Unit 13 Therapeutic Approaches to Psychiatric Care

Question 1

What is the definition and Milieu therapy?

Answer 1

• therapeutic community defined as a scientific structuring of the environment ti effect behavioral changes and to improve psychological health of the individual
• So ask yourself, what things make the environment therapeutic? What doesn’t?

Question 2

What is expected of the patient regarding Milieu?

Answer 2

-Within the community setting, the patient is expected to learn, adaptive coping, interaction, and relationship skills that can be generalized to other aspects of his/her life

**let the group come to decisions

Question 3

What are the basic assumptions of Milieu?

Answer 3

• Health of the individual is encouraged to grow
• Every interaction is an opportunity for therapeutic intervention
• The client owns his own environment and behavior
• Peer pressure is a useful and powerful tool
• Inappropriate behaviors are dealt with as they occur
• Restrictions and punishments are to be avoided

Question 4

What are conditions that promote a therapeutic environment?

Answer 4

• Basic needs are met
• Physical facilities are conductive to therapy
• Democratic self government (patients in charge of unit)
• Unit responsibilities assigned according to abilities
  (ex: depressed person wouldn’t be speaker)
• A structured program of social and work related activities is scheduled
• Community and family are included

Question 5

What group positioning is most therapeutic?

Answer 5

Circle formation

Question 6

What is a group?

Answer 6

• Collection of individuals whose association is founded on shared commonalities of interested, values, norms, purpose.
  ex: patients in hospital, nursing students, etc.

Question 7

What are the 6 types of groups?

Answer 7

Task
Teaching
Self-help (AA, NA, etc.)

Supportive- prevent future upsets by teaching effective ways of dealing with emotional stress arising from situational or developmental crisis (nurses can arrange)

Therapeutic groups- focus on group’s relationships, interactions, and a selected issue. (nurses can arrange)

Group therapy- a leader with an advanced degree conducts group psychotherapy based on theoretical frameworks. Focuses on interpersonal level

Question 8

What are the group dynamics and physical conditions?

Answer 8

size
setting
membership

Question 9

What are the leadership styles?

Answer 9

Autocratic (in crisis)
Democratic
Laissez-Faire (do whatever you want)

Question 10

Name in order the counseling process and how goals are achieved through this model. ***

Answer 10

1. Identify client’s problem (client identifies)
2. Promote discussion of desired goal (client identifies)
3. Identify realistic change
4. Discuss aspects that cannot be realistically changed and ways to more adaptively cope with them
5. Discuss alternative strategies
6. Weight benefits and consequences of each alternative
7. Assist client to select an alternative
8. Encourage client to implement the change
9. Provide positive feedback for the client’s attempts to change
10. Assist client to evaluate outcomes of the change and make modifications if necessary

Question 11

What is therapeutic use of self?

Answer 11

Ability to use one’s personality consciously to attempt to establish relatedness and to structure nursing interventions

Question 12

What are conditions essential to the development of a therapeutic relationship ?

Answer 12

• Rapport
• Trust (basis of a therapeutic relationship)
• Respect
• Genuineness (open, honest)
• Empathy

Question 13

What are the phases of a therapeutic nurse-client relationship?

Answer 13

Pre-interaction Phase
The Orientation Phase
The Working Phase
Termination Phase

Question 14

Name goals and principles of cognitive therapy.

Answer 14

Create change in the client’s thinking and belief system
to bring about lasting emotion and behavioral change

Goal is for the client to learn to identify and alter dysfunctional beliefs

Therapy is highly structured and short term, 12-16 weeks

Question 15

Define automatic thoughts and give examples.

Answer 15

Thoughts that occur rapidly and without rational analysis

• Coming to conclusions without facts
• Overgeneralization
• Dichotomous thinking (black and white)
• Magnification (exaggerating the negative)
• Minimization (Undervaluing the positive)

Question 16

Define schemas and give examples.

Answer 16

Core beliefs; that develop early in life and are reinforced by further experiences and influences beliefs, values, and attitudes.
-General or specific
-Positive or negative (are you loveable or un-loveable)
(are you helpless or competent)

Question 17

What are techniques to recognize automatic thoughts in cognitive therapy?

