THERAPEUTIC MODELS AND RELEVANCE TO NURSING EXAMPLE: You walked past a stranger eating ice cream, it would most

ream, it would most likely

take the ice cream for itself. It doesn’t know, or care, that it is rude to take
PRACTICE something belonging to someone else; it would care only that you wanted
the ice cream.
A. PSYCHOANALYTIC THEORIES
If your superego walked past the same stranger, it would not take their ice
Sigmund Freud cream because it would know that that would be rude. However, if both your
id and your superego were involved, and your id was strong enough to
 Believed that an individual’s drivers, instincts, override your superego’s concern, you would still take the ice cream, but
afterward you would most likely feel guilt and shame over your actions.
and defenses are formed early in life and are
crucial to an understanding of the personality. If you walked past the stranger with ice cream one more time, your ego
would mediate the conflict between your id (“I want that ice cream right
 argues that human behavior is the result of the now”) and superego (“It’s wrong to take someone else’s ice cream”) and
interactions among three component parts of decide to go buy your own ice cream.

the mind: the id, ego, and superego. While this may mean you have to wait 10 more minutes, which would
 places great emphasis on the role of frustrate your id, your ego decides to make that sacrifice as part of the
compromise– satisfying your desire for ice cream while also avoiding an
unconscious psychological conflicts in shaping unpleasant social situation and potential feelings of shame.
behavior and personality
DEFENSE MECHANISM
LEVELS OF CONSCIOUSNESS
 -when anxiety is too painful, the individual
 Consciousness__- material within an copes by using defense mechanisms to protect
individual’s awareness is only one small part of the ego and diminishes anxiety.
the mind.  when these mechanisms are used excessively,
 Preconscious - refers to memories that can be individuals are unable to face reality and do not
recalled to consciousness with some effort. solve their problems.
 Unconsciousness_- larger area consists of  these are primarily unconscious behaviors,
memories, conflicts, experiences and material however some are within voluntary control.
that have been repressed and cannot be
recalled at will. TYPES OF DEFENSE MECHANISMS

Denial- Unconscious and involuntary forgetting of

 According to Freud, our personality develops painful ideas, events, and conflicts.
from the interactions among what he proposed
as the three fundamental structures of the Suppression- conscious exclusion from conscious
human mind: the id , ego , and superego. exclusion from awareness- anxiety producing feelings,
 Conflicts among these three structures, and our ideas and situations.
efforts to find balance among what each of
Rationalization - conscious and unconscious attempts to
them “desires,” determines how we behave and
make or prove that one’s feelings or behaviors are
approach the world.
justifiable.
ID- the most primitive of the three structures, is
Intellectualization - consciously or unconsciously using
concerned with instant gratification of basic physical
only logical explanations without feelings or an affective
needs and urges. It operates entirely unconsciously
component.
(outside of conscious thought).
Dissociation - unconscious separation of painful feelings
SUPEREGO- concerned with social rules and morals—
and emotions from an unacceptable idea, situation, or
like what many people call their ”conscience” or their
object.
“moral compass.” It develops as a child learns what
their culture considers right and wrong. Introjection - unconsciously incorporating values and
attitudes of others as if they were your own. (px
EGO- is the rational, pragmatic part of our personality.
following therapist)
It is less primitive than the id and is partly conscious and
partly unconscious. It is what Freud considered to be Sublimation - consciously or unconsciously channeling
the “self,” and its job is to balance the demands of the instinctual drives into acceptable activities.
id and superego in the practical context of reality.
Identification- conscious or unconscious attempt to B. INTERPERSONAL THEORIES AND THERAPIES
model oneself after a respected person.
Harry Stack Sullivan
Compensation – consciously covering up for a weakness
 Believed that the interactional was more
by overemphasizing or making up a desirable trait.
important than the intrapsychic
Reaction formation- a conscious behavior that is the  Viewed mental illness as any degree of lack of
exact opposite of an unconscious feeling. mental awareness or skill in interpersonal
relations.
Undoing- consciously doing something to counteract or
 Viewed relationships as source of anxiety,
make up for a transgression or wrongdoing.
maladaptive behaviors and negative personality
Displacement - unconsciously discharging pent-up formation.
feelings to a less threatening object.  Developed the Interpersonal Psychotherapy
used (IPT) for treatment of depression and
Projection- unconsciously or consciously blaming
other mood d/o.
someone else for one’s difficulties or placing one’s
unethical desires in someone else Interpersonal psychotherapy (IPT)

