Psychiatric

Nursing Day 1

Merchie Lissa F.
Tandog, RN
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QUIZ
1. Define the following Terms (5
points each)
a. Health
b. Psychiatric Nursing
2. Compare and contrast Mental
Health from Mental Illness (10
points)
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Definition of Terms
Health is a state of
complete physical, mental,
and social wellness, not
just merely the absence of
disease or infirmity (WHO)

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Definition of Terms
PSYCHIATRIC NURSING is an
interpersonal process whereby
the nurse assists an individual,
family or community, to
promote health, to prevent or
cope with experience of mental
illness

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Mental Health
Mental Health is a state of
emotional, psychological, and
social wellness as evidenced by
satisfying interpersonal
relationship
effective behavior and coping
positive self concept, and
emotional stability
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Mental Disorder
Mental Disorder is a
clinically significant
behavioral or psychological
syndrome or pattern that
occurs in an individual and
that is associated with
present distress or disability
(APA)
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Criteria of Mental
Illness
General Criteria (American
Psychiatric Association (APA), 2000)
Dissatisfaction with ones characteristics,
ability and accomplishments
Ineffective or unsatisfying relationships
Dissatisfaction with ones place in the world
Ineffective coping with lifes events
Lack of personal growth

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Mental Health and Mental Illness

Mental Health Mental Illness

Positive attitude Problems due to
towards self stress
Growth, Maladaptive behavior
development and Disruption in ability
self actualization to relate successfully
Integration with others
Autonomy Inability to meet
Reality perception basic needs in a
Environment socially acceptable
Mastery way

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Mental Health-Illness
MALADAPTIVE
Continuum Psychosis
ADAPTIVE Maladaptive Coping:
Health withdrawal or
Adaptive Coping aggression
Reality orientation Psychotic: denies
(3x) reality, creates new
Interacts with real environment
environment Hallucination/delusio
Socially n
acceptable Bizarre behavior
behavior, insight (gesturing, pouring);
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 Along the adaptive-maladaptive continuum,
behaviors are assessed to the degree that they
contribute to or are detrimental to the individual's
psychological well-being.
Maladaptive behavior allows a problem to continue
and often generates new problem. Interfering
significantlyoften over an extended period of time
with an individual's ability to function in such
important areas of life as health, work, love, and
interpersonal relationships.
On other hand, adaptive behavior solves problems
in living and enhances an individual's life.

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Factors Affecting Mental
Health
Individual/Personal
Persons biologic make-up,
autonomy and independence,
self-esteem, capacity for growth,
ability to find meaning in life,
emotional resilience, sense of
belongingness, reality
orientation, stress management
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capabilities 15
Factors Affecting Mental
Health
Interpersonal/Relations
hip
Effective communication,
ability to help others,
intimacy, balance of
separateness and
connectedness
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Factors Affecting Mental
Health
Social/Cultural/Environment
al
Sense of community, access to
adequate resources, intolerance
to violence, support of diversity
among people, mastery of
environment, positive yet realistic
view of ones world
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Diagnostic and Statistical Manual of Mental Disorders, 4 th Edition, Text
Revision (DSM-IV TR)

Taxonomy published by APA

which describes all mental
disorders, outlining specific
diagnostic criteria for each
based on clinical experience
and research
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DSM IV TR
Purpose:

To provide a standard nomenclature and

Language for all mental health
professionals
To present defining characteristics or
symptoms that differentiate specific
diagnosis
To assist in indentifying the underlying
cause of disorders
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DSM IV TR Classification
System
Axis I is for identifying all major
psychiatric disorders except mental
retardation and personality disorder
Axis II is for reporting mental
retardation and personality
disorders as well as prominent
maladaptive personality features and
defense mechanisms

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DSM IV TR Classification
System
Axis III is for reporting current
medical condition that are
potentially relevant to
understanding or managing the
persons mental disorder as well
as medical condition that might
contribute to understanding the
person
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DSM IV TR Classification
System
Axis IV is for reporting psychosocial
and environmental problems that
may affect the diagnosis, treatment
and prognosis of mental disorder
Axis V presents a Global
Assessment of Functioning (GAF),
which rates the persons overall
psychological functioning on a scale of
0-100
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 Examples

