Mental Health Chapter 5-6

Clazre G. WaughJic

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Fifth Edition ----7 -

Mental This book is dedicated to ny ehildre~ Evfick- Anne,Malik, and Jan@.

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&cematie d a x a t i ~ n dmemitization implosive therapy modebg rol~-p1ayin&

ranfrontaeion b&&m modBcarion o p e r a mnditioning negative condit~onlng positiw conditioning %@wive passive assertive

a Differentiae the &aracteristim d &ay, fear, pwi~a d

Desensitization ImpIosiveTherapy Problem Solving Rchiques for Changing Behavior Modeling Bole-Playing Confbntation Behavior MoMsation Assertlvmess Tr-

aggression I I& seven symptoms of seaae anxiety. D State four wp of redudng anxiety Discuss urnsing actionslinterventi~m for @e anxious client D Zxplajn modeltng, role-pIayiq,confrontation, and behavior modBcation as techniques for changing bebaviars, D List three elements afpassive, aggressive, and assertive behavior. S t r a is a nonspe&c response to any demand made on the body,

These demandis w 4 e d stressors. People are constantly affmed by ph@cal and psTfch~10gicalS ~ S O ~ Adaptation S . urmally goes unnoticed rmless the stressors are severe or prolonged. How strew is perceived by the person detesmines whether the stpess produces anxiety in that individuaL It also determines the degree of atMdety psoduced We bave become a harried people with stmsors rapidly accelerating wd eontrjbuting 10bincreased anxi* in our environment and daily To live is to experience anxlife. Anxiev&ts thm constant ious moments, but @ety C a n stimu1ate personal $ravtk

ANXIETY: MILD, MODERATE, SEVERE Amd- is a vague, uneasy f e w of discomfbrt It is a term used to describe reaction to s ~ e s swhen the source is Weved to be threatening but is not obviow. The source of anxiety is usuallywithin the person's intend environment &ety is diffaent from fear in that fear is the reaction to a known and usuaUy e x t e t d threat E w ~ ~ experiIL~

LNXIETY

ences anxiety at some point in their lives. In fact some W t y is nee essary. Withogt it, people would be apathetic and disinttxsted in their s u r r o u n ~ Anxiety mag occur at mytime during the life cycle. It may be the

resrilt of a de~el6~mental or situational saessor. S i t i o n a l strossors slre cfismptiire changesin ow's life such as divorce, serious i l l n a the death of a loved one, or lass of a job. Although anxi* is often acute and ofsbort duration, there are people wtm consistentlyh with a certain level ofanxi* This is called chronic,or long-term, People with cbmnic anxiety may additionally experience acute episodes of anxiety. Amiety canbe mild, &te, or severe Mild anxiety warns the body to m o m its form to handle an impending threat It increases the energy level a8d alertness. The irtdiidnal is then better rrble to a u k , analyze,draw condusions, and solve problans Cable 5-11. Moderate d e + g decrea~esperceptim The p o n fonnes atrention on the particular task or problem This 3s called selective inattenfion 0th-voices or events witbin the room may not be miiced

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Severe anxiety decreases pemption to an even greater extent Theperson selects only p of an experience and focuses a11 attention on ?t.Abstract thinking js lost Some concrete directions nury be fol-

pulse

and m&ations;

a rise in blood pressure; dry mouth. s p e d

ences intolerable seess. The physiological changes caused by M e V are inmased. Attention is focusad em a miaute detail that is often b 1 0m ~ t of proportion Speech is wuaIly incoherent and u~mnuni:

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PERCEPTION

PHYSIOLOGICAL CHANGES

BEHAVIOR

Relievfns Anxiety

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selected focus of attention tense muscles

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Increased biood preswve I

respiration

posture

Speech FIGURE 5-1

coping

Rapid pulse

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Mod'crate anxietp: aWentibn focwed on getting to work on tlme

Physical and mental responses to sBvere anxfety.

Anxiety-pmdueing situations are not the same for all people A situstion that is unimportant to m e person may cause andety in another (EguE 543. A situation that is seen as a chanage to one person may cause panic in another person The followfng are emmplee of anxi*producing situations. Joyce was broqht up in a family that considered time very importmt She was mntinually admanshed ts, h w and was punished for being late. She internalized thi?. value !~f being on time and coatinued to function under its shess. l o p coped with && I stress by being M y aware of tim% organizing h a activkb by the clock,and allovving added W e for possible delays. One morning Joyce overslept She handled this added , ~treSsor hunying. At the last minute, she discovered her car kevs were miss&. She felt omwhelmed and no fozxger ab~e rely on her usual coping me-sms. Her muscles

Severe anxiety: loss of control. no coping mechanisms

FlOURE 5-2 A seemingly insignfmant sttuation can lead m severe

anxiew Tfthe person views the situation as a severe Mlreat,

b e a e f e w her thinIeing was disorgmhed, and she feIp helplas. I-laving excw en-& nor lolowing what to do, she moved from place to place, becornin$ bs aware ofher e n k o m t She kltEke smeambg or crying. SSh looked at her keys mvefztl times bm did not we them.As h a a m ieygrew, thee w;rsa greater dispuptieninprocestngstimtdi firom hei senses. When samepne eIse fotad the k m p 3 hai~dedt h m tc, 4% the severam&e%g ended. Ex this

cham5 time, Joyce had already spent a @at deal Of ad@%

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..II Karen a straight 4. studwt, was known as a "brainP Her dmmates b e l i d amdie6 wera. easy fi3.r her. They did not m a k the high En'en paid fm her achievement Karen m e fmm a family that p?tized sacRer father w a p&du@t aml Lter mother a c o w @sar. When other ch3dren praised for good wark she *S aitidmd fm not dQTxg mom Notlntng lessl than the best m toleratad. She began to &eI inferiw To &a but was $till lmder the ufcomtanfly having to acbieya Earen &me she $ muId make gmd gr& by re* lemm owaand Corneq'uentl~ she spmtmmy extm h o w in studp and many dety-f?Dd days bt&e each examinafion. Wahm time far &ends a d ofher a e b i t i , %en w a I& alone. Tb prom her &-esteem an8 compemate for her laek affkknnds,IZ;aren achieved h%gh grades. & r d s d e is an m p k of dominz~tiun.m y time domimition I s a fa~de; the pemn using it is insecure The tdperson mu& project an km@of md m n y ~ e t Karen a @mdmedm the &roonlt but others may project dm&am% in gener;il The dominant person mmt make dlofthed e 6 . Depensency-mses em ietybeeuse -in o h m has mer davetop,edForcedinro a dep&q position, the dominant p"sm my def3tthe rules, c o m p l d m a b a u t i n c o ~and , &saditothersin or& fnremain supt3ia.

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Iahn, tool k d i o n e d under stress. B e m e of his background,he viewed all &en& with mental illnws not asfhey were but as be @ a d &em to be. Re reartea to the e x p a t i o m &at had been e8zabMhed in his youtk &om the time John auld member, hi6 &milyftetpent].y t-tlked about Wa$ Aunt Suzy: %heshould be locked up. She can not be tnrsted You never how what she is goin$ to do: Even though John nwer met his Armt Swy or ilny other person wi& mental m,be formed opihm9 about th~m These spinons lay aonnant b e n r k his awaWses.9. fohn%ventinto nmsing ftom high school Hewas well W by his okssmate4 aria &cult$ Dming the fbtsemww, Johnd&ved sbhoWc stle cess wtthsut &cnl& IJurfng the8econd semeten hewas

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RelievingAnxietv "121

.mm car doslg a da"Bmw One evening, Jack was cWViq eight-mold son was sitting mountain road. him.m e was:hmvy in tbe opposite direction and most of &led to dim their h&gh&. JaOk WaS driv@1dy,but the dnvm bebind him semed to be in a h m . mey f~uowedclosely behind and honked He Pm horn. Jack began calJbg tbe other posefuny turned on his bright lights whenever a appIm&ed when bit: Yaung S O n BZXRaPkd that his dad seemed awfully tense, the father responded by shuin& ~~~~t gau $lare my a w a d If it was not for gou, I w d d not be on t hmad, so yon jm k e q*~

Desensitiiation

mn waysin which people tend to hmdk a stres$ful6kuation and lessen anxiety include dependenmt domhtioni withdrawid, and a m a & n ~oycevgas dependent mr Me. More w d l g , one is MpfuL but It. depends on omer people In a time of b e e o m a pmblem when the dependence P s i s @and is mane. Dependent perrple are inseaup.and C ~ X K J ace* ~ that thyhaw @w& Or bilitia, mey are mhly ~et&tive ~~%idsm, iqection For this reason dependant pea~le sfmadmily be v i m d 1~f o l l the ~ d-ds of othd, men if those denan& canflict with their mwishes. Jack were in a crisis, A crisis OClXJ3 when fie ji~p, John and @ * d m p p r o w that produced the M e t @ a ing m e h e ape not effecave,Helping a person helpin$ the solve problems, Par PIVblm sol*g to be latvered to a l e d at which learning OCCw,m e t y in their p r a .~& ~ p t i n gto help Joyce, John or Jack p r o a m state ofsevere a m wuld ha% been Wtl-3.

