Chapter 3

Theories and Therapies

Mental health and illness
 Mental health and illness are based on both
psychological and biological factors with a
dynamic interplay between the two
 Psychotherapy: “talk therapy” –
-used exclusively by early practitioners focusing
on the complexity and inner workings of mind
 Theoretic models and therapeutic strategies
provide a useful framework for the delivery of
psychiatric nursing care
Major theories of the psychiatric
care
 Psychoanalytical Theory
 Sigmund Freud (1856-1939) – the “father of
psychiatry”
 Focus is on the understanding of the unconscious
mind
 Based on unconscious motivations and the dynamic
interplay in between:
- the unconscious - primitive brain (id-pleasure
seeking),
- the preconscious - the sense of self (ego –defense
mechanism, such as repression, denial and
rationalization)
-the conscious (superego-conscience)
Major theories of the psychiatric
care
 Interpersonal Theory
 Ed Sullivan (1892-1949)
 Focuses on “here and now” and emphasizes
relationships; therapist is an active participant
 Personality dynamics and disorders are created by
social forces and interpersonal experiences
 Provides positive and interpersonal repairing
experiences
 Healthy relationships are necessary for healthy
personality
Major theories of the psychiatric
care
 Behavioral Theory
 Developed by Pavlov (1927) who is famous for
investigating classical conditioning in which
involuntary behavior or reflexes could be conditioned
to respond to neutral stimuli (Pavlov’s dogs)
 This model suggests that because behavior is
learned, therapy should improve behavior through
rewards and reinforcement of adaptive behavior using
behavioral
therapy/modification
Major theories of the psychiatric
care
 Cognitive Theory (Aaron T. Beck -1963)
 Depression is the result of faulty thinking
 Cognitive Behavioral Therapy (CBT) is
effective and empirically supported
 Helps people reorganize distorted thinking
and replace it with accurate and positive
thoughts
Major theories of psychiatric care
 Cognitive Development
 Developed by Jean Piaget (1896-1980)
 Our mental representations of world (schemata)
depend on the cognitive stage we have reached
 3 Stages
 Sensorimotor stage (0-2 yrs)

 Preoperational stage (2-7 yrs)

 Concrete operational stage (7-11 yrs)

 Formal operational stage (11-adulthood)

 Major theories of psychiatric care
 Theory of Psychosocial Development
 Erik Erickson (1902-1994) described development as
occurring in 8 predetermined life stages , stages whose
success are related to preceding stage
 Psychosocial Life Stage  
 1. Trust v Mistrust Infancy: (0-1½ yrs)  
 2. Autonomy v Shame and Doubt: (1-3 yrs)  
 3. Initiative v Guilt Play: (3-6 yrs)  
 4. Industry v Inferiority School Age (5-12 yrs)
 5. Identity v Role Confusion Adolescence (9-18 yrs) puberty, teens
 
 6. Intimacy v Isolation Young Adult 18-40, courting, early
parenthood  
 7. Generatively v Stagnation Adulthood 30-65, middle age,
parenting  
 8. Integrity v Despair Mature Age 50+, old age, grandparents
Major theories of psychiatric care
 Humanistic Theory
 Psychological science concerned with human
potential for logical science concerned with the
human potential for development, knowledge
attainment, motivation and understanding
 Carl Rogers (1961): developed patient centered
psychotherapy, a technique that emphasized role of pt
in understanding ones own problems
 Abraham Maslow (1970): developed the theory of
personality and motivation based on hierarchy of
needs; Psychological needs, safety needs,
belongingness and love needs, esteem needs, self-
actualization and self-transcendent needs
Major theories of psychiatric care
 Biological Model
 Dominant model for psychiatric care
 Belief that mental disorders have physical causes
 Psychopharmacology (medicine) is the primary biological treatment
for mental disorders
 Major Classifications of medications used for psychiatric pts
 Antidepressants
 Mood Stabilizers

 Antipsychotics

 Antianxiety

 Psychostimulants
Major theories of psychiatric care
 Nursing Model: Developed by Hildegard Peplau
(1909-1999)
 Published Interpersonal Relationships in Nursing
 Foundation for understanding and conducting
therapeutic nursing relationships
 Based on Sullivan’s Interpersonal Theory
 Peplau’s theory provides structure for how the
therapeutic relationship is viewed
 Four phases
 Preinteraction Phase
 Orientation (Introductory) Phase
 Working Phase
 Termination (Resolution) Phase
Therapies for specific populations
 Group therapy
 Provides a formal setting for this influence
 Derived from interpersonal theory and assumption is
the interaction among participants can support or
bring desired change among individual participants
 Offers significant interpersonal feedback fro multiple
people
 Group is defined as a gathering of 2 or more
individuals who share a common purpose and meet
over a substantial time period in a face to face
interaction to achieve an identifiable goal
Therapies for specific populations
 Group Therapy
 Setting: room, privacy, seating
 Group Development: 5 stages: forming,
storming, norming, performing and adjourning
 Roles of Group Members: task, maintenance
and individual
 Roles of Group Leader: multiple roles in
starting, maintaining and terminating a group.
Leadership style depends on the group type
 Types of Groups: education, tasks, support
and therapy
Therapies for specific populations
 Roles of Nurses
 Psychoeducational groups; teach about a specific
somatic or psychological subject
 Medication education group

 Dual diagnosis group

 Addiction recovery group

 Symptom management group

 Stress management group

 Multifamily group

 Self help group

 Therapeutic Milieu
 Healthy environment +healthy social structure

 Community Meetings: pts, treatment team to discuss

goals
Therapies for specific population

 Family Therapy
 Based on various theoretical models and aims
to decrease emotional reactivity among family
members and encourage differentiation
among individual family members