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DSM IV TR Classification
System
Axis I: Schizophrenia,
disorganized type
Axis II: Depressive
Axis III: DM II
Axis IV: Two small daughters
at home
Axis V: 50
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DSM IV TR Classification
System
Axis I: Bipolar I Disorder, most
recent episode manic, severe with
psychotic features
Axis II: Borderline personality
Disorder
Axis III: Alopecia
Axis IV: Unemployed
Axis V: 62
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 Historical Perspective on the
Treatment of Mental Illness

Early man widely believed that mental

illness was the result of supernatural
phenomena such as spiritual or demonic
possession, sorcery, the evil eye, or an
angry deity and so responded with equally
mystical, and sometimes brutal, treatments.
Attempts to treat mental illness date back
as early as 5000 BC as evidenced by the
discovery of trephined skulls in regions that
were home to ancient world cultures.
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 Trephining (also referred
to as trepanning) first
occurred in Neolithic times.
During this procedure, a
hole, or trephine, was
chipped into the skull using
crude stone instruments. It
was believed that through
this opening the evil
spirit(s)--thought to be
inhabiting ones head and
causing their
psychopathology--would be
released and the individual
would be cured.
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 Between the 5th and 3rd centuries BC,
Greek physician proposed that mental
illness stemmed from natural
occurrences in the human body,
particularly pathology in the brain.
Hippocrates, and later the Roman
physician Galen, introduced the concept
of the four essential fluids of the human
bodyblood, phlegm, bile, and black
bilethe combinations of which
produced the unique personalities of
individuals.
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 In early Christian times (11000 AD), primitivebeliefs
and superstitions were strong. All diseaseswere again
blamed on demons, and the mentally illwere viewed
as possessed.
Priests performed exorcismsto rid evil spirits. When
that
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failed, they usedmore severe measures
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such as
 During the Renaissance (13001600), people
withmental illness were distinguished from
criminals inEngland.;dangerous lunatics were
thrown inprison, chained, and starved
(Rosenblatt, 1984).
In 1547, the Hospital of St. Mary of Bethlehem
was officiallydeclared a hospital for the insane,
the first ofits kind.
During this same period inthe colonies (later the
United States), the mentallyill were considered
evil or possessed and were punished.
Witch hunts were conducted, and offenderswere
burned at the stake.

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 Bedlam

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 Period of Enlightenment
In the 1790s, Phillippe Pinel inFrance and
William Tukes in England formulatedthe
concept of asylum as a safe refuge or haven
offeringprotection at institutions where
people hadbeen whipped, beaten, and
starved just because theywere mentally ill
(Gollaher, 1995).
Dorothea Dix (18021887) begana crusade
to reform the treatment of mental illnessafter
a visit to Tukes institution in England.
Shewas instrumental in opening 32 state
hospitals that offered asylum to the suffering.
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 Scientific Study and treatment of
mental disorders began with
Sigmund Freud, also Emil Kraeplin
and Eugene Blueler
Development of
psychopharmacology
Chlorpromazine
Lithium
MAOIs
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 Psychiatric Nursing
Practice
Linda Richards- first American Psychiatric
Nurse
First training of nurses to work with persons
with mental illness was in 1882 at McLean
Hospital in Belmont, Massachusetts
Nursing Mental Diseases by Harriet Bailey- 1st
psychiatric nursing textbook
Nursing theorists who shaped psychiatric
mental health nursing: Hildegard Peplau
(Interpersonal Relations in Nursing, 1952) &
June Mellow (Nursing Therapy, 1968)
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 Standards of Care
In 1973, the American Nurses
Association developed standards of
care; revised in 1982, 1994 & 2000.

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 Standards of Care
Statement on Psychiatric-Mental Health
Nursing Practice and Standards of
Psychiatric Mental Health Clinical
Nursing Practice jointly published by ANA
and American Psychiatric Nurses
Association, et. Al.
Outlines the areas of concern and standards of
care for todays psychiatric-mental health nurse
Used to determine safe and acceptable practices
and to assess quality of care when legal
problems arise