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RELIEVING ANXIETY

Systematic Relaxation ~ystemaflc -tian

is one method fodopsd by hehwioral psZTa01*ts to relieve d e t y . It is based on the faa that M e V and ea&at ge~axationexercises stem from the *that -tiOn that musch is awareness of a tense mvde wables one to not easy to do and consums &art must be used afiou$h the take begin to ltnuer immdiatdy, total relaxation of -ety seved w e .

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hother method used by therapisrs to r&me a r ~ d * is && des-thflon Desensitization is a way of conditioning a to be non. re@Ponsive to a stimulus. This technique is usuaIly done by counselors, nurse w-, and psy~hologists,but other health w e tyopkers should be kmjliax with the method Cliem arefirst trained muscle *tion They are then asked t6 identi& (13 the &etpprodueing *itaatio21;(2) a place iusually home) in which theg feel safea d seem; and 13) another place or situation that is rekxing, such lying on the b e d C k n t ~ then asked to imagine the &ey-pmdudng fion while tbe therapist desixibes it in some detail &ts feel the16wts@ of w e % a pmmmged signal,such as mov$lg a The description of the stressful evene is stopped and the amaPist be@ d e ~ ~ 1 i i fbg n g safe haven When clients fed seme they are taken, thmugh imagination, to tbe resitu&on m e n dents WYr&e& the entire process r e p e a e Su~posebundergoes desensitization. The therapst might ask Karen to * e hemeIf in a specific s i t u a t i ~as he H~ %ht begin saying You are now sitting m the ~ s r o o myow . desk is chred. Your p m d is out You are ready to take the exam. he professor walks in the room. He has papers under his a m He O m to clear their desks. The test papeas are passed out you reeive Papa and look it over. There are some questiom ym do not remember ever d i s e u a . You are trplng to think offhe ansrnrerbut ft

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Fh?n might & h~ froger at this point The therapht immdatel~ with, "OX,YOII ant now out ofthe- classroom you are @ h-e with YO^ MY. you are sitting at the p*. your is and YoW father is smokiog his favorlte pipe. m e dog lies near-.

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@Thereis a ~ i n t h e f h p l a c e a n d t h e ~ f i . a m % f egood & Ynur father d i e s as he lrstens ro gou play:* When Karen app- more mlaxed, the thempist &t continue ~"N~wyouarelying~thebeach.ThewfiiCesandiswarm~t your skin You ean hew the quiet q~kshhgof the waves a m the *The sun is warm. YOU ean feel youpmdes rek&g as the sa$s umlm ea& p a + baok to tbe dibssmorn wh84 sh@ The therapist d e n takes appears relaxed MTau have nsw handed in the test pap&. YOUhimst0 wait* the grade. Ypn have no idea hawyou did, but you are wcirzkd about the questiom you did not r e m e . ! The entire proms is repeated aver d over, mtflhtaren n@ lower elrperiendes amiety&tt,?hbk&% about t b me6sful-t

from avmeneh. Time .is mated on srrper6.M W w while the real probLem gQ%. W:c&wdIf J Q wen: ~ && her pB1m vm, she prokwy would .wm&, UI axmot find ,mykepac or.UIfI wdd find my keys, I w@ddnot h a pmblem? mnld no W b t gay Pr-have ta make an Ann-@&test' &en ifshecould not *lain why., J e h muld be qe.et@ to rampkin ofphysical d i m &en ifI& &ds k@, EU%J gets M.&and J o b 5 abd&I &em&m is f e l i e ~ dthe undefllying problems-the o m th.a am the d e t y the first placeiaresrilldm.These am upbrl$ng probIw thatneed

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about Karen rmght hdprbe. team & The f6h.~~shformati011 .W&? pmlem and assess the sbatim

Has ICaren f@ wemh&ed & did, what the sttuarien? \What theaT Wwe they &ediv& What we ken!s R~tmmgoaIs?

Implio&e therapy is in direct c0mt.t to desemifid-ion B s @ ~ s k therapy attempts to arouse as much anxiety in theindmidual possible. Relaxation is srnetimes used but only at thew end ofthe s w i o ~ , Calrtio~This technique re@m a prof&onanp uaiaedU1mpIst Relamiion And desensitization are not the only meam af &ucing arude, In worlrtng wEeh 0th- the nurse will ikd &at a &attimde and quiet music can have a soothing $fmt Warm bathS or hot drinks s~m&rieahelp. k s i o n a l actkith have also been used suc. cessfdly to relieve anxiety. Qnce anxiety ia l m r e d to a manageable level, th~problemthat caused the anxiety mu@be sobed.

PROBLEM SOLVING

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Solving a problem may involve sel@&% other aptions, cchaneSlng b&& about an event, &m@rngbehaviot or kdQ'a more e$e* coping m e w % Problem solving involves a change. Before apmbl acan be solved, the person mutit remgniag the needfar c ~ X @ and know that he or she has the &abili$y to Very fewproblems have dearcut solutiom In-g a deckion it is necessary to weigh possible $a&f&ctioma g e t padBible and corn. its.imea l l ihat aftkt an action cannot he conuoUeck it is imgossible to know whether the c$osendecision da a y e d u c e the plwned result However, a M i o n must be made It Mlill be a more &e& solution ifthe entire health team, as well as the client is hvi&$& tlze process. step pblem. salw is to problem. w., m m . m e REAL ~sob&m is hiddm mt.ssthe his ~. si'roa*

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Wbat is hw relatiamhip vvith hex f d y ? , H C h whom docs she call for help? Ma she ask W w o n ' s help at:theof fkpblem? Did the p~tim wbnd? In w h m does Karen confide?' Phatis Karen's dmbpmcntal level? ~ S Wt-oW these questions vviU hdp the fwmrach somemdqions & O ~ U T ; ~Sarae ~ ~ , of the anduBiom thqmigbt wch are S k m k s ;las pmr s ~ E G Q - ~ ~

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S k ha,spoor p r d b l e m ~ osW. l~ m' SXte does not use adapti* @*dm.

give direction to the nursing care m e n will receive.PmsibIe ggoals for Help Karen become mare a w e of her situation. . i Qach Karen prablem-solvinp ~kill.9. I& Teach her more adaptiee coping ra$asures. ,a &&t her in setthg more reabtic goals fof herself. _ Tea& her assertlw skills.

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Nursing Intewentlon6 1% Fl&.de a stlpporflvem e -

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Nursing - Care Plan: '

d k t reTatiomhip inwM& ChriswiIIfdfrrl:tcwenf

The Client with Anxiety and Stress a thiq-rrineytx~~ld lawIpram@in m m a C y m&icd fkWy stawg fhat be b4ls b e f l o m 4 dblood flxthe~ast few days. He r&tes to the n m se one^ bathe has been q&* wmptcm of hembum and epig&~ pain f a the pas^ ma* vial si&ware and U m d m p w a ~ 98& e puke 9D, wpiratr,q rate ~ # S D . Dtnimg the W asswrnent interyiewu;, be TATS that hjg vvife ~ k % for d a dieorce &m&s ago became l a g m-hours and time a ~ a liam y the WY He st&s mt he also is in the M 1 e of a d & d t & X k & d suit He & a ~ ~ & x e abl t q of~thmaricattack. A complete blaod m t and an uppet gas@e d e e d for the next morning. The mm p d t f m ap x o m & W s see a clinfcaI s p d s t in ps)rchin ~ i n gtb &CUBS the S~IXSWS in his Me The initial e g ri~aalsthat he is expepieneingsymptome of m 0 h ate to -8 anxiety. ws ha agreed to an extended d m tion &er the inttial fntemie~Chris elates that he b ap&en&g fkquent headaches and is fmdbg it @cult to c o n e a t e on his corn Wed

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headaches, deaeaaed consen* tratfon, e p l g e p a i n , and c0 -riwhen symptom develop.

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NURSING MOM-8

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la Protliddg a supprnfive t l o W p gives Chris the sense a f ~ ~ t ys t oh lifeSituatiom and stwsm*

comV=hg session@g i w Cbrb an oppo* tc pnxess sbessffil&mti~m. Zie wiuhave an oppo&~~-

2b-~ p ~ b 1 ~ m - ~ o d I v in $ Zb. LeamLFle, ~mbIan.go~ving +-%Iqllesencpurageu Chris W seepofBible opticm~ and de-es 2c Qlristo keep a 2c. J g d wring provih an d * ~ o ~ o f ~omnritpf"orCMst€l ~ ~ methods of so* m& pooeess I@ situations. 28. ~eardhmetho& ofrelie* SEWS f.%, -dse, y@or feIaxa,tianante.&q@e@.

