Theories and Therapies
Chapter 3
Candace Makant, MSN-Ed, RN, CMSRN
Objectives
Explain the
theories that
shape nursing
care.
Understand types
of therapies used
in mental health
nursing.
Theories and
Therapies
• These provided the structures for:
• Considering developmental
processes.
• Possible explanations about
how we think, feel, and behave.
• Theorists believed if complex workings
of the mind could be understood, then
they could be treated.
• Therapies evolved from these models
and theories.
Freud’s
Psychoanalytic
Theory
• Personality structure
• ____
• Pleasure principle
• Reflex action
• Primary process
• _____
• Problem solver
• Reality tester
• _______
• Moral component
Freud’s Psychoanalytic Theory
• Levels of Awareness
• Conscious-thoughts, beliefs, and feelings
• Preconscious-not currently the subject of
our attention, but accessible
• Unconscious- Biggest chunk; seat of
primitive feelings, drives, and memories,
especially those that are unbearable and
traumatic
Freud’s Psychoanalytic Theory
• Experiences during the early stages of life determine an
individual’s lifetime adjustment patterns and personality traits.
• Unconscious influences the conscious
• Personality formation is associated with erogenous body zones
• Noted the presence of transference and ________________
Therapeutic Models
• Behavioral Theories
• Pavlov’s classical conditioning• Watson’s behaviorism- learned
behaviors
• Skinner’s operant conditioningpositive and negative reinforcement
• Implications for nursing
• Altering targeted behaviors and
behavior management
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Therapeutic Models
• Behavioral Therapy
• Behavioral modification- positive reinforcement
• Systematic desensitization- gradually introducing anxiety
provoking stimuli
• Aversion therapy- associate unpleasant consequences for
unwanted behaviors
• Biofeedback- control physiological responses
Maslow’s
Hierarchy
of Needs
Prioritizes nursing actions
in the nurse-client
relationship.
Cognitive Theories
• Cognitive-Behavioral Therapy
• Tests distorted beliefs and
changes way of thinking.
• Replace maladaptive patterns
with rational thoughts.
• Used to treat most mental
illnesses
• Dialectical Behavioral Therapy
• Longer term CBT
• Includes psychotherapy and
group therapies
Biological Theories and Nursing
• Mental disorders are from physical causes
• Basis of drug-based treatments
• Electroconvulsive therapy (ECT) and other brain
stimulation therapies based in biological theories
• Often used in conjunction with talk therapies
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• Progression from primitive awareness to complex
thought
Piaget:
Cognitive
Development
• Stages of Cognitive Development
• Sensorimotor (birth to 2 years): Object
permanence
• Preoperational (2 to 7 years): Language;
egocentric thinking
• Concrete operational (7 to 11 years):
Conservation, logic, abstract problem solving;
patterns; reversibility
• Formal operational (11 to adult): Conceptual
reasoning; problem solving like an adult
Erikson’s Eight Stages of Development
• Personality continues to develop through old age.
• Failures at one stage CAN be rectified at another stage.
Group Therapy
• Can be led by a nurse, counselor, or peer.
• Meeting Face-to-Face over Time for a Common Purpose
• Keys to Efficacy:
• Setting: private and comfortable- no physical barriers
• Group content- dialogue
• Group process- ALL communication
• Group development phases
• Group dynamics
• Group leadership style: autocratic, democratic, or laissez-faire
Group Development
• Initial- superficial, unclear purpose, roles established, termination starts.
• Working- Major of work is happens
• Termination- starts in the initial phase, reflection on progress
Interpersonal
therapy
• Works on changing behavior with
the use of a therapist- client
relationship
• Healthy relationship
Milieu therapy
• Uses the total environment.
• People, setting, structure, and
emotional climate are all
important to healing.
• Safety
Family Therapy
• Address foundational issues
within family
• Strengthen support
• Define roles and rules
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