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Morrison-Valfre’s

FOUNDATIONS of
MENTAL HEALTH CARE
in CANADA
This page intentionally left blank

     
Morrison-Valfre’s

FOUNDATIONS of
MENTAL HEALTH CARE
in CANADA
CANADIAN AUTHORS US AUTHOR

Boris Bard, RN, MSc, ACMHN Michelle Morrison-Valfre, RN, BSN,

Manager, Neurology Service MSN, FNP
Health Care Educator/Consultant
University Health Network Health and Educational Consultants
Toronto, Ontario Forest Grove, Oregon

Eric MacMullin, RN, MSN

Professor
Bridging to University Nursing Program
School of Community and Health Studies
Centennial College
Toronto, Ontario

Jacqueline Williamson, RN, MEd, PhD

Professor
Practical Nursing Program
School of Health and Community Services
Durham College
Oshawa, Ontario
MORRISON-VALFRE’S FOUNDATIONS OF MENTAL HEALTH CARE
IN CANADA ISBN: 978-1-77172-233-9
Copyright © 2022 by Elsevier, Inc. All rights reserved.

Adapted from Foundations of Mental Health Care, Sixth Edition, by Michelle Morrison-Valfre,
Copyright © 2017, by Elsevier, Inc.

978-0-323-35492-9 (softcover)

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval
system, without permission in writing from the publisher. Reproducing passages from this book without such
written permission is an infringement of copyright law.

Requests for permission to make copies of any part of the work should be mailed to: College Licensing Offi-
cer, access ©, 1 Yonge Street, Suite 1900, Toronto, ON M5E 1E5. Fax: (416) 868-1621. All other inquiries should
be directed to the publisher, www.elsevier.com/permissions.

Every reasonable effort has been made to acquire permission for copyrighted material used in this text and to
acknowledge all such indebtedness accurately. Any errors and omissions called to the publisher’s attention will
be corrected in future printings.

This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).

Notice

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds or experiments described herein. Because of rapid advances
in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be
made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or con-
tributors for any injury and/or damage to persons or property as a matter of products liability, negligence
or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in
the material herein.

Library of Congress Control Number: 2020947856

VP, Education Content: Kevonne Holloway

Content Strategist (Acquisitions, Canada): Roberta A. Spinosa-Millman
Director, Content Development: Laurie Gower
Content Development Specialist: Martina van de Velde
Publishing Services Manager: Catherine Jackson
Senior Project Manager: Claire Kramer
Design Direction: Bridget Hoette

Last digit is the print number: 9 8 7 6 5 4 3 2 1

 To my wife, Kira Bard, who always loves and supports me.
To the memory of 6 million Jewish victims of the Holocaust and the memory of
the Righteous Among the Nations who helped some to survive, leading, among
other things, to the new edition of this book.
Boris Bard

To my family, Rita, Bob, Rose, Colin, Linda, and Shirley for a lifetime
of support and encouragement. Special thanks to Chris Gray just for
being there and more thanks than I have words to express to my mentor
and friend, Professor Jonathon Bradshaw.
Eric MacMullin

To my beloved husband, Adolph; my cherished friend Marian

McCollum; and to you, dear reader.
May you leave this book richer in the knowledge of human behaviour.
Michelle Morrison-Valfre
This page intentionally left blank

     
 REVIEWERS

Sharon Clegg, BSc(PT) Kelly McNaught, RN, MN

Physiotherapist Nursing Faculty
Faculty of Physiotherapy Technology Nursing Education and Health Studies
Dawson College Grande Prairie Regional College
Montreal, Quebec Grande Prairie, Alberta