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 Standards of Care
Standard I. Assessment
The Psychiatric Mental Health Nurse
collects the clients health data
Standard II. Diagnosis
The Psychiatric Mental Health Nurse
analyzes the data in determining diagnosis
Standard III. Outcome Identification
The Psychiatric Mental Health Nurse
identifies expected outcomes individualized
to the client
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Standards of Care
Standard IV. Planning
The Psychiatric Mental Health Nurse
develops a plan f care that prescribes
interventions to attain expected outcomes
Standard V. Implementation
The Psychiatric Mental Health Nurse
implements interventions identified in the
plan
Counseling
The Psychiatric Mental Health Nurse uses
counseling interventions to assist clients in
improving or regaining their previous
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coping abilities, fostering mental health,
Standards of Care
Milieu therapy
The Psychiatric Mental Health Nurse provides, structures and
maintains a therapeutic environment in collaboration with the
client and other care providers
Self Care Activities
The Psychiatric Mental Health Nurse structure interventions
around the client's activities of daily living to foster self care
and mental and physical well being
Psychobiologic interventions
The Psychiatric Mental Health Nurse uses knowledge of
Psychobiologic intervention and applies clinical skills to restore
clients health and prevent further disability
Health Teaching
The Psychiatric Mental Health Nurse through health teaching,
assist the client in achieving satisfying productive, and healthy
patterns of living
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Standards of Care
Case Management
The Psychiatric Mental Health Nurse provides
case management to coordinate comprehensive
health services and ensure continuity of care
Health promotion and Maintenance
The Psychiatric Mental Health Nurse employs
strategies and interventions to promote and
maintain mental health and prevent mental
illness
Standard VI. Evaluation
The Psychiatric Mental Health Nurse evaluates the
client's progress in attaining expected outcomes

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Multidisciplinary Team in
Mental Health
Psychiatrist
Pharmacist
Psychologist
Psychiatric Nurse
Psychiatric Social Worker
Occupational Therapist
Recreation Therapist
Vocational Rehabilitation Specialist
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 Role of Psychiatric Nurse as a Team
Member
1. Teacher
2. Caregiver
3. Advocate
4. Parent Surrogate
5. Ward Manager
6. Socializing Agent
7. Therapist
8. Healthy Role Model
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The student nurse at the Mental
Ward

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 Student Concerns
What if I say the wrong thing?
What will I be doing?
What if no one will talk to me?
Am I prying when I ask personal questions?
How will I handle bizarre or inappropriate behavior?
What happens if a client asks me for a date or
displays sexually aggressive or inappropriate
behavior?
Is my physical safety at jeopardy?
What if I encounter someone I know being treated
on the unit?
What if I encounter someone I know being treated
in the unit?
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 Self-awareness
Activity

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Instructions
Get a piece of paper and fold it into 2
parts.
In the inner side of the paper, Answer
the question Who am I now?
List all your values, attitude, feelings,
strengths, behavior,
accomplishments, needs, desires and
thoughts known to others.
In the other side those qualities that
are only known to you.
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Instructions
Using that same piece of paper, ask
your seatmate to tape it on your
back with the blank portion in front.
Roam around the room and let your
classmates write on the paper at
your back regarding values, traits
and character they know you have
(who are you in their eyes)

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 Self-Awareness
The process by which the nurse gains
recognition of his or her own feelings,
beliefs, and attitudes.
The nurse needs to discover himself or
herself and what she believes before trying
to help others with different views
Can be accomplished through reflection,
spending time consciously focusing on how
one feels and what one values or believes

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 Self-Awareness
Caring, the basis of good nursing, depends on
you knowing more about who you are. Why?
Because we cannot help other people until we
are a bit clearer about ourselves. (Burnard
1992)
Becoming self aware is a conscious process in
which we consider our understanding of
ourselves. It is only when we know ourselves
that we can be aware of what we will and will
not accept from others in our lives- it helps us
to relate with other people.
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 Self-Awareness
Being self-aware enables us to identify our
strengths and also those areas that can be
developed. If we do not know our good and bad
points then we are less likely to be able to help
others.
Nurses can use the self to therapeutic effect
when working with patients, for example when
empathizing or advocating.
Rungapadiachy (1999) suggests that becoming
self-aware is compulsory in the caring professions
and that it comprises three interrelated aspects:
cognitive, affective, and behavioral. (thinking,
feeling, acting)
Example: feelings about something could
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 Self-Awareness
Value Enhanced :
Social-Responsibility, Determination, Respect
for Self and others
WHO definition:
This includes our recognition of ourselves,
our character, strengths and weakness,
desires and dislikes. It is a pre requisite for
Effective- Communication, Interpersonal
Relationship and Developing Empathy.
When this assessment is level - headed,
reasonable and positive, we develop a strong
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sense of Self- esteem.
 Self-Esteem
Self-Esteem is essentially a measure of self
worth and importance. It is an important
part of the personality that should be
shaped from the very early years. During
childhood, if an individuals feelings are
respected, thoughts valued and abilities
recognized, the childs Self - Esteem is
strengthened.
When feelings are trampled upon and
thoughts belittled with remarks like, I dont
care what you think / want or what a
stupid idea! the childs Self- Esteem
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Individuals with a strong Self-
Esteem:
Know their own capabilities, are more
effective learners, dynamic, more confident
and ambitious, function effectively and with
personal satisfaction and are more likely to
succeed
Have feelings of being valued and
worthwhile, are able to act towards others
in non - threatening ways, build healthy
relationships and are active members of
social groups.
Show healthy growth and development,
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Whereas, individuals with low
Self - Esteem:
Feel that others dont respect / value
them, dont know their capabilities and less
likely to succeed.
Are less capable of responding to others,
feel isolated and less capable of forming
good and long term relationships
Are unable to control their personal life or
to make decisions, less able to resist
external pressures such as from peers, the
media, etc. and more likely to smoke, abuse
alcohol and other drugs
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 Our Self-Awareness and self-esteem
start to develop very early on in life.
They are formed out of our
observation of:

