N 584 Humanistic Therapy
N 584 Humanistic Therapy
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Assignment:
Critical Thinking Exercises :
Case Study #1: McLanahan University
McLanahan University is an accredited university of
approximately 28,000 full-time and 12,000 part-time students, offering
baccalaureate, masters, and doctoral programs. It is located in a multicultural
city of 1,200,000 inhabitants. There are five acute care hospitals, one of
which is a 375-bed magnet hospital. Other health care facilities in the city
include three chronic and long-term care agencies, numerous nursing homes,
eight home health care agencies, a public health unit, physicians’ and nurse
practitioners’ offices, and walk-in clinics.
Dr. Seranous Koupouyro is the director of The McLanahan
School of Nursing, which comprises 10 masters-prepared and 11
doctorally-prepared full-time nursing faculty. Faculty have been meeting for
four months to redesign the BSN curriculum. Part-time faculty have been
regularly invited to join the curriculum work, but their involvement has been
slight. The goal is to implement the revised curriculum in 18 months for a
class of 125 students.
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N 584 Humanistic Therapy
The Total Faculty group endorsed the existing
humanistic-caring, feminist philosophical approaches. Core curriculum concepts,
key professional abilities, and principal teaching-learning approaches were
identified and the curriculum nucleus endorsed.
The curriculum committee has developed the outcome
statements, and after these were approved, they formulated the level
competencies. The outcome statements address the provision of evidence-based
nursing care in accordance with regulatory standards, effective communication
and management, ethical and cultural competence, and advocacy to enhance social
justice. The faculty are now ready to consider the curriculum design.
How should the curriculum committee proceed with the work
yet to be done?
What should the curriculum committee consider next?
What resources would assist the committee in its curriculum
design process?
What should be included in the curriculum design?
How will the curriculum nucleus influence the curriculum
design?
How could nursing and non-nursing courses be determined?
What policies should be taken into account for the
curriculum design?
Case Study #2: Philmore College
Situated in a small, non-industrial town, Philmore College
was originally a “hilltop” college established in 1818 as a school
for boys and later, for boys and girls. The school has evolved into a 4-year,
privately endowed, non-sectarian, post-secondary institution. Since the 1960’s,
programs leading to baccalaureate degrees in psychosocial and physical sciences
have been offered. A decision has been made to offer a 12-month accelerated BSN
program in response to the nursing shortage and the demand by applicants with
prior degrees. This program will be additional to the upper division BSN degree
that is currently offered.
The 9 master’s-prepared and 4 PhD full-time nursing faculty
have combined nursing practice and teaching experience ranging from 4–18 years.
The director, Dr. Agnes Philmore, a direct descendant of the founder, joined
Philmore College in 1996. All nursing faculty, including the director, engage
in classroom and clinical teaching. The practice experiences for the upper
division BSN students are offered in one local 200-bed community hospital, a
224-bed tertiary care hospital in a neighboring city, and a 76-bed long-term
and residential care facility. Students also have community nursing experience,
which is coordinated and supervised by a primary care nurse practitioner with
an adjunct faculty appointment. Approximately 85 students graduate annually and
have been consistently successful in the licensure examinations and in
obtaining employment.
The director, faculty, several students, and a local nurse
practitioner, who comprise the curriculum committee, have been meeting to
design the 12-month program. The curriculum nucleus has been determined and the
curriculum outcomes written. The principal teaching-learning approaches are
focused on active and constructed learning. Courses for the
discipline-specific, accelerated 182-month program have been identified. The committee
is ready to begin course design.
What parameters must the curriculum committee consider when
designing the courses?
In what way will a commitment to active learning influence
course design?
Which components should be included in the courses?
What classroom and clinical experiences could be
incorporated into the courses?
What would sample clinical and classroom courses look like
for this accelerated baccalaureate-nursing program?
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows:
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To examine the effectiveness and acceptability of all humanistic therapies compared with all other psychological therapy approaches for acute depression.
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To examine the effectiveness and acceptability of different humanistic therapy models (person-centred, gestalt, process-experiential, transactional analysis, existential and non-directive therapies) compared with all other psychological therapy approaches for acute depression.
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To examine the effectiveness and acceptability of all humanistic therapies compared with different psychological therapy approaches (psychodynamic, behavioural, humanistic, integrative, cognitive-behavioural) for acute depression.
BACKGROUND
Description of the condition
Major depression is characterised by persistent low mood and loss of interest in pleasurable activities, accompanied by a range of symptoms including weight loss, insomnia, fatigue, loss of energy, inappropriate guilt, poor concentration and morbid thoughts of death (APA 2000). Somatic complaints are also a common feature of depression, and people with severe depression may develop psychotic symptoms (APA 2000).
