Ch 2 Relevant Theories and Therapies

Freud's Psychosexual Oral - 0-1 yr

-Mastery of gratification of oral needs, beginning of ego development; Development of trust in the environment, with the realization that needs can be met. Conflict is weaning; -fixation at this stage assoc with passivity, gullibility, dependence, sarcasm, orally focused habits such as nail biting and smoking

Autonomy vs. Shame and Doubt (1.5-3yr) Erikson's 8 Stages of Development

Early Childhood. Gaining some basic control of self and environment (e.g., toilet training, exploration) Autonomy - Sense of self-control and adequacy; will power Shame and Doubt - Independence/fear conflict; severe feelings of self-doubt

Intimacy vs. Isolation (20-35) Erikson's 8 Stages of Development

Early adulthood. Establishing intimate bonds of love and friendship. Intimacy - Ability to love deeply and commit oneself Isolation - Emotional isolation; egocentricity

Interpersonal Psychotherapy

Effective *short-term therapy* derived from the school of psychiatry that originated with Adolph Meyer and Harry Stack Sullivan. The assumption is that *psychiatric disorders are influenced by interpersonal interactions and the social context*. The goal of interpersonal psychotherapy is to reduce or eliminate psychiatric symptoms (particularly depression) by improving interpersonal functioning and satisfaction with social relationships.

Joyce Travelbee

Emphasizes the role of nursing in *affirming the suffering* of the patient and in being able to *alleviate that suffering* through *communication skills* used appropriately through the stages of the nurse-patient relationship.

Sister Callista Roy

Emphasizes the role of nursing in assisting patients to *adapt so that they can cope more effectively* with changes.

Betty Neuman

Emphasizes the role of nursing in assisting patients to discover and use *stress-reducing strategies.*

Dorothea Orem

Emphasizes the role of the nurse in promoting *self-care activities* of the patient; this has relevance to the seriously and persistently mentally ill patient.

Patricia Benner

Encourages nurses to provide caring and comforting interventions. She emphasizes the importance of the nurse-patient relationship and the *importance of teaching and coaching* the patient and bearing witness to suffering as the patient deals with illness.

Cognitive-Behavioral Therapy

It is based on the underlying theoretical principle that *feelings and behaviors are largely determined by the way people think about the world and their place in it*. Test distorted beliefs and change way of thinking to reduce symptoms. Homework assignments play an important role.

Integrity vs. Despair (65yr-death) Erikson's 8 Stages of Development

Later years. Looking back over one's life and accepting its meaning. Integrity - Sense of integrity and fulfillment; willingness to face death; wisdom Despair - Dissatisfaction with life; denial of or despair over prospect of death

Disqualifying the positive

Maintaining a negative view by rejecting information that supports a positive view as being irrelevant, inaccurate, or accidental

Generativity vs. Self-absorption (35-65yr) Erikson's 8 Stages of Development

Middle adulthood. Fulfilling life goals that involve family, career, and society; developing concerns that embrace future generations. Generativity - Ability to give and to care for others Self-absorption - inability to grow as a person

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Table 2-6 ;

Rational-Emotive Behavior Therapy

The aim is to *eradicate core irrational beliefs* by helping people recognize thoughts that are not accurate, sensible, or useful.

Aversion Therapy

Used widely to *treat behaviors such as alcoholism, sexual deviation, shoplifting, hallucinations, violent and aggressive behavior, and self-mutilation*. Aversion therapy is sometimes the treatment of choice when other less drastic measures have failed to produce the desired effects. *Includes Punishment, Avoidance, and Pairing of a maladaptive behavior with a noxious stimulus so that anxiety or fear becomes associated with the once-pleasurable stimulus*.

Overgeneralization

Using a bad outcome (or a few bad outcomes) as evidence that nothing will ever go right again

Operant Conditioning

Voluntary behaviors are learned through *consequences*, and behavioral responses are elicited through *reinforcement*, which causes a behavior to occur more frequently.

Modeling

The therapist provides a role model for specific identified behaviors, and the patient learns through *imitation*. The therapist may do the modeling, provide another person to model the behaviors, or present a video for the purpose.

Systemic Desensitization

Therapy that involves the development of behavior tasks *customized to the patient's specific fears*; these tasks are presented to the patient while using learned relaxation techniques

7. Which client problem would be most suited to the use of interpersonal therapy? A. Disturbed sensory perception B. Impaired social interaction C. Medication noncompliance D. Dysfunctional grieving

ans B - Interpersonal therapy is considered to be effective in resolving problems of grief, role disputes, role transition, and interpersonal deficit.