John Collins, PhD, MA, Dip. Ed(NT), BA(Hons), DPSN, Holldrid Odreman, RN, MScN-Ed, PhD
CMS(dist.), RN, RPN Professor of Nursing
President/CEO, John Collins Consulting Inc. School of Nursing
Instructor, BSN Program Niagara College
Vancouver Community College Welland, Ontario
Vancouver, British Columbia
Kathlyn Palafox, BSN, BCPID
Cheryl Derry, RN, CAE Practical Nursing Program Coordinator
Instructor, Practical Nursing Secondary Senior Educational Administrator
School of Health and Human Services Canadian Health Care Academy
Assiniboine Community College Surrey, British Columbia
Brandon, Manitoba
Angela Rintoul, NP, MN-ANP
Thomas Gantert, RN, MBA, PhD Coordinator
Professor of Nursing Bachelor of Science in Nursing Program
Fanshawe College Algonquin College
London, Ontario Pembroke, Ontario

Treva Job, RN, PHCNP, RN(EC), MEd, PhD(c)

Professor
Faculty of Nursing
Georgian College
Barrie, Ontario

Eric MacMullin, RN, MSN

Professor
Bridging to University Nursing Program
School of Community and Health Studies
Centennial College
Toronto, Ontario

vii
This page intentionally left blank

     
 TO T H E I N ST RU C TOR
Morrison-Valfre’s Foundations of Mental Health Care in
Canada, first edition, is intended for students and practition-
ers of the health care professions. Basic and advanced learn-
ers will find the information in this text useful and easy to
apply in a variety of practice settings. Students in fields such
as nursing, social work, respiratory therapy, physiotherapy,
recreational therapy, occupational therapy, rehabilitation,
and medical assisting will find concise explanations of adapt-
ive and maladaptive human behaviours, as well as the most
current therapeutic interventions and treatments.
Practising health care providers—all who care for patients
in a therapeutic manner—will find this book a practical and
useful guide in any health care setting.
At its core, this text has three main goals:
1. To help soften the social distinction between mental
“health” and mental “illness”
2. To assist all health care providers in comfortably work-
ing with patients who exhibit a wide range of maladaptive
behaviours
3. To apply the concepts of holistic care when assisting
patients in developing more adaptive attitudes and behav-
iours
Unit I, Mental Health Care: Past and Present, provides a
framework for understanding mental health care. The evolu-
tion of care for persons with mental challenges from primitive
to current times is described. Selected ethical, legal, social,
and cultural issues relating to mental health care are explored.
Community mental health care is explained, followed by
chapters pertaining to theories of mental illness and comple-
mentary and alternative therapies. A chapter on psychothera-
peutic medication therapy ends the unit.
Unit II, The Caregiver’s Therapeutic Skills, focuses on
the skills and conditions necessary for working with patients.
Eight principles of mental health care are discussed and then
applied to the therapeutic environment, the helping rela-
tionship, and effective communications. Material devoted
to self-awareness encourages readers to develop introspec-
tion—a necessary component for working with people who
have behavioural difficulties. Readers explore common basic
human needs, personality development, stress, anxiety, crisis,
and coping behaviours. The section concludes with a descrip-
tion of the basic mental health assessment skills needed by
every health care provider.
The patients for whom we care are the subject of Unit III,
Mental Health Challenges Across the Lifespan, which focuses
on the growth of “normal” (adaptive) mental health behaviours
during each developmental stage. The most common mental
health challenges associated with children, adolescents, adults,
and older persons are discussed using the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5) as a frame-
work. A chapter on dementia and Alzheimer’s disease discusses
the care of patients who have cognitive impairments.
Unit IV, Patients With Psychological Problems, explores
common behavioural responses and therapeutic interven-
tions for illness, hospitalization, loss, grief, and depression.
Maladaptive behaviours and mental health disorders are
described in chapters on somatoform, anxiety, eating, sleep-
ing, mood, sexual, and dissociative disorders.
The chapters in Unit V, Patients With Psychosocial
Problems, relate to the important social concerns of anger
(and its expressions), suicide, abuse and neglect, acquired
immunodeficiency syndrome (AIDS), and substance use.
Sexual and personality disorders are also discussed. Chapters
on schizophrenia and chronic mental illness focus on a multi-
disciplinary approach to treatment. The text concludes with
a chapter titled “Challenges for the Future,” which prepares
students for the coming changes in mental health care.
STANDARD FEATURES
• Several key features are repeated throughout the text:
Objectives stated in specific terms and a list of Key Terms
(most with pronunciations) and page numbers.
• The nursing process is applied to specific mental health
challenges throughout the text, with emphasis on multi-
disciplinary care. This helps readers understand the inter-
actions of several health care disciplines and determine
where they fit in the overall scheme of managed care.
• A continuum of responses describes the range of behav-
iours associated with each topic.
• Development throughout the life cycle relates to the
aspect of each personality being studied.
• Clinical disorders include behavioural signs and symp-
toms based on the DSM-5.
