Interpersonal theory
3rd Lecture
 This concept focuses on interaction between an individual and his
environment
 Personality is shaped through “interaction” with significant others
 We internalize approval or disapproval form our parents
Harry Stack Sullivan (1892–1949
Personality has three SELF-SYSTEM
1. “Good Me” develops in response to behaviors receiving approval by
parents/SO
2. “Bad Me” develops in response to behaviors receiving disapproval by
parents/SO
3. “Not Me” develops in response to behaviors generating extreme
anxiety in parents/SO and this is denied as part of oneself
Mental Health is Viewed as:
1. Related to conflict or problematic interpersonal relationships
2. Past relationships, inappropriate communication and current
relationship crisis are etiologic factors of mental illness
Treatment of Mental illness:
 Focuses on anxiety and its causes
 Therapeutic relationship with client that is active and participative
 Feelings and emotions are verbalized by the clients to modify
problematic relationships
Usefulness in Nursing
 Nurse and client can participate in and contribute to the
relationship that is therapeutic
 This relationship can be used as a corrective interpersonal
experience
 Anxiety management
Humanistic theory
 Human nature is positive and growth centered and existence
involves search for meaning and truth
 Maslow’s theory of Needs are organized in a hierarchy
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Mental illness in this framework
1. The failure to develop one’s FULL potential leads to poor coping
2. Lack of self awareness and unmet needs interfere with feelings of
security
3. Fundamental human anxiety is fear of death which leads to
existential anxiety
Application of the theory to Nursing
1. NCR is based on positive regard, respect and empathy
2. Nurses assess the spiritual aspects of the client including religion,
love and relationships
3. Through reflective listening and emphatic responses, the nurse
helps the client gain self-understanding
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Behavioral Theory
 This concept describes a person’s function in terms of identified
BEHAVIORS
 People learn to be who they are
 Behavior can be observed, described and recorded
 Behavior is subject to reward or punishment
 Behavior can be modified by changing environment
 The Classical Conditioning by Pavlov
 Learning can occur when a stimulus is paired with an
unconditioned response
 Conditioned responses happens when stimulus is present
 Acquisition – gain of learned response
 Extinction – loss of learned response
B. F. Skinner (1904–1990)
 Positive reinforcement increases the frequency of behavior
 Removal of negative
reinforcers increases the frequency of behavior
 The Operant Conditioning by Skinner
 Rewards and punishments are utilized
 Positive reinforcement- rewards
 Negative reinforcement Positive punishment
 Negative punishment- withdrawing reward
Mental Illness is viewed as:
 Mal-adaptive BEHAVIORS are learned through classical and
operant conditioning
 Mal-adaptive behaviors can be changed by altering environment
Application to Nursing
1. The nurse assess both adaptive and ,al-adaptive behaviors
2. The nurse and client collaborate in identifying behaviors that need
to change
3. Behavioral modification techniques are utilized by the nurse in the
treatment of mental illness
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Hildegard Peplau: The Power of
Empathy
 Hildegarde Peplau’s (1909–1999) theoretic perspectives continue
to be an important base for the practice of psychiatric–mental
health nursing. Influenced by Harry Stack Sullivan, Peplau
introduced the first systematic theoretic framework for psychiatric
nursing and focused on the nurse–patient relationship in her book
Interpersonal Relations in Nursing in 1952 (Peplau, 1952).
She believed in the importance of the “interpersonal environment,”
 which included interactions between person and family, parent and
child, or patient and nurse.
 She believed in the importance of the “interpersonal environment,”
 which included interactions between person and family, parent and
child, or patient and nurse.
 Peplau also emphasized the importance of empathic linkage, the
ability to feel in oneself the feelings experienced by another person
or people. The interpersonal transmission of anxiety or panic is the
most common empathic linkage. According to Peplau, other
feelings, such as anger, disgust, and envy, can also be
communicated nonverbally by way of empathic transmission
There are various levels of anxiety
 MILD: Awareness heightens
 MODERATE: Awareness narrows
 SEVERE: Focused narrow awareness
 PANIC: Unable to function
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