10. Freud believed that individuals cope with anxiety by using A. the superego. B. defense mechanisms. C. security operations. D. suppression.

ans B - The ego develops defenses or defense mechanisms to ward off anxiety by preventing conscious awareness of threatening feelings. Reference: pp. 20-21

Maslows Hierarchy of Needs (bottom to top)

*Physiological Needs* - *basic needs* Food, water, oxygen, elimination, rest and sex *Safety Needs/=* - Security, protection, stability, structure, order, and limits *Love and Belonging Needs* - Affiliation, affectionate relationships and love *Esteem* - Self-esteem related to competency, achievement, and esteem for others *Self-Actualization* - Becoming everything one is capable of Self- Transcendence -founder of *humanistic* psychology; self-actualization and human motivation CHARACTERISTICS OF SELF ACTUALIZED PERSONS: • Accurate perception of reality. Not defensive in their perceptions of the world. • Acceptance of themselves, others, and nature. • Spontaneity, simplicity, and naturalness, do not live programmed lives. • *Problem-centered rather than self-centered orientation*. Possibly the most important characteristic. SAs have a sense of a mission to which they dedicate their lives. • Pleasure in being alone and in ability to reflect on events. • Active social interest. • Freshness of appreciation. SAs don't take life for granted. • Mystical or peak experiences. A peak experience is a moment of intense ecstasy, similar to a religious or mystical experience, during which the self is transcended. • SAs may become so involved in what they are doing that they lose all sense of time and awareness of self (flow experience). • Lighthearted sense of humor that indicates "we're in it together" and lacks sarcasm or hostility. • Fairness and respect for people of different races, ethnicities, religions, and political views. • Creativity, especially in managing their lives. • Resistance to conformity (enculturation). SAs are autonomous, independent, and self-sufficient.

Conscious (levels of conscious) (Freud)

- contains all the material a person is *aware of* at any one time, including, perceptions, memories, thoughts, fantasies, and feelings; the "tip of the iceburg"

Cathartic Method (Freud)

-*"talk therapy"* used by Freud; allows patients to get relief by talking out their previously repressed emotions. Now referred to as *"getting things off our chests"* -evolved to include "free association" which requires full and honest disclosure of thoughts and feelings as they come to mind; -dream alalysis became an essential part bc he believed urges and impulses of unconscious mind were symbolically played out in dreams -he concluded talking about difficult emotional issues had the potential to heal the wounds causing mental illness

Freud's Psychosexual Anal - 1-3yr

-Beginning of development of a sense of control over instinctual drives; Ability to delay immediate gratification to gain future goals; Control of impulses; Conflict is toilet training. -fixation assoc with anal retentiveness (stingy, rigid thought patterns, OCD) or anal-expulsive character (messiness, destructiveness, cruelty)

Freud's Psychosexual Genital - 12yr+

-Development of satisfying sexual and emotional relationship. Emancipation from parents-planning life goals and sense of personal identity; Ability to be creative and find pleasure in love and work. -fixation inability to negotiate this stage may derail emotional and financial independence, impair personal identity, future goals and disrupt ability to form satisfying intimate relationships

Transference

-Feeling that the patient has toward health care workers that were originally held toward significant others in his or her life; when transference occurs, these feelings become available for exploration with the patient and this helps the patient to better understand certain feelings and behaviors.

Psychoanalytic theory (Freud)

-Freud was known as the "father of psychoanalysis"; revolutionized thinking about mental health disorders with his theory of personality structure, levels of awareness, anxiety, role of defense mechanisms and the stages of psychosexual development -*believed the vast majority of mental disorders were due to unresolved issues that originated in childhood* -

Freud's Psychosexual Latency - 6-12yr

-Growth of ego functions (social, intellectual, mechanical) and the ability to care about and relate to others outside the home; development of skills needed to cope with environment. -fixations result in difficulty identifying with others and dev social skills, leads to inadequacy and inferiority

Peplau's Theory

-Peplau known as the mother of psychiatric nursing -mainly concerned with the *processes by which the nurse helps patients make positive changes in pt health care status and well-being*. She believed that illness offered a unique opportunity for experiential learning, personal growth, and improved coping strategies and that psychiatric nurses play a unique role in facilitating this growth. Nurse provides care, compassion, and advocacy and enhances the patients comfort and well-being.

Freud's Psychosexual Phallic - 3-6yr

-Sexual identity with parent of same sex. Beginning of superego development. Conflict is Oedipus and Electra; -fixation result in reckless, self-assured and narcissistic person; lack of resolution results in inability to love and difficulty with sexual identity

Sullivan's Interpersonal Theory

-Sullivan focused on interpersonal processes that could be observed in a social framework; he defined personality as behavior that can be observed within interpersonal relationships. -*believed the purpose of all behavior is to get needs met thru interpersonal interactions and decrease or avoid anxiety*; -defined *anxiety* as any painful feeling or emotion arising from social insecurity or prevents biological needs from being satisfied; -coined the term *security operations* to describe measures employed to reduce or avoid anxiety and make up the self-system -very similar to freuds def mech; both are processes we are unaware of and used to reduce anxiety, but sullivans are interpersonal relationship activities that can be observed

Countertransference

-Unconscious feelings that the health care worker has towards a patient; exp: if the pt reminds you of someone you don't like, you may unconsciously react as if the pt were that person; Underscores the importance of maintaining self-awareness and seeking supervisory guidance as therapeutic relationships progress.

*Id* (personality systems) (Freud)

-at birth we are all ID