• Therapeutic interventions include multidisciplinary treat-
ment, medical management, application of the nursing pro-
cess, and pharmacological therapy.
• Each chapter concludes with Key Points that serve as a
useful review of the chapter’s concepts.
FEATURES OF THE FIRST CANADIAN EDITION
The First Canadian Edition builds on the work of the venerable
US-based text. Information specific to Canada and Canadian
research, programs, and practices has been included, giving
readers a current and clinically relevant perspective on the
state of mental health care in Canada.
Throughout the text, a focus on the Canadian health care
system and the influence of the Canada Health Act have been
maintained. Medications referenced are currently used and
available in Canada.
Where applicable, DSM-IV diagnoses and references from
the American Psychiatric Association have been updated to
the current DSM-5.
ix
x TO THE INSTRUCTOR
Increased attention to Indigenous health and healing prac-
tices has also been included, along with expanded exploration
of other vulnerable populations in Canada.
An appendix featuring the Canadian Standards for
Psychiatric-Mental Health Nursing, from the Canadian
Federation of Mental Health Nurses, has been added to the
end of the book for student reference.
The authors have worked from the perspective that men-
tal health and addiction disorders are primarily chronic and
genetic, setting treatment goals to maximum recovery as
opposed to curative.
LEARNING AIDS
Because the majority of mental health care takes place outside
the institution, the book emphasizes the importance of using
therapeutic mental health interventions during every patient
interaction. The following features encourage the reader’s
understanding and are designed to foster effective learning
and comprehension:
• The two-colour design stimulates learning and calls atten-
tion to the important terms and concepts within the text.
• Selected Key Terms with phonetic pronunciations and a
specific page reference to where the term can be found are
listed at the beginning of each chapter, and each Key Term
appears in colour at the first or most detailed mention in the
text. Complete definitions are located in the Glossary. Terms
with phonetic pronunciations were selected because they are
either (1) difficult medical, nursing, or scientific terms or (2)
words that may be difficult for students to pronounce.
• Throughout the text, cultural aspects of various mental
health principles are explored in Cultural Considerations
boxes to encourage further thought and discussion.
• Critical Thinking boxes pose questions designed to
stimulate critical thinking.
• Case Studies with thought-provoking questions encour-
age readers to consider the psychosocial aspects of pro-
viding therapeutic care in both community and hospital
settings.
• Medication Alert boxes prepare readers for the com-
plexity of therapy with psychotherapeutic medications,
including identifying drug interactions and potentially
life-threatening side effects.
• Descriptions of each mental health disorder are drawn
from DSM-5 criteria.
• Multidisciplinary Sample Patient Care Plans demonstrate
the application of the therapeutic (nursing) process to the
care of individuals with various mental health disorders.
• Nursing diagnoses are stated in multidisciplinary terms
within a holistic framework.
• Th
 e holistic approach to care offers readers a view of the
“whole person” context of health care delivery.
• NEW Critical Thinking Questions at the end of each
chapter encourage students to reflect on specific topics
and scenarios, develop problem-solving skills, and con-
sider how they might address current health care issues in
practice. Suggested Answers to these questions, to guide
class discussion, are found on the Evolve website.
• References encourage further exploration of the topics
presented in the chapter. For easy access, the references are
found at the end of each chapter in the book.
• The Glossary of Key Terms, written in an easy-to-under-
stand format, follows the text and is also available on the
Evolve website.
ANCILLARIES
For Instructors
We recognize that educators today have limited time to pre-
pare for classroom and clinical activities. Therefore we provide
a rich collection of supplemental resources for instruct-
ors within the Evolve Resources with TEACH Instructor
Resource, including:
• TEACH Lesson Plans, based on textbook learning object-
ives and providing a roadmap to link and integrate all
parts of the educational package. These straightforward
lesson plans can be modified or combined to meet your
unique teaching needs.
• PowerPoint Presentations, including approximately
800 slides with i-clicker questions and talking points for
instructors.
• ExamView Test Bank, with more than 800 multiple-choice
and alternate-format examination-style questions. Each
question provides the correct answer, rationale, topic,
client need category, step of the nursing process, objective,
and cognitive level.
• Open-Book Quizzes for each chapter in the textbook,
with separate answer guidelines.
• Suggested Answers to the Textbook Critical Thinking
Exercises offer instructor guidance for classroom discus-
sion about the Critical Thinking Questions found at the
end of each chapter.
• Answer Key to the Study Guide.
For Students
In the Student Resources section of the Evolve website, there
are more than 300 Review Questions with rationales for both
correct and incorrect responses; an accompanying online
Study Guide; Suggested Answers to the in-text Critical
Thinking Questions; and an Audio Glossary.
 TO THE STUDENT