Our own behavior - how we cope with

situations, our successes and failures;
How other people significant to us,
behave towards us (parents, teachers,
close community);
The way we believe that others see us.

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Self-Esteem can be increased by:

A history of success (nothing succeeds like

success).
Receiving respect, acceptance and
concerned treatment from significant
others.
An accepting, considerate environment at
home, school and work place.
At school- improved student - staff
relationships; certain types of teaching
methods (group work, active tutorial work
etc)
Developing Social and Life Skills.
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 Key Messages
We all have different
attributes/qualities.
Some we like, and others we do
not.
We can either learn to like the parts
we do not like or to change them.
We have a choice.
By being aware of our positive
qualities we are more sure of
ourselves and more able to
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 By focusing on the concept of liking
ourselves, we feel good around other
people and perform better at anything
we do.
Focusing on Positive Self-Esteem is
essential; it affects how we view others
and ourselves, and the way we approach
almost every aspect of our life. People
with low Self-Esteem often engage in
Self-Destructive behavior.
Life Skills such as Self-Awareness, Critical-
Thinking, Coping with Stress and
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 Review of
Anatomy and
Physiology
of the
Nervous System

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The Nervous System

Center of thinking, memory,

judgement, sensation, movement,
cognition, communication, behavior,
and personality
Innervates many other body systems
and indirectly influences their actions

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 Nervous system is divided into:

Central nervous system (CNS)

Brain
Spinal cord
Peripheral nervous system (PNS)
Cranial nerves
Spinal nerves
Autonomic NS
Sympathetic
Parasympathetic NS

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 Nervous System
Cells
There are two main types of brain cells:
Neurons
Neuroglial cells
- Provide protection, structure and nutrition to the
neurons
4 types:
1. Astroglial
2. Ependymal
3. Oligodendrocytes
4. Microglial

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Neurons
Basic structural and functional units of the
nervous system
Cannot divide by mitosis
Respond to physical and chemical stimuli
Produce and conduct electrochemical
impulses
Release chemical regulators

*The brain contains approximately more

than 20 billion nerve cells, or Neurons

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Parts of a Neuron
Cell body (perikaryon)
Nutrition center
Cell bodies within CNS clustered into
nuclei, and in PNS in ganglia

Axons
Transmits impulses from its cell body to
other neurons

Dendrites
Provide receptive area
Transmit electrical impulses to cell body

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 Synapses

Impulses are transmitted to their

final destination through synapses
Types:
Neuron to neuron
Neuron to gland

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3 Types of Neurons

Sensory neuron- takes a message from

the receptors in the sense organ to the CNS;
Afferent Neurons
Motor neuron- sends a message away
from the CNS to an effector, a muscle fiber
or a gland; Efferent Neurons
Interneuron- always found completely
within the CNS and conveys messages
between parts of the system

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 Central Nervous System:
The Brain

1. Cerebrum (the Latin word for

brain)
The 2 major subdivision which makes up
approx. 85 % of the brains weight is
known as hemispheres
The exterior surface of the cerebrum, the
cerebral cortex, is a convoluted, or
folded, grayish layer of cell bodies
known as the gray matter.
This covers an underlying mass of fibers
called the white matter
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The Cerebrum is composed of two large,
almost symmetrical hemispheres
known as:

