The study aimed at focusing on the health concerns of a 35-year-old lady with a 12-year-old diagnosis of personality disorder. The medical staffs have placed her on the disability support pension. From further determination, she has been found to have a personality disorder, as well as severe depression resulting from anxiety. She has a record of child emotional abuse because, when she was growing up, her parents got involved in domestic violence. The lady lives with her grandmother since the age of 12 years, the reason being her mother committed suicide due to divorce. The lady had developed critical symptoms of depression associated with her childhood traumatic experiences, social discrimination as well as lack of family support. These factors negated her school performance, social stigma, inadequate support at a little age led to the development of borderline personality traits.
She was an employee in the customer service sector, but her tolerance in the workplace was very low. After a verbal altercation with her former employer, she lost her job. Her mental condition is to a large extent affected by diabetes and unemployment. She lives with a negative perception of the world. Her life has a history of admissions in mental health hospitals with her recent entry being in 2017, which was due to mirtazapine overdose. I majorly looked at her past traumatic experiences, social stigma due to depression and anxiety associated with borderline personality traits, poor tolerance at work, and wanting to cope to work skills in the job environment. According to Batten (2011), acceptance and commitment therapy is the best therapeutic interventions for her, because the treatment is a pioneering behavioral therapy considered to optimize the stance to value their lives. While using my nursing professionalism, the best decision was to come up with an idea of establishing a therapeutic relationship by ensuring the maintenance of professional boundaries.
An ACT is instrumental in controlling anxiety disorder and depression, and it’s used it as the primary factor of consideration. It is evident that most patients with Personality Disorder and depression are at higher risk of self-harm (Versaevel & Lajugie, 2013). The lady requires much counseling services which could be the best to help her relax. Group activities and massage therapies are the most useful options for improving her condition. I made use of the acceptance model and commitment therapy as per A-tjak et al. (2015), which proved to be positive for her recovery. It meant that occupational therapists and psychologists needed to be involved in helping find an alternative solution to her rescue.
The acceptance and commitment theory exists towards skills’ development occurs a multi-step process that creates skilled nurses like I have become having completed the training into being not only qualified but also competent. My decision to study the ATC model was motivated by the zeal of having a deeper understanding of the theoretical and practice-based subject. I had to focus on the poor coping skills of one of the female patients in association with her erratic manners in a mental. The study focus on coping skills was done in a working atmosphere characterized by occupational challenges (Maclean, Webber & French, 2015).
Focus on the current happenings is one of the methods applicable to sharpening nurse’s clinical skills since leadership skills, as well as principles, are required in dealing with medical clients. Being in a position to understand patients’ expressions in line with the specific context was the initial but the most important step (Russ, 2009). As a nurse, focusing on the behavioral issues facing patients in their life was vital for therapeutic processes and working on the specific client’s needs. In fact, the need to have a deeper understanding of the therapeutic model was critical in the process. As well, cultivating my compassionate skills was of importance in building therapeutic relationships with the patient since building rapport and trust remained vital.
As I was taking care of the patient, my therapeutic communication skills were enhanced by having a sense of humanity characterized by active listening and non-judgemental attitudes in every professional approach. Managing her stress levels as well as developing compassion and mindfulness approach in my practice helped me in the process of realizing the behavioral change in the patient. According to Rubb (2014), the methods I applied were in line with the stress-reduction efforts as provided through the clinical healthcare sector. Having learned the mindfulness strategies, I had to use them in line with the acceptance and commitment therapy including leaves on the stream and breathing exercises. Observe, breath, expand, allow, objectify, normalize, show self-compassion and expand awareness make up the eight techniques of the mindfulness exercise (Russ, 2009).
For the acceptance and commitment theory to have its core competencies in place, it needs specific skills that in turn shape the dependability capacity of a nurse. On my side, I would look at the patient’s behavior like the cognitive fusion as well as avoidance with the aim of better discrimination of the therapeutic practices relevant to each patient. According to Jameson (2015), the Borderline Personality Disorder has unique connections with self-harming behavioral risks. Having adequate skills on defusion and acceptance is essential in therapeutic practices as helping others involves the articulation of client’s values in the process of giving solutions.