Critical Thinking Boxes contain thought-provoking scenar-

READING AND REVIEW TOOLS
Objectives introduce the chapter topics.
Key Terms are listed with page number references, and
selected difficult medical, nursing, or scientific terms are
accompanied by simple phonetic pronunciations. Key terms
are considered essential to understanding chapter content
and are defined within the chapter. Key terms are boldfaced in
the narrative and are briefly defined in the text, with complete
definitions in the Glossary.
Each chapter ends with (1) Key Points that reiterate the chap-
ter objectives and serve as a useful review of concepts, (2)
Additional Learning Resources, and (3) Critical Thinking
Questions.
Complete References at the end of each chapter cite evi-
dence-informed information and provide resources for
enhancing knowledge.
ios and critical thinking questions.
Cultural Considerations address the mental health needs of
culturally diverse patients.
Medication Alert boxes identify the risks and possible
adverse reactions of psychotherapeutic medications.
Sample Patient Care Plans are multidisciplinary and address
how members of the health care team work collaboratively to
meet patient needs.
EVOLVE RESOURCES
Be sure to visit your textbook’s Evolve website (http://evolve.
elsevier.com/Canada/Morrison-Valfre/) for a Study Guide, an
Audio Glossary, Review Questions, and more!

CHAPTER FEATURES
Case Studies contain critical thinking questions to help you
develop problem-solving skills.

xi
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 ACKNOWLED GEMENT S

Canada is a country of immigrants. English is my fifth language. I am grateful to my daughter,

Shelly Bard, for her help with this book.
Boris Bard

Much appreciation to Professor Lisa-Marie Forcier for her assistance with research and clinical
scenarios and for her dedication to battling the stigma of mental illness.
Eric MacMullin

No text is written alone. The continued support of my husband, Adolph; of my friend Marian
McCollum; and of other colleagues has provided the energy to complete this project when
my own energy was low. The guidance, expertise, and encouragement from my editors Nancy
O’Brien, Becky Leenhouts, and Mike Sheets are much appreciated. I also thank all the health care
providers who so freely share their time and expertise with those who want to learn more about
the dynamic and complex nature of human behaviour.
Michelle Morrison-Valfre