Conversion - unconscious expression of intrapsychic GOAL: To improve social functioning by examining

conflict symbolically through physical symptoms interpersonal disputes, role transitions, grief and
interpersonal deficits.
Regression- unconscious return to an earlier and more
comfortable developmental level. FOCUS :Is on the patient’s interpersonal issues and
distortions created by past experiences
Erik Erikson (Psychosocial Theory)
NURSE’S ROLE: Helps correct these distortions with
 Erikson’s theory was built from Freud’s
clear communication, consensual validation, and a
psychoanalytical model however it included the
warm and collaborative relationship.
impact of environmental factors, parents, and
society on personality development from Hildegard Peplau
childhood to adulthood.
 defined nursing as “an interpersonal process of
 He believed every person must pass through a
therapeutic interactions between an individual
series of 8 interrelated stages over the life cycle
who is sick or in need of health services and a
from birth to death.
nurse especially educated to recognize, respond
to the need for help.”
 she saw a major goal in nursing as helping
patients reduce their anxiety and convert it to
constructive action.

The assumptions of Hildegard Peplau’s Interpersonal

Relations Theory are:

1. Nurse and the patient can interact.

2. Peplau emphasized that both the patient and
nurse mature as the result of the therapeutic
interaction.
3. Communication and interviewing skills remain
fundamental nursing tools.
4. Peplau believed that nurses must clearly
understand themselves to promote their client’s
growth and to avoid limiting the client’s choices
to those that nurse’s value.
FOUR PHASES OF THE THERAPEUTIC NURSE-PATIENT  Sometimes may be difficult for both as
RELATIONSHIP psychological dependence persists.

1. Orientation Phase - The orientation phase is directed

C. BEHAVIORAL THEORIES AND THERAPIES
by the nurse and involves engaging the client in
treatment, providing explanations and information, and Ivan Pavlov (Classical Conditioning Theory)
answering questions.
Basic Principles of Classical Conditioning Classical
 Problem defining phase. conditioning is a form of learning whereby a
 Starts when the client meets nurse as a conditioned stimulus (CS) becomes associated with an
stranger. unrelated unconditioned stimulus (US) in order to
 Defining problem and deciding the type of produce a behavioral response known as a conditioned
service needed. response (CR). The conditioned response is the learned
 Client seeks assistance, conveys needs, asks response to the previously neutral stimulus. The
questions, shares preconceptions and unconditioned stimulus is usually a biologically
expectations of past experiences. significant stimulus such as food or pain that elicits an
unconditioned response (UR) from the start. The
2. Identification Phase - The identification phase begins conditioned stimulus is usually neutral and produces no
when the client works interdependently with the nurse, particular response at first, but after conditioning it
expresses feelings, and begins to feel stronger. elicits the conditioned response.
 Selection of appropriate professional assistance.  The unconditioned response was the dogs’
 Patient begins to have a feeling of belonging natural salivation in response to seeing or
and a capability of dealing with the problem smelling their food.
which decreases the feeling of helplessness and  The unconditioned stimulus was the sight or
hopelessness. smell of the food itself.
3. Exploitation Phase - In the exploitation phase, the  The conditioned stimulus was the ringing of the
client makes full use of the services offered. bell, which previously had no association with
food.
 Use of professional assistance for problem-  The conditioned response, therefore, was the
solving alternatives. salivation of the dogs in response to the ringing
 Advantages of services are used is based on the of the bell, even when no food was present.
needs and interests of the patients.
 The individual feels like an integral part of the John B. Watson’s (Behaviorism Theory)
helping environment.  In the early 1900s, John B. Watson carried out a
 They may make minor requests or attention- controversial classical conditioning experiment
getting techniques. on an infant boy called “Little Albert.” (9mo. old
 Nurse aids the patient in exploiting all avenues child shown a rat but had no fear, at 11 mo. old
of help and progress is made towards the final noise was added when seeing rat)
step.
B.F Skinner (Operant Conditioning Theory)
4. Resolution Phase - In the resolution phase, the client
no longer needs professional services and gives up  According to this principle, behavior that is
dependent behavior. The relationship ends. followed by pleasant consequences is likely to
be repeated, and behavior followed by
 Termination of professional relationship unpleasant consequences is less likely to be
 The patients needs have already been met by repeated.
the collaborative effect of patient and nurse.
 Now they need to terminate their therapeutic Neutral operants: responses from the environment
relationship and dissolve the links between than neither increase nor decrease the probability
them. of a behavior being repeated.
 Reinforcers: Responses from the environment that
increase the probability of a behavior being
repeated. Reinforcers can be either positive or
negative.

