Transcript Theories and Therapies for Nursing Practice

Psychiatric Nursing: Theories
and Therapies for Nursing
Practice
NUR 145
Sandy Mishkin, RN, BC, MSN, Med
© 2008
Psychodynamic Theories
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Freud: Psychoanalytic Theory
 Harry Stack Sullivan: Interpersonal Theory
 Erik Erikson: Ego Theory
Freud’s Psychoanalytic
Theory
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Most mental disorders  Five psychosexual
due to unresolved
stages of development
issues in childhood
 Personality formed by
 Three levels of
school age
awareness: conscious,  Therapy focused on
preconscious, and
individual talking
unconscious
freely (“free
 Three interactive
association”), therapist
systems of personality:
listening for and
id, ego, and superego
interpreting themes
Sullivan’s Interpersonal
Theory
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Purpose of all behavior to
get needs met and
reduce/avoid anxiety
through interaction with
others
Anxiety as key element
Security operations as all
the strategies to minimize
anxiety and maximize
security
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Therapy based on
education, insight, practice
of interpersonal skills
Therapist demonstrating
empathy, respect, active
involvement
Foundation for Hildegard
Peplau’s Nursing Theory
of Interpersonal
Relationships
Erikson’s Ego Theory
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Culture and society impact
personality
Personality continuously
developing
Eight stages of
development
Failures at one stage
corrected in later stages
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Development model
utilized in assessment
of individuals and then
implementation of
appropriate
interventions
Humanistic Theories

Abraham Maslow Humanistic Psychology
 Emphasis on human need fulfillment,
human growth, self-actualization, and
individual strengths
 Hierarchy of needs consisting of six stages
 Focus on individual’s priorities in
developing interventions
Behavioral Theories

Ivan Pavlov: Classic Conditioning Theory
 John B. Watson: Behaviorism
 B.F. Skinner: Operant Conditioning Theory
Pavlov’s Classic Conditioning
Theory
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Stimulus-Response or Respondent
Conditioning
 A learned association between two events
 The basis for the other behavioral theories
Watson’s Behaviorism Theory

The impact of social environment on
behavior
 A specific stimulus results in a specific
response
Skinner’s Operant
Conditioning
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Reinforcer as the
consequence of a behavior
Positive reinforcement to
increase the likelihood of
a behavior
Negative reinforcement to
decrease the likelihood of
a behavior
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No reinforcer to
decrease the behavior
 Basis of behavior
modification and
behavior management
programs
Biological Theories

Focus on neurological, chemical, biological,
and genetic contributions to behavior,
including the dysfunctional behavior of
mental illness
 Reduce the stigma of mental illness
 The basis of psychopharmacology
Nursing Theories
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Hildegard Peplau
 Patricia Benner
 Dorothea Orem
 Sister Calista Roy
 Betty Neuman
 Joyce Travelbee
Hildegard Peplau

Influenced by Sullivan
and learning theory
 Helped establish the
specialty of
psychiatric nursing
 The nurse-patient
relationship as the
foundation of nursing

Nursing as the
education of patients
to make positive
changes in their health
status
 Stages for the nursepatient relationship
 The importance of
self-awareness for
nurses
Traditional Therapeutic
Approaches
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Classical psychoanalysis
Psychodynamic and psychotherapy
Short-term dynamic psychotherapy
Interpersonal psychotherapy (IPT)
Cognitive therapy
Behavioral therapy
Cognitive-Behavioral therapy (CBT)
Rational-Emotive therapy (RET)
Classical Psychoanalysis

Generally not popular due to expense,
length of treatment, and lack of research
 Two important contributions:
– Transference: Client experiences feelings
toward therapist based on feelings towards
another individual
– Countertransference: Therapist experiences
feelings toward client based on feelings towards
another person
Psychodynamic and
Psychoanalytic Psychotherapy
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Psychoanalytic psychotherapy
– Uses free association, dream analysis,
transference, and countertransference
– Therapist actively involved with the client
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Psychodynamic psychotherapy
– Focus is here and now, not the past
– Uncover unconscious material related to
symptoms
Short-Term Dynamic
Psychotherapy
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10-25 sessions
 Concrete goals
 Active involvement of therapist
Interpersonal Psychotherapy
(IPT)
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Focus on reassurance, clarification of
feelings, improvement of interpersonal
skills and communication
 Four general problem areas: grief, role
disputes, role transition, and interpersonal
deficits
Cognitive Therapy

Active, directive, time-limited
 Irrational and dysfunctional thoughts and
beliefs determine feelings and behavior
 Clients helped to change the way they think
about themselves, the world, and the future
– Identify, reality-test, and correct cognitions
– Substitute positive thinking for negative
thinking
Behavioral Therapy
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Behavior is learned so
problematic behavior can
be unlearned.
Insight unnecessary for
behavior change
Modeling: therapist as role
model
Operant conditioning:
positive reinforcement to
increase desirable
behavior
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Systematic
desensitization: Four steps
to incrementally pair
feared situation with state
of relaxation
Aversion therapy:
Undesirable behavior
paired with uncomfortable
state
Milieu therapy: creation of
a therapeutic environment
Cognitive-Behavioral Therapy
(CBT)
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Focused, time-limited, active
 Evidence-based and effective
 Combines strategies of cognitive and
behavioral therapies
Rational-Emotive Therapy
(RET)
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Developed by Albert Ellis
 A-B-C-D-E
– A=Activating experience
– B=Beliefs
– C=Consequences of beliefs (emotional
response)
– D=Disputing irrational beliefs
– E=Effect (new beliefs)
References

Varcarolis, E., Carson, V., & Shoemaker, N.
(2006). Foundations of psychiatric mental
health nursing: A clinical approach (5th
ed.). St. Louis: Saunders.