$tress.rn-

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~va~uation

Chris is wmd&g three timesa week @,ndpfactiices ~ h ation teehnquea wheA he hcomm t w e . He fs BPI* amepmble5ns&ving tdmiqrres in iAs daily Bfk

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at the D e & d @ a d elated to &%kof losing q e w e d f o c c u p ~ t i p n d m p ~ sewndaaf eg to pmibfe m n z as znmifwted by m-t af wife divare due m C W : a . ~ p a t i o Ms e s p o ~ b s i band ~ medical sppttxm (@eat headachess,inrmacehrn& and epga@tPic *).

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outcome Identification Qz& will &ate pafehtldl oEtcameg of divorct?aEtd OCOUpaziuaal mpoetiea and prlo~izeresults uuithin one

N u Y S I ~Interventions ~

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ati ion ales

Dlrms Chrlfi'S exgeECatioliti Dwssing ~ e m o d ofmagiage and c m h p ~ t i i ~ ~and , o&upatjId -atiam asgIsrS in vd-

nee and mim.

RoIe-pIs\yinmctiomwith f i d y a d work modatea

&Itrplaying prcwide~oppoP-

Wty to identifywith otheri+

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I7iscuw possible behavior &ages as needed.

&ndt b o ~ g b .

.Modeling is a method used to imp~.oveinterpersonal wmmunication skills. The nurse, acting a.9 the teacher, dc~nonstnrteshow K m n might

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I $ Chapter 5

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confrontatlon is a method of e~mmunication that fo- the client It t a means of helping the p W n validate reality. The nurse might wnfront Karen with the following: Tou told me your father q e c t s you to get can y.ou relate one incidence m which your father told YOU this?"

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to bok at inconsweneie~ ~b. Eeehg md vo&atiom.

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'wdeatisw ham &cam& $& ,a very rewar& Wbix the began wring j $ i q s gctian, and

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Benavior Modiflcatlon Beha* rn~dtfication is a technique b a t d on &e hetheory b t b W r must be rewarded or reinfed to mntinueThis t a m e bas been used kquently with children but i s d d v e with age groups. Behaoior iS determined by the reinforment pattern the in&ddual & learned throughout his hi h a her' fe. is knbnown aS o p e &wad@ anundesirable behavior is known as t, -monfng; reinfarein$ a desirable G W m is called conmoning.~ehavibr, whether sodally acceptableor not the bbehavior sees is continued for a reason. The individual reason as g o d , no matter howdbtwdng it may s e e m to 0tha8. change an undesirable behavior, the reward for the behavior is - ~ d . ~o a-engthen an acceptable behavior, the behavior is rewarded. It souads simple,but inactual practice it is not easy. Not all beh&~Tsare wntinued by the same reinfarc-t and not aILpeople respond to the same reward be speci6edlyidentiTf a behavior is to be ehnged, mustfied The beh~xiormustbe stated inconmte t m . A baseline is then estabIished by obsming the bhvior to be changed and rec~rdingthe n w e r of times it ouws. This provides a basis for d e t w the effectivenessof modifiealtion attempts. ~ nofthe e most d@I&t aspects of behavior modificationiS to dismvtr the rewanl the individual is mxiving ,&m the behavior. DDuring the baseline observations, events before and after their behavior This fnay give a clue to tfie reward the individtd is mitrjng from the WOI. In the htillowhg examfle, it is evident that the an &&rewives i&J from a behavior is not alway~0bhllS. On sL*(ieTBIoccasioas, M y hit Annie Mthile playing in the

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m A n n i e i i u t t o t h e d&* her, Wys bzh&&I ,fitappe& '~om&es a u?itten met @ in bm,diftca.tioa 'i"clientand n m e R@W ia w~itinga the dew,^ mir rhe r d to lae'recehd d e n isa&&. ne&& W i8 dated and sighed by Bo&~ and & me j-~].

Assertiveness warning

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?mPle m y respond to situations in an or t @ ~ e r t imanner. ~e &pssion implies meeting &S *aout regard otherg. The passive pasm S U P P ~ ~ or S her avn desires in h r o f others. ~ssertiwbehavior implie -~ing on&s Own needs, but unlike m a n , it & ~ . m c ~ ~ il d e ~s i~nthe g ,other

S d y , ,women were wnaoned to be p&ve J' -)& were aught to s y p r a their needs. The pawiye person is oftentaken ahof ~ & e peopleem be counted onto do w&t

4 Chanter 5 is asked of them but t h e y q raent i t They can bemnie very w, but ange~is seldom - W e d openly. Ifthey do express an$,&, they fed g d Q and mu@make arnends. Passive people hawe d great need ta be liked Their self-mnqt is vulnerable to the comments of othars, GomsequeatIp &q are not seI€-dbctin$ and have & c d ~ feel@ p o d about themsek. Men in our sodetg. have EaaifiomIIy b&n fa@t €0 be openiy aggresm. Tomen have been encow-d to be wewive anly in a msaiwe sense. Passive-oarafa to a manip&tive type of behaulor. The mmlipuhtor %mpts tn get his or her b a y by inflicting guilt on the receiver. 'The following is an example of manipulative lxhavinr.

It is all right if you want to go t~ your party a d Leave me not @vea thon@Lt to yoaf paormoher in this big house wfth n&hg to da. I stapd home Mthyou whw you wae small because I laved you, but I do .at want youto fdahligated. You go tojrowr party and hve aacod t h e .

all done. Enjoy po!melf and

Thiskind of statement is &e&ve for getting whatis desired by inflicting; guilt fdirlgs. Asse&m requasts .we made in a n ~ tonedof miee.They afe spefftic md reasonr;ble and hcludc three elements: Q~sbdetationofthe other pezwn9sk e h g s 0understand how you feel) 11I A stawnent of one's own Peelings I W is the way ifed,) The request itself Ehis ia whae f would W.3 The following emmpte 8Iustratx-x the dB3ence bemeen ggraske, passim and l~ssertive~espoflse~. Sitaatiatt: Jane is a nurse workjag in a twaty-bed cornp 1 e t e ~ T~k rt e i s a k e a d n m RN, and an aide Jane hirs been a s w e d &$it cIienb, the RP6 has five clients, a d Phe aide bas s e w 4 Jane f& she cannot give adequate ~ t 0 ~ a a d t h i t' t ~ tisuidw &ee ;;he has taka &z? =*at dI week Slxe decides to tak ta the head nurse a b u t the &wtPDn The head amst ~esponds, *I m somy Them i9 nothing I can do. The

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,. . . ,* .. PASSIVE ..-i: .~A:,;:-: ASSERTIVE BEHAVIOR i L ' w-@ $+; BEHAVIOR

AGGRESSIVE BEHAVIOR

Eelieuing Anxiety

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mow AND C O M ~ P R E H ~

&ice* 6el@ the one Bpst x ~ ~ p & , ~ fn~~t ~-3* . g ~

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SUGGESTED ACTIVITIES Consider the d s-r undw whi&yo~become d o u s . Do yo8 usually respand byh"oz&g dependent witMraw @gcessive, or &mt? T q ~d the feeling9 evoked in you when you are a r o d someone uiho is e x p & m moderate or severe anxietyty Pmctb fhe relaxation ezergsw d w d e d in this chapter for twmly to thkgr minutesa day. a m e a crtmdous &-to Mm b&r&your next ~sni&+@a. Dbe.enam,tr~a d m p w &eUnp;g. q m &q d i f ? h-w ,duringan w t s o n y . , mw&

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183E Chapter 5 digplayed by a buspitalked dent who mnstant ly compkin! and defies rules Is R dependence. Lt B.withdrawal Q C, donina'tion o -ssion.

i! The b-or

n.

r n L Y YOUR LEARiuma A. MuEtiple choice. Sdeetthe one bedt ansnier. shift fm Eor weekends so that 1.A n m e has worked a fbe peer could have time ofTfor reamtiowl &ties. The per says to therurr^je,"Im d ~ o u m w&for~nextw&end, too." Choose an meptive response fw the nurse to give ta fbg co-worker, d A,Y~~dthaty~uhavep~forthe~eelren&hutI lave plan9 also. Sfnce Pae already WQW three weekends for you, please mk komeone elsew P B. ? had made p h fax the h e n d but realize 2 s ImpDxtant tg help yon Sur& Ill work nwt we%kendfor paa 0 C,~o~bahiMtysaskingmetoryarkforyo~ Youneedg, agk m e b o d y else.{ Lt D. m y do you k q askUl;e: me fa work for you? Dodt youthWTba&lkkT" 2. The anme gathers data fivm a new client adWted with Genera&ed lX8arder. Which statement the client wouId hcfkate the client uses pasame beha16m i n-tapesonal lalapimhips7 4 3 d Y've b e e n m m my &ter do my h o n m r k fm me: She d o a t have a job and might as ;well help me." D B, "I dwnp put my Mdrenasand spouse's nee.& first but itdytiresmemta,adit'shardmkeegupwithwhat fhey wantu D C. JI think I talfe good care dmf*sselE I'm proud of my professiand work and hawe a d g dationskip with my BenndsP P D.'"L'~&gotto~valcecareafmy6e1Pbearusewb~&~ia $0to tfait. I d ~ y say, @ '&lve them an inch md b y ' U ale a mile."

