responses will vary and will be similar to those for the previous question. It is expected that learners will make contact with local learning disability health services to find out this information. Learning activity 4.9 Case study: Robert List all the factors/events that might have prevented Robert from engaging in therapy. Learners are expected to identify some or all of the following factors: Robert is unaware of the purpose of the referral Robert is further confused by the range of questions he is asked by the community nurse Robert’s appointment is late and he is unsure of what it will involve, so his anxiety may increase. List all the factors/events that might have encouraged Robert to participate in therapy. Learners are expected to identify some or all of the following factors: the development of a therapeutic relationship through the psychologist less formal and choosing a topic of conversation that is far less threatening the use of appropriate communication aids clarification of the purpose of the meeting with the psychologist. Learning activity 4.10 Case study: Christina What factors have hampered the development of the therapeutic relationship – with Christina and with the workers? Learners should identify issues of whether Christina consented to the referral, knew its purpose or understood what the role of a psychologist would be. They may also suggest that Christina may have had negative experiences with psychologists in the past, particularly if she has stated that “no one tells me what to do”, and that she may
be generally anxious because she has become aware that the woman she knew from hospital is now living in her local area. In terms of developing a therapeutic relationship with workers, learners are expected to be able to identify the same issues of knowledge of role (of the psychologist) and fear of changes to Christina’s care package affecting staff jobs. In addition, the psychologist appears to have information which wasn’t shared with them, perhaps signalling tensions between services and those who provide services (for instance, between social work and provider organisations). How would you deal with the workers’ anger, and what action would you take to try to resolve the situation? Learners should identify the need to clarify their role with Christina and the staff team, but clarity should also be sought with other members of the multi-agency team (particularly social work and care provider management) about what information was passed on to Christina and her staff team. If you were asked to do this over again, detail, step-by-step, how you would support Christina through the referral process. Would you do anything differently with staff? Learners should suggest some or all of the following steps: clarify expected role before accepting referral ensure that Christina has been informed of the reason for the visit and consider a joint visit with someone she knows well ensure that the team has been informed (possibly through a team meeting) of the reasons for referral take information in an accessible format about the role of a psychologist for Christina on her first visit and explain this when first meeting with her arrange for a visit via workers in a place and with people with whom she is comfortable. What other things do you think might be affecting Christina (think of age and stage and some of the presenting problems)?
Presenting problems: significant weight gain, low self-esteem and motivation, sedentary lifestyle, anger and low mood, ignoring the risk to his health. Predisposing factors: experience of sexual abuse, learning disability. Precipitating factors: long-term unemployment, still living with his parents, lack of either knowledge or awareness of the effect of type 2 diabetes, potentially lack of feelings of control and so lack of action on Robert’s part. Perpetuating factors: lack of appropriate activities and structured occupation, seeing his sister move on in her life, mood, past history of sexual abuse, potential lack of feelings of control and so lack of action on Robert’s part, possible denial. Protective factors: continues to go out with support workers, parents are making an effort. How you address these difficulties? Learners should consider whether Robert understands the health issues related to his weight gain and possible risk of diabetes. He may require use of “easy-read” materials on the subject of weight gain, diabetes and healthy lifestyles, and input from a specialist dietician may be required. They may also consider whether support workers understand the health risks to Robert of continually using support hours to enable him to access cafes and suggest this represents a training need for the workers. In addition, learners may suggest introducing health promotion for Robert and consider: the vicious circle of weight gain and low levels of physical activity leading to low self- esteem and poor motivation, and vice versa signs and symptoms of mental health issues, such as depression, and introducing mood monitoring diagnostic overshadowing and the psychological effects of long-term unemployment.