The product you are holding in your hands or viewing on your screen exists as a result of a great
deal of work, research, and review. Although authors tend to get the most obvious credit (after all,
it is our names that appear on the cover), a text of this nature would be entirely impossible if not
for the work of many dedicated publishing professionals.
Although we have worked diligently to “Canadianize” the venerable Morrison-Valfre text,
many other unsung heroes have toiled away to make this text as valuable to you, the reader, as
humanly possible. Although it would be almost impossible to list them all, there are three individ-
uals we would like to thank specifically.
Content Strategist/Acquisitions person extraordinaire Roberta Spinosa-Millman recognized
the need for a specifically Canadian, fundamental text that addresses how we—as Canadians—
approach, treat, and recognize mental health. Roberta pulled together three very different auth-
ors/mental health practitioners and set the foundation for us to work together to produce what
we consider to be an excellent text and reference. Thank you, Roberta, for the dual opportunities
of producing a text of this nature and of allowing us the honour to work together.
Somehow balancing Zen-like patience along with a subtle ability to kindly motivate and dir-
ect, Content Development Specialist Martina van de Velde worked extensively to ensure that our
efforts were consistent and relevant. Many, many thanks to her for her collaboration, profession-
alism, and kindness. Again, for the times we did not get chapters completed on time, missed a
deadline, or simply forgot, we offer apologies and, in equal measure, sincere admiration.
Finally, our “almost at the finish line” copy editor, Jerri Hurlbutt, who has a keen eye for detail,
word, and idea flow and for use of reference and Internet-accessible information, took a some-
times rough draft and turned it into something of equal measures of accuracy and art. Jerri has
also motivated and inspired us with her efficiency and work ethic. We simply cannot imagine this
final product without Jerri’s input and direction.
There are many, many others who were involved in getting this text from our brains into your
hands, and to those far-too-anonymous people, we also give our sincere thanks. Sales staff, printers,
clerical workers, technicians, and others have all played a vital role in making this text available.
Boris Bard
Eric MacMullin
Jacqueline Williamson

xiii
This page intentionally left blank

     
 CONTENTS

UNIT I Mental Health Care: Past and Ethics, 23

Present Ethical Principles, 23
Codes of Ethics, 24
1 The History of Mental Health Care, 2 Ethical Conflict, 24
Early Years, 3 Laws and the Legal System, 25
Ancient Societies, 3 General Concepts, 25
Greece and Rome, 3 Legal Concepts in Health Care, 25
Middle Ages, 4 Laws and Mental Health Care, 26
The Renaissance, 5 Patient–Caregiver Relationship, 26
The Reformation, 5 Adult Psychiatric Admissions, 26
Seventeenth Century, 5 Areas of Potential Liability, 26
Eighteenth Century, 5 Patient Restraint, 27
Nineteenth Century, 6 Care Providers’ Responsibilities, 28
Twentieth Century, 7 The Reasonable and Prudent Caregiver Principle, 28
Psychoanalysis, 7 4 Sociocultural Issues, 31
Influences of War, 7 The Nature of Culture, 31
Introduction of Psychotherapeutic Medications, 8 Characteristics of Culture, 32
Adult Community Mental Health Programs, 8 Influences of Culture, 33
Twenty-First Century, 8 Health and Illness Beliefs, 33
2 Current Mental Health Care Systems, 10 Cultural Assessment, 35
Mental Health Care in Canada, 10 Communication, 35
Mental Health Care in Industrialized Countries, 11 Environmental Control, 36
Norway, 11 Space, Territory, and Time, 37
The United Kingdom, 11 Social Organization, 37
Australia, 11 Biological Factors, 38
The United States, 11 Culture and Mental Health Care, 38
Care Settings, 12 5 Theories and Therapies, 41
Inpatient Care, 12 Historical Theories, 42
Outpatient Care, 12 Darwin’s Theory, 42
Delivery of Community Mental Health Services, 13 Psychoanalytical Theories, 42
Community Care Settings, 14 Psychoanalytical Therapies, 44
Advocacy, 15 Transference and Countertransference, 44
Therapy, 15 Analytical Psychotherapy, 44
Crisis Intervention, 15 Other Theories, 45
The Multidisciplinary Mental Health Care Team, 15 Developmental Theories and Therapies, 45
Care Team, 16 Cognitive Development, 45
Patient and Family, 16 Psychosocial Development, 46
Patient Populations, 16 Behavioural Theories and Therapies, 46
Impact of Mental Illness, 18 B.F. Skinner, 47
Incidence of Mental Illness in Canada, 18 Other Behavioural Therapies, 48
Economic Issues, 18 Humanistic Theories and Therapies, 48
Social Issues, 18 Perls and Gestalt Therapy, 48
3 Ethical and Legal Issues, 21 Maslow’s Influence, 48
Values and Morals, 22 Rogers’s Patient-Centred Therapy, 49
Acquiring Values, 22 Current Humanistic Therapies, 49
Values Clarification, 22 Systems Theories, 49
Rights, 23 Cognitive Theories and Therapies, 50
Patient Rights, 23 Cognitive Restructuring Therapies, 50
Care Provider Rights, 23 Coping Skills Therapies, 50

