Theoretic Perspectives of Mental Health Nursing

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Theoretic Perspectives of Mental Health Nursing

• Class 54 Your Last!!
• NURS1228
• Spring 2003

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Familiarize Yourself some more

• Alter Ego
• Super Ego
• Ego
• ID
• Ego Stage
• Libido
• Faulty Information Processing
• Interactive Context of Behaviors

• Final Goal
• Pleasure Principle
• Reality Principle
• Inferiority Feelings
• Reframing
• (Ghosts of Freud!!)

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OK. Why do we have to know this??

• Simply put, you will be using at least some of
  it.
• And then you need to know how the team is working
  to help the patient.

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An overview

• Psychoanalytic Theory Freud
• Adlerian Theory Alfred Adler
• Psychodynamic model and unity of personality
• Transactional Analysis Eric Berne
• Self talk and communication with others and Ego
  States
• Gestalt Therapy Fritz Perls
• Top Dog and Under Dog
• Chair work
• Client-Centered Therapy Carl Rogers
• Unconditional Positive Regard

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An overview continued

• Behavior Therapy (Pavlov and Skinner)
• Systematic desensitization and relaxation
  training
• Rational Emotive Therapy (RET Albert Ellis)
• Basic irrational ideas
• Cognitive Therapy (Aaron Beck)
• Cognitive Triad
• Strategic Therapy
• A form of communication therapy solution
  focused, brief
• Symptom prescription and reframing

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A Flight Through Freud Psychoanalysis

• Level of consciousness
• Unconscious, repressed thoughts
• Freudian Slips come from here
• Huge area of our beings
• Functions of personality
• Id instincts
• Libido energy held by the Id drives for
  pleasure, primarily sexual.
• Ego Reality principle, in touch with reality.
  Intermediary and go-between (ID and external
  reality)
• Super Ego Parental conscience and ego ideal

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Freud continued

• (Psycho)Sexuality Phases of development
• Oral phase (0 18 months)
• Anal phase ((18 months 3 years)
• Phallic phase (3 years 5 years)
• Oedipus complex
• Anna Freud Latency (5-12) and prepubescent
  (12-15)
• Genital phase (15 years )
• Techniques free association, dream analysis
• This work is still the basis for much of what is
  done in psychotherapy

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Alfred Adler

• Personality Development motivation by social
  urges
• Inferiority feelings develop
• We must live in community
• Gemeinschaftsgefuhl social interest
• Techniques 4 stages of therapeutic relationship
• Establishing the relationship
• Exploring pschologic dynamics
• Encouraging development of insight
• Assisting in making new choices

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Transactional Analysis

• Ego States
• Parent
• Adult
• Child
• Life stances
• Communication Patterns between two of the three
  Ego States between individuals
• Positive transactions are called strokes

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Techniques for TA

• Structural Analysis
• Assisting the patient in functioning
  predominantly from the reality-testing ego state
  (adult) and keep mastery by this state.
• Transactional Analysis
• Establish the adult ego state in the executive
  role of the personality
• The patient is asked to choose appropriate
  responses to situations
• Game analysis and Script analysis examine
  specific transactions and scripts of the
  different states

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Gestalt Therapy

• No intrapsychic conflicts, but rather conflicts
  with interactions with society.
• Society sets standards and individual knuckles
  under. External controls are the norm.
• Top Dog vs. Underdog Top Dog - the shoulds of
  society (the superego) and the underdog is the id
  the impulses and desires.
• Techniques Chair work is the classic
• Differentiation and integration
• Dream work
• Letter writing can also be part of this
  re-integration

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Client-Centered Therapy

• The individual can deal constructively with
  aspects of life that come into conscious
  awareness. The organism needs to work towards
  integrating experiences.
• Interpersonal relationships are the basis for
  health and neurosis where the self is defined.
• Techniques involve unconditional positive
  regard for the patient. The patient (client) is
  competent to direct him/herself.

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Behavior Therapy

• Focus on behavior, not cause
• Modifies observable behavior
• Conditioned response
• The problem must be clearly defined
• Techniques
• Systematic Desensitization
• Works well with phobias journaling helps
• Relaxation training abdominal breathing,
  progressive relaxation, autogenics (self talk to
  promote relaxation)

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Rational Emotive Therapy (RET)

• Interpretation of Data
• Terrible, destructive vs.
• Clearing the air validated, assertive
• Basic irrational ideas
• ABCs
• A Action, Activity, Agent
• B Belief system activated by A (rational or
  irrational)
• Irrational belief should ought must etc.
  etc.
• C Consequence rational or irrational.
• Techniques involve confronting irrational beliefs

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Cognitive Therapy

• Counteracting negative thoughts or cognitions.
  Internal experiences are more important than
  behavioral experiences. Works well in depression
• Cognitive triad
• Negative view is (always) held individual
  defective
• Ongoing events in life are viewed (always) in a
  negative way.
• Assumption that the future holds no promise and
  it will always continue that way. Expectation of
  despair, frustration and failure to persist.
• Faulty information processing

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Cognitive Therapy continued

• Techniques
• Combination of behavioral and cognitive
  techniques
• Evidence supporting automatic thought vs. reality
  based interpretations.
• Use of therapeutic relationship
• The patient must be able to feel and express
  feelings. The therapeutic relationship assists
  in developing emotional congruency
• Collaborate with patient to explore attitudes
  which cause emotions
• Skillful questioning useful to identify consider
  and correct cognitions and beliefs

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Cognitive Therapy continued

• Techniques continued
• Reattribution
• Many reasons for things to go wrong, not just
  ones presence in the world
• Helps to relieve the person of total
  responsibility for everything that happens in the
  world and in his/her life.
• Journal situations, emotions, automatic
  thoughts, other interpretations
• Behavioral techniques supplement cognitive work

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Strategic Therapy

• Communication based, solution based, and brief.
• Interactive context of behavior
• Attempted solutions first order what didnt
  work
• Understand the patients position
• Benevolence vs. victimization
• Techniques provide patient with a new frame of
  reference with a planned chance occurrence

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Strategic Therapy continued

• Techniques continued
• Symptom Prescription
• Dont stop behavior but stop the attempted
  solution.
• Be exposed to the unwanted task but do not try to
  master it. (Gives alternate behavior to stop it.)
• Reframing Changes the way the situation is
  viewed. Does not change the situation.

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So. You are the RN working with

• A depressed patient who would seem to respond
  well to cognitive therapy. What kinds of things
  would you do with this patient?
• Situation
• Emotions
• Automatic Thoughts
• Other Interpretations
• What is this technique?

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So. You are the RN working with

• A patient who is convinced that they are a
  failure and worthless to society.
• You want to use RET. You would
• Ask
• Point out
• And the desired patient response is

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So. You are the RN working with

• A patient who has an irrational fear of nursing
  tests. You would
• A phobia of going out to eatthe RN would begin
  with...