5. fear

D. Briefly answer the fonawing. 1. Create a table listing each letd of anxiety and an exmplle,oe Row you have e q e r i e ~ d each l e d What ~ y l

..

2. %%atare fm ways ta relieve anxiety?

n

of OoncUtlpnWref!eXeS &Used UY prevlaus e v e m l t " ' can be unlearned and replam by new, more aDpror DriBte b%hav(gr

OBJPCTWES --

Cllkil't.

centered aherapy

AAee studyin$'this chapter, d e the~den€shauld be able m. r IdemS.f3ifhe theories of three pqdmtkrapim.

E~ewpemonwants to BChwVebBlfactuatlzatlon and MI6 drwefs the Derson's mottue fop action

nti Ide~tify wdmicpm wedby each we of psych*apist

m

"

Abnormal aenavrafts a result M e-Iences that have beran repfessed Into the perSon's unwnserous mlnq

Brina repressed expenances to the Oomctaus mind wherethey can be resolved

Rational emotive f?eraoy

Behavlorls due to what peoule bellevs about an event and not $he event itself

Help the person ta amteue a more real. rflc bellef svstem and to know that he MUSCle PelMtlOR or me hss tns a111lty Problem solving to Cope WIM events Asslsoeg readings and actlwtles

&mi& Rogers, and Perb ark just a few of the people who have develop4 psr;.hother@ies. Egch af theta men has coatribwed informatipn us& ia d e ~ s t a m and t r w human behavior pmb-

empthe t d o I o & s rn d and thebasic belie&miler@% each p&&apy mble 61). Althoq$ t kheN is not apsychothWpW the LWN inrwam with &ens who arp beirrg treated by +&empu and therefore, should mde&and the prindpb ofthe p@otherapY

A

PSYCho. anaksis

barn.

'Be nurse bee& to h v e some howledge of the techniques

8

tenslan, and deewbeness by provlutng a nojmiflgrnentat envipnwnt Ref;leEtwllngs Accept psrson as is Rgktate person's thought5 sna feelings

Help the person orem exQerlences become more Leamtng s* aware SO he or awareness she completes Relaxation experience.;, Presanttzlng accepts reswn. FantaWng sibillty for hls or mageration her iBe, anq eo~ves Problems

how seIfdwareness helpti to Solve mental problems.

lems.

Help the
The mind conceives experiencesas a whole: when an expefleflce 1s Incomplete,a problem may r s u R

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There are many methods wed to mt mental b e probIenfsenfS M&& wed dIre&y on the body are called somatic therapies. oVlrea the d o n m e n t is chargd or c@d& the m w t is r e f 4 to as &eutherapy. P@&empyum vetbal anaqreas& tecbaicpm to hhp clients resolve i~lflepW&C@ and ma*

-

~~-UIUS

TI

D e h e r a m ? fteqwntly used in psyCh0thmp~ l& of rnm&wness of tke id, ego, and State the functFon

El @lain

for ourvent bahavr6~ h@@ psrsan & w e th&Deh;?Yior by W V h g ttlb

j" -, x

Themptgt ~ntwaretatlonof statements Free assocla$ion cathauls HY~no$IS oream anelysls

.. ,.,

'PSVC~O*~~~~~~ ~-

aggres~iana n d ~The ~ ~id .opmtes at the u n w , m ,level ais ruled @ the pleasme prineipIe. W e ?s. no sense of right or w o n i $ the id,On?ythe seeking pr dem@ding dEdEimmedizt& satisfacfion, Theego i S the w3nsdous seE It is through the ego thatthoqhts, f em.atians, ~ ,and compxomirrs a. famed. The ego sw& to control the pleasure prindpie of the id by substituting the r d t y pjm+lee This means t h s the ego seeks u,delay the drim &the id until they ran be releaged through appmpriate bebvicu, The ego WWS to Control and to guide the actions of an indlvid? U@. It is a mediator between the &cfw &vm of the id and th@ afsearie& It develops through internebion With the enuimn~faent, DeveIopmmt of the ego begins during the six to eight month ,oflife. ~t about rhe age of two lt ism^ fairly dm10ped The .aperego dwelop later, usuallgaround the age of three or fm.It eS genmally fairly well dewdoped at the age often years. m e SaptTego i6 the i n t e W e d parental value system &d the cons c i w S t i s concerned withthe demands.of society and a d o r e controb i m ~ u that k would mdager stieie~It is responsible for help ing; the individual to d i g n i s h rtght &om mng. The supeEgo wbrh iitboth the m&ns.md u n c ~ m ~lev& i ~ ~but s pat the uncc~nsciousi& Tp?

I

~SYCHOII.NALVSIS, Q#& ferndhril@m

-dilt&,h~ h

*& v:-m*2.hieve @ -@ miad g ImYimg

'* a

STAGES OF PsYcHBS~$Lib@JgLop~&q~

Libido refas to the sexual dIf'vp. P i e d pz-opr~sedb\tthe lib$&, be$ins ta deoelap at birth imd &DU@ & & @ ~ ! ~ ~ ~ t a g the mih ,&t@% bmp& . ts, @ '-&US %&it%i.:aR! , life of the individual rable 6-31. The ~ h stage t of libido devilop-t g&@pa&& hb W OD mw& ,d a is from birth to e i p ; h months. This is & o m m &the s t a s t 3 @ m t & m because the idint recziva all of his or her pleas- h u g h the I*hknri$*f&~ @ $ ~ t a W , , - & g b%mB&& , 2! @&tFy mouth The second stage is the anal we,whi& oecm Between the % -, *a&,W @+@@ma @r-;f,i.i@ ~'erma88& W m of one and Three. It is in this period that toilet V q become -$' :, rn @the 8ab%o*% ,a ,*, &m& 3*.-, very ~bportant The third stage is^ the p h a c %a$e. &e child g p e n t iiWHSs, fl-j not tare w be@ to develop a wxwd idenBty and becomes aware ofhis or her 4 9 w m w & e &wm&yd &;anytw" body, espealIygenitalia Mris ail e a t p e , t saim a a a~bf, m d &w. n a g the W d stage, the child develops stsong feelings towad & w q y.@ & , a m *f@& PSrenf ofthe opposite sex The boy 6Us in love'with mother WQla"iQup and becomes jealouiofhis f&m. The $irl grows doser €0her father a d kames jealoou8ofher mother. This behavior, n e c p s s fa ~ nor+.* @gl:w.adbred, sw +w, dweIopment is mned me Oedipus conplw x_ inmales and &,;tnd;tndInS'mM &&&a&&@ $ Tfre $l ,& dae@ e @ a complex in females. The Oedipus: comple m d &m the @@&qi$y ~ 3 Qj ~&s@, a x ? : @ id &@@&.-, bP1'&,& p@ &&e mythical 1%~ ~ ~ &, p who W ldlled h@ Gther and w e d his w*" &gidla &"*. m*. as.& :I& mother:

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pmgress wiU not confinue. Transferenre occrrrnt when the persan gm% the tlierapist characbisties of signi6cant orhem in the person's past lifo. Thi&process is thought to be n e w q for mwmq Psycbmnalysis is a very sl~~process. ReCovexy m y require fmm om to many yeam of intensfivetreatment

CLIENWCEMERED THERAPY

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I.

%ma1 ~r&ntltybwlns to develop. he Plea,5 zone 1s the genT&l area. The rdVld

anrc stage i7vy"-,-.'---

:? &ency stage

oenttal stage

rirr~lalnnsm w n s feeLlhss forthe parent W - - - - ~ ~~,

.-;

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the opposite sexand w&ts:that p e w all t@r J .. hrmself. ~ t w stwe ends w h m me c ~ i l d5 t a ' ' ~8 , to Identlfy wi&.ttwparentof m e same sex. 1 ' ,

netween the qges OF six and eleven, sexual U@ ings are gomant. The child paitlclpates m , more soclallv approved actlvmes. OrOUP tnt* I , . I action IS very Important. mi. IS t h e m 1 phase and I a reawakening o w sexual urges. The stage begins with adoles. ; (; cence and moves toward sexual maturanon~, 1 $ and sexual relatlonshtPS. - .f

,

It should be noted that same experts do not believe that all chil dren experience Ereud's swes of libjdo development krtheraore, these stages are not accepted by all a u t h m a .

