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