The cognitive-behavioral model posits that bulimia is maintained through dysfunctional thought patterns and maladaptive behaviors perpetuated by negative reinforce­ment cycles. This model emphasizes the importance of understanding and restructuring distorted cognitions and addresses behavioral patterns such as bingeing and purging (Fairburn & Harrison, 2003). Dr. Heston’s intervention plan reflects this approach by integrating nutritional education, cognitive restructuring, and behavioral monitoring, thus directly targeting the core features of the disorder.

Connection Between Theoretical Orientation and Interventions

The cognitive-behavioral orientation informs Dr. Heston’s emphasis on self-monitoring, including Rita’s reluctance to record her eating behaviors. This resistance aligns with evidence suggesting that individuals with bulimia often experience ambivalence toward self-monitoring, which they perceive as intrusive or judgmental (Halmi, 2013). The therapist’s role includes addressing this resistance through motivational interviewing techniques and gently guiding Rita to understand the benefits of self-monitoring as a tool for change. The cognitive-behavioral model underpins these strategies by highlighting the reinforcing cycles that sustain bulimic behaviors and targeting them directly.

Challenges in Self-Monitoring and Resistance

Rita’s reluctance to keep detailed records can be attributed to shame, guilt, and fear of confronting her behaviors, as discussed in Halmi (2013). Resistance to self-monitoring may also stem from a desire to avoid the emotional distress associated with recognizing the severity of her condition (Halmi, 2013). Addressing this resistance involves employing therapeutic rapport, emphasizing the collaborative nature of treatment, and framing self-monitoring as a non-judgmental exploratory process rather than an evaluative measure. Such approaches align with best practices outlined by Waller et al. (2014), emphasizing patient-centered care.

Recommendations for Outside Providers

Effective collaboration among health professionals is crucial for complex cases like bulimia nervosa. Recommended outside providers include a psychiatrist for medication management, a nutritionist to address dietary behaviors, and a social worker to provide psychosocial support. DeJesse and Zelman (2013) highlight the importance of interdisciplinary collaboration, emphasizing clear communication, role delineation, and shared treatment goals. For Rita, a coordinated effort involving these professionals could optimize her recovery by addressing biological, psychological, and social determinants of health. The clinician must also navigate ethical considerations such as confidentiality, informed consent, and professional boundaries when collaborating across disciplines.

Ethical Challenges and Principles

Potential ethical issues in collaboration include maintaining patient confidentiality across providers, ensuring informed consent, and balancing differing professional opinions. The American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct (2017) stipulate adherence to confidentiality, competent practice, and respect for patient autonomy. Dr. Heston must ensure that outside providers are briefed on treatment boundaries and that Rita’s rights and preferences are prioritized. Challenges may arise from differing professional standards, scope of practice, and communication hurdles. Ethical practice requires clear agreements, documentation, and ongoing supervision to uphold standards of care.

Evaluation of Current Treatment Interventions

The interventions utilized by Dr. Heston appear consistent with evidence-based standards for bulimia nervosa, including cognitive restructuring and behavioral modification. Literature from the Ashford University Library supports the efficacy of these methods, indicating significant reductions in binge-purge episodes (Aardoom et al., 2015; Hay, 2015). However, the initial resistance to self-monitoring suggests that integrating motivational enhancement strategies could improve engagement. Studies reinforce that combining motivational interviewing with CBT enhances treatment adherence and outcomes in eating disorder populations (Le Grange et al., 2017).

Additional Treatment Interventions

Three additional interventions could further support Rita’s recovery. First, dialectical behavior therapy (DBT) skills training can help address emotional dysregulation, which often underlies bulimic behaviors (Safer et al., 2014). Second, incorporating family therapy may improve relational dynamics and provide a stronger support system, especially considering the external influences on eating behaviors (Le Grange et al., 2019). Third, pharmacotherapy, such as selective serotonin reuptake inhibitors (SSRIs), has demonstrated efficacy in reducing binges and purging behaviors (Kaye et al., 2019). These interventions should be tailored to Rita’s specific needs, considering her readiness and the clinical presentation.

Conclusion

Rita’s case illustrates the importance of integrating evidence-based practices within a collaborative, ethical framework. Cognitive-behavioral therapy remains fundamental, but augmenting it with motivational strategies, family involvement, and pharmacological options can optimize treatment outcomes. Effective interdisciplinary collaboration, guided by ethical principles, ensures comprehensive care that addresses all facets of bulimia nervosa. Continued assessment and adaptation of interventions will be essential in supporting Rita’s recovery journey.

References

• Aardoom, J. J., Dingemans, A. E., Slof-Op 't Landt, M. C., & van Furth, E. (2015). The effectiveness of cognitive-behavioral therapy for bulimia nervosa: A systematic review. European Eating Disorders Review, 23(4), 312-319.
• American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. APA.
• DeJesse, C. M., & Zelman, A. M. (2013). Promoting optimal collaboration between mental health providers and nutritionists in the treatment of eating disorders. Journal of Clinical Psychology in Medical Settings, 20(4), 472-481.
• Fairburn, C. G., & Harrison, P. J. (2003). Eating disorders. The Lancet, 361(9355), 407-416.
• Hay, P. (2015). Cognitive behavior therapy for bulimia nervosa: An overview. Journal of Psychotherapy Practice and Research, 24(2), 89-104.
• Kaye, W. H., Wagner, A., & Twohig, M. (2019). Pharmacological treatment of bulimia nervosa. Biological Psychiatry, 85(10), 765-772.
• Le Grange, D., Lock, J., & Loeb, K. (2017). Enhancing motivation and engagement in treatment for eating disorders. Journal of Clinical Psychology, 73(2), 245-256.
• Le Grange, D., Loeb, K. L., & Lock, J. (2019). Family-based treatment of eating disorders. Child and Adolescent Psychiatric Clinics, 28(2), 341–352.
• Halmi, K. A. (2013). Perplexities of treatment resistance in eating disorders. Journal of Clinical Psychiatry, 74(9), 895-896.
• Waller, G., Gray, M., Hinrichsen, H., Mounford, T., Lawson, P., & Patient, C. (2014). Cognitive-behavioral therapy for bulimia nervosa and atypical bulimic nervosa: Effectiveness in clinical settings. European Eating Disorders Review, 22(6), 415-422.