Accalding to Freud, psychologid pmblem may occur because of anrested d d o p n e n t of the libido. The therapist attempts to dis r n where the libido stopped developing and why It is beIieved thaj this information is in the unconscious. Through psychoanalysis, tbic idormation is raised to wnseious level where it canbe dealt with Free association, c a W i s , hypnosis, and dream analysis are tech dques used in psychodysis. Free associatton d e r s to a proms of counselingin which the person says aloud whatever c o r n to mind The t h q i s t listens and interprets the person's statemenu &thmia is a method of fecaUing to memory an experience that i c a w a problem and helping the personto eqresv it Hypnosis i an w y induced state in which there is maeased responsimes to swaestion In dream analysis, the therapist interpreB th imagery that occurs dming sleep. Witance and transference are a h terms frequently used i psychoanalysis. Resistance ocnus when the person tdes to p M the movlng of infarmation from the unconscious to the consdo1 level. UnIess the w o n is able to work through this fesistanc

Elient-centered or nondirective therapyww developed by Carl Rogers, a wntemperary psychologist Accordfag to Rogen, the actuakhg tendencg i# the person's motive for action. He b&eves that under the propet cDndifiow, people have a natural tendency to progress to selfactualimtion. Rogers does not Gee terms suchas ~ c o m d o uor s libida. He does not beliem iE is helpful to interpret past experiences. Instead he uses terms such 49 8 e l ; F - a w m and achdimdon temlardes. Rogers bekern that anention sbould be centered on the person3 pf%6on&ty and feelings at the present A poor seEmcept can prevent seIf-a&dization. When people see themdives as Merent b m what they are actually experiendng, they become incongruent b c intemal harmony). They distort and deny anything that is not consistent with their self-concept incongruence causes them to become anxious. The purpose of clienteenrered therapy fs to help people i n w e && selfawareness and thm Improve their seIf-wncept By beeomiag self-me, people can view their problems more re&tidy Tbis enables themTo begin to accept themeIves and their enwonmentts. %chiques med by the thempist are based on the belief that the person has a strang drive for serf-achldizarionThe therapist @la to help the pepson reduce anxie9 tension, and defensiveness that block this drive by pmviBmg a nonjudgmentaI e n v i r o m t in which the pewen actadp heIps himself or heA noniudgmental envkonmerit helps the person ta feel safe and nnderstood Wheh d&enses are Eelaxed, amore redistic concept of self and the environment can dewl5p. The therapist accepts the person as he or she is and does not try to %e him or her.The therapist promotes an e~lvjronmentin which the person can change himself or hersel£ The client is encouraged to -1:~s his or her feelings. The theraptst listens, tries to understand, then restates the person's thonghts and feelings. In this way, the person is able to hear his or her own Teelings expressed This leads to increased self-awareness Dnce a person is aware of-howhe os she feels and what makes the person feel that w a he ~ or she can begin to *rove the behavior Rogers' a ~ r o a c hto psychology is humanistic and hop&.

.

7& Chapter 6 -

I

Some terms m m m n in belraviorlsm are eztinctiolr, displaceme- r e i $ m m and conflid E3tinrrion occurs when a conditioned response is stopped. To Frend, displacanent mmeant taking our hostility on someane orher than the one for whom it is intended ?t, beha*i o m , dispkmmmt is the act of engaging in %&stitUte behavim Reir&ormrwt is &e saiefaction one gets from a @ d a r respon9e. It

Tbe zttinule of b e therap?& is af primary concern to hgk+. Rogers b b v m rhat the therapbt mmt have thee basic qnatitim to bring about behavioral change €T&path~, pmitive regard, d genuineness. The meet i m p m t Ofthwe 13 m g . knpathg is the quality df fur$ undersyandhg Zbe person b o q I& or her ex@eriences, and tqing to &eethe world as the client $mit Empathy is understmding the person's fediap, even h s e b e h awareness The swond, quatily, positive regar& mwns that the thempist must accept the pmon as he or she iS,The therapist w%er judge%interprets, a probes. The cIient is mtstedto ma-ka the change mssaty iar m e I f ~rhWself. -eness is thethird q d i @ For chage to o m thetheraipist must w m a @ t eSincerity .to the pwon.

Behawinpism is a type of therapy that examine RarZnal and a b w ~ mal hehadior a8 a result of mdiri[~nedreflexes It i$ ppNarily used fw p q i e in anxiety states or vvitb &eah disodpps. It ts Geldom rised with a thaught-d.isodered perso% Joseph %1pe hits d m muebwork III beha4orism. Behaviolism is based an the bewthat a11 aaion { r a p m l is mused by a p d o u s m t ( s h ~ lb.p o n s a are learned durjng life -. m m . %%en a stindm o'ccnps, a pasgn wponds in a m y Wt @wes plea8um or pnts hurf. Tor exdmplle, each time a W $a= near a glass w e , the mother sap M with it @ at Of purdshment This is the thetsndm. The cbild stops to save or hm1P from h e This is the rspnnw When the child Iearns that stoppin$ is the safest bebvior, this behavier continues 6h e the sthuh mcm'9. BvenfuaDythe response becomea automatic The child is &en safd to be c~ditbnedAll rwonsm M e both pnsitiw and negative aspects. The childls respoase saves him qr her &omp i i s h e n &but itdenis the plmwe of twi%ng the was& If arespome has more positim tban ne&tive aspects, it is said to be nrlaptive. childten m y respond to &mulus with temper tan-. Efhe .-. tan€mmrestrlt &them getting what thep wsnt Gin this we, hanthe vilse3,tl~ey;o\Fi2tmiauausing this behavior H ~ Fa tan,is ws& in terms of en=, so &isconsidered a maladaptive rmpme. Once a beha8ior h;?s been learned, it may result £ruma s t b d u s similar to a associated wi& the orlghd one. Tbis iS calledgetlemliaa&sf For axample, a a m a n dev8Iops a fear &plane tdps beawe of an acdaeht. EarentuaIly, this faar may p m l i a e to other The I T S mag feel anxiery when he goes to rhe airport to mea a friend.72ssmf and s m d of a pl&e msy b q distress.Eoen t%llbddings ma$"c a w

w.

him €0&el uneasy

is why the behabehavior continues. Con$& as wed by the behaviorist, to a situation in which two conditioned respomes oppose each o*het Por example, Jane's boyfriend has requested that she we= a parti& dress on a spedal date. U n f o r t ~ ~ ~ tJane + , hih(i gllined weight and the dress no longer firs.Jane has been cqditbned to please her boytitend so she goes an a dlet She also has been conditioned .to satisfy frustration & eating.If Jane becomes Eutratexl while diettag?she is faced with c&ct bemuse she must give up one conditioned respame to satispYanother. Maladaptive w o n s e s mult fmm e a r h wents, but the behavioral there 'st& net interested in exploring the cIienfs prast It is the current be ravior and its eurreut stimulus that interest fhe thefapi& Behavior conrinues only as 104% as it js reh%orcedced The stimulus or rein%ommust be determhed and stopped, an avmive comequmce added, or a difkent b e h a w reinfor~dfor change PO o c m Dm@ the first sea$iOn,the them@&takes a derailed his,tory,The brstory includes such hhemsw the client's age, marital status, edueat~n, and occupation as well as & a her relations@s with athers, U d behavion, activities, and hkes and disalso are & ~ s e dat this tim% The focus is on the hehavior the dent wishes to chan$;e The k a p f s t may ask the client to keep a The &'tory and d i q help the therapist determine the maladaptive behavior, the extent of the behaPior, and the stimulus for and consequences o f d e behavior. The behiorisst is primarily a teacher of new behavia=. Arti~ix are oriented totvcird a goal fh;lt is stated in specific, m u r a b l e tams. Helping a permn to impme his or her personality is not a measurable god because it is too vague Success of the therapy cannot be determined bya vague goal, Gods musf be specificAn example of a sp&c goal is Teach the client musele relamion exercim .she can use ro relieve a m i q r before examhatiom: The technique used by the behaviorist depends on the sitllrrtion and the consent of the client. Tkchaiqaes include Modeling to demonstrate appropriate behavior. Q Desensitization. ': Maselerelaxation 13 Assertiveness training. Role pb@ngq Behawirk modification.

re&

I

'i

"

I'M-,Chapter 6

RATIONAL EMOTIVE THERAPY

COONltIVE-BEHAVIORAL THERAPY

Rational emotive therapy, known as RET, is related to behauiorism Wonal refers to the person's abBy to think; to emote is to express feelings. Its founder, Albert EUis,was convinced that aperson's behavior is dne to his or her avn thinking, Problems are not caused by specific events but are a direct m u k ofwhat theperson belimes about the

Today, eognitivebehaviod therapy CCBTI, adapted Emm the wark of A;aon Be& is a current, sucwsful fmof' psy&other"py, espeoially in outpatient5-s Eor both indivldual and group th-. In GET, the dient is cmfhnted with inationaL negafive beliefsand

events.