Depression is the third leading cause of disease burden worldwide and is expected to show a rising trend over the next 20 years (WHO 2004; WHO 2008). A recent European study has estimated the point prevalence of major depression and dysthymia at 3.9% and 1.1% respectively (ESEMeD/MHEDEA 2004). As the largest source of non-fatal disease burden in the world, accounting for 12% of years lived with disability (Ustun 2004), depression is associated with marked personal, social and economic morbidity, loss of functioning and productivity and creates significant demands on service providers in terms of workload (NICE 2009). Depression is also associated with a significantly increased risk of mortality (Cuijpers 2002). The strength of this association, even taking account of confounders such as physical impairment, health-related behaviours and socio-economic factors, has been shown to be comparable to, or greater than, the strength of the association between smoking and mortality (Mykletun 2009).
Description of the intervention
Clinical guidelines recommend pharmacological and psychological interventions, alone or in combination, in the treatment of moderate to severe depression (NICE 2009). Antidepressant prescribing has increased dramatically in many Western countries over the last 20 years, mainly with the advent of selective serotonin reuptake inhibitors and newer agents such as venlafaxine. Antidepressants continue to be the mainstay of treatment for depression in health care settings (Ellis 2004, NICE 2009).
Whilst antidepressants are of proven efficacy for the acute treatment of depression (Guaiana 2007; Arroll 2009; Cipriani 2009a; Cipriani 2009b; Cipriani 2009c), adherence rates remain very low (Hunot 2007; van Geffen 2009), due in part to patients’ concerns about side effects and possible dependency (Hunot 2007). Furthermore, surveys consistently demonstrate patients’ preference for psychological therapies over that of antidepressants (Churchill 2000; Riedel-Heller 2005). Therefore, psychological therapies provide an important alternative intervention for depressive disorders.
A diverse range of psychological therapies is now available for the treatment of common mental disorders (Pilgrim 2002). Psychological therapies may be broadly categorised into four separate philosophical and theoretical schools, comprising psychoanalytic/dynamic (Freud 1949; Klein 1960; Jung 1963), behavioural (Watson 1924; Skinner 1953; Marks 1981), humanistic (Maslow 1943; Rogers 1951; May 1961) and cognitive approaches (Lazarus 1971; Beck 1979). Each of these four schools contains a number of differing and overlapping psychotherapeutic approaches. Some psychotherapeutic approaches explicitly integrate components from several theoretical schools (e.g. cognitive analytic therapy (Ryle 1990)), or have been developed to address specific characteristics associated with particular disorders (e.g. interpersonal therapy for depression (Klerman 1984)).
During the first half of the twentieth century, psychology had been dominated by two schools of thought, behaviourism and psychoanalysis. Humanistic psychological therapies were developed in the 1950s and 60s as a protest against the diagnostic and prescriptive approaches characterised by the analytic and behavioural schools (Thorne 2007). These so-called ‘third force’ psychology approaches (Maslow 1959) brought about a paradigm shift, away from the ‘psychological determinism’ (the philosophical view that human cognition, behaviour, decision, and action, is causally determined by events, and implying a lack of free will) and towards client choice and responsibility (Pilgrim 2002). Key psychological therapies considered as humanistic in approach include Gestalt therapy (Perls 1976), existential therapy (Deurzen 1997), transactional analysis (Berne 1961), person-centred therapy (Rogers 1951), and process-experiential therapy (a manualised humanistic intervention combining person-centred therapy and emotion-focused therapy) (Greenberg 1998).To date, person-centred therapy remains the most commonly used psychotherapeutic approach in UK health care settings (Stiles 2008) (see Types of interventions section for a detailed description of each type of therapy).
How the intervention might work
Humanistic psychological therapies are based on the premise that people are ‘self-actualizing’, that is, they have an inherent tendency to develop their potential (Rogers 1951; Maslow 1970). Other defining characteristics of humanistic therapies include the belief that people are self-aware, are free to choose how they will live, are responsible for the choices they make, and are unique entities that need to be understood in the context of their individual experiences and characteristics (Cain 2002).
In clinical practice, manualised or highly specific treatments for psychological disorders are largely avoided by humanistic therapists, on the basis that therapy should be individualised to fit with the personal goals, preferences and values of each client. Whilst contemporary models of humanistic therapies may differ somewhat from a conceptual perspective and in terms of strategies/techniques, all emphasise the ‘growth-inducing power’ (Cain 2002) of the therapeutic relationship. Therapist ‘core conditions’ of empathy, genuineness and unconditional positive regard, described by Rogers 1951 as ‘the definable climate of facilitative psychological attitudes’, are considered as cornerstones of therapy. Creation of an optimal interpersonal environment to facilitate client insight, leading to acceptance, change and personal growth with resulting potential for a reduction in depression symptoms (Cain 2002). Presenting problems are person rather than disorder-focused, and individuals are treated as experts in their psychological distress. Whilst formal reduction in symptoms is not regarded as a goal in humanistic therapies practice, depression symptoms may decrease or remit as the client experiences increased self-acceptance and personal growth.