Therapeutic Relationships in Mental Health
SCENARIO: John Short
John Short is a 45-year-old gentleman admitted to your assessment unit after he presented at A&E with cuts to his wrists and neck. He had cut himself with a kitchen knife following what he described as a “panic attack” where he “lost the plot”. He is settled, his wounds have been dressed and overall were not life threatening. Following assessment John was offered an informal admission to the local inpatient assessment unit. John has no previous contact with primary or secondary mental health services.
John works in the office of a delivery company and says that there has been asked to do more and more in the past few months as people have left or retired from their posts and he has not been coping well.
John was also informed that the company were planning on outsourcing some of their work, and as a result there might be redundancies in the near future. John describes feeling increasingly stressed over this time, unable to concentrate, worrying that he might lose his job and ruminating on how this would affect the family.
John is married with two small children 10 and 5 years old. During his admission assessment he described his wife as loving and supportive and is worried that he “has put her through hell” and that he has “behaved stupidly”. He feels he has let his children down even though they did not see him harm himself or witness any of his distress and worry. John reflected on feeling increasingly anxious on heading out to work, worrying about his job security, so much so that he has not been sleeping well. John said that he feels he has been depressed for a short while but felt unable to talk to anyone about this.
His wife is very worried about him, and he stated that she has told him many times that, “we can cope John, your job is not as important as your health”. John stated that he has been “stupid” and that he has “ruined everything”. He wishes he could turn the clock back to a time when he was “on top of things at work”. He worries that he might panic again and is scared of what he might do.
This is John’s first day on your unit, and this is his first 1-1 session with you since his admission. He is happy to talk to you.
WORD COUNT
Insert the final word count for the essay after the conclusion (3500 words).
QUESTIONS
How would you begin to engage with John and encourage him to talk about his issues and make him feel comfortable? How would you build rapport?
Think about how you are going to create a safe therapeutic milieu for John.
Remember that everything you are going to do with John, and the nature of the unit John has been admitted to is alien to John.
If John says, “I am a useless Father, I just panicked, how could I put my family through this?”
Offer a
How would you approach the issue of risk with John, and how can you use your chosen therapeutic approach to help support John in managing this?
Suggest a way to close or finish the 1-1 session with John
to John’s statement, and your rationale for your response as it links to your chosen approach.
You must then explore how this will enable you to develop dialogue with John e.g. what are you trying to do and how will your response/approach enable you to do this.
When John states, “I haven’t been sleeping very well, I just keep thinking about work”.
Offer a verbatim response to John’s statement, and your rationale for your response as it links to your approach.
You might want to think about how sleep impacts on his mental health and how you can support this on the unit; or you may wish to consider the role of John’s negative thoughts about work, and how this might be affecting his sleep.
John has been admitted to the unit following an episode of self-harm.
How would you approach the issue of risk with John, and how can you use your chosen therapeutic approach to help support John in managing this?
Suggest a way to close or finish the 1-1 session with John e.g. you must relate this to the principles that underpin your chosen approach.
You need to be mindful of three things,
First, how you close the session needs to be in keeping with your chosen approach to working with John.
Second, it must take into account the context of this 1-1 session and the situation John finds himself in.
Third, consider John’s needs, vulnerability, and emotions as he spends his first night on the unit.
