COMMUNICATION – is a two-way process between two
Physical deformities and injuries
or more individuals. It is an interaction between two or
more people that involves the exchange of information
between a sender and a receiver. The product of
communication is the message, which is interpreted by
the receiver.
PSYCHIATRIC NURSING - therapeutic communication
is one of the most important tools that nurses can use
for building trust, developing therapeutic relationships,
providing support and comfort, encouraging growth
and change, and implementing patient education.
Therapeutic use of self – in psychiatric nursing, the
nurse, using verbal and nonverbal communication, is
the primary therapeutic agent with psychiatric patients.
The nurse’s communication is a major vehicle that helps
patients achieve productive thinking and good
emotional and behavioral outcomes.
⋅ Using silence and therapeutic listening are
important components of the therapeutic use of self
with patients, crucial for getting to know patients
as individuals, as well as their needs and concerns.
THERAPEUTIC LISTENING HAS THE FOLLOWING
ATTRIBUTES:
● Being actively alert
● “Hearing” with all the senses.
● Using eye contact
● Exhibiting an attending posture
● Ensuring concentration
● Being patient
● Displaying openness to receive information.
● Offering empathy and support
● Asking questions
● Assimilating verbal and nonverbal
information
● Organizing, synthesizing, and interpreting
information
● Validating and clarifying information
● Responding verbally and nonverbally to
encourage patients to continue.
● Summarizing important points
● Giving feedback appropriately
COMMUNICATION ARE INFLUENCED BY THE
FOLLOWING FACTORS:
1. Environmental Considerations -the
environment can facilitate or impede
therapeutic communication. Factors such as
noise level, privacy, type of furniture, space,
and temperature can affect the quality of
communication.
2. Physical Considerations – patients with
certain physical problems might experience
communication difficulties like hearing loss,
speech impediments or other problems might
interfere with the nurse’s ability to understand
the patient’s needs. Physical pain often
interferes with a patient's abilities to think
clearly and concentrate and might affect the
sense of priority regarding problems to be
addressed.
might inhibit the ability to talk and interfere.
3. Kinesics Considerations – Kinesics is the
study of body movements. The nurse must be
sensitive to these cues and interpret them in a
global context of therapeutic communication. If
the message appears inconsistent or confusing,
explore the meaning of body language.
THERAPEUTIC COMMUNICATION IN PSYCHIATRIC
NURSING
THERAPEUTIC COMMUNICATION – is a process in
which the nurse consciously influences a CLIENT or
helps the client to a better understanding through a
verbal or non -verbal communication. It involves the
use of specific strategies that encourage the patient to
express feelings and ideas and that they convey
acceptance and respect.
SIGNIFICANCE – the GOAL is to increase self-worth or
decrease psychological distress by collecting
information to determine the illness, assessing and
modifying the behavior, and providing health
education.
PRINCIPLES OF THERAPEUTIC COMMUNICATION
● Concreteness -caregivers are specific and clear
when they communicate.
● Honesty- consistent and open. They communicate
with the client as an authentic person.
● Assistance – commit time and energy to
therapeutic relationships. Convey their presence.
● Acceptance – it is only when people feel
accepted for what they are that they will
consider change.
● Interest – show or express the desire to know the
other person.
● Respect – communicate willingness to work
with clients and accept their ideas, feelings and
rights.
● Empathy – understand feelings of patients.
● Protection – always ensure client’s safety.
GOALS:
1. Obtain useful information.
2. Show caring.
3. Help the patient understand himself.
4. Relieve stress.
5. Provide information.
6. Teach problem solving skills.
7. Encourage acceptance of responsibility.
8. Encourage activities of daily living.
THERAPEUTIC TECHNIQUES
1. Offering self
● Making self-available and showing
interest and concern
● “I will walk with you.”
2. Active listening
● Paying close attention to what the
patient is saying by observing both
verbal and non-verbal cues.
 ● Maintaining eye contact and making
verbal remarks to clarify and
encourage further communication.