Por example, Karen expects all A@but receives a E on a test As a result, Karen becomes depressed and leaves schooI. Sup&%dy, it seems that the grade caused the depression. Ellis, however, would take the pasition that it- not the grade but how W e n viewed the went that cansed the depression. To Karen, the B meant failwe She tells herself that she is an awful person because she did not get an A. This makes the event a disaster that Karen cannot handle If the p d e had not been al-important, the depression would not have occnrred Ellis calls this type of thinking mas&* and says it is the cause of all mental health problems. In RET there are no m C s or shaulds. There is only the reality of the situatian Oae shouId not demand hut oirly desire. It is not sationa1 to believe that one must get all As. It is irrational to demand that 0th crs respond in a certain wvay. Some ~!~ents arc impc~rtant,hut none are important, Some events ?re unrlcsirill~lt.rjr ~ncc~nvellierlt. hut none are b t r o u s . To Ellis, whep a person sees an went as awful or tenible, he or she is aa@IizinJ; or c a t a s f m p w . Catastrophizing results in a lass of caanol over behavior. 'W~thoutconboL there is no problem solving. The consequen- may be s&-defeating or maladaptit-e.The philosophy of rational emowe therapy is expressed in the phrase %' the world gives you almon, make lanowdcNIt is not what happens to a petson but what theperson does about the event that counts. Since problems are a result of masturbatory rhinking, the therapbt wbally attacks the &leafs thinkjng ~r belief system Though other techniques are used, this wnfsontation or attack is the 6ne m e , basic RET technique. The therapist might say something such as Where is the law that says you must always get an A?" "%ow me The proof that you are an awfd stdent' Throuph this technique, the dmapist teathe person to thmk realistfcally.Realistic thinking leads to problem solving or to the ability to cope uith situations that cannot be chanffed.Many RET thefipists ehffluragetheir clients to live bythe fol~~-

~

~

God grant me the serenity to accept the things I cannot change, the muage to c h q e the W g s I can, and thewisdom to h o w the difference

and emotiom. The goal is attitudes that drive faulty, negafive to recognize the mnnection between predpitxting even@, tbaugh~, m d actions. The "I shaWwuld/woulAiought toirnght W if'onkf thou@ts are reframed into T WP la positive tho@% producing a pasition astiori).The mdt is an inneased abaty TO adjust and func~ eion eEecridy, whish I=& to m9re m-firfactbn with life Style of disordeM m g includa eatastraphizing,ovwgene~ abatio~, and a l l o t - n w thinlang. 1 Catastrophizing: exaggerating the importance of negative aspects and pla.ving donm the jtnportance of positive things. ?eg& 'thought: I am done in the world r: Positme thought: I knaw and love many people. t Ooergmerdzation: maP;ing a gemal nrle fmm one idstance.

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Negative rbo&t:: 1am a &taI B.ot at math *- Positiw thonght: I'm h a w a W d t time r4gat howeve?, I I fmprmymsth scorn now fhat I bat% a tutor. 3 All-o~mthhg thmk.ing' things are black or white, good or b9d, ohm is no midTEle ground. Nqdve thought: I am not perf- I an a rmal W m Posirhte thought I have imperfections, sa dodoes eoerJrone I am making an effort to feel good about myself &lapfed $om Buras, J3.fi98D). Feelingped. Mew %irkSignet.

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GESTALT THERAPY Gest;llt therapy w a developd by Pritz MIS. It t 5 my cornplat the mind conceives Brperiences as a whole When an cqmime is inmmpl&e, a pmblem may rmIt The goal of the Gestalt thm@$t. is to help the pemn complete rha experience and incrwe au\mreness. A wmpleted eqedenee is &d a tern based on the theory that

Zb the Gestalt themprst homfflsktiiebalanOe between the person a d ltis or hez imimmentis inrponmt tahealth. Theh d y person is in b h e e w i d tbe enairarmern and rnathted by an awareness of needs, ~ ~ u r c eas d, re&-& i ans. This avwenes8 makes choiw available and allm the pason to take fflnml of his or her Me.Problem

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3 s ;, Chapter 6

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result from a disturbance in homeostasis+Symptoms anse as a result of the body's attempt to maintain the stam quo. Fqmknce and awareness are thetwo most important.aspem of Wtalt ~ P J " Only . the preswt r t m because only tIuc present can be experienced. C d f s that were inmxnplete in the past mwt be brought to the present in order to be completed. Each person has the ability to complete his or her etlperience and relieve the prqblem. The thempbt acts as a guide in helping-the p m became m m aware ~ GestaIt therapy is used to treat people in anxiety states and tho* with somaticand affective disorders. It can alsa he used to enhanceliving Eor the mentally heal* person. Three common techniques in Gestalt therapy are exaggeration, f a n t q and ppesentiEin$. Ezgp&n i5 a technique used to help the persat become aware of his or her body hguageI verbal language, or frEa6ine;s. For exampl~the student jvst baught herself anew dress. She spent a great deal of money onit, but now she does not like it The problem is that she dues not know why. The qtudent is mld to Iaok at the dress and tdlthedress she does aotlike it Shemaybe agked ta rep& the wards several times, meh time saying tbem iwder and more f o d u l $ Soon will o e m if the student is listening to her feelings instead of just her wards. Ettggeratian is &o used when a person is unaware of his or he2 body lang~~+$eIffhe dient wwm his h a d while talking,the therapist might ask him fo waggerate the movement by waving his atm in an ever-widening arc. Since fhe movement is cxagpated, awaxenes of the m o m e n t increases. When a person is aware of behaviorr be or she can control it When ;Fan&ng, the &eat is asked to b d g the futufe to &e here and now. The student wan@to buy a nay car and has tQ choose hemeen two possib&ies. Oae is a baghfly eolored sporty caf and the othef is a much less q x p e n s i a e wmpact She conTindy uaciIlates betareen the two md just m o t make up her mind. Ta help her, the tbarapist agks the student to fantasize that she has each ofthe w,obe at a time She is ask& to pretend that she is 8-g in them, dslYing them and meeting herfrienh, Then she trm on each situation she is asked to concentrate on how each fek, Presentkingis a means o f b r h g i i a past went into tbe pment as &own in the follomg example. A student come8 to the M p b t bemuse she f&

@lty. She bad been invited to yisit her great aunt but went 8ut with her Bends. The avnt djnd suddenly and the student: cannot forgive W The therapist encowages a dialogue bemen the aunt and the student A n empty chair is plat&

in &wt of the h e E The stadeat pretends -rt.leaunt is e a t e l inthe chair. She is then asked to converse wfth the mt The student alternawiakm t M part of her asmi and hers* dxqing chairs whea appmpriate. $be is enegmaged to say w&Ww c m s to her while pkBrng each part, She is ah0 encouraged to be aware of her fadings while playing each This d i a l m e is a fmtasy, but it helps to inwease awaenms. Through the pleexce, she is able to b a m e amre of her fedhgs toward hergreat annt Ammess is usually sudden as if a 14ght has been fumed onw& m e a s comas wnW. The student Ls thenable to rid hm@ofhff gt&"feelin@. Por Gestalt thempgrto be effective9 tbe perma m m ~think t dw fn$- presentizinp,hPasiz&g, ar ~ ~ t ihe or o h e~is jusr , to aperienee &dingis. Peehgs amthe matar Tancern.Forthe person to riencefdhgss,it is neeessuy to be selfdware.A great d d oftime m y he qent b y a e thaapist inhdping tb.~hecfteat increase his ox hw selPawapqness The therapist map dracy amtionto the &en& pasture o? tone of voice, 13rether%pWsawnfee&@+ doubts, fadatasld &en* also be expressed. D r m are a dfmmttmtion of an ?.xompl& e q m r i m ~U~&, Freud, the G e s W t daes wt attempt to d e m a n d or malye dreams The &erapi& helps the &eat expalent% the &am and increase awmeness. &periencees are taken at fa&vaIue. The Gestalt therapist feels &at meanings emerge by tbemsdves with time. TIE &.era@t uses &ed and p w o m &qua. AU te&miqnes are geared to hdp the person in-e his is her self-a-m, qaienee *s, am3 complere previouS2gii~~mglete experiences.

REALITY THERAPY

I

II

WlEiam Glaasef8 waby thesapyfs one of the newresf psychotherapies. Itsp q s e is to M p people gee themselves aamatel. 6ce re&$, and fhEU their q ~ ~eeds. n Glasser beliweg that each pawn fias a mpmsibility for his mher owm k W r . A pason's prmmt behaoior mmot be blamed oar what wcumd in t k p m RediQtherapy has been used Wensiveipin the rehabilitatfon o f j u v a e delinquents and with Wwho h&ie&led in ~ a o iIt. has &o succmfdy berrn used tu @duncethe lives ofpegpie during m&d eonnicts, &es, and in treatment for chemical d q e n h Reality therap has been sukwWp applied by parents, teachers, and nder Ia~tpeopLe The xed+@ dmm@t must be a warm, conceined person who js real and genuim %%en sppmpriate,thmapIstsdismss their anm ape

