Transcript Chapter 26
Chapter 26: Therapies: Theory and Clinical Practice Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Hildegard Peplau Pioneer/educator in psychiatry and mental health Nurse-client relationship; central framework for therapeutic interventions Nurse assists patient to identify difficulties; express feelings and thoughts; explore options; and reinforce healthy coping Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 2 Theoretic Perspectives Humanistic Approach Emphasis on human potential and inherent worth Behavioral Approach Behavior is a learned response to a stimulus in the environment Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 3 Humanistic Approach Abraham Maslow Humans are motivated by basic needs Carl Rogers Person-centered approach Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4 Classical Conditioning Classical Conditioning Behaviorism Ivan Pavlov John B. Watson Operant Conditioning B.F. Skinner Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 5 Reinforcement Continuous Intermittent Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 6 Underlying Principles of Behavioral Therapy Modeling Premack Principle Shaping Counterconditioning Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 7 Cognitive Behavioral Therapy Aaron T. Beck Distorted thinking causes psychological disturbances in mood and behavior Goal of therapy is to help clients begin to identify automatic thoughts and their connection to feelings Cognitive appraisal Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 8 Dialectic Behavioral Therapy Marsha Lineham Difficulty regulating emotions is related to an inborn temperament that is unable to regulate emotions or emotional vulnerability High sensitivity to emotional stimuli with emotional intensity Experiences difficulty returning to neutral emotional baseline Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 9 Individual Therapy Focus on particular problematic behaviors Chain analysis of events Validation Alternative behavioral responses Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 10 Group Skills Training Core mindfulness skills Interpersonal effectiveness skills Emotion modulation skills Distress tolerance skills Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 11 Psychoanalytic Psychodynamic Approach Gallop & O’Brien Provides deep understanding of how early childhood relationships and experiences heavily influence the client’s present symptoms and interpersonal difficulties Sigmund Freud Founder of psychoanalytic theory; proposed the structure of id, ego, and superego Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 12 Defense Mechanisms Conflict occurs between the ego and the id or superego Serve as protector to the ego Channels overwhelming anxiety Operate unconsciously or consciously Adaptive and maladaptive Psychopathology is reflective of ineffective use of defense mechanisms Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 13 Therapeutic Milieu Environment specifically created to promote, maintain, or restore optimal psychologic health Maxwell Jones: Social psychiatrist developed the concept of therapeutic community in the 1950s Nightingale: Organizing the environment allows the mind and body to heal Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 14 Group Types Content Process Tasks, activities and procedures Interpersonal relationships among members Mid-range Combine functions of task and process Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 15 Group Dynamics Leadership Norms Cohesiveness Roles Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 16 Group Dynamics, cont’d. Leader: Emotional stimulation Caring Meaning attribution Members: Get information about how they present to others Assess whether fixed patterns are realistic to continue Discover previously unknown parts of selves Try new behaviors within safety of group Accept responsibility for the way they live Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 17 Safety and Trust in Group Nurse: Shows personal acceptance and valuing of members, respect, empathy Reinforces strengths Encourages higher level behavior Discourages self-defeating behavior Acknowledges contributions of members Intervenes in verbal attacks Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 18 Phases of Group Development Orientation Conflict Cohesion Working Termination Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 19 Phases of Group Development, cont’d. Orientation Conflict Cohesion Working Termination Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 20 Family Therapy Relieve pain, promote functional nurturing Foster greater self-worth in members Promote clear, direct, honest communication Create flexible, humane, need-responsive rules Link with society in open, hopeful ways Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 21 Activity Therapy With advent of managed care, nurses colead OT, RT, art, music, movement/dance, psychodrama Provide encouragement, support, role modeling, teaching, discussion, reality testing Foster independence, problem-solving, interactive skills Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 22 Electroconvulsive Therapy (ECT) Useful treatment for pharmacotherapyresistant clients with major psychotic disorder Informed consent required Pretreatment routine similar to preop routine Posttreatment routine similar to recovery room Side effects: headache, temporary loss of recent memory Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 23