1.Right hemisphere- controls left

side of the body; center for creative
thinking, intuition and artistic abilities
2.Left hemisphere- controls right side
of the body; center for logical
reasoning and analytic functions such
as reading, writing and mathematical
tasks
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 The convolutions are made
up of ridge-like bulges,
known as gyri separated by
small grooves called sulci
and larger grooves called
Fissures

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 These sulci and gyri divide the cerebrum
into four lobes:
Frontal
Temporal
Parietal
Occipital

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 Frontal-largest lobe; primary motor
area (cortex); behavior, judgment;
abstract thought; current and past
information storage, moral behavior
Arousal, focuses attention, enables problem
solving and decision-making
Brocas area- responsible for formation
of words or speech
Parietal-sensory lobe; taste and
touch,; essential for individuals
awareness in space, as well as
orientation in space and spatial relations
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 Temporal- contains the auditory
receptive area; smell and hearing;
interpretive area provides integration
of somatization; visual and auditory
areas
Wernickes Area- processing of words into
thoughts and recognition of the idea
behind written or printed words (language)

Occipital- posterior lobe; language

generation; responsible for visual
interpretation such as depth
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2. Brain Stem
Have special cells that constitute
the reticular activating system
(RAS)
Sensory fibers branch and
terminate here
RAS controls awareness and
alertness, motor activity

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 It includes three main structures lying
between and below the two cerebral
hemispheres
1.Midbrain- connects pons and
cerebrellum with the cerebrum
2.Pons- bridges gap; motor
pathway
3.Medulla oblongata-
respiration and cardiovascular
functions; Regulates breathing
and blood pressure.
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 3. Cerebellum
Coordinates body
movements
Maintains posture and
balance by controlling
muscle tone and sensing the
position of the limbs.

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Cerebellar function enables the
individual to do the following:

Keep a moving part from overshooting

the intended destination
Move from one skilled movement to
another in an orderly sequence
Predict distance or gauge the speed with
which one is approaching an object
Control voluntary movement
Maintain equilibrium

* Cerebral control of the body is

ipsilateral
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 Limbic System
Thalamus
main relay station for incoming sensory
signals to the cerebral cortex and for
outgoing motor signals from it.
Hypothalamus
Regulates eating, drinking, temperature
regulation, sleep, emotional behavior, and
sexual activity, thirst, hormonal activity
Pituitary Gland (Hypophysis)
Master gland
Releases specific hormones under the regulation of the
hypothalamus
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 Hippocampus & Amygdala-
emotional arousal and memory

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Neurotransmitters

Chemical substances manufactured in

the neuron that aid in the transmission
of information throughout the body.
Chemicals that take a nerve signal
across the synaptic gap between a
sending neuron, and a receiving one.
Excitatory or inhibitory

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Neurotransmitters
Dopamine(DA) Monoamines- Catecholamines

Norepinephrine (NE)

Serotonin (5HT) Monoamines- Indolamines

Acetylcholine (Ach) Cholinergics

Glutamate (Glu) Amino Acids

Gamma-Aminobutyric Acid Amino Acids

(GABA)

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 NAME LOCATION(S)

DOPAMINE Brain, smooth muscle

SEROTONIN Brain

NORADRENALINE/NOREPINE
PHRINE
Brain, smooth muscle

Parasympathetic nervous
ACETYLCHOLINE (ACH) system, brainstem,
neuromuscular junction

GABA Brain

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Where synthesized in the
brain:
Dopamine
Serotonin
Substancia
nigra Raphe nuclei
Ventral Norepinephrine
segmental Locus ceruleus
area Acetylcholine
Hypothalamus Nucleus Basalis
of Meynert

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Dopamine
Synthesized from tyrosine a
dietary amino acid
Excitatory
Control arousal levels, attention,
complex movements, motivation,
cognition, regulates emotional
response

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DOPAMINE
MORE LESS
Schizophrenia Antipsychotic effect
Hallucinations Negative symptoms
Dyskinesias Increased
Nausea temperature
Vomiting Antiemetic
addiction EPS
Sexual Anhedonia
enhancement sexual dysfunction
Overmovement
undermovement

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Serotonin
Inhibitory
Controls mood, food intake,
sleep, wakefulness, temperature
regulation, pain control, sexual
behavior, regulation of emotions
Found only in the brain- derived
from tryptophan

