Notre Dame University

GRADUATE SCHOOL
Cotabato City

MAJOR THEORIES IN PSYCHIATRY

DAVE C. DEL ROSARIO

JEANIEL B. SENO

SUMMER 2019
 MAJOR THEORIES OF PSYCHIATRY

I. PSYCHOANALYTIC MODEL
II. DEVELOPMENTAL MODEL
III. INTERPERSONAL MODEL
IV. HUMANISTIC THEORY
V. COGNITIVE STAGE OF DEVELOPMENT
VI. COGNITIVE-BEHAVIORAL MODEL
VII. STRESS MODELS
PSYCHOANALYTIC MODEL

Theory of the personality originated by Sigmund Freud that emphasized

unconscious processes or psychodynamic factors as the basis for motivation and
behavior. Freud believed that an individual’s drives, instincts, libido, and
psychosexual attitude are formed early in life and are crucial to an
understanding of the personality.

KEY CONCEPTS:

Personality Processes

The personality consists of three processes:

a. Id – the individual is all id at birth, wanting to experience

only pleasure. This instinctual drive is known as the
pleasure principle; this involves immediate gratification,
enabling the individual to strive for pleasure through the
use of fantasies and images. The id is compulsive and
without morals.
b. Ego- focuses on the reality principle and strives to meet
the demands of the id while maintaining the wellbeing of
the individual by distinguishing fantasy from
environmental reality. Secondary process thinking
comprises rational, logical thinking and intelligence. The
ego is the part of the personality that experiences anxiety
and uses defense mechanisms for protection.
c. Superego – concerned with right and wrong, that is, the
conscience. It provides the ego with an inner control to help
cope with the id. It is formed from the internalization of
 what parents teach their children about right and wrong
through rewards and punishments. Self-esteem is affected
by the perception of a person’s actions as good or right.

Consciousness
Freud’s concepts of the levels of consciousness are central to
understanding problems of the personality and behavior. Consciousness,
or material within an individual’s awareness, only one small part of the
mind.

Unconscious
Larger area and consists of memories, conflicts, experiences, and
material that have been repressed and cannot be recalled at will

Preconscious
Refers to a memories that can be recalled to consciousness with
some effort.
 Freud’s Psychosexual Stages

Consequences of psychologic
Stage Age Range Erogenous zone
fixation

Orally aggressive: chewing gum

and the ends of pencils, etc.
Orally passive: smoking, eating,
Birth–1
Oral Mouth kissing, oral sexual practices[4]
year
Oral stage fixation might result in a
passive, gullible,
immature, manipulativepersonality.

Anal 1–3 years Bowel and bladderelimination Anal retentive: Obsessively

organized, or excessively neat
Anal expulsive: reckless, careless,
defiant, disorganized, coprophiliac

Oedipus complex (in boys and

Phallic 3–6 years Genitalia
girls); according to Sigmund Freud.
Electra complex (in girls); according
to Carl Jung.

Latency Dormant sexual feelings Sexual unfulfillment if fixation

6–puberty
occurs in this stage.

Genital Puberty– Sexual interests mature Frigidity, impotence, unsatisfactory

death relationships
 Defense Mechanisms

The ego usually copes with anxiety through rational means. But
when anxiety is too painful, the individual copes by using defense
mechanisms to protect the ego and diminish anxiety.

Defense Definition Patient example

mechanism
Denial Unconscious refusal to admit Mr. Juan was diagnosed as
an unacceptable idea or diabetic patient but still
behavior continue to eat sweet foods.
Repression Unconscious and involuntary Ms. Ann, a victim of incest, no
forgetting of painful ideas, longer remembers the reason
events and conflicts she alwaus hated the uncle who
molested her.
Suppression Conscious exclusion from Mrs. Perez states to the nurse
awareness anxiety- producing that she is not ready to talk
feelings, ideas and situations about her son’s death