3. Exploring
● “Tell me more about your son.”
4. Giving broad openings
● What do you want to talk about today?
5. Silence
● Planned absence or verbal remarks to
allow patient and nurse to think over
what is being discussed and say more.
6. Stating and observing
● Verbalizing what is observed in the
patient for validation and to
encourage discussion.
● “You sound angry.
7. Encouraging comparisons
● Asking to describe similarities and
differences among feelings, behaviors
and events.
● “Can you tell me what makes you
more comfortable, working by
yourself or working as a member of a
team?”
8. Identifying themes
● Asking to identify recurring thoughts,
feelings and behaviors.
● “When do you always feel the need to
check the locks and doors?”.
9. Summarizing
● Reviewing the main points of
discussion and making appropriate
conclusions.
● “During this meeting, we discussed
what you will do when you feel the
urge to hurt yourself again and this
includes…”
10. Placing the event in time and sequence
● Asking for relationships among events.
● “When do you begin to experience
this tick? Before or after you entered
grade school?”.
11. Voicing doubt
● Voicing uncertainty about the reality of
patient’s statements, perceptions and
conclusions.
● “I find it hard to believe…”
12. Encouraging descriptions of perceptions
● Asking the patients to describe feelings,
perceptions and views of their
situations.
● “What are these voices telling you to
do?”
13. Presenting reality or confronting
● Stating what is real and what is not
without arguing with the patient.
● “I know you hear these voices, but I do
not hear them”.
● “I am Deborah, your nurse, and this is a
hospital and not a beach resort”.
14. Seeking clarification
● Asking the patients to restate,
elaborate, or give examples of ideas
or feelings to seek clarification of
what is unclear.
● “I am not familiar with your work; can
you describe it further for me”.
● “I don’t think I understand what you
are saying”.
15. Verbalizing the implied
● Rephrasing patient’s words to
highlight an underlying message to
clarify
statements.
● Patient: I will not be bothering you
anymore soon.
● Nurse: Do you think you should leave
now?
16. Reflecting
● Throwing back the patient’s statements
in a form of questions helps the patient
identify feelings.
● Patient: I think I should leave you now
● Nurse: Do you think you should leave
now?
17. Restating
● Repeating the exact words of patients
to remind them of what they said and
to let them know they are heard.
● Patient: I cannot sleep. I stayed awake
all night.
● Nurse: You cannot sleep at night?
18. General leads
● Using neutral expressions to encourage
patients to continue talking.
● “Go on…”
● “You were saying…”
19. Asking question
● using open-ended questions to achieve
relevance and depth in discussion.
● “How did you feel when the doctor told you
that you are ready for discharge soon?”
20. Empathy
● Recognizing and acknowledging patient’s
feelings
● “It’s hard to begin to live alone when you
have been married for more than thirty
years”.
21. Focusing
● Pursuing a topic until its meaning or
importance is clear.
● “Let us talk more about your best friend in
college.”
● “You were saying…”
22. Interpreting
● Providing a view of the meaning or
importance of something.
● Patient: I always take this towel wherever I
go.
● Nurse: That towel must always be with you.
23. Encouraging Evaluation
● Asking for patients' views of the meaning
or importance of something.
● “What do you think led the court to commit
you here?”.
● “Can you tell me the reasons you don’t want
to be discharged?”.
24. Suggesting Collaboration
● Offering to help patients solve problems.
● “Perhaps you can discuss this with your
children so they will know how you feel
and what you want”.
25. Encouraging goal setting
● Asking patients to decide on the type of
change needed.
● “What do you think about the things you
have to change in yourself?”.
26. Encouraging formulation of a plan of action
● Probing for step-by-step actions that will
be needed.
● “If you decide to leave home when your
husband beat you again and what will you
do
next?”.
27. Encouraging decisions
● Asking patients to make a choice among
options.
● “Given all these choices, what would you
prefer to do?”.