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Serotonin
MORE LESS
Antidepressant Depression
Anxiety Suicidal
Migraines Aggressiveness
Nausea Obsessiveness
GI upset Pain
Sexual dysfunction Anxiety
Movement Panic
disorders
temperature
Temperature
elevated
elevated
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Norepinephrine
Excitatory
Causes changes in attention,
learning and memory, sleep and
wakefulness and mood
regulation
Induce arousal, heighten mood,
dreaming

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Norepinephrine
MORE LESS
Antidepressant Depression
Vasoconstrictio Vasodilation
n Decreased HR
Increased HR Sexual
dysfunction
Bronchial
Social
dilation withdrawal
Memory loss
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Acetylcholine
Excitatory/inhibitory
Controls sleep-wakefulness cycle,
signals muscles to be alert
Role in memory, vasodilation,
activates muscles
Synthesized from choline found
in red meat and vegetables

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Acetylcholine
MORE
LESS
Pupil constriction
Pupils dilation
Decreased HR
Increased HR
Bronchi constrict
Bronchi dilate
Increased
Decreased
Respiratory
secretions
secretions
Decreased
Increased
elimination
elimination
Decreased sweating
Sweating
Decreased cognition
Enhanced cognition
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Glutamate
Excitatory
Results in neurotoxicity if
levels are too high

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GABA
Inhibitory
Modulates other
neurotransmitters
Control anxiety level, nerve
and muscle transmission

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 ENKEPHALIN, ENDORPHINS

Located in the brain, spinal cord

Pleasure sensation, reduce stress,
promote calm, natural painkiller

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 Histamine
Controls gastric secretions, cardiac
stimulation, and alertness

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 Theories
of
Human Behavior

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Psychoanalytic Theories by
SIGMUND FREUD
Developed on late 19th and early
20th century
It supports the notion that all
human behavior is caused and can
be explained (Deterministic Theory)
Repressed (driven from conscious
awareness) sexual impulses and
desire motivate much of human
behavior
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Psychoanalytic Theories
Behavior motivation by
subconscious thoughts and
feelings
Conscious
Subconscious/Preconscious
Unconscious
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Psychoanalytic Theories
Personality Components
Id
Ego
Superego

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Psychoanalytic Theories
Ego defense Mechanisms
Methods of attempting to
protect self and cope with basic
drives or emotionally painful
thoughts, feelings or events
Most operate at the
unconscious level of awareness
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Ego Defense Mechanisms
COMPENSATION- Covering up for a weakness by
overemphasizing or making up a desirable trait.

CONVERSION- The unconscious expression intra-

psychic conflict symbolically through physical
symptoms.

DENIAL- Unconscious or conscious refusal to admit

an unacceptable idea or behavior.

DISPLACEMENT- Discharging pent-up feelings to a

less threatening object.

DISSOCIATION- The unconscious separation of

painful feelings and emotions from an
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Ego Defense Mechanisms
FIXATION- never advancing to the next level of
emotional development or organization, arrested at
fixed level

IDENTIFICATION- A conscious or unconscious

attempt to model oneself to a respectful person.

INTELLECTUALIZATION- Using only logical

explanations without feelings or an affective
component.

INTROJECTION- Unconsciously incorporating wishes,

values, and attitudes of others as if they were your
own.
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Ego Defense Mechanisms
PROJECTION -Blaming someone else for
ones difficulties or placing ones unethical
desires on someone else.

RATIONALIZATION- Attempts to make or

prove that ones feelings or behavior are
justifiable.

REACTION-FORMATION- A conscious
behavior that is the exact opposite of an
unconscious feeling.

REGRESSION- Return to an earlier111 and more

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Ego Defense Mechanisms
REPRESSION- Unconscious and
involuntary forgetting of painful
ideas, events, and conflicts.
RESISTANCE Overt or covert
antagonism towards remembering or
processing anxiety producing
information
SUBLIMATION- Channeling instinctual
drives into acceptable activities.
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Ego Defense Mechanisms

SUBSTITUTION replacing the desired

gratification with one that is readily
available

SUPPRESSION- Voluntary exclusion from

awareness, anxiety- producing feelings,
ideas, and situations; conscious

UNDOING- Doing something to counteract

or make up for a transgression or
wrongdoing.
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Vaillants 4 Levels of Defense
Mechanisms
Level I : Psychotic Mechanisms
Denial , delusional projection, Distortion
Level II: Immature Mechanisms
Projection, Schiziod Fantasy,
hypochondriasis, Passive- Aggressive
behavior, Acting out
Level III: Neurotic Defenses
Intellectualization, repression,
displacement, reaction Formation,
dissociation
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Psychoanalytic Theories
Freudian Dream Analysis
A persons dream reflects his subconscious and
have a significant meaning, although sometimes
the meaning is hidden or symbolic
Dream Analysis involves discussing client's
dreams to discover their true meaning and
significance
Free Association therapist tries to uncover
the true thoughts and feelings by saying a word
and asking the client to respond quickly with the
first thing that comes to mind

