Case Analysis: Collaborating With Outside Providers Prior To

Case Analysis Collaborating With Outside Providersprior To Beginning

Case Analysis – Collaborating with Outside Providers prior to beginning work on this assignment, read the PSY650 Week Three Treatment Plan and Case 9: Bulimia Nervosa in Gorenstein and Comer (2014). Please also read the Waller, Gray, Hinrichsen, Mounford, Lawson, and Patient (2014) “Cognitive-Behavioral Therapy for Bulimia Nervosa and Atypical Bulimic Nervosa: Effectiveness in Clinical Settings,” Halmi (2013) “Perplexities of Treatment Resistance in Eating Disorders,” and DeJesse and Zelman (2013) “Promoting Optimal Collaboration Between Mental Health Providers and Nutritionists in the Treatment of Eating Disorders” articles. Assess the evidence-based practices implemented in this case study.

In your paper, please include the following.

- Explain the connection between each theoretical orientation used by Dr. Heston and the treatment intervention plans utilized in the case.

- 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. Use information from the Halmi (2013) article “Perplexities of Treatment Resistance in Eating Disorders” to help support your statements.

- Recommend outside providers (psychiatrists, medical doctors, nutritionists, social workers, holistic practitioners, etc.) to assist Rita in achieving her treatment goals. Use information from the DeJesse and Zelman (2013) “Promoting Optimal Collaboration between Mental Health Providers and Nutritionists in the Treatment of Eating Disorders” article to support your recommendations.

- Describe some of the challenges and ethical issues that Dr. Heston may encounter when working collaboratively with the professionals you recommended. Apply ethical principles and standards of psychology relevant to your description of Dr. Heston’s potential collaboration with outside providers.

- Evaluate the effectiveness of the treatment interventions implemented by Dr. Heston, supporting your statements with information from the case and two to three peer-reviewed articles from the Ashford University Library.

- Recommend three additional treatment interventions that would be appropriate in this case.

The case analysis should be 4 to 5 double-spaced pages, excluding title and references pages, and formatted according to APA style as outlined in the Ashford Writing Center. Include a separate title page with the following:

- Title of the paper

- Student’s name

- Course name and number

- Instructor’s name

- Date submitted

Use at least two peer-reviewed sources from the Ashford University Library. Document all sources in APA style. Include a references page formatted according to APA style.

Paper For Above instruction

Case Analysis Collaborating With Outside Providersprior To Beginning

Effective treatment of bulimia nervosa often requires a comprehensive, multidisciplinary approach that involves collaboration between mental health professionals, medical practitioners, nutritionists, and other specialists. In the case of Rita, as presented by Dr. Heston, integrating evidence-based practices from cognitive-behavioral therapy (CBT), nutritional counseling, and medical monitoring is essential for promoting recovery and addressing the complex biological, psychological, and behavioral components of the disorder. This analysis explores the connection between theoretical orientations, evaluates treatment plans, assesses collaboration challenges, and recommends additional interventions grounded in current research and clinical standards.

Theoretical Orientations and Intervention Plans

Dr. Heston employs a cognitive-behavioral approach that aligns with the established evidence base for treating bulimia nervosa. Central to this orientation is the understanding that maladaptive thoughts and behaviors maintain the disorder. The intervention plans focus on cognitive restructuring to challenge distorted beliefs about body image and food, as well as behavioral strategies like meal planning and regular eating patterns (Fairburn, 2008). The integration of behavioral experiments aims to reduce binge-purging behaviors by altering the antecedents and consequences associated with these episodes. Furthermore, family therapy principles may be incorporated to enhance support and accountability, contributing to a more sustained recovery (Le Grange et al., 2012). Each theoretical orientation supports specific treatment tasks, emphasizing the importance of a tailored, flexible approach rooted in cognitive-behavioral therapy.

The Cognitive-Behavioral Model of Bulimia Nervosa

The maintenance of bulimia nervosa, according to the cognitive-behavioral model, revolves around dysfunctional attitudes toward weight and shape, reinforcement of binge-purge behaviors, and maladaptive coping strategies (Fairburn & Harrison, 2003). Core cognitive distortions include beliefs that self-worth depends on thinness and that food is a primary means of emotional regulation. These distorted cognitions perpetuate cycles of binge eating as a response to negative affect or perceived loss of control. The behavioral component, involving recurrent episodes of bingeing and compensatory actions such as vomiting, further entrenches the disorder by providing temporary relief but reinforcing maladaptive patterns (Wilson et al., 2007). This cyclical pattern explains why targeting both cognitively and behaviorally is fundamental in treatment.

Rita's Reluctance and Resistance to Record-Keeping

Rita's reluctance to keep a record of her eating behaviors is understandable within the framework of treatment resistance discussed by Halmi (2013), which emphasizes the multifaceted nature of resistance in eating disorder treatment. Resistance may stem from feelings of shame, fear of judgment, or a lack of insight into the severity of her condition. Rita might also perceive the log as intrusive or judgmental, which could heighten her defensiveness and impede engagement. Halmi (2013) notes that resistance can be a manifestation of ambivalence about change and often requires strategic therapeutic techniques such as motivational interviewing to gently explore underlying fears and enhance motivation. Building rapport and providing psychoeducation about the purpose of record-keeping as a tool for empowerment can help reduce distress associated with this task.