28. Encouraging consideration of options
● Asking patients to consider the pros and
cons of possible options.
● “Have you thought of the possible effect of
your decision on you and your family?”.
29. Giving Information
● Providing information that will help
patients to make better choices.
● “Nobody deserves to be beaten and there
are people who can help and places to go
when you do not feel safe at home
anymore”.
30. Limit Setting
● Discouraging nonproductive feelings and
behaviors and encouraging productive
ones.
● “Please stop now. If you don’t, I will ask you
to leave the group and go to your room.”
31. Supportive confrontation
● Acknowledging the difficulty in changing
but pushing for action.
● “I understand you feel rejected when your
children sent you here but if you look at
this way…”
32. Role Playing
● Practicing behaviors for specific
situations, both the nurse and patient play
a particular role.
● “I’ll play your mother, tell me exactly what
you would say when we meet on Sunday”.
33. Rehearsing
● Asking the patient for a verbal description
of what will be said or done in a particular
situation.
● “Supposing you meet these people again,
how would you respond to them when
they ask you to join them for a drink?”.
34. Feedback
● Pointing out specific behaviors and giving
impressions of reactions.
● “I see you combed your hair today”/
35. Encouraging evaluation
● Asking patients to evaluate their actions
and their outcomes.
● “What did you feel after participating in the
group therapy?”.
36. Reinforcement
● Giving feedback on positive behaviors.
● “Everyone was able to give their options
when we talked one by one and each of
them
waited patiently for our turn to speak.”
AVOID PITFALLS:
1. Giving advice
2. Talking about yourself
3. Telling clients are wrong.
4. Entering hallucinations and delusions of client
5. False reassurance
6. Cliché
7. Giving approval
8. Asking WHY?
9. Changing subject
10. Defending doctors and other health team
members
NON-THERAPEUTIC TECHNIQUES
1. Overloading
● Talking rapidly, changing subjects too
often, and asking for more information
than can be absorbed at one time.
● “What’s your name? I see you like sports.
Where do you live?”.
2. Value Judgements
● Giving one’s own opinion, evaluating,
moralizing, or implying one’s values by
using words such as “nice”, “bad”, “right”,
“wrong”, “should”, and “ought”.
● “You shouldn’t do that, it’s wrong.
3. Incongruence
● Sending verbal and non-verbal messages
that contradict one another.
● The nurse tells the patient “I’d like to spend
time with you’ and then walks away.
4. Underloading
● Remaining silent and unresponsive, not
picking up cues, and falling to give
feedback.
● The patient asks the nurse, but the nurse
 simply walks away.
5. False reassurance agreement
● Using cliché to reassure clients.
● “It’s going to be alright”.
6. Invalidation
● Ignoring or denying another’s presence,
thoughts or feelings.
● Client: How are you?
● Nurse responds I cannot talk now. I am too
busy.
7. Focusing on self
● Responding in a way that focuses attention
to the nurse instead of the client.
● “This sunshine is good for my roses. I have
a beautiful rose garden.”
8. Changing the subject
● Introducing a new topic.
● Inappropriately, a pattern that may
indicate anxiety.
● The client is crying when the nurse asks.
“How many children do you have?’.
9. Giving advice
● Telling the client what to do, giving
opinions or making decisions for the
client, implies the client cannot handle his
or her own life decisions and that the
nurse is accepting responsibility.
● “If I were you. Or it would be better if you
do it this way.
10. Internal validation
● Making an assumption about the meaning of
someone else’s behavior that is not
validated by the other person (jumping
conclusions).
● The nurse sees a suicidal client smiling and
tells another nurse the patient is in good
mood.
OTHER INEFFECTIVE BEHAVIORS AND RESPONSES:
• Defending – your doctor is very good.
• Requesting an explanation – Why did you do
that?
• Reflecting – You are not supposed to talk like
that!
• Literal responses – if you feel empty then you
should eat more.