Rationalization Conscious or Unconscious Mr. Miguel, diagnosed with

attempts to make or prove schizoprenia, states that he
that one’s feekings or cannot go to work because his
behaviors are justifiable. co-workers are mean, instead of
admitting that his illmess
interferes with working.
Intellectualization Consciouly or unconsciouly Ms. Mann talks about her son’s
using only logical death from cancer as being
explanations without feelings merciful and shows no signs of
or an affective component her sadness and anger.
Dissociation The unconscnious separation Ms. Nena recalls that when she
of painful feelings and was sexually molested as a
 emotions from an un idea, child, she felt as if she were
situation, or object outside of her body watching
what was happening without
feeling anything.
Identification Conscious or unconscious Mr. Galang states to the clinical
attempt to model oneself after instructor, “When I finished my
a respected person college, I wanted to be a clinical
instructor just like you.
Introjection Unconsciously incorporating Without realizing it, Mr. Lance
values and attitudes of others wishes, talks, and acts
as if they were you own similarly to his therapist,
analyzing other patients.
Compensation Consciously covering up for a Mr. Rizal, who is depressed and
weakness by overemphasizing unable to share his feelings
or making up a desirable trait with other patients, writes and
becomes known for his
expressive poetry.
Sublimation Consciously or unconsciously Mr. Smith, a former perpetrator
channeling instinctual drives of incest who fears relapse,
into acceptable activities forms a local chapter of Sex
Addicts Anonymous.
Reaction A conscious behavior that is Ms. Wheng, who unconsciously
formation the exact opposite of an wishes her mother were dead,
unconscious feeling continuously tells staff that her
mother is wonderful.
Undoing Consciously doing something After accidentally eating
to counteract or make up for another patient’s cookies. Ms.
a transgression or Dacayan apologizes to the
wrongdoing. patients, cleans the
refrigerator, and labels
 everyone’s snack with their
names.
Displacement Unconsciously discharging Students fail in their final
pent-up feelings to a less examination and blame their
threatening object. professors for not teaching
properly.
Projection Unconsciously ( or An adolescent comes home late
consciously) blaming from a dance and states that
someone else for one’s her van was busted
difficulties or placing one’s
unethical desires on someone
else
Conversion The unconscious expression A student awakens with a
of intrapsychic conflict migraine headache the morning
symbolically through physical of a final examination and feels
symptoms to ill to take the test. She does
not realize that 2 hours of
cramming left her unprepared.
Regression Unconscious return to an A 6 year old child has been
earlier and more comfortable wetting the bed at night since
developmental level the birth of his baby sister.

RELEVANCE TO NURSING PRACTICE

In therapeutic encounters, the nurse must recognize and understand the

maladaptive defense mechanisms that patients use. The nurse assesses and
analyses the clients’ behaviours and other relevant data gathered to formulate a
nursing diagnosis. The nurse carefully shares observations regarding these
mechanisms and works with patients to increase awareness about these
behaviors to increase adaptive behaviors.
 DEVELOPMENTAL MODEL

Erik Erikson (1963, 1968) built on Freud’s psychoanalytic model by

including psychosocial and environmental influences along with the Freudian
psychosexual concepts. Erikson’s development model spans the total life cycle
from birth to death. He believed that each of the eight stages of development
afforded opportunities for growth, even up to the acceptance of the person’s own
death.

KEY CONCEPTS

Each Ericksonian stage is comprised of a development crisis involving

positive and negative experiences. Mastery of critical tasks is the result of having
more positive than negative experiences. Non mastery of tasks inhibits
movement to the next stage.