Recommendations for Outside Providers

To support Rita’s recovery, a multidisciplinary team including a psychiatrist for medication management, a medical doctor for monitoring potential physical complications, a registered dietitian specializing in eating disorders, and a social worker or therapist for ongoing psychosocial support is recommended (Jansen et al., 2019). Incorporating a holistic practitioner or integrative health provider may also be beneficial for addressing underlying emotional or spiritual concerns (Waller et al., 2014). The collaboration should be coordinated centrally through Dr. Heston to ensure consistency and communication while respecting the roles and expertise of each professional. The nutritionist can help modify Rita's eating patterns, while the psychiatrist may prescribe selective serotonin reuptake inhibitors (SSRIs), which have shown efficacy in reducing binge episodes (Kaye et al., 2019).

Challenges and Ethical Considerations in Collaboration

Collaborating across disciplines introduces potential challenges such as maintaining confidentiality, ensuring informed consent, and navigating differing professional perspectives. Ethical principles articulated in the APA Ethical Principles of Psychologists and Code of Conduct emphasize the importance of confidentiality, competence, and dual relationships (APA, 2017). Dr. Heston must ensure that communication with outside providers abides by legal and ethical standards, sharing information only with client consent and in a manner that aligns with the client’s best interests. Conflicts may arise regarding treatment approaches or goal priorities, requiring professional consensus and respect for differing scopes of practice. Each provider must also consider cultural competence to adequately address Rita's unique background and values (Fitzpatrick et al., 2018).

Effectiveness of Interventions and Supporting Evidence

The interventions employed by Dr. Heston, primarily cognitive-behavioral strategies, are supported by extensive research demonstrating their efficacy in reducing binge-purge behaviors and improving psychological outcomes (Le Grange et al., 2012). Peer-reviewed studies (e.g., Waller et al., 2014; Fairburn et al., 2009) confirm that CBT produces significant symptom reduction compared to alternative therapies and pharmacotherapy alone. The use of psychoeducation, behavioral modification, and relapse prevention strategies has shown positive results in clinical practice and research. However, ongoing evaluation through outcome measures, such as frequency of binge episodes and psychological assessments, is crucial to determine treatment success and modulate interventions accordingly (Treasure et al., 2020).

Additional Treatment Interventions

Three additional interventions that would complement existing treatment include:

1. Dialectical Behavior Therapy (DBT): To address emotional dysregulation and reduce impulsivity related to binge behaviors (Safer et al., 2019).

2. Acceptance and Commitment Therapy (ACT): For fostering acceptance of difficult emotions and promoting committed action aligned with personal values (Twohite et al., 2018).

3. Family-Based Therapy (FBT): Particularly suitable if Rita’s familial environment contributes to her condition, encouraging family involvement to support recovery (Le Grange et al., 2012).

Implementing these approaches can diversify therapeutic tools, address underlying affective issues, and enhance relapse prevention.

Conclusion

The treatment of bulimia nervosa requires a comprehensive, collaborative, and evidence-based approach, integrating diverse professional expertise. Dr. Heston’s focus on CBT appropriately addresses the core maintaining factors of bulimia, and fostering collaboration with outside providers can improve outcomes while navigating ethical challenges requires careful adherence to professional standards. Incorporating additional interventions such as DBT, ACT, and FBT may further enhance Rita’s recovery prospects, emphasizing the importance of personalized, multidisciplinary treatment plans grounded in current empirical research.

References

• American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. APA.
• Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. Guilford Press.
• Fairburn, C. G., & Harrison, P. J. (2003). Eating disorders. The Lancet, 361(9355), 407-416.
• Fitzpatrick, M., Julion, W., & Williams, S. (2018). Cultural competence in mental health care: A review. Journal of Counseling & Development, 96(2), 189-201.
• Jansen, E., et al. (2019). Multidisciplinary approaches in eating disorder treatment. International Journal of Eating Disorders, 52(1), 22–31.
• Kaye, W. H., et al. (2019). Pharmacotherapy and psychotherapy in the treatment of bulimia nervosa. Journal of Clinical Psychiatry, 80(4), 1-8.
• Le Grange, D., et al. (2012). Family-based treatment of anorexia nervosa: The success of a comprehensive approach. Child and Adolescent Psychiatric Clinics, 21(4), 655-673.
• Halmi, K. A. (2013). Perplexities of treatment resistance in eating disorders. Journal of Psychiatric Practice, 19(2), 144-152.
• Waller, G., Gray, M., Hinrichsen, M., Mounford, M., Lawson, J., & Patient, M. (2014). Cognitive-behavioral therapy for bulimia nervosa and atypical bulimic nervosa: Effectiveness in clinical settings. International Journal of Eating Disorders, 47(2), 157-162.
• Treasure, J., et al. (2020). Updated guidelines for the treatment of bulimia nervosa. European Eating Disorders Review, 28(4), 398-415.