1. Chapter 26: Therapies: Theory and Clinical Practice Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

2. 2 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

3. 3 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Theoretic Perspectives  Humanistic Approach  Emphasis on human potential and inherent worth  Behavioral Approach  Behavior is a learned response to a stimulus in the environment

4. 4 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Humanistic Approach  Abraham Maslow  Humans are motivated by basic needs  Carl Rogers  Person-centered approach

5. 5 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Classical Conditioning  Classical Conditioning  Ivan Pavlov  Behaviorism  John B. Watson  Operant Conditioning  B.F. Skinner

6. 6 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Reinforcement  Continuous  Intermittent

7. 7 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Underlying Principles of Behavioral Therapy  Modeling  Premack Principle  Shaping  Counterconditioning

8. 8 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

9. 9 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

10. 10 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Individual Therapy  Focus on particular problematic behaviors  Chain analysis of events  Validation  Alternative behavioral responses

11. 11 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Group Skills Training  Core mindfulness skills  Interpersonal effectiveness skills  Emotion modulation skills  Distress tolerance skills

12. 12 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

13. 13 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

14. 14 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

15. 15 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Group Types  Content  Tasks, activities and procedures  Process  Interpersonal relationships among members  Mid-range  Combine functions of task and process

16. 16 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Group Dynamics  Leadership  Norms  Cohesiveness  Roles

17. 17 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

18. 18 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

19. 19 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Phases of Group Development  Orientation  Conflict  Cohesion  Working  Termination

20. 20 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Phases of Group Development, cont’d.  Orientation  Conflict  Cohesion  Working  Termination

21. 21 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

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

23. 23 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Electroconvulsive Therapy (ECT)  Useful treatment for pharmacotherapy- resistant 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