Chapter 007: Models for Working with Patients

Define Recovery Model + ultimate goal

• Goal is improving the patient’s competencies, not simply alleviating symptoms. It is not a medical model and does not involve a "cure"

• Ultimate Goal: Movement toward a meaningful way of life where the patient strives to improve their own health, wellness, and full potential

Recovery Model 10 guiding principles?

1. Person-driven

2. Occurs via many pathways

3. Hollistic

4. Supported by peers

5. Supported through relationships

6. Culturally based & influenced

7. Supported by addressing trauma

8. Strength-based

9. Based on respect

10. Emerges from hope

Define Attachment Theory

Humans have a natural tendency to develop intimate emotional bonds, and disruptions or childhood trauma can lead to the development of psychiatric disorders

Define Psychoanalytic Theory (Freud)

Emphasizes the unconscious process of psychodynamic factors driving motivation and behavior. Secure and loving early parental relationships lead to secure adults, while disruptions distort perceptions of others

Psychoanalytic Theory levels of awareness?

Consciousness: Information within the person’s awareness

Preconscious: Memories that can be recalled to consciousness with some effort

Unconscious: Repressed memories/conflicts/experiences that cannot be recalled at will

Purpose of defense mechanisms?

Primarily unconscious tools used to protect ego & diminish anxiety when it becomes too painful; excessive use prevents effective problem solving

Define Transference

Unconscious distortion in a relationship

ex: patient displacing distrust of parents onto clinician

Define Projecting

Unconsciously or consciously attributing one’s own repressed thoughts to someone else, often causing the second person to react.

Define Denial

Unconscious refusal to admit an unacceptable idea or behavior

Define Repression

Unconscious & involuntary forgetting of painful ideas/events/conflicts

Define Suppression

Conscious exclusion from awareness of anxiety-producing feelings/ideas/situation

Define Rationalization

Conscious or unconscious attempts to justify one’s feelings/behaviors

Define Intellectualization

Conscious or unconscious logical explanations without an affective (emotional) component

Define Dissociation

Unconscious separation of painful feelings & emotions from an unacceptable situation/object/idea

Define Identification

Conscious or unconscious attempt to model oneself after a respected person

Define Introjection

Unconsciously incorporating values & attitudes of others as if they were your own

Define Compensation

Consciously covering up a weakness by overemphasizing or making up a desirable trait

Define Sublimation

Consciously or unconsciously channeling instinctual drives into acceptable activities

Define Reaction Formation

Conscious behavior that is the exact opposite of an unconscious feeling

Define Undoing

Consciously doing something to counteract or make up for a transgression

Define Displacement

Unconsciously discharging pent-up feelings to a less threatening object

Define conversion

Unconscious expression of intrapsychic conflict symbolically though physical symptoms

Define Regression

Unconscious return to an earlier more comfortable developmental level

Define Developmental Model (Erikson)

Individuals pass through eight interrelated stages, and failure to complete a stage reduces psychological coping ability

Trust vs. Mistrust

Age: 0 - 18 months

Core task / milestone: Develop trust of self of others

Autonomy vs. Shame & Doubt

Age: 18 months - 3 years

Core task / milestone: Develop self-control & willpower

Initiative vs. Guilt

Age: 3 - 5 years

Core task / milestone: Developing an adequate conscience

Industry vs. Inferiority

Age: 6 - 12 years

Core task / milestone: Sense of competence

Identity vs. Role Diffusion

Age: 12 - 20 years

Core task / milestone: Developing a confident self of self

Intimacy vs. Isolation

Age: 18 - 30 years

Core task / milestone: Ability to give & recieve love

Generativity vs. Stagnation

Age: 30 - 65 years

Core task / milestone: Productive, constructive, & creative activity

Integrity vs. Despair

Age: 65+ years

Core task / milestone: Achieve feelings of self-acceptance

Relevance of Developmental Model?

Patients with psychiatric disorders demonstrate partial mastery of developmental stages

Define Interpersonal Model (Sullivan & Peplau)

Interactional dynamics are more important than intrapsychic ones. A healthy person is a social being, while mental illness stems from a lack of awareness or skills in interpersonal relationships

Define Interpersonal Psychotherapy (IPT)

Typically 3-month, time-limited therapy used for depression & mood disorders addressing interpersonal disputes/role transitions/grief

Peplau’s Nursing Role?

Decrease patient insecurity & improve functioning through interpersonal relationships

Define Cognitive-Behavioral Model

Recurrence of irrational thoughts produce emotional disturbances & keep dysfunctional behaviors operant; prioritizes changing faulty thinking & behavior (as opposed to merely expressing feelings)

Define Rational-Emotive Therapy

Teaches individuals to stop blaming themselves & attack problems using A-B-C theory of personality

Define Behavioral Therapy

Utilizes classical & operant conditioning → skills training, response prevention, & systematic desensitization

Define Cognitive-Behavioral Therapy

Most evidence-based; effective in directly changing dysfunctional behaviors & faulty thinking

Define Dialectical Behavioral Therapy (DBT)

Specific to borderline PD & complex PTSD; decreases parasuicidal behaviors

Define Motivational Enhancement Therapy

CBT variation utilizing motivational interviewing to enhance patient’s readiness to change habits (especially r/t addictions)