In the process of handling my clients, it had no option other than demonstrating various techniques on acceptance and commitment and their relative relationship with each other as well as with the basic therapeutic principles. The impact of counselling in alleviating emotional stress relative to traumatic childhood encounters and the positive psychoeducation impact on acceptance were some of the issues I learnt (Russ, 2009). Although the approaches needed some form of education and research, my therapeutic skills were enhanced by the participation in the inpatient trauma care unit. In fact, the experience I had was of benefit to both me and the clients I served. According to Geller (2012), patient care during the healing processes has the capacity to help clients towards their full acceptance as they understand their suffering.
Geller (2012), defines some of the essentialities considered in establishing a therapeutic presence for clinicians as well as the pause moment concepts helpful in boosting clinicians’ refreshments and skills. In one of the patients, I recognized that involvement with stressful moments has an impact of making me recall some of the past experiences I had in time. Geller (2012), explains bracketing as a process through which clinicians abandon some of their thoughts. Bracketing was practical and useful to me in developing my mental health skills in the nursing field to high capacities. The approach was, in fact, relevant to the case of the patient I was handling since it helped them have an atmosphere to focus on their goals. According to Dahl, Lariviere & Corbiere (2017), through therapeutic interventions, a patient is revealed by depression and the lack of purpose. In this case, my client has poor coping skills thus she would be depressed as well as have no purpose in her work environment.
The acceptance and commitment therapy exists as a practical approach that gives patients the opportunity to have a deep understanding of the processes that would give them hope in life. As well, it gives them the capacity to manage their livelihood as well as show interest in participating in all they do. According to McCracken & Vowles, (2014), Acceptance and Commitment therapy leads stress and ache. The lady, in this case, needs purposeful attention to have a deep understanding of herself and the situation at hand. The Internet Acceptance and Commitment therapy can be quite effective in reducing depression among people with Mental-related health issues as it applied various therapeutic techniques to bring patients into acceptance (Lappalainen et al, 2015).
In the process of accepting oneself, under the Acceptance and Commitment therapy this lady needs to allow her feelings as well as thoughts to flow having no action on them. Failing to act on the thoughts and opinions on the patient will translate into an approach where only the strengths are enhanced with no concern on the flaws thus overrule them. According to Geller & Greenberg (2012), the therapeutic process gives a patient the opportunity to see everything positively while negating the dangerous issues that a situation might bring. The acceptance and commitment theory requires one to set great skills followed by enough experience headed on the cognitive defusion of other psychologically heightened situations. The ACT is seen to inspire the affected people in resolving issues on their own by enhancing their ability to adopt different patterns of thinking through the cognitive diffusion process. The process empowers the individual over the situational challenges and gives them control over some unnecessary reactions.
The Acceptance and Commitment Therapy aligns with the mindfulness skills in teaching people different methods applicable to living with their values, generally referred to as positivity. Positivity is a pragmatic process involving therapeutic counseling in addition to acceptance and other mindfulness approaches in enhancing increased flexibility in the positive, practical aspects (Russ, 2009). The ACT model exists as a psychological flexibility approach based on six primary therapeutic processes including acceptance, defusing, contact with the present moment, Self-as -context, values and committed action (Batten, 2011). The six procedures exist as the functional components of the Acceptance and Defusion model where positive emotional thoughts and experiences are contained (Russ, 2009).
Having to focus on the current moments as well as the self-as-context capacity would become a positive aspect of the ACT therapy. As well considering the present moments with no consideration of some of the other point of one’s life makes human a multitasked focus with full ambitions having the capacity to develop the lack of concentration. It as well brings self-awareness self-as context and communicating present moment both involves in contact with our mind and observance of our mind with self-awareness (Russ, 2009) and the third part is recognising personal values and commitment to action are essential to motivate ourselves to be committed to reach our goal with our values (Batten, 2011).
The ACT model as presented to the customer happens to be both simple and convenient. When Abbreviations are used as Accepting thoughts and feelings by being present, choosing the valued pathway and acting becomes easy (Russ, 2009). Suicidal thoughts have been troubling the client as one of the traits of her poor coping skills. Our internal thoughts of experiences are used in developing the cognitive fusion approach involving more attachment to past encounters such as her traumatic childhood. All the negative thoughts make her unable to focus on the real issues that would somehow be the reason for her poor coping capacities characterized by low tolerance, depression, self-harm thoughts, anxiety and other forms of negativity. ACT interventions are seen to be not only creative but also resourceful as they aim at promoting cognitive diffusion and acceptance.