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Psychoanalytic Theories
5 Stages of Psychosexual
Development:
Sexual energy pr libido, is the driving
force of human behavior
Psychopathology results when a person
has difficulty making the transition
from one stage to the next or when the
person remains stalled at a particular
stage or regresses to an earlier stage

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 Stages of Psychosexual
Development

1. Oral Phase (0-18 mos)

2. Anal Phase (18mos-3 years)
3. Phallic Phase (3-5 years)
4. Latency (5-11 years)
5. Genital Stage (11-13 years)

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Psychoanalytic Theories
Transference and Counter
Transference
Transference occurs when the client
displaces into the therapist attitudes and
feelings that the client originally
experiences in other relationships

Counter transference occurs when the

therapist displaces into the client
attitudes and feelings from his past
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 Psychoanalysis
Focuses on discovering the causes of
the clients unconscious and
repressed thoughts, feelings and
conflicts believed to cause anxiety
and on helping the client gain insight
into and resolve these conflicts and
anxieties.

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Developmental Theories
Psychosocial Stages of
Development (Erik Erikson)
Person must complete a life task
Allows a person to achieve lifes virtues
of hope, purpose, fidelity, love, caring,
and wisdom

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 Eriksons
Stages of Psychosocial Development
AGE STAGE VIRTUE
Infancy (0-18 mos) Trust vs Mistrust Hope
Toddlerhood (18-3yrs) Autonomy vs Will
Shame
Pre-school (3-5 ) Initiative vs Guilt Purpose
School-Age (6-12) Industry vs Competence
Inferiority
Adolescence (18-20) Identity vs Role fidelity
Confusion
Young Adulthood (25-30) Intimacy vs Love
Isolation
Middle Adulthood (30-65) Generativity vs Care
Stagnation
Older Adult (65-death) Integrity vs Wisdom
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Developmental Theories
Cognitive Stages of Development
(Jean Piaget)
Explored how intelligence and cognitive
functioning develop in children
Believed that human intelligence processes
progress through a series of stages based on
age
Biologic changes and maturation were
responsible for cognitive development
Cognitive maturity is reached by middle to late
adolescence

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 Piagets Cognitive Stages of
Development

STAGE AGE
Sensorimotor (0-2 years)
Pre-operational (2-6 years)
Concrete (6-12 yrs)
Operation
Formal Operation (12 years
onwards)

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Interpersonal Theories
Interpersonal Relationship and
Milieu Therapy

Developed by Harry Stack Sullivan

He believes that ones personality
involves more than individual
characteristics, particularly how one
interacts with others
Inadequate or non-satisfying
relationships produce anxiety, which is
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125
Sullivans Life Stages
LIFE STAGES AGES

Infancy birth to onset of

language
Childhood Language 5 years

Juvenile 5-8 years

Pre-adolescence 8-12 Years

Adolescence puberty to adulthood

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 Interpersonal Relationship
DEVELOPMENTAL MODES
Prototaxic Mode (Infancy/Childhood) involves
brief, unconnected experiences that have no
relationship to one another
Parataxic Mode (early childhood)begins when
child connects experiences in sequence. Child
does not make any logical sense of experiences
(coincidences) and relieves anxiety by repeating
familiar experiences.
Syntaxic Mode begins to appear in school age
children and becomes predominant in
Preadolescence where the person perceives
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himself and the world within the context
127
f the
environment and can analyze experiences in a
Milieu Therapy
Developed by Sullivan who envisioned the
goal of treatment as establishment of
satisfying interpersonal relationships
Involves client interaction with one another,
including practicing interpersonal relationship
skills, giving one another feedback about
behavior, and working together as a group to
solve day-to-day problems
The role of the therapist is PARTICIPANT
OBSERVER

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Interpersonal Theories
Therapeutic Nurse-Patient
Relationship

Developed by Hildegard Peplau

A series of interactions between nurse and
the patient in which the nurse assists the
patient to attain positive behavioral change
The client accomplishes certain tasks and
makes relationship changes that help the
healing process