• False reassurance/reassuring – “Everything will
be alright”, “Don’t worry”.
• Giving approval – “That’s good”.
• Rejecting – “I don’t want to hear about”.
• Disapproving – “That’s bad, “I rather you
wouldn’t’.
• Agreeing – “That’s right”.
• Disagreeing – “I don’t believe that”.
• Advising – “Why don’t you”.
• Probing – asking questions for curiosity only.
“Now tell me about”, “Why did you”.
• Challenging – ‘If you’re dead why is your heart
beating”.
• Testing – “What day is it”. “Do you know what
kind of hospital this is?”.
• Belittling – “I felt that way too”. When a patient
says she feels everything is against her.
• Making stereotype comments – “It’s for your
own good. “Nice weather we are having’.
• Using denial – “of course you're something”.
• Interpreting – “What you really mean is”.
• Changing subject
• Threatening – ‘If you don’t eat, will be forced to
tube feed you.
• Looking too busy
• Appearing uncomfortable in silence.
• Being opinionated.
• Avoiding sensitive topics.
• Arguing and telling the client is wrong.
• Having a closed posture – crossing arms on
chest
• Making false promises – I’ll make sure to call
you when you get home.
• Ignoring the client – I can’t talk to you right
now.
• Making sarcastic remarks
• Laughing nervously
• Showing disapproval -You should not do those
things.
NURSE- PATIENT RELATIONSHIP
NURSE- PATIENT RELATIONSHIP
• Refers to the experience or series of
experiences between the nurse and the patient.
• Refers to the total relationship.
• Mutually defined relationship.
• Provides counseling, crisis intervention and
individual therapy.
NURSE – PATIENT INTERACTION
• Any nurse patient contact during
which the nurse and the patient have
reciprocal influence on each other,
communicating verbally and non-
verbally.
• Refers to communication.
OBJECTIVES OF NURSE-PATIENT RELATIONSHIP:
1. To know the patient.
2. To ascertain and meet the needs of the patient.
3. To fulfill the purpose of nursing
4. To develop self-awareness.
FACTS TO REMEMBER:
• It is not a friendship.
• Its main benefit is to the client.
• It represents an opportunity for a client to deal
with his problems and bring him/her to
treatment.
• The nurse approach is crucial to the clients being
able to express his/her feelings.
GUIDELINES IN NURSE-PATIENT RELATIONSHIP:
• Use the HERE and NOW rather than the past.
• To promote trust, use description rather than
judging.
• Use sharing of information and exploring rather
than give advice or solutions.
• Use HOW or what rather than WHY?
• Orientation and presentation of reality.
CHARACTERISTIC OF NURSE-PATIENT
RELATIONSHIP:
1. Listening – perceiving the patient’s message in
the cognitive level and affective domain.
2. Warmth – feeling of cordiality and inaction.
3. Genuineness – being oneself and non-acting
out a role; being open & truthful.
4. Attentiveness – demonstrating a concentration
of time & attention to the patient.
5. Empathy – understanding the patient's feeling
& viewing the world as he/she does.
6. Positive regard – accepting the patient as
he/she is.
INTERVIEWING TECHNIQUES:
• REFLECTION. repeating content or feelings. You
might simply repeat what the patient has said, to
give him time to mull it over or to encourage him
to respond. Or, and often more effectively, you can
reflect on what you think the patient is feeling. “It
sounds like you’re concerned about your family”.
OR “I don’t think you’re very happy about this.” By
reflecting on his feelings, you may be encouraging
him to talk about something he may have been
hesitant to bring up himself. Or you may be
helping the patient to identify his own feelings
about something.
• RESTATING. rephrasing a question or
summarizing a statement. “You’re asking why
these tests are needed? OR “In other words you
think you’re being treated like a child”.
• FACILITATION. occasional brief responses,
which encourage the speaker to continue. A nod
of the head; an occasional verbal cue, such as “go
on” or “I see” and maintaining eye contact
throughout the conversation all imply that you
are listening and that you understand.