xv
xvi CONTENTS

Problem-Solving Therapies, 50 Special Considerations, 78

Reality Therapy, 50 Adverse Reactions, 78
Sociocultural Theories, 51 Nonadherence, 78
Mental Illness as Myth, 51 Informed Consent, 79
Biobehavioural Theories, 51
Homeostasis, 51
Stress Adaptation Theory, 51 UNIT II The Caregiver’s Therapeutic
Psychobiology, 52 Skills
Psychoneuroimmunology, 53
Nursing Theories, 53 8 Principles and Skills of Mental Health Care, 82
Psychotherapies, 53 Principles of Mental Health Care, 83
Individual Therapies, 53 The Mentally Healthy Adult, 83
Group Therapies, 53 Mental Health Care Practice, 83
Online Therapy, 54 Do No Harm, 83
Somatic Therapies, 54 Accept Each Patient as a Whole Person, 83
Brain Stimulation Therapies, 54 Develop Mutual Trust, 84
Pharmacotherapy, 55 Explore Behaviours and Emotions, 84
Future Developments, 55 Encourage Responsibility, 85
Encourage Effective Adaptation, 86
6 Complementary and Alternative Therapies, 58
Provide Consistency, 88
Definition of Terms, 59
Skills for Mental Health Care, 89
Allopathic Medicine, 59
Self-Awareness, 89
Complementary Medicine, 59
Caring, 89
Alternative Medicine, 59
Insight, 90
Integrative Medicine, 59
Risk Taking and Failure, 90
Holistic Care, 59
Acceptance, 90
Health Canada’s Licensed Natural Health Products
Boundaries and Overinvolvement, 90
Database, 59
Commitment, 91
Body-Based CAM Therapies, 60
Positive Outlook, 92
Whole Medical Systems, 60
Nurturing Yourself, 92
Biologically Based Therapies, 61
Body-Based Practices, 62 9 Mental Health Assessment Skills, 95
Energy-Based CAM Therapies, 62 Mental Health Treatment Plan, 95
Mind-Body Medicine, 62 DSM-5 Diagnosis, 96
Energy Medicine, 64 Nursing (Therapeutic) Process, 96
Technology-Based CAM Applications, 65 About Assessment, 97
CAM Approaches to Mental Health Care, 65 Data Collection, 97
CAM Mental Health Therapies, 65 Assessment Process, 98
Words of Caution, 66 The Patient at Risk, 100
Adverse Effects, 66 Obtaining a History, 100
Implications for Care Providers, 66 Effective Interviews, 100
Physical Assessment, 101
7 Psychotherapeutic Medication Therapy, 68
Mental Status Assessment, 102
How Psychotherapeutic Medication
General Description, 102
Therapy Works, 69
Emotional State, 102
Classifications of Psychotherapeutic
Experiences, 102
Medications, 70
Thinking, 103
Antianxiety Medications, 71
Sensorium and Cognition, 104
Antidepressant Medications, 72
Mood-Stabilizer Medications, 73 10 Therapeutic Communication, 107
Antipsychotic (Neuroleptic) Medications, 74 Theories of Communication, 108
Signs and Symptoms, 76 Ruesch’s Theory, 108
Patient Care Guidelines, 76 Transactional Analysis, 108
Assessment, 77 Neurolinguistic Programming, 109
Coordination, 77 Characteristics of Communication, 109
Medication Administration, 77 Types of Communication, 109
Monitoring and Evaluating, 78 Process of Communication, 109
Patient Teaching, 78 Factors That Influence Communication, 110
 CONTENTS xvii