ADULT MANIFESTATIONS OF ERIKSON’S STAGES OF DEVELOPMENT

LIFE STAGE ADULT BEAHAVIORS ADULT BEHAVIORS REFLECTING
REFLECTING MASTERY DEVELOPMENTAL PROBLEMS
TRUST VS  Realistic trust of self and  Suspiciousness or testing of
MISTRUST others others
(0-18 mos.)  Confidence in others  Fear of criticism and closeness
 Optimism and hope  Dissatisfaction and hostility
 Sharing openly with others  Denial of problems
 Withdrawal from others
or
 Overly trusting of others
 Naïve and gullible
 Sharing too quickly and easily
AUTONOMY  Self-control and will power  Self -doubt or self-consciousness
VS SHAME  Realistic self-concept and  Dependence on others for
AND DOUBT self-esteem approval
(18 mo- 3 y.o)  Pride and a sense of good  Feeling of being exposed or
will attacked
 Simple cooperativeness  Sense of being out of control of
 Knowing when to give and self and one’s life
take  Ritualistic behaviors
 Delayed gratification when  Projection of blame and one’s
nessary feelings
or
 Excessive independence of
defiance, grandiosity
 Reckless disregard for safety of
self and others
 Unwillingness to ask for help

INITIATIVE  An adequate conscience  Excessive guilt or embarrassment

VS GUILT  Initiative balanced with  Passivity and apathy
(3-5 y.o) restraint  Avoidance of activities or
 Appropriate social behaviors pleasures
 Curiosity and exploration  Rumination and self-pity
 Healthy competitiveness  Assuming a role as victim of self-
 Original and purposeful punishment
activities  Reluctance to show emotions
 Underachievement of potential
or
 Multiple incomplete projects
 Little sense of guilt for actions
  Excessive competitiveness or
showing off
INDUSTRY  Sense of competence  Feeling unworthy and inadequate
VS  Completion of projects  Poor work history (quitting, being
INFERIORITY  Pleasure in effort and fired, lack of promotions,
(6-12 y.o) effectiveness absenteeism, lack of productivity)
 Ability to cooperate and  Inadequate problem solving and
compromise follow through on plans
 Identification with admired  Manipulation of others or violation
others of others’ rights
 Sense of direction  Lack of friends of the same sex
 Balance of work and play or
 Overly high achieving
 Perfectionist/obsessive-compulsive
 Reluctance to try new things for fear
of falling
 Feeling unable to gain love or
affection unless totally successful
 Being a workaholic

IDENTITY VS  Confident sense of self  Lack of or giving up of goals, beliefs,

ROLE  Commitment to peer group values, productive roles
DIFFUSION values  Feelings of confusion, indecision,
(12-18 or 20  Emotional stability and alienation
y.o  Development of personal  Vacillation between dependence and
values independence
 Sense of having a place in  Superficial short-term relationships
society with opposite sex
 Establishing relationship with or
the opposite sex  Dramatic overconfidence
  Testing out adult roles  Acting out behaviors (including
 alcohol and drug use)
 Seductive or “macho” behaviors
INTIMACY VS  Ability to give and receive love  Persistent aloneness or isolation
ISOLATION  Commitments and mutuality  Emotional distance in all
(18-25 or 30 with others relationships
y.o)  Collaboration in work and  Prejudices against others
affiliations  Lack of established vocation; many
 Sacrificing for others career changes
 Responsible sexual behaviors  Seeking of intimacy through casual
 Commitment to career and sexual encounters
long-term goals Or
 Possessiveness, jealously,
abusiveness to loved ones
 Dependency on parents or partner,
or both
GENERATIVE  Productive, constructive,  Self-centeredness or self-indulgence
LIFESTYLE creative activity  Exaggerated concern for
VS  Personal and professional appearance and possessions
STAGNATION growth  Lack of interest in the welfare of
OR SELF-  Parental and societal others
ABSORPTION responsibilities  Lack of civic and professional
(30-65 y.o) activities or responsibilities
 Loss of interest in marriage,
extramarital affairs, or both
Or
 Too many professional or
community activities to the
detriment of the family or self
 Taking care of others, not oneself
INTEGRITY  Feelings of self-acceptance  Sense of helplessness,
VS DESPAIR  Sense of dignity, worth and hopelessness, worthlessness,
(65 y.o to importance uselessness, meaninglessness or all
death)  Adaptation to life according to of these
limitations  Withdrawal and loneliness
 Valuing one’s life  Regression
 Sharing of wisdom  Focusing on past mistakes, failures
 Exploration of philosophy of and dissatisfactions
life and death  Feeling too old to start over
 Giving up on oneself and life
Or
 Inability to reduce amount of
activities when needed
 Overtaxing strength and abilities
 Feeling indispensable
 Acting as if life is forever