• OPEN- ENDED QUESTIONS. Questions that
encourage the patient to expound a topic. If you
want to encourage the patient to speak freely, you
might ask “How are you feeling” rather than “Are
you in pain?”.
• CLOSE-ENDED QUESTIONS. Questions, which
focus the patient on a specific topic. If you want a
short, straight answer, ask a question which will
allow only for a direct response such as “When
was your accident?” or “Do you have pain after
eating?”.
• SILENCE. A quiet period that allows a patient to
gather his thoughts. Of course, this would be an
occasional practice, used when you feel that the
patient could use a little time to think about his
response to a question or just to think.
• BROAD OPENING. A few words to encourage the
patient to further discuss a topic. For
• example,” and after that...” or “you were saying….”
• CLARIFICATION. Statements or questions that
verify a patient’s concern or point. “I’m a bit
confused about….” “Do you think you could go
over that again please?”.
PHASES OF NURSE- PATIENT RELATIONSHIP
• When psychiatric care was provided primarily in
long-term hospitals, Peplau believed that the
nurse and the patient begin as strangers and
move in stages to become collaborators in
problem solving.
• It is a tool that the nurse can use to assess each
patient’s problems, select and carry out
• specific interventions, and evaluate the
effectiveness of care.
A. ORIENTATION/INITIATION PHASE
• Establish boundaries.
• Inform about time, place, duration of each
meeting & the length of the relationship
will be in effect (WHEN, HOW LONG, HOW
OFTEN THE NURSE WILL MEET THE
CLIENT).
• Build trust & rapport (acceptance).
• Establish a therapeutic environment
(warm, empathetic, caring).
• Establish a mode of communication that is
acceptable to both client & nurse.
• Nurses help patients look at realistic
options so patients can make their own
decisions.
• Assess the client’s strengths & weaknesses.
• Assess the patient’s health status.
• Begin an assessment of the patient's needs,
coping strategies & defense mechanisms.
• Preparation for the termination phase.
B. WORKING PHASE
• Explore the patient's perception of reality.
• Help patients develop positive coping
behaviors.
• Encourage & help patients set goals.
• Promote a positive self-concept.
• Develop a plan of action with realistic goals.
• Identify support systems.
• Encourage verbalization of feelings – self
disclosure & confrontation.
• Promote patient’s independence.
• Patients are guided in making decisions
about change, developing, and
considering alternative solutions, and
formulating a method for carrying out the
plan.
C. TERMINATION PHASE
• End of relationship, discuss termination.
• Smooth transition for the client to other
 caregivers as needed. Massachussete.
• Increase of patient’s anxiety level – hostility, - 1961 NCMH by Dr Jaime Castaneda & the late Ms.
hallucination, delusion, regressive behavior. Teofila Axibal
- 1968 training of nursing attendants by Ms, Diana
• The nurse & client express thoughts and Viasy & Mrs. Belen Alcalde who were trained in
feelings. Australia.
• Synthesizing the outcomes. - 1969-40 attendants gave in different Partlians
• Evaluate goal achievement
OBJECTIVE
PHASES OF NURSE-PATIENT RELATIONSHIP
● To develop the patient's ability to communicate.
G - Goal oriented ● To stimulate patients' interest in reality
U - Understanding situations.
C - Concreteness ● To develop group harmony & identification
H - Honest ● To develop feelings of recognition & acceptance
A - Acceptance
INDICATION: chronic, regressed, long term hospitalized
ORIENTATION PHASE clients may be done in any ward situation regardless of
length of hospitalization & nature of illness & the age.
T - Trust and Rapport
E - Environment Values of Remotivation Technique to the Patient
A - Assess
C - Contact 1. It takes you out from custodial care / "vegetable
H - Help the patient communicate class"
2. Increase interest in the patient- makes a person
WORKING PHASE value himself & increase her self-respect
stimulates the patient to think about something &
P - Promote self-concept talk about himself.
