A psychological framework for use in the Regional Inpatient Unit?

Schema Therapy and Needs Research

Schema Therapy -Unmet Core Psychological NeedsJeff Young

Maslows Hierarchy of NeedsRichard Ryan and Edward Deci – Social

Psychology - developed Needs theoryApplying to severe AN:

Addition unmet Core Physical NeedsApplying basic consistent approach across all

members of the MDT

ANITT Core Needs FrameworkCore Psychological Needs:

*Emotional Safety: need to feel safe, secure, stable

*Agency: need to feel are competent, good enough, coping, ‘in control’

Nurturance: need for love, care, compassion, understanding

Acceptance: need for self-acceptance, to feel accepted by others and to be accepting of imperfection, complexity, failure and risk in self, others and the world.

ANITT Core Needs FrameworkCore Physical Needs

Physical safety: need for safety, security, protection eg. warmth, shelter , physical health etc

*Activity: need for movement, activity, exercise

Nutrition: need for minimum energy , spread of nutrients, hydration

Rest: need for physical rest, including sleep

Prioritisation of Needs in ANPrioritise

Emotional safety – feeling safe enoughAgency – feeling in control enough

Secondary effectActivity – excessive amount

NeglectAll the other needsIs severe AN a Self-Deprivation Disorder?

Function and purpose of ANTo try to feel safe enough and ‘in control’ enough

to try not to have vulnerable feelings, doubts, uncertainty etc.

Partial meeting of Needseg. Short-term reduction in anxiety, when avoid

eating or burn off some calorieseg. Short-term sense of achievement, when weight

goes down or simply when resist urge to eatCost of narrowing focus and limited, over-

controlled lifeMedium term experience of failing to be normal/cope

with living a normal life

How would an inpatient unit function informed by a Needs-based psychological framework?

Scenario 1A patient at meal time is refusing to finish their meal:

empathise with their instinct to try and control their fear and anxiety

reinforce that they are not in danger, nothing terrible is going to happen if they finish it, even though it feels really wrong

assert your need to try and help them pay attention to their other needs that will let them get their life back again accepting themselves as good enough whatever their weight training themselves to take the nutrition they need again to be

physically strong enough to have a proper life letting you care for the Needs that they find it hard to look after,

even if that feels wrong

Scenario 2A patient in a group is not speaking or engaging at

all and the key worker sits down to discuss this with themempathise with them feeling uncomfortable

(vulnerable) and not wanting to say anything in case its wrong or gets misunderstood (out of control)

validate it being normal to feel uncomfortable/anxious about what others will think, but that it is safe enough to say whatever she feels/thinks (trying to encourge self-acceptance, taking ‘risk’ of being criticised etc)

Reinforce the value of being open about feelings so others get a chance to understand you and accept you