RELEVANCE TO NURSING PRACTICE

Most patients with psychiatric disorders demonstrate partial mastery of

the developmental stage preceding the stage expected for their chronologic age.
The nurse conducts an assessment of the patient’s level of functioning through
the interpretation of verbal and nonverbal behaviors and identifies the degree of
mastery of each stage up to the patient’s chronologic age. The behavioural
manifestations of problems are clues to issues to be addressed in working with
patient.
INTERPERSONAL MODEL

Harry Stack Sullivan (1953) developed a comprehensive examination of

interpersonal and inter-group relationships. Sullivan believed that the
interactional was more important than the intrapsychic. Sullivan considered the
healthy person as a social being with the ability to live effectively in relationships
with others. Mental illness was viewed as any degree of lack of awareness of or
the skills in the processes in interpersonal relationships.

KEY CONCEPTS

Interpersonal psychotherapy (IPT) addresses the stressful social and

interpersonal relationships associated with the onset of depressive symptoms.
IPT does not propose that the only cause of depressive symptoms is interpersonal
rather depressive symptoms occur within an interpersonal context that is
mutually dependent within the illness.
Interpersonal disputes and role transitions often occur in family; social or
work settings; there may be differing outlooks and expectations.

Therapist’s Role

The IPT therapist focuses on a patient’s current interpersonal

relationships and experiences. The goal of the therapy is to develop mature and
satisfactory relationships that are relatively free from anxiety. The therapist-
patient relationship is a vehicle for analysing the patient’s interpersonal
processes and testing new skills in relating. The focus of therapy is on the
patient’s interpersonal issues and distortions created by past experiences.
 RELEVANCE TO NURSING PRACTICE

Hildegard Peplau (1952, 1963) a nursing theorist and clinician played a

significant role in applying Sullivan’s original concepts regarding interpersonal
relationships to nursing practice. Peplau saw a major goal of nursing as helping
patients reduce their anxiety and convert it to constructive action. She
elaborated on and applied Sullivan’s concept of degrees of anxiety to nursing
(pure euporia, mild anxiety, moderate anxiety, severe anxiety, panic, terror
states, and pure anxiety. She saw the nurse’s role as helping patients decrease
insecurity and improve functioning through interpersonal relationships that can
be seen as a microcosms of how patients function in other relationships.

HUMANISTIC THEORIES

Some psychologists at the time disliked psychodynamic and behaviorist

explanations of personality. They felt that these theories ignored the qualities
that make humans unique among animals, such as striving for self-
determination and self-realization. In the 1950s, some of these psychologists
began a school of psychology called Humanism.

Humanistic psychologists try to see people’s lives as those people would

see them. They tend to have an optimistic perspective on human nature. They
focus on the ability of human beings to think consciously and rationally, to
control their biological urges, and to achieve their full potential. In the
humanistic view, people are responsible for their lives and actions and have the
freedom and will to change their attitudes and behavior.

Two psychologists, Abraham Maslow and Carl Rogers, became well known
for their humanistic theories.
 Abraham Maslow’s Theory

The highest rung on Abraham Maslow’s ladder of human motives is the

need for Self-Actualization. Maslow said that human beings strive for self-
actualization, or realization of their full potential, once they have satisfied their
more basic needs. Maslow’s hierarchy of needs theory is described on page 247.