13enm,achnitpezmd faults, an$ are w i Q n & W &&%ewS m M$y~mthe 32ent lm@dMost impwtmtl$ the th!m@t truly The reakfy therapst is soneemed a b m b e W r , r&w tb*ur feeIings ar tb.&ghts, G ~ M belie= Z thatpeople h&e Emkd 1~wtErej,fe&@adthaZon&beba~canbechaqkd.Ifrhepon ~ p h i m of @t kelings, the thefapi6tmjgbt ask the peruj@nis doing to ma?& himself or herself fed &?"; This &w%@ ehe cump M t b m a feeling ra a behauio~It also f6euses zesponsibj%@&r the guilton the p m . CMgthe present i s impmE4nI;~epast is $one and m e . t be changed. Ethe past & d&emsed at allr it is to &cover the p.s@onlssmm$u. The strm$ths 81% zhen dated m mmmt behavior. Each p m m has a respomiblitg to e Y a I W his or her awn beh&r, This ~aalmttwnis essential bewnse behavior m n ~ mbe changed unlessthepersonis comrmeed4batthebebaaimi-~harrnfvlto hiin or bee The &&pist m y e x p ~ e 8 sp m a l vdae.9 bat daw not attanpi to f m p gt3m.1on tbe hew pemon behavier is eduated and a d&im sS nliiae to change a sp&c behavlm?a pLBn is daielopd Eor chn@% that behaylor. Mu& ofthe therapist's time Ss spent in helping ?heperson make p h For ~ W change.Tfie next step is k r Ore client to eomaithims&ar herself to eaqylng out tEIE plBn EsSentid to d t y t h q p the cofmnim%ent may be verbal or in the form ofa &%ea c~ntiati.It is u s e ma& to sweane @her than the dfent Glassm b&eoes m1$ fdil . bec~me theycmn&makeca gp&mxits to themelm, Tf a plan &hno excuse is accept& S a m d m a the p m n is asked whether be er ,she ininrendad to Tu16I1 f.hcommitment gometimes &atmay be wked &en he or she intends t@do w b t wa px0mif.d At other rimes,the&nmaprtlqui*.e m 5 o n Abmluttely

~is~ptable,memadismt~Thisis&em~importtant to d t y therapy. An An talcst ~srespansfbiliqfrorcl the pet%&arrd thaapy duag at prwiding suaf% etnpha&zes failure Verbal arphysioslptmishenf is never med by th&i-tdky t h e pi& I;lasser aq1oysr w& he terms the E O of ma&. Por exampIe, a a d my ammi$himSe!for hw& to pmottQ the d m every day in exhn@ f o r p I @ ~ x Ifttu: a child f& tQ pxacticec he or she does not get ta play Thi6 is the B B WmquenCe ~ b m m e it w;ls mntually agreed on b&m the act Wty therapists belie vet hi^ rmp&mis the ssame as mmtiil hdfh. Ifpeople aet in a responsible way, they atlain @& happiness, a d sueass.

~~

fRANGACtIONAL ANALYSIS 'Itansactional ilnalysis was dnzlloped by Fkc Rcrne in the 1950s. 'me atm of tzansactional analysis is to help people impme their 1h.e.s.It has

m e mmm!yb&&ypeopk .a& as &o$e & ~i4~m+m&&&edim&&&,~~& & eep ~ w i e s , wa@.;wi~ p w i l p ~11-d gr~qs~ &me beii- that each persen a m && ta .a &pt or qtnjtesuipt mnntfmaipt t h e s f k n parental S a m w . The sCr& is-Weniby the individual at .avefy esu1~tage and is bas4 5n a deisiop. fhe hedbidgd makw &om self and othem. AemnIime; to tran$8crlanal analJsis, a &soA mice 'me of four d e o a : a y$n O.K., yotrtre Q.KU T m O.K, yodre not OKP, I "I'm no€OE, pu'm O.K* H Trn not QX, yunOU'le not 0.E The aachlal ricLipt i~ patlelped r5n the We of a s i ~ c aother. t ~ At flm, it is an outhe, hut @add& it is m&ed md detailed. Even~aL1-p; itlmwmes the s d p t that M u e n w t hpawn's life. A pason ensum the oatsome ofhis or her script tbroup;h garnc pky*. A game is a sedw t ~ifn w o n a l r e l a ' t i a w & I&& to desired results far game player A script based on "I'm nat. O,Kr m r r ~ ciall for fhe h e d u r i l to get hurt V pmple do not a~tamatiCany hurt him or her, the person engages in behmim &at will Eerm fhm to do 80. This behaviar is wharkme c;rlls g p r pla)riw ~ T h e errdremlt &a game is the cement ofthe person'$ %sling about self: Tkmwtiod analysis recogaizes three ega statepi:the pawat the child, and the adult These three ego stares &st simdtaneously in aR people; M e a on& one is dombmt at a time.Behmlas beloqg&g to the tbw ego states rn learned by chWm $-om th& a'@~Bcult othelis. Pam& contain all the rules and adnxooiti~wchildren have h e ~ dthe i look# o f h and the dmppf~vdseen on the mother's %a, t-he Ieflder hug8 and the severe pw&n@ fhe &Id has received P,nIscanbeeithernuzturbg~rcritimL w d r e nhold alltkefeekngs and map be mt~ml or adaptive,joy ~ or miscbievo~s. ~ Izaattd children behave by ku@&g, smik~@ sad, Pd %are fmpd* aild sporrtaneous. They fee1 i% s a m w guilC and Natural dbildra are ~reatme,Whaeasadap W dddrsn me hvdved with rihmb and coafxmitr: The adult processes and andpea arimut'i Itis the adult wko asks cluestion?, mans, plans, and make$ dedsiolls (Table 6-31. Feople mlip~ndi n my iraeraction through one of these ego States. A husband coma home from work and asks in his %ddY * m e nwiU dinner be ready? Ilis wife may respond by saying "Is k t ~yauthInkIhavetodo?I ' o u m n I d d o s o m e ~ s ~ m d h e r e ~ help. Then mybe yon muld have your dinner on tfmpt" Ehe would be responaing in her"&Hcal p m t e Had she %lie& CIt uriU be rmdy +&~ld

~

w. a.

EIlo state

Eao state

Of

Of

husband

"Wllen wit dinnep Be ready?"

*

4

"In one hour"

flCURe 6-1 A slmple uncrossed tran9action. Three ego states exist in all People simultaneously. Peaple respond in any interac tion through one of these ego states. If the resDonss 1s In the same ego state as addressed, a simple uncrossed transaction occurs and communscation conffnues.

in a few minutps. You fust sit dowa thee and put your feet up. Gee honey,you look SO tired," she would be responding in her " u d n g parentn Her 'child e g mmight have s&d " k f sgo out and eat to-hp nr 4* vou fc:am mey Ha "adulf would have simply said - that -'Dinnet d ire reah in a half hour." Jn any tl:a.nsaction one m o t predict the ego state in whi& another p e r s o n d respand. Iftheresponse is in the same ego state a6

„ go state

sgm state

of husband

wife

1 1-

Of

E lParent

"when wUl dinner be ready?"

"IF you W O U I ~hem me, you might have dinner on the."

Tranbfemd to parent for response

. ... ChiId

FII;URE &2 Crossed transaction. The husband asks a question in his adult ego state, but tne wlfe responds in her ctltEal parent. The critical parent directs her statement to the child; thus, the transaction is crossed. CrQsseatransactions are often destructive.

Others, though, feel that the vanous schools ofp~ychologyhave samethig to offer, but none has the entire an?.= Thwe therapbts are known as eclectics. They pick and c h o w techniwes from any school that seem to fit the siD1ation They might d y z e relationships with one client and use fantasy with ano€her. They may confront one client and use the word assouation with another. Mmy times these therapists have two or threefavorire therapies that they usemost oftw but they use none exclusive&.

SUMMARY

:

----

Psychotherapy is a method of trea?ingmental illness in which verbal ana expressive techniques are used W help the person resolve inner c&cts and m o d e behavior. Mmy techniques are used, including psychodysis, client-centered therapy, behavio&m, rational emotive therapy, Gat& thepapy, and transactid mdpis. Psyhoanaly~isis based on the work of Siptmd Freud The thempist obtains hformation about past and present eacpefa~es that have been repressed in the client's subcomkious mind By

IWE bf tpe ppwm tips p r ~ b l k ~ can a be h m e t to the ebmtioua migm Wile@, it w be d d t w%&The id, w, and sup&zB;o balance eaCh oibw to check behavior. P~yehoanalyskis a aery lang p m w , sometaKing-y yeare. CIientcenteed thff~apyis based on the belief that peoplenatm a y gww t u w d seEa~twht%on under the rigla canditiuns. It is the p p s e afthe h a @ to praide these conditfons. The @ax-

pist provides an accqTtng, nonnjagmmtal environment aimed at reducftlg the client% m$iety and clefemsea that block ?his driwe. Client9 are m u r a g e d to ~ r e z their s f-ge and i n m their self-awamaesa When people are amre of howthey feel an6 what makes them feel fiat way, they can wowork on improxdng behaxioe Empathy, positive regard and g a u h m w are dhmctedstirs that the client-oriented therapist mwt show the client kh;wjorism is a school of therap that believes actioIbg m caused by past even- Behadom mnthue only if they are aceampanied by a ward m e n a learned response becomes a m & people am M d to be canditioned to tlre response- ThaapWme ptlr m y teachem of new behaviom m u s e a d y of te&nique t~eliminate rewards for und&ble Behavior or inm i l s Ew d&able behavior. Ra?iorlal emotive therapy is related to b&vimism Its fmder, &rt Ellis, w u wvinced tbat a person's behwkr is due to his or her her tbhkmg. Prabierns are not caused by evenfa .that happen but are a result of wha B e p a o n b e b s about the eyents. Therapy is aimed at h @ p g the pwon's belief s g a k and t e d ~~epersonthatheorshehas'theab~toc~pe~anye~enf CogniGive-behawid therapy is a+ted ftom the work of AaronBeck It is a cum&zt and successful form of therapy in ouLpab t Bettings. a i m ate wnf5onted with hatio~lgLnegative beli& end a W e 8 and learn how their belie% influence thefr thongbts, iWin@,d a c t b m . Gestalt theram is hued onrhe theory Bat the mind conceives e?rperiences a whole. When an experience is hwmplete, a pmbIem may mirlt Tl?e gml of the Gestalt tke~tpististo help tke client m p l e t e the expaknce though awareness. ExpMendng and awweness am the two =st irtlpmant aspem of k a p y . ma wmes9,the person canchange his or her a o ~ behavim n The t h e apkt ~pendsmuch tjme help* people hacome more anrafe. ReaEQ Therapy ahas to wsiat people €0 see themseha accurately, ro fam reaIi@, and to bXlll peFsanal nee&. Individuals are mpomible far t b k own behior; present behavior cannot be b k e d on past events. The r e w aerapbt is concerned wiih

fw*.