Levels of Communication, 110 Self-Esteem Needs, 137

Verbal Communication, 110 Self-Actualization Needs, 137
Nonverbal Communication, 111 Variables of the Therapeutic Environment, 138
Intercultural Communication, 111 Admission and Discharge, 138
Intercultural Differences, 111 Adherence, 138
Therapeutic Communication Skills, 112
Listening Skills, 112
Interacting Skills, 112 UNIT III Mental Health Challenges Across the
Nontherapeutic Communication, 114 Lifespan
Barriers to Communication, 114
Nontherapeutic Messages, 114 13 Challenges of Childhood, 142
Problems With Communication, 114 Normal Childhood Development, 143
Communicating With Mentally Troubled Common Behavioural Challenges of Childhood, 143
Patients, 117 Mental Health Challenges of Childhood, 145
Assessing Communication, 117 Environmental Issues, 145
Homelessness, 145
11 The Therapeutic Relationship, 120
Abuse and Neglect, 147
Dynamics of the Therapeutic Relationship, 120
Problems With Parent–Child Interaction, 148
Trust, 121
Parent–Child Conflicts, 148
Empathy, 121
Emotional Challenges, 148
Autonomy, 121
Anxiety, 148
Caring, 122
Depression, 149
Hope, 122
Somatoform Disorders, 149
Characteristics of the Therapeutic
Post-Traumatic Stress Disorder, 149
Relationship, 123
Behavioural Challenges, 149
Acceptance, 123
Children and Violence, 149
Rapport, 123
Children and Electronic Media, 150
Genuineness, 123
Attention-Deficit/Hyperactivity Disorder, 150
Therapeutic Use of Self, 124
Disruptive Behavioural (Conduct) Disorder, 151
Phases of the Therapeutic Relationship, 124
Challenges With Eating and Elimination, 152
Preparation Phase, 124
Eating Disorders, 152
Orientation Phase, 125
Elimination Disorders, 152
Working Phase, 125
Developmental Challenges, 153
Termination Phase, 126
Intellectual Development Disorder, 153
Roles of the Care Provider, 126
Learning Disorders, 153
Change Agent, 126
Communication Disorders, 154
Teacher, 126
Pervasive Developmental Disorders, 154
Technician, 127
Autism, 154
Therapist, 127
Schizophrenia, 155
Problems Encountered in the Therapeutic
Therapeutic Actions, 155
Relationship, 127
Meet Basic Needs, 155
Environmental Problems, 127
Provide Opportunities, 156
Problems With Care Providers, 127
Encourage Self-Care and Independence, 156
Problems With Patients, 128
14 Challenges of Adolescence, 160
12 The Therapeutic Environment, 131
Adolescent Growth and Development, 161
Use of the Inpatient Setting, 132
Physical Development, 161
Crisis Stabilization, 132
Psychosocial Development, 161
Acute Care and Treatment, 132
Common Challenges of Adolescence, 162
The Chronically Mentally Ill Population, 132
Internal (Developmental) Challenges, 162
Goals of a Therapeutic Environment, 133
External (Environmental) Challenges, 162
Help Patients Meet Needs, 133
Teens and Electronic Media, 165
Teach Psychosocial (Adaptive) Skills, 133
Mental Health Challenges of Adolescence, 165
The Therapeutic Environment and Patient
Behavioural Disorders, 165
Needs, 134
Emotional Disorders, 166
Physiological Needs, 134
Mood Disorders, 167
Safety and Security Needs, 135
Eating Disorders, 167
Love and Belonging Needs, 136
xviii CONTENTS