R - Realistic goal setting 3. Makes him part of a group.
O - Organize support system 4. It gives you a feeling of advancement.
V - Verbalize feelings 5. It gives you satisfaction for doing something.
I - Implement plan
D - Develop positive coping behavior Values of Remotivation Technique to the Nurse
E - Evaluate
• Gives chance for a closer working relationship
TERMINATION PHASE
Subjects covered during the session
P - Promote self-care
R - Recognize anxiety • Geography
I - Increase independence • Industry
D - Demonstrate emotional stability • History Sport
E - Environmental support • Literature
• Hobbies
MILIEU THERAPY • Science
• Nature
• Scientific manipulation of the patient's
environment aimed at producing changes in the Subjects to be avoided: religion, politics, family
patient's personality. problems, sex, love

ELEMENTS: People. Organized activity, Environment Physical Set UP: CIRCLE, HORSE SHOE SHAPE, / U SHAPE

Milieu Therapy: • Reason- to have a closer contact with each other

give everyone a feeling of belongingness
• Remotivation Techniques • Nurse stays at the center to have control of the
• Therapeutic Community patient & avoid neglect of other patients & to get
• Attitude Therapy their attention so that everyone could participate.
• Requires 10-15 patients
REMOTIVATION TECHNIQUE • Activity takes about 45 minutes to 1 hour or twice a
week.
RE- Again , MOTIVATION: Move
Proper approach:
A very simple group therapy, objective in nature, used by
nursing attendants / nurses in the ward in an effort to ✓ be natural
reach the unwounded areas of the patient’s personality & ✓ non urging relationship
keep him moving again towards reality.
✓ don't side track into individual concerns
History: Founded by DOROTHY HOSKINS SMITH a gifted ✓ expect something good
English teacher in 1956
Steps in Remotivation
- It started in the US in 1949 in north Huston,
 1. Creating a Climate of Acceptance
• greet the group in general
• expressing appreciation of the group’s
attendance
• After a few introductory remarks about the
discussion, the nurse / leader gives his /
her name & asks each patient to create a
relaxed & comfortable atmosphere in
which the patients feel accepted &
recognized as individuals.
• The nurse also comments on the
appearance of the patients or could ask
questions like the date or food at breakfast.
2. Bridge to Reality
• ask questions leading to the topic to be
discussed.
• A poem appropriate to the topic may be
used by reading the first few lines, then
asking each of the group members to read a
line or two until everyone has participated.
• the nurse or leader could also read a
pertinent quotation or lines or stanza & use
this as a focus of group discussion.
• highly effective way of creating interest is
by the use of related "props" such as actual
objects, picture, posters, drawing or maps
• The poem & the picture / visual aid serve
as a bridge between the topic of discussion
& reality.
3. Sharing the World, We Live In
• leader / nurse tries to explore the topic
• ask stimulating questions about the topic to
promote discussion & help group focus on
the topic.
• let the group share or talk one at a time
about the topic.
• a nurse should show patience & tact to give
each opportunity to share something about
the topic since the patient portrays
different behavior.
4. Appreciation of the Work of the World
• exchange of views & ideas about the topic
from their own personal experiences
(communication & interactions are taking
place freely w/ lesser stimulation from
the nurse)
• a way to initiate possible job opportunities
related to the topic
5. Climate of Appreciation
• ask for the summary about the topic
• ask suggestions for future discussion
• express appreciation to the patient for
coming to the session
Other Therapeutic Activities
1. Music Appreciation thru Arts - clients are
encouraged to express their feelings, emotions
painting, drawing or sculpting.
a. music enables one to express themselves
especially those who have difficulty
communicating
2. Newspaper discussion - 5 "W's" & 1 "H" (when where,
what, who, whom, how)
3. Biblio-therapy- enhances patients' awareness regarding
an article or material as well as it increases their level of
understanding with the information & content of such
reading material.
