Chapter 26: Therapies: Theory and Clinical Practice Copyright © 2012, 2007 Mosby, Inc., an...

Chapter 26:Chapter 26:

Therapies: Theory and Therapies: Theory and Clinical PracticeClinical Practice

Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

22Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Hildegard PeplauHildegard Peplau

Pioneer/educator in psychiatry and mental Pioneer/educator in psychiatry and mental healthhealth

Nurse-client relationship; central framework Nurse-client relationship; central framework for therapeutic interventionsfor therapeutic interventions

Nurse assists patient to identify difficulties; Nurse assists patient to identify difficulties; express feelings and thoughts; explore express feelings and thoughts; explore options; and reinforce healthy copingoptions; and reinforce healthy coping


Theoretic PerspectivesTheoretic Perspectives

Humanistic ApproachHumanistic Approach Emphasis on human potential and inherent worthEmphasis on human potential and inherent worth

Behavioral ApproachBehavioral Approach Behavior is a learned response to a stimulus in Behavior is a learned response to a stimulus in

the environmentthe environment


Humanistic ApproachHumanistic Approach

Abraham MaslowAbraham Maslow Humans are motivated by basic needsHumans are motivated by basic needs

Carl RogersCarl Rogers Person-centered approachPerson-centered approach


Classical ConditioningClassical Conditioning

Classical ConditioningClassical Conditioning Ivan PavlovIvan Pavlov

BehaviorismBehaviorism John B. WatsonJohn B. Watson

Operant ConditioningOperant Conditioning B.F. SkinnerB.F. Skinner


ReinforcementReinforcement

ContinuousContinuous IntermittentIntermittent


Underlying Principles of Underlying Principles of Behavioral TherapyBehavioral Therapy

ModelingModeling Premack PrinciplePremack Principle ShapingShaping CounterconditioningCounterconditioning


Cognitive Behavioral TherapyCognitive Behavioral Therapy

Aaron T. BeckAaron T. Beck Distorted thinking causes psychological Distorted thinking causes psychological

disturbances in mood and behaviordisturbances in mood and behavior Goal of therapy is to help clients begin to identify Goal of therapy is to help clients begin to identify

automatic thoughts and their connection to automatic thoughts and their connection to feelingsfeelings

Cognitive appraisalCognitive appraisal


Dialectic Behavioral TherapyDialectic Behavioral Therapy

Marsha LinehamMarsha Lineham Difficulty regulating emotions is related to an Difficulty regulating emotions is related to an

inborn temperament that is unable to regulate inborn temperament that is unable to regulate emotions or emotional vulnerabilityemotions or emotional vulnerability

High sensitivity to emotional stimuli with High sensitivity to emotional stimuli with emotional intensity emotional intensity

Experiences difficulty returning to neutral Experiences difficulty returning to neutral emotional baselineemotional baseline


Individual TherapyIndividual Therapy

Focus on particular problematic behaviorsFocus on particular problematic behaviors Chain analysis of eventsChain analysis of events ValidationValidation Alternative behavioral responsesAlternative behavioral responses


Group Skills TrainingGroup Skills Training

Core mindfulness skillsCore mindfulness skills Interpersonal effectiveness skillsInterpersonal effectiveness skills Emotion modulation skillsEmotion modulation skills Distress tolerance skillsDistress tolerance skills


Psychoanalytic Psychodynamic Psychoanalytic Psychodynamic ApproachApproach

Gallop & O’BrienGallop & O’Brien Provides deep understanding of how early Provides deep understanding of how early

childhood relationships and experiences heavily childhood relationships and experiences heavily influence the client’s present symptoms and influence the client’s present symptoms and interpersonal difficultiesinterpersonal difficulties

Sigmund FreudSigmund Freud Founder of psychoanalytic theory; proposed the Founder of psychoanalytic theory; proposed the

structure of id, ego, and superegostructure of id, ego, and superego


Defense MechanismsDefense Mechanisms

Conflict occurs between the ego and the id or Conflict occurs between the ego and the id or superegosuperego

