1. Chapter 3 Theories and Therapies

2. Mental health and illness • Mental health and illness are based on both psychological and biological factors with a dynamic interplay between the two • Psychotherapy: “talk therapy” – -used exclusively by early practitioners focusing on the complexity and inner workings of mind • Theoretic models and therapeutic strategies provide a useful framework for the delivery of psychiatric nursing care

3. Major theories of the psychiatric care • Psychoanalytical Theory • Sigmund Freud (1856-1939) – the “father of psychiatry” • Focus is on the understanding of the unconscious mind • Based on unconscious motivations and the dynamic interplay in between: - the unconscious - primitive brain (id-pleasure seeking), - the preconscious - the sense of self (ego –defense mechanism, such as repression, denial and rationalization) -the conscious (superego-conscience)

4. Major theories of the psychiatric care • Interpersonal Theory • Ed Sullivan (1892-1949) • Focuses on “here and now” and emphasizes relationships; therapist is an active participant • Personality dynamics and disorders are created by social forces and interpersonal experiences • Provides positive and interpersonal repairing experiences • Healthy relationships are necessary for healthy personality

5. Major theories of the psychiatric care • Behavioral Theory • Developed by Pavlov (1927) who is famous for investigating classical conditioning in which involuntary behavior or reflexes could be conditioned to respond to neutral stimuli (Pavlov’s dogs) • This model suggests that because behavior is learned, therapy should improve behavior through rewards and reinforcement of adaptive behavior using behavioral therapy/modification

6. Major theories of the psychiatric care • Cognitive Theory (Aaron T. Beck -1963) • Depression is the result of faulty thinking • Cognitive Behavioral Therapy (CBT) is effective and empirically supported • Helps people reorganize distorted thinking and replace it with accurate and positive thoughts

7. Major theories of psychiatric care • Cognitive Development • Developed by Jean Piaget (1896-1980) • Our mental representations of world (schemata) depend on the cognitive stage we have reached • 3 Stages • Sensorimotor stage (0-2 yrs) • Preoperational stage (2-7 yrs) • Concrete operational stage (7-11 yrs) • Formal operational stage (11-adulthood)

8. Major theories of psychiatric care • Theory of Psychosocial Development • Erik Erickson (1902-1994) described development as occurring in 8 predetermined life stages , stages whose success are related to preceding stage • Psychosocial Life Stage • 1. Trust v Mistrust Infancy: (0-1½ yrs)   • 2. Autonomy v Shame and Doubt: (1-3 yrs)   • 3. Initiative v Guilt Play: (3-6 yrs)   • 4. Industry v Inferiority School Age (5-12 yrs) • 5. Identity v Role Confusion Adolescence (9-18 yrs) puberty, teens   • 6. Intimacy v Isolation Young Adult 18-40, courting, early parenthood   • 7. Generatively v Stagnation Adulthood 30-65, middle age, parenting   • 8. Integrity v Despair Mature Age 50+, old age, grandparents

9. Major theories of psychiatric care • Humanistic Theory • Psychological science concerned with human potential for logical science concerned with the human potential for development, knowledge attainment, motivation and understanding • Carl Rogers (1961): developed patient centered psychotherapy, a technique that emphasized role of pt in understanding ones own problems • Abraham Maslow (1970): developed the theory of personality and motivation based on hierarchy of needs; Psychological needs, safety needs, belongingness and love needs, esteem needs, self-actualization and self-transcendent needs

10. Major theories of psychiatric care • Biological Model • Dominant model for psychiatric care • Belief that mental disorders have physical causes • Psychopharmacology (medicine) is the primary biological treatment for mental disorders • Major Classifications of medications used for psychiatric pts • Antidepressants • Mood Stabilizers • Antipsychotics • Antianxiety • Psychostimulants

11. Major theories of psychiatric care • Nursing Model: Developed by Hildegard Peplau (1909-1999) • Published Interpersonal Relationships in Nursing • Foundation for understanding and conducting therapeutic nursing relationships • Based on Sullivan’s Interpersonal Theory • Peplau’s theory provides structure for how the therapeutic relationship is viewed • Four phases • Preinteraction Phase • Orientation (Introductory) Phase • Working Phase • Termination (Resolution) Phase

12. Therapies for specific populations • Group therapy • Provides a formal setting for this influence • Derived from interpersonal theory and assumption is the interaction among participants can support or bring desired change among individual participants • Offers significant interpersonal feedback fro multiple people • Group is defined as a gathering of 2 or more individuals who share a common purpose and meet over a substantial time period in a face to face interaction to achieve an identifiable goal

13. Therapies for specific populations • Group Therapy • Setting: room, privacy, seating • Group Development: 5 stages: forming, storming, norming, performing and adjourning • Roles of Group Members: task, maintenance and individual • Roles of Group Leader: multiple roles in starting, maintaining and terminating a group. Leadership style depends on the group type • Types of Groups: education, tasks, support and therapy

14. Therapies for specific populations • Roles of Nurses • Psychoeducational groups; teach about a specific somatic or psychological subject • Medication education group • Dual diagnosis group • Addiction recovery group • Symptom management group • Stress management group • Multifamily group • Self help group • Therapeutic Milieu • Healthy environment +healthy social structure • Community Meetings: pts, treatment team to discuss goals

15. Therapies for specific population • Family Therapy • Based on various theoretical models and aims to decrease emotional reactivity among family members and encourage differentiation among individual family members