- it stimulates their inner self by expressing their
feelings regarding the given story.
4. Activities of daily living- personal hygiene & grooming to
promote self-independence
5. Calisthenics
6. Indoor & outdoor games
7. Play therapy-form of psychotherapy for regressed
psychotic patients to an extent of making it impossible to
communicate with them verbally.
○ promotes cooperation sportsmanship
○ used in treatment of children with
maladjustment or behavior disorders.
○ The child is given toys while being
observed to try & discover the cause of
the child's conflict. child usually imitates
parents, sisters, brothers teachers etc.
8. Crafts/ Occupational therapy-uses mental / physical
activity prescribed or guided to aid an individual's
recovery from illness.
○ facilitate personal experiences & Increase
social responses & self esteem
○ ex. rug weaving, painting, paper machete
etc.
Therapeutic Community
A simple type of milieu therapy by which the total social
structure of the treatment unit is involved in the helping
process.
Characteristics of a Therapeutic Community
1. Emphasis is on social & group interaction
2. Focuses on communication
3. Sharing responsibility with patient
4. Living & learning abilities
Goals & Objectives
• To help patient develop a sense of self-esteem &
self-respect
• To help him learn to trust others
• To improve their ability to relate to others & w/
authority
• To return him to the community, better prepared
to resume his role in living & working
Therapeutic Meetings
1. Circle meeting- discussion of the highlights of the
24-hour report.
- carry meeting for patients wherein all the
incidences are being reported & new
members should be introduced.
2. Small group meeting- meeting between the
health team & a group of patients.
• usually, 10-15 members
 • they discuss about their personal
problems
3. Community meeting- meeting between the
health team members regarding problems in the
ward.
4. Patient government meeting- meeting between
the health team & officers of the patient to discuss
issues relative to their welfare.
- select their own government: pres., vice
pres. etc
5. Advisory board meeting- discussion on the
promotion, demotion of patient’s status.
A. Staff special
B. Patient special
C. Semi- independent
D. Independent
E. Step-privilege
6. Treatment Planning- Kardex meeting
• meeting among health team, discussion of
patient’s condition, cases, special
referral/cases
• treatment regimen of patient
7. Discharge planning conference- heath team
plans out the discharge of patients
8. Staff meeting shift to shift- endorsement of all
out-going & incoming patients.
9. Patient Staff meeting
10. Staff meeting
11. Discharge planning
ATTITUDE THERAPY
Prescribe ways on how to handle patients and the
symptoms they manifest.
Characteristics of Attitude Therapy
a. Consistency must be used in order for the patient
to reach the maximum therapeutic value
b. All persons who come in contact with the patient
should have a Uniform Attitude.
c. It should be prescribed by the physician & should
be Individualized depending on the patient's
individual needs.
Attitude Therapy
- ACTIVE FRIENDLINESS
- Advisable for withdrawn, apathetic
patients usually schizophrenics, don't
have anger, simply withdrawn, without
energy
- PASSIVE FRIENDLINESS
- Indicated for paranoid patients with
latent homosexual problems, suspicious
- you cannot do anything for them unless
he /she asks for it. Nurse should maintain
distance since the patient hates too much
closeness. Make the patient feel you are
willing to help anytime he needs you.
- KIND FIRMNESS
- Indicated for depressed patient with
suicidal tendencies
- Patients who have a lot of internalized
hostility, work monotonously,
ungratifying. repetitive work
- Criticize how the work is done not the
patient
- This therapy helps patients turn / channel
their hostility outside.
- MATTER OF FACT
- Indicated for manipulative, demanding,
elated patients Character disorders:
alcoholics, drug addicts, passive
individuals Indicated for patients who are
inpatient in life, they "want what they
want"
- Nurse should stick to the rules, be firm &
consistent
- patient should learn that manipulation is
unrewarding
- We should teach them to grow up & meet
their responsibilities
- Explain the routines of the ward & that
they should follow
- Don't ever allow yourself to argue or to be
upset with patients’ behavior otherwise
they will be happy for manipulating you.