Chemical Dependency, 168
Personality Disorders, 169
Sexual Disorders, 169
Psychosis, 170
Suicide, 170
Therapeutic Interventions, 171
Surveillance and Limit Setting, 171
Building Self-Esteem, 171
Skill Development, 171
15 Challenges of Adulthood, 174
Adult Growth and Development, 174
Common Challenges of Adulthood, 176
Internal (Developmental) Challenges, 176
External (Environmental) Challenges, 178
Mental Health Challenges of Adults, 180
Therapeutic Interventions, 180
Health Care Interventions, 180
Preventing Mental Illness, 180
16 Challenges of Late Adulthood, 183
Overview of Aging, 183
Facts and Myths of Aging, 184
Physical Health Changes, 185
Mental Health Changes, 185
Research and Aging, 185
Common Challenges of Older Persons, 186
Physical Adaptations, 187
Health Care Services, 187
Psychosocial Adaptations, 188
Mental Health Challenges of Older
Persons, 190
Elder Abuse, 191
Dementia, Depression, and Delirium, 191
Therapeutic Interventions, 192
Age-Related Interventions, 192
Mentally Ill Older Persons, 192
Mental Health Promotion and Prevention, 193
17 Cognitive Impairment, Alzheimer’s Disease, and
­Dementia, 196
Confusion Has Many Faces, 196
Normal Changes in Cognition, 196
The Three “D’s” of Confusion, 197
Medications and the Older Population, 197
Patients With Delirium, 197
Finding the Cause, 199
Treating Delirium, 200
Patients With Dementia, 200
Symptoms of Dementia, 200
Gentle Persuasive Approach, 201
Dementia Care, 201
Causes of Dementia, 202
Alzheimer’s Disease, 202
Symptoms and Course, 202
After the Diagnosis, 204
Principles of Management, 204
Therapeutic Interventions, 205
Assessment, 205
Interventions for Patients Living With Alzheimer’s
Disease, 205
Caregiver Support, 207
UNIT IV Patients With Psychological
Challenges
18 Managing Anxiety, 211
Continuum of Anxiety Responses, 212
Types of Anxiety, 212
Types of Anxiety Responses, 212
Coping Methods, 212
Defence Mechanisms, 213
Crisis, 213
Self-Awareness and Anxiety, 215
Theories Relating to Anxiety, 215
Biological Models, 215
Psychodynamic Model, 215
Interpersonal Model, 216
Behavioural Model, 216
Other Models, 216
Anxiety Throughout the Life Cycle, 216
Anxiety in Childhood, 216
Anxiety in Adolescence, 217
Anxiety in Adulthood, 217
Anxiety in Older Persons, 217
Anxiety Disorders, 217
Separation Anxiety Disorder, 218
Selective Mutism, 218
Specific Phobia, 218
Social Anxiety Disorder, 218
Panic Disorders, 218
Agoraphobia, 219
Generalized Anxiety Disorder (GAD), 219
Obsessive-Compulsive and Related
Disorders, 219
Obsessive-Compulsive Disorder (OCD), 219
Body Dysmorphic Disorder, 220
Hoarding Disorder, 221
Hair-Pulling Disorder (Trichotillomania), 221
Excoriation Disorder (Skin Picking), 221
Substance-/Medication-Induced Obsessive-
Compulsive and Related Disorder, 221
Obsessive-Compulsive and Related Disorder
Due to Another Medical Condition, 221
Other Specified Obsessive-Compulsive and Related
Disorder, 221
Unspecified Obsessive-Compulsive and
Related Disorder, 221
Trauma- and Stressor-Related Disorder, 221
Reactive Attachment Disorder, 221
Disinhibited Social Engagement Disorder, 222
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