Maslow also provided his own account of the healthy human personality.
Psychodynamic theories tend to be based on clinical case studies and therefore
lack accounts of healthy personalities. To come up with his account, Maslow
studied exceptional historical figures, such as Abraham Lincoln and Eleanor
Roosevelt, as well as some of his own contemporaries whom he thought had
exceptionally good mental health.
 Carl Rogers’s Person-Centered Theory

Carl Rogers, another humanistic psychologist, proposed a theory called

the Person-Centered Theory. Like Freud, Rogers drew on clinical case studies to
come up with his theory. He also drew from the ideas of Maslow and others. In
Rogers’s view, the Self-Concept is the most important feature of personality, and
it includes all the thoughts, feelings, and beliefs people have about themselves.
Rogers believed that people are aware of their self-concepts.

Congruence and Incongruence

Rogers said that people’s self-concepts often do not exactly match reality.
For example, a person may consider himself to be very honest but often lies to
his boss about why he is late to work. Rogers used the term Incongruence to
refer to the discrepancy between the self-concept and reality. Congruence, on
the other hand, is a fairly accurate match between the self-concept and reality.

According to Rogers, parents promote incongruence if they give their

children conditional love. If a parent accepts a child only when the child behaves
a particular way, the child is likely to block out experiences that are considered
unacceptable. On the other hand, if the parent shows unconditional love, the
child can develop congruence. Adults whose parents provided conditional love
would continue in adulthood to distort their experiences in order to feel accepted.

Results of Incongruence

Rogers thought that people experience anxiety when their self-concepts

are threatened. To protect themselves from anxiety, people distort their
experiences so that they can hold on to their self-concept. People who have a
high degree of incongruence are likely to feel very anxious because reality
continually threatens their self-concepts.
 Example: Erin believes she is a very generous person, although she is often
stingy with her money and usually leaves small tips or no tips at restaurants.
When a dining companion comments on her tipping behavior, she insists that
the tips she leaves are proportional to the service she gets. By attributing her
tipping behavior to bad service, she can avoid anxiety and maintain her self-
concept of being generous.

Criticisms of Humanistic Theories

Humanistic theories have had a significant influence on psychology as well

as pop culture. Many psychologists now accept the idea that when it comes to
personality, people’s subjective experiences have more weight than objective
reality. Humanistic psychologists’ focus on healthy people, rather than troubled
people, has also been a particularly useful contribution.

COGNITIVE STAGE OF DEVELOPMENT

Jean Piaget (1896-1980) developed a stage of theory of cognitive

development that explained how intelligence and cognitive functioning developed
in children. He believed that human intelligence has a series of stages based on
age. Each successive stage demonstrates a higher level of functioning that the
previous stage ( Videbeck, 2008). His theory was based on the belief that children
themselves develop their cognitive structures. Piaget believed that this process
of understanding and changes involves assimilation, accommodation, and
organization.

RELEVANCE TO NURSING PRACTICE

 Nurses perform different tasks with which they help the client, particularly
depressed clients, with technique of cognitive therapy. In cognitive therapy, the
individual is taught to control thought distortions considered to be a factor in
the development and maintenance of mood disorders.

PIAGET’S THEORY OF COGNITIVE DEVELOPMENT

STAGES AND AGE CHARACTERISTIC OF THEORY ADDENDUM
STAGES
SENSORIMOTOR Child develops sense of self Child slowly develops that
(BIRTH TO 2 as separate from the people and object have
YEARS) environment and the permanence, even though
concept of objects they are no longer visible.
permanence.
PREOPERATIONAL Childs develops the ability Child focuses on only one
2 TO 6 YEARS) to express self with aspect at a time(centration),
language, understands the thought often seems
meaning of symbolic illogical because child
gestures, and begins to reasons from one specific to
classify objects. another.
CONCRETE Child begins to apply logic Child’s thinking is restricted
OPERATIONS to thinking, understands to immediate and physical.
(6 TO 12 YEARS) spatiality and reversibility, School-aged child can
and is increasingly social reason about what is but
and able to apply rules; cannot hypothesize about
however, thinking is still what may be and thus
concrete cannot think about future
problems.
FORMAL Child learns to think and Adolescent may confuse
OPERATIONS reason in abstract terms, ideal with practical but,
12 TO 15 YEARS further develops logical when problem (real or
AND ABOVE hypothetical), can suggest a
 thinking, and achieves number of solutions. Ability
cognitive maturity. to consider moral and
political issues from variety
of perspective is presents.