Serve as protector to the egoServe as protector to the ego Channels overwhelming anxietyChannels overwhelming anxiety Operate unconsciously or consciouslyOperate unconsciously or consciously Adaptive and maladaptiveAdaptive and maladaptive Psychopathology is reflective of ineffective Psychopathology is reflective of ineffective

use of defense mechanismsuse of defense mechanisms


Therapeutic MilieuTherapeutic Milieu

Environment specifically created to promote, Environment specifically created to promote, maintain, or restore optimal psychologic maintain, or restore optimal psychologic healthhealth

Maxwell Jones: Social psychiatrist developed Maxwell Jones: Social psychiatrist developed the concept of therapeutic community in the the concept of therapeutic community in the 1950s1950s

Nightingale: Organizing the environment Nightingale: Organizing the environment allows the mind and body to healallows the mind and body to heal


Group TypesGroup Types

Content Content Tasks, activities and proceduresTasks, activities and procedures

ProcessProcess Interpersonal relationships among membersInterpersonal relationships among members

Mid-rangeMid-range Combine functions of task and processCombine functions of task and process


Group DynamicsGroup Dynamics

LeadershipLeadership NormsNorms CohesivenessCohesiveness RolesRoles


Group Dynamics, cont’d. Group Dynamics, cont’d.

Leader: Leader: Emotional stimulationEmotional stimulation CaringCaring Meaning attributionMeaning attribution

Members:Members: Get information about how they present to othersGet information about how they present to others Assess whether fixed patterns are realistic to continueAssess whether fixed patterns are realistic to continue Discover previously unknown parts of selvesDiscover previously unknown parts of selves Try new behaviors within safety of groupTry new behaviors within safety of group Accept responsibility for the way they liveAccept responsibility for the way they live


Safety and Trust in Group Safety and Trust in Group

Nurse:Nurse: Shows personal acceptance and valuing of Shows personal acceptance and valuing of

members, respect, empathymembers, respect, empathy Reinforces strengthsReinforces strengths Encourages higher level behaviorEncourages higher level behavior Discourages self-defeating behaviorDiscourages self-defeating behavior Acknowledges contributions of membersAcknowledges contributions of members Intervenes in verbal attacksIntervenes in verbal attacks


Phases of Group DevelopmentPhases of Group Development

OrientationOrientation ConflictConflict CohesionCohesion WorkingWorking TerminationTermination


Phases of Group Development, Phases of Group Development, cont’d.cont’d.

OrientationOrientation ConflictConflict CohesionCohesion WorkingWorking TerminationTermination


Family TherapyFamily Therapy

Relieve pain, promote functional nurturingRelieve pain, promote functional nurturing Foster greater self-worth in membersFoster greater self-worth in members Promote clear, direct, honest communicationPromote clear, direct, honest communication Create flexible, humane, need-responsive Create flexible, humane, need-responsive

rulesrules Link with society in open, hopeful waysLink with society in open, hopeful ways


Activity TherapyActivity Therapy

With advent of managed care, nurses colead With advent of managed care, nurses colead OT, RT, art, music, movement/dance, OT, RT, art, music, movement/dance, psychodramapsychodrama

Provide encouragement, support, role Provide encouragement, support, role modeling, teaching, discussion, reality testingmodeling, teaching, discussion, reality testing

Foster independence, problem-solving, Foster independence, problem-solving, interactive skillsinteractive skills


Electroconvulsive Therapy (ECT)Electroconvulsive Therapy (ECT)

Useful treatment for pharmacotherapy-Useful treatment for pharmacotherapy-resistant clients with major psychotic disorderresistant clients with major psychotic disorder

Informed consent requiredInformed consent required Pretreatment routine similar to preop routinePretreatment routine similar to preop routine Posttreatment routine similar to recovery Posttreatment routine similar to recovery

roomroom Side effects: headache, temporary loss of Side effects: headache, temporary loss of

recent memoryrecent memory

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