- NO DEMAND ATTITUDE
- Indicated for assaultive/ combative/
furious patients
- Never approach the patient alone for they
might perceive that you are challenging
him / her for a fight.
- A large group surrounding him helped
diffuse his hostilities. Tell the patient that
you / group will not harm him instead
you are there to help him.
THERAPEUTIC MODALITIES
1. PSYCHOTHERAPY- a process by which a person
enters into a contract to interact with a therapist
to relieve symptoms, resolve problems in living or
seek personal growth.
- This treatment for persons with
emotional, personality problems &
disorders is done through psychological
means.
a. INDIVIDUAL THERAPY - is a confidential
relationship between the client & the therapist.
- Ex. hypnotherapy, reality therapy,
psychoanalysis or rational-emotive
therapy
- Goals of therapy: alleviate the client’s
discomfort or pain strengthen the client’s
ego promote emotional & interpersonal
maturation improve the client’s ability to
act appropriately
b. GROUP THERAPY- a method of therapeutic
intervention & is more effective than individual
therapy because it allows greater opportunity for
reality testing & allows clients to experience
mutual concern & support.
- This method usually has 3-10 members
who share a common goal.
- Advantages: decrease isolation; decrease
dependence, develop coping skills
develop interpersonal learning, develop
opportunities for helping others develop
ability to listen to other members
c. FAMILY THERAPY- a method of treatment in
which the family members gain insight into the
problems, improve communication & improve
functioning of individual members as well as the
family as a whole.
- Goals: facilitate positive changes in the
family: fostering or giving an open
 communication of thoughts & feelings
promoting optimal functioning in
interdependent roles
d. COGNITIVE THERAPY - the goal is to identify &
change the patient’s negative generalization &
expectations & thereby reduce depression,
distress & other emotional problems.
- The therapist assigns homeworks such as
making lists of pleasurable activities.
2. MILIEU THERAPY- socio-environmental therapy,
in w/c a therapeutic environment Cr is organized
to encourage & assist the client to control
problematic behavior & to function within the
range of social norms.
- Ex. play, recreational, art, psychodrama etc.
3. BEHAVIOR THERAPY- is a mode of treatment
that focuses on modifying observable &
quantifiable behavior by means of systematic
manipulation of the environment? & variables
thought to be functionally related to the behavior.
- Ex. limit setting, systematic desensitization,
cognitive behavior therapy biofeedback, implosive
therapy (for phobias), aversion therapy,
assertiveness training
a. ASSERTIVENESS TRAINING - uses positive
reinforcement, shaping & modeling to reduce
anxiety.
- It teaches patient ways to express
feelings, ideas, & wishes w/o feeling
guilty or demeaning others
b. AVERSION THERAPY- painful stimulus is applied
to create an aversion to the obsession underlying
the patient’s undesirable behavior.
c. DESENSITIZATION -the treatment of choice for
phobias.
- The patient is slowly exposed to
something they fear.
- Provide reassurance to the patient &
review relaxation techniques while it is
being done.
d. FLOODING -also known as implosive therapy & it
brings rapid relief from phobias
- It involves direct exposure to anxiety
producing situations.
- It assumes that direct confrontation helps
the patient overcome fear
e. POSITIVE CONDITIONING- it attempts to
gradually instill a positive or neutral attitude
toward a phobia
f. RESPONSE PREVENTION- seeks to prevent
compulsive behavior through distraction,
persuasion, or redirection of activity
g. THOUGHT STOPPING- helps the patient break the
habit of fear-inducing anticipatory thoughts
h. THOUGHT SWITCHING- the patient learns to
replace fear inducing self-instructions w/
competent self-instructions
i. TOKEN ECONOMY- the therapist rewards
acceptable behavior by giving out tokens, w/c the
patient uses to buy a privilege or object The token
may be withheld as punishment to avert
undesirable behavior.