Punishers: Responses from the environment that

decrease the likelihood of a behavior being
repeated. Punishment weakens behavior.

D. COGNITIVE THEORIES AND THERAPIES

Aaron Beck and Albert Ellis

 Beck’s Cognitive Therapy and Ellis’ Rational

Emotive Therapy focuses on cognitive approach E. HUMANISTIC THEORIES
based on an individual’s abilities to think,
analyze, judge, decide and do. Abraham Maslow Hierarchy of Needs
o view individual’s present perceptions,
thoughts, assumptions, beliefs, values,
attitudes, and philosophies as needing
modification or change.
o even distorted thinking learned from
childhood can be unlearned.

Rational Emotive Therapy using A-B-C theory of

personality
A- Activating event
B- belief about A
C- Emotional reaction
*A(event) does not cause C (emotion); rather B
(irrational beliefs about A) causes C. *
Carl Roger (Client Centered Theory)
Intervention is aimed at B (irrational beliefs) and is  he suggested that clients would be better
called D ( disputing and changing irrational beliefs) . The helped if they were encouraged to focus on
outcome is E (the end result or profound effective new their current subjective understanding rather
philosophies) than on some unconscious motive or someone
else's interpretation of the situation.
Jean Piaget’s (Cognitive Development)
 His theory focuses not only on understanding
how children acquire knowledge, but also on
understanding the nature of intelligence.
 As kids interact with the world around them,
they continually add new knowledge, build
upon existing knowledge, and adapt previously
held ideas to accommodate new information.
F. BIOLOGICAL THEORIES

1. Advent of Pharmacology
2. Stress Diathesis Model -posits that psychological
disorders result from an interaction between inherent
vulnerability and environmental stressors.
3. Biological Model - involves such things as studying
the brain, immune system, nervous system, and
genetics.

G. ADDITIONAL THEORIES AND THERAPIES

1. Milieu (Environment) Therapy - manipulate the

environment so that all aspects of the client’s hospital
experience are considered therapeutic.
*psychiatric nursing rest on the principle of
psychotherapeutic management with 3 major factors
(ME – nurse; agent of therapy, MEDS – medications,
MILIEU – changing the px environment)

2. Albert Bandura Social Learning Theory -emphasizes

the importance of observing, modelling, and imitating
the behaviors, attitudes, and emotional reactions of
others.
 4 steps:
o Attention – for behavior to be imitated
the individual must have attention of
the behavior and its consequences in
form of a mental representation.
o Retention – how well the behavior is
remembered. Behavior might be
noticed but not always remembered.
o Reproduction – ability to perform the
behavior that the model just
demonstrated.
o Motivation – the will to perform the
behavior. Rewards and punishment of
the behavior will be considered by the
observer. If the rewards are greater
than perceived cost, then the behavior
is more likely to be imitated by the
observer.