Needs Framework

1
Needs Framework

• A psychological framework for use in the
  Regional Inpatient Unit?

2
Schema Therapy and Needs Research

• Schema Therapy -Unmet Core Psychological Needs
• Jeff Young
• Maslows Hierarchy of Needs
• Richard Ryan and Edward Deci Social Psychology
  - developed Needs theory
• Applying to severe AN
• Addition unmet Core Physical Needs
• Applying basic consistent approach across all
  members of the MDT

3
ANITT Core Needs Framework

• Core 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.

4
ANITT Core Needs Framework

• Core 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

5
Prioritisation of Needs in AN

• Prioritise
• Emotional safety feeling safe enough
• Agency feeling in control enough
• Secondary effect
• Activity excessive amount
• Neglect
• All the other needs
• Is severe AN a Self-Deprivation Disorder?

6
Function and purpose of AN

• To try to feel safe enough and in control
  enough
• to try not to have vulnerable feelings, doubts,
  uncertainty etc.
• Partial meeting of Needs
• eg. Short-term reduction in anxiety, when avoid
  eating or burn off some calories
• eg. Short-term sense of achievement, when weight
  goes down or simply when resist urge to eat
• Cost of narrowing focus and limited,
  over-controlled life
• Medium term experience of failing to be
  normal/cope with living a normal life

7
Inpatient scenarios

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

8
Scenario 1

• A 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

9
Scenario 2

• A patient in a group is not speaking or engaging
  at all and the key worker sits down to discuss
  this with them
• empathise 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