COGNITIVE – BEHAVIORAL MODELS

Aaron Beck’s cognitive therapy (CT) (1967, 2005) and Albert Ellis’s
rational- emotive therapy (RET) (1973) models focus on thinking and behaving
rather than on expressing feelings. These models use a cognitive approach based
in individual’s abilities to think, analyse, judge, decide, and do.

KEY CONCEPTS

Beck and Ellis believe that individuals think both rationally and
irrationally, and that irrational beliefs or automatic thoughts are responsible for
causing problems because self –defeating behaviors are maintained. They also
assert that individuals are capable of understanding their limitations can change
their values and beliefs while challenging their self-defeating behaviors.
Cognitive behavioural therapy (CBT) is a talking therapy that can help
you manage your problems by changing the way you think and behave.
It's most commonly used to treat anxiety and depression, but can be useful for
other mental and physical health problems.

Mental health disorders that may improve with CBT include:

 Depression

 Anxiety disorders

 Phobias

 PTSD

 Sleep disorders

 Eating disorders
 Obsessive-compulsive disorder (OCD)

 Substance use disorders

 Bipolar disorders

 Schizophrenia

 Sexual disorders

Therapist Role

The patient-therapist relationship is viewed as a collaborative effort to

achieve goals for improved self-esteem, coping, relationships and lifestyles
(Beck, 1976, 2005). Because patients have many irrational should, oughts
and musts, the therapist actively and directly challenges these beliefs. The
therapist demonstrates the degree to which the patient’s thinking is
illogical. Humor is often used to confront the patient’s irrational thinking.
The therapist explains ways to replace irrational thinking.

RELEVANCE TO NURSING PRACTICE

Nurses help patients change irrational beliefs and reduce stress and
anxiety through effective problem solving. Patients have many self-
deprecating or negative feelings about themselves that the nurse can
dispute by pointing out and reinforcing specific positive behaviors.
Cognitive behavioral therapy (CBT) is a psychological treatment
which aims to understand problems in terms of the relationship between
thoughts, emotions, physiological sensations and behavioursn
In CBT patients are encouraged to use a number of techniques to
gain greater insight into the development and maintenance of their
problem
 Using CBT can improve patients’ coping skills and reduce healthcare
costs.
The scope of CBT is far reaching and has many benefits for other
nursing specialties.

STRESS MODELS

Stress models provide nurses with a framework for understanding

how stress affects individuals and their responses. The ability to adapt to
stress leads to conflict resolution whereas the inability to adapt effectively
might result in physical or mental disorders, or even death.

The three stages:

 alarm reaction
 resistance
 exhaustion
What happens within the body during each of these stages is explored below.

 Alarm reaction stage

At the alarm reaction stage, a distress signal is sent to a part of the brain
called the hypothalamus. The hypothalamus enables the release of hormones
called glucocorticoids.
Glucocorticoids trigger the release of adrenaline and cortisol, which is a stress
hormone. The adrenaline gives a person a boost of energy. Their heart rate
increases and their blood pressure rises. Meanwhile, blood sugar levels also go
up.
These physiological changes are governed by a part of a person's autonomic
nervous system (ANS) called the sympathetic branch.
 The alarm reaction stage of the GAS prepares a person to respond to the
stressor they are experiencing. This is often known as a "fight or flight" response.
 Resistance
During the resistance stage, the body tries to counteract the physiological
changes that happened during the alarm reaction stage. The resistance stage is
governed by a part of the ANS called the parasympathetic.