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 Therapeutic Nurse-Patient
Relationship
PHASES
1. Orientation directed by the nurse and
involves engaging the client in treatment,
providing explanation and information and
answering questions
2. Identification begins when the client works
interdependently with the nurse, expressing
feelings, and begins to feel stronger
3. Exploitation the client makes full use of the
services offered
4. Resolution - the client no longer needs
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professional services and gives up dependent
 Therapeutic Nurse-Patient
Relationship
ROLES OF THE NURSE IN THERAPEUTIC
NURSE-PATIENT RELATIONSHIP:
Stranger
Resource person
Teacher
Leader
Surrogate
Counselor
Others: consultant, tutor, safety agent,
medicator, administrator, observer, researcher
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Levels of Anxiety
1. Mild Anxiety is a positive state of heightened
awareness and sharpened senses, allowing a
person to learn new behavior and solve
problems
2. Moderate Anxiety involves decreased
perceptual field (focus on immediate task
only). The person can learn new behavior or
solve problem only with assistance
3. Severe Anxiety involves feelings of dread or
terror. The person cannot be redirected to a
task and has physiologic symptoms
4. Panic Anxiety can involve loss of 132
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rational
thought, delusions, hallucinations, and
Humanistic Theories
Hierarchy of Needs
Formulated by Abraham Maslow
Illustrates the basic drives or needs that
motivate people
Basic needs at the bottom of the
pyramid would dominate the persons
behavior until those needs were met, at
which time the next level of needs
would become more dominant
Explains individual differences in terms
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 Hierarchy of Needs

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Humanistic Theories
CLIENT-CENTERED THERAPY

Formulated by Carl Rogers who was first

to coin the word client rather than Patient
Focuses on the client role as the key to the
healing process
3 central concepts:
Unconditional Positive regard
Genuineness
Emphatic Understanding

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Behavioral Theories
Classical Conditioning
Developed by Ivan Pavlov
Behavior can be changed by
conditioning with external or
environmental conditions or stimuli
Experiment with dogs

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Behavioral Theories
Operant Conditioning
Developed by BF Skinner
People learn their behavior from their
history or past experiences
particularly those that were reinforced
Principle is used in Behavioral
Modification Therapy:
Positive/negative reinforcement
Systematic desensitization
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 Existential Theories
Believe that behavioral deviations result
when a person is out of touch with
himself and the environment
A person who is self-alienated is lonely
and sad and feels helpless
Goal: help the person discover an
authentic sense of self
Existential therapies encourage the
person to live fully in the present and to
look forward to the future
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Existential Theories
Cognitive Therapy
Developed by Aaron Beck
Focuses on the immediate
thought processing how a
person perceives or interprets
his experiences and determines
how he feels and behaves
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 Existential Theories
Rational Emotive therapy (RET) or
Rational Emotive Behavior Therapy
(REBT)
Founder of RET was Albert Ellis
Identified 12 irrational beliefs that people
use to make themselves unhappy-
automatic thoughts
Therapy using confrontational or irrational
beliefs that prevent the individual from
accepting responsibility for self and
behavior
Uses ABC technique
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 12 Irrational Beliefs
1. I must be loved by everyone or I am not lovable.
2. I must do everything well or I am incompetent.
3. I must damn others if they do not treat me well.
4. I must damn life if things do not go well.
5. I must control events and people because they control
how I feel.
6. I must worry about anything fearful or risky.
7. I must avoid responsibilities and problems in order to be
comfortable and-or content.
8. I must depend on others or my life and-or my self will fall
apart.
9. I must forever be controlled by my past, and I must
continue to be strongly affected by anything that once
strongly affected me.
10. I must damn other's problems and be disturbed by
them.
Existential Theories
Logotherapy
Formulated by Viktor E. Frankl
Therapy designed to help
individuals assume personal
responsibility. The search for
Logos or meaning in life is the
central theme
Used in spiritual and grief
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Existential Theories
Gestalt Therapy
Developed by Frederick S. Perls
Focus on the identification of
feelings in the here and now, which
leads to self acceptance
Write letters, keep journals and
perform activities designed to put
past to rest and focus on the present
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Existential Theories
Reality Therapy
Developed by William Glasser
Focus on the person's behavior and
how that behavior keeps him from
achieving lifes goals
Challenges clients to examine the ways
in which their own behavior thwarts
their attempts to achieve life goals

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