Friendliness exists between the Christianism faith and the ACT interventions as they have been compared to reading the bible (Rosales, A., & Tan, S. Y. 2016). Since the therapy’s basis, reins in considering a patient’s character, reducing avoidance as one of the coping styles exist in it while the person’s behavior is investigated. On account of this approach, the patient was optimized of her values, and the quality of life since the therapy was useful in confronting the psychological rigidities related to the negative thoughts, painful emotions, and even her traumatic experiences. The face to face conversations characterizing the therapy helped in addressing her problems.
The process encountered some challenges where the first one was the certainty to retain the client. The past family life of the patient traced associated with substance and emotional abuse. The client had a higher chance of leaving the process than staying to undergo it. It took a longer time than usual to establish a good relationship with the client. Also, the lady made a long duration before being free with the environment.
The client would lose focus and concentration during the intervention process hence hindering its continuity. The process made the client to go back to the past thoughts and to lose her attention on the process. Her character developed to fear, and anger and freedom diminished slowly. It made her process get more prolonged than usual as well as raising concerns on the health status of the client and future endeavors after the procedure. What was faced as the most significant issue was on how to develop an environment that would reduce despair and untrustworthy while conversing.
Group work sessions shared pats experiences and concerns among the members, but it didn’t seem helpful to the lady as she only increased her discomfort. It did not link well with the case of the patient. They just took her back to the feelings of depression and indicated to the patient the disregard to show her change. She only got misplaced. The challenges showed themselves in most parts of the process, but they didn’t exist permanently. They just indicated environmental threats to the client and prompted that could enable the success of the intervention. Lastly, a positive result got presented by the case.
References:
Ahmadsaraei, N.F., Doost, H. T. N., Manshaee, G. R., & Nadi, M.A. (2017). The Effectiveness of Acceptance and Commitment Therapy on Depression among Patients with Type II Diabetes. Iranian Journal of Diabetes & Obesity (IJDO), 9.
A-tjak, J. G., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A., & Emmelkamp, P. M. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30-36.
Batten,S.V 2011, Essentials of Acceptance and Commitment Therapy,1st (edn) Sage
Dahl, K., Lariviere, N., & Corbiere, M. (2017). Work Participation of Individuals with borderline personality disorder: A multiple case study. Journal of Vocational Rehabilitation, 46(3), 377-388.
Geller, S. M., & Greenberg, L. S. (2012). Therapeutic presence: A mindful approach to effective therapy. American Psychological Association.
Jamieson, L. (2015). A brief guide to borderline personality disorder and prehospital clinician s in an emergency setting. Journal of Paramedic Practice, 7(8), 386-392.
KELLEY RAAB (2014). Mindfulness, Self-Compassion, and Empathy among Health Care Professionals: A Review of the Literature Journal of Health Care Chaplaincy, no.20, pp.95–108
Lappalainen, P., Langrial, S., Oinas Kukkonen, H., Tolvanen, A, & Lappalinen, R. (2015). Web-based acceptance and commitment therapy for depressive symptoms with minimal support: a randomized controlled trial. Behaviour modification, 39(6), 805-834
Maclean, J. C.,Webber, D., & French, M.T. (2015). Workplace problems, mental health and substance use.” Applied Economics 47, no. 9 (2015): 883-905.
McCracken, L. M., & Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress. American Psychologist, 69(2), 178.
Rosales, A., & Tan, S. Y. (2016). Acceptance and commitment therapy (ACT): Empirical evidence and clinical applications from a Christian perspective. Journal of Psychology and Christianity, 35(3), 269.
Verginia,A.S. & Pedro,Ruiz 2017, Kaplan and Sadock’s concise textbook of Clinical psychiatry,4th (edn),Wolters,Kluwer
Versaevel, C., Vinckier, F., Jeanson, R., Defromont, L., Lebouteiller, V. & Lajugie, C. (2013). Links between dependent personality disorder, depression and suicide attempts. In Annales Medico Psychologiques, 171(4): 232-237.
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