b&+r,

r&@ ;@Q :@tpare @ % a g e d @@uate _> && bkvi~r o m f13@&g?q inahtdap!@eb-@cr: The wrq&t helps @ &&e,pI@m for fhat &~&t$r @@a* p*; h&epp. &;lt rwm$$ig &, M e :@mend&ealrh, pmP&d i s g . 9th~~py~@@hud ~ ~ Ifhelps pe~agd ;@,id@ maitg -&+-&&.* wusipn, o,X,,ym9te-QXK &tapBt wegg&Biqgea from mme than one & sch00I &pq&oiO@ a&& ~ d e@&trpn&$ &Q%@8to a a t & ~e @f&e &.en@ may .red&@ The me ,cwnmonlly nsed d . & e g& Qf the rherapies mimes migilt rn.WUDlW. -.., .., . * L.x,;~I .

*:

w&

a

8-

=J

SUGGESTED ACTIVlTlES m

Wth a small groupr make and play word b i o . M e several bingo car& with d W m 0fpyehuthmpji terms, A d e r caIks Qttt the thnns. Ea& player alea to &d the ddW%onon h& or hm d T h firstplayer to mer the definitions m e t -

&*, hhkv a 4 fk fm the yadoug p6ychOthmapie8. Lrstthe p w choth.ewpy, its intended goal,andthe techntgaes used to

aamnpbh this gad

REVIEW

rn C O ~ m m k Maltiple choice, Select the one b& answer. 1. C o n d i W r@m f~ a term aswciated with whi& ofthe KNOW

m n h g psycho€herapiie9?

o k b&Wwm

o B. Getitdt *ob@ 0

C,~ Z c e n ~ D. reality t h e r m

a. According to Preud whit& ofthe f o U o W controls and guides the actions afa p w a d P tl ego Q B.id

Q C, libido

0 D. superego

3. A Gestalt therapist assists s client in acting out a manary af

a tra-atic childhood experience vvfth m abusive family member. Which technique'is tbe rhmpist using? tl A. fantasizing tl B. presentizing D G resistance Ll D. awareness B. Erwd d&ed the O&pm avnplea aswhich of the foUmving? O A. an abnormal hahador in developing gii-IB o 3. a f e e k g of inferior+tyassociatedwith familg.relationQ C. a strong; f w of doseness a child has for the p w n t of the appasitesa Q D. a smng feeling of doseness a child has for the p p n t of the same sex 5.The term Ebidu refers to which afthe following? Q A. canseience o B. setf-conoept Q C. available sexual enexgy 0 D. m d t i o reapme ~ 6. Which phrase c m C t l y defhe8 ?-rt O A moving wwmcious thmgha to the consworn level Q B. anributing b c f M e S of a sigmEcant other to the P C. substituting one behavior for m d e r 0 D. verbfPelin$s af@ and anxiety

9 Whkh situation accurately identifies incongruencs? Clients: Q k see themselves as different &amwhat theg m earperienefng. 0 B,play m a n i p W Y e gslnes to aadsfy internd drives. 12C. respond t6 a message in a cbild-Wnemarmer. CI D. change their behavior inresponse to a repeated stimuIus. 3. Which therapist W d use dwensitimtion and r~laxation te~hniques? D A behavioriet Q B. client-entered therapist P c. psy&oan*t 0 D, reality therapist

niques? D A, dient-ceatered therapist a. P B. Gestalt therapist .Im t . 0 C. transactional analyst U D.behado& 10. Accarding to Freud's Stag'& of libido developx~ntwhich stage develops fist? U k anal a B. phallic 0 C superego O D. osal

.. I .

APPLY YOUR LEARNING B.Multiple cboie Seled the one best answer. 1.The nurse is assigned to care for a nwly admitted adult cEw on the ps'ychiatric unit The n&s physical features and mane@rns are similar to those ofthe client's motha, who was physically abusive during the client's childhood. Which factor below is most likely t~ affect the nurse-client relationship? O A. transferenw O B. disphcement CJ C, game playing

a D. ca6amis

2. A client diagnosed with an anxiev disorder is involved*

Gestalt psychotherapy. 73% client attends sessions twiweek with the psychotherapist In w W of the following ways would the practical nurse most appropmte1y suppm the pyehatherapy? Q A. Have the client describe the dis&on from each a=sion with the psychotherapist D B. Use exaggeration, fantrtsiz'i and presentiang techniques in the nurse-client interactions. 01 C. Ask the client to deswibe dreams and hdp the client interpret the dreams' meanings. u D. Assist the client to attend the psydmthempy sessions regularly and to be on time.

mend gsychothwpy sessIcms trs help me with my problemsj

but I'm n a going. I've s m examplea of paychoan&ysfsin e e s md th&s nat fos me? Whtch response by the nurse would be most apEnapPiate? C;I k Tsychoanalysis would be y a y efferpive for pour problems You should follaw your doctor's r e m d -

tion"

!2 a 'T9ychoanalysis is j ~ m one t type ofpayeho&erap~ "Iclyour therapist can dedlde WMch approach i s bem for

yau? U C. %a have the right to d&de w h a e r or not to follow your doctor'sr e c c n n m d a t i ~ ~ . " R D. '"It does% 5 m d &e yanr doam is o~eringhelpful recmmendatim. Terhap9 you s h d d w e docto& 4. Thg nurse assists a client daring an acts and cr& group. The client sagis, Tm jlSst no gomi at fhis stuff I don" t o w why I keep coming to rh- $roupkV The clients plan of m e also indudes c o ~ ~ h e h a v i o rth aa l w swsions Wee il week Fhi& wsnment by the n m e would be qprckre of the planofwe7 O A /? notieed yoa srayed for the entire arb anti crafts group and were encoxmgbg to D B. "What typm of activities d d appeal to you more tban a m and cr&T O C. Tou &odd uy hanler to &b the a& projects you start You give up too U D. "GOeasiex on pornelf: Aas and 6is just a 6imple

wmaeiiw 5. A &entin a psy.chiatric unit who i s also a suctressful inmtment dm%, sap te the nurse Y'm nmr going ro bemmt: a partner at my wmpans I jm can't predict ibanda].trends Eke other [email protected] The hoqital uses problem-ariated progress notes, Beside which ofthc fdnowing problem statements would the n m e doeament the &e&s d m n m n t ? Ci A, defmkve coping a B. impaired adjmtment U altered role petfonnance R D. self-esteemdistwban-ce

c.

3. Name three essenW awbutes of the dient-ed

1. Bsinging exp&*ncas repreraed is a. Behaxiorism de~ a c w d o m to the mnscious C&ntcentered level therapy 2. Baviding an acrepting, c @ s M t therapy nonjudgmmtd enxdronmmt kfmed at redwing the &&'P met$ and deftha*block selfacmaI&aerntendencies 3. Kmoving or inmming a reward to cbxilge mnditioned r a p e s 4. frrarional beliefs are refrmed into a post& thaught producing a p o w e action 5. Therapy M on the b M ~ a t p r o B b s are c a i e d by what a person belie- about an event and not the event itself 6. Iiclping the dient to complete an incomplete experience 7. Helping the &nf m see himself or herself acwa€dpItD face reali$, andtomatGepbt0-e maladaptive bdavior 5. &@up therapy inwbich CHents m Mped to a d p their mnsamons with others D, Brief* mwt~ the finowins I- Define psychotherapy

2, State the function ofthe id, ego, aad superego,Indicate the

l e d of Cansdousne8s at wHch each opera*.

4.

3.

therapist,

How does selfawarema help a person to solve a meatal problem?

rk-xribe the PcTicalivocatianal nurses role keg* P.%cMtberapy.

and Phurmcologcal bter/entions induded for chapters on Humq s Geriaaic MentalZIealth @ us in each chaptn encourage analysis and developmtnt

I

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