Answer 17

• Socratic questioning
• Imagery
• Role play
• Thought recording “journal”

Question 18

What are ways to modify automatic thoughts in cognitive therapy?

Answer 18

• Generating alternatives
• Examining evidence
• Decatastrophizing
• Daily record of dysfunctional thoughts
• Cognitive rehearsal (practicing different ways of thinking)

Question 19

Give examples of behavioral interventions.

Answer 19

• Activity scheduling
• Graded task assignments
• Behavioral rehearsal
• Distraction
• Relaxation, assertiveness, social skills, training, etc

Question 20

What is the behavioral approach to therapy and the basic assumption with that?

Answer 20

• The behavioral approach to therapy is that people have become what they are through the learning process or through the environment with their genetics
• Basic assumption is the problematic behaviors occur when there has been inadequate learning and therefor can be corrected through provision of appropriate experiences

Question 21

What was the earliest form of classic conditioning and by who?

Answer 21

Pavlov

dog and the bell scenario

Question 22

What is operant conditioning?

Answer 22

• Introduced by Skinner

- Connection between stimulus and response is strengthened or weakened by consequence response

Question 23

What is a stimulus that follows a behavior called?

Answer 23

Stimulus that follows behavior or response is called reinforcer

Question 24

What is shaping?

Answer 24

Shaping behavior of another, reinforcements are given for the increasingly closer steps to desired goal

Question 25

What is modeling?

Answer 25

Learning of new behaviors by imitating the behaviors of others

Question 26

What are techniques for modifying client behavior?

Answer 26

Contingency contracting
-contract for behavioral change is developed, positive and negative reinforcers for the behaviors performed are stated explicitly in the contract

Token economy
-type of contingency contract that reinforcement for desired behaviors are presented with tokens. Tokens then exchanged for privileges (ex: gold stars for candy)

Time out
-punishment where you removed from environment when unacceptable behavior is shown

Overt sensitization
-aversion therapy that uses unpleasant consequence (ex: I’ll taze you every-time you pick up a cigarette)

Covert sensitization
-mental imagery of an adverse stimulus to divert undesirable behavior (ex: any time you pick up cigarette picture a diseased lung)

Systematic desensitization
-technique to gradually desensitize an individual to overcome phobia

Flooding
-basically, you’re just thrown into it

Question 27

What is family therapy?

Answer 27

Intervention in which members of a family are assisted to identify and change problematic, maladaptive, self-defeating, repetitive relationship patterns

Question 28

What are Boyer and Jeffrey’s six family functioning elements? Describe them and behaviors that interfere with each.

Answer 28

1. Communication
   - family members encouraged to express honest opinions and all members participate in decisions that affect the family system
   - Behaviors that interfere are: making assumptions, belittling feelings, failing to listen, presenting double-blind messages
2. Self Concept reinforcement
   - functional families reinforce each member’s self concept, positive result that members feel valued and loved
   - Behaviors interfering with that are: withholding supportive messages, expressing poor remarks
3. Family memebers’ expectations
   - functional families expectations are realistic and flexible
   - Behaviors that interfere are: ignoring individuality, demanding proof of love
4. Handling differences
   - functional families understand that it is acceptable to disagree and deal with differences in an open non attacking manner
   - Behaviors interfering with that are: attacking, avoiding, surrendering
5. Family interactional patterns
   - function when when they are constructive and promote needs of all family members
   - dysfunctional when they become, destructive and contradictory, ex: intensify problems rather than solve
6. Family climate
   - positive family climate founded on trust, openness, appropriate humor and laughter, expressions of caring, mutual respect, and a general feeling of well-being.
   - dysfunctional family climate is evidenced by tension, pain, physical disabilities, frustration, guilt, persistent anger, and feelings of hopelessness.

Question 29

What is enmeshment?

Answer 29

Exaggerated connectedness among family members. (over-close, not individualizing enough)

Question 30

What are triangles?

Answer 30

• Emotional tension in a two person system exceeds a certain level it triangles in a third person (child) permitting the tension to shift within the triangle
• they are dysfunctional because they offer relief through diversion rather than resolution

Question 31

What is double-blind communication?

Answer 31

A statement is made and followed by and contradictory statement. This occurs with a contradictory non-verbal with a verbal.