The parasympathetic branch of the ANS tries to return the body to normal by
reducing the amount of cortisol produced. The heart rate and blood pressure
begin to return to normal.

If the stressful situation comes to an end, during the resistance stage, the body
will then return to normal.

However, if the stressor remains, the body will stay in a state of alert, and stress
hormones continue to be produced.

This physical response can lead to a person struggling to concentrate and

becoming irritable.

 Exhaustion stage
After an extended period of stress, the body goes into the final stage of GAS,
known as the exhaustion stage. At this stage, the body has depleted its energy
resources by continually trying but failing to recover from the initial alarm
reaction stage.

Once it reaches the exhaustion stage, a person's body is no longer equipped to

fight stress. They may experience:

 Tiredness
 Depression
  Anxiety
 Feeling unable to cope
If a person does not find ways to manage stress levels at this stage, they are at
risk of developing stress-related health conditions.

KEY CONCEPTS: LAZARUS’S INTERACTIONAL MODEL

In contrast to Selye’s emphasis on the physiologic effects of stress,

Lazarus (1966, 2006) focused on the psychological aspects. According to
Lazarus, psychological stress is “a relationship between the person and
environment that is appraised by the person as taxing or exceeding his or her
resources and endangering his or her well-being(Lazarus and Folkman, 1984).
Lazarus believed that the basis of coping is not a result of anxiety, per se, but
of personal, cognitive appraisal of threat. “Anxiety is the response to threat”

RELEVANCE TO NURSING PRACTICE

Stress theories provide a framework for the nurse to use to assess the
effects of stress on patients and their coping processes. To assist patients with
developing adaptive or effective coping methods, nurses must help patients
identify and evaluate palliative, maladaptive, and dysfunctional behaviors that
enable patients to become aware of the consequences of their behavior.
Pallative mechanisms decrease the emotions without solving the problems.
Maladaptive mechanisms do not manage the emotions sufficiently and do not
solve the problems. Dysfunctional mechanisms create new or additional
problems.
REALITY THERAPY

Reality therapy is a therapeutic approach that focuses on problem-

solving and making better choices in order to achieve specific goals. Developed
by Dr. William Glasser, reality therapy is focused on the here and now rather
than the past.
The goal of reality therapy is to solve problems, rebuild connections and
begin working toward a better future. The therapist works with the patient to
figure out what they want and how their current behaviors are bringing them
closer (or farther) from their goals.
Central to reality therapy is a trusting relationship between patient and
therapist that strives to make the patient feel safe, heard and respected. This
relationship is nurtured by finding healthier ways for patients to get their basic
needs met. These needs include:
 Love and belonging
 Power
 Survival
 Freedom
 Fun
Together, therapist and patient explore the ideal solution to problems
and lay out the steps to make those solutions a reality. They also make an
honest evaluation of the patient’s current choices and behaviors to determine
whether change is needed to achieve the patient’s goals. Throughout the
process, emphasis is placed on those actions and thoughts that are within the
patient’s control rather than blaming or trying to control others.
Reality therapy is a highly effective way to solve problems and set and
achieve goals. With an emphasis on changing thoughts and actions, reality
therapy empowers individuals to improve the present and future. As the
patient begins to experience small successes their confidence improves,
allowing for more advanced goal-setting and problem-solving.
Because reality therapy focuses on problem-solving, it can be effective for
a variety of mental health disorders, including addiction and eating disorders.
It is particularly useful for at-risk or resistant teens struggling with substance
abuse, defiance, manipulation, and other emotional and behavioral issues.
INTEGRATIVE APPROACH
Most psychiatric nurses adopt an integrative approach with the
therapeutic models. Concepts from various models that best explain a patient’s
behaviors, problems and needs are selected. The psychiatric nurses recognize
that the key component in any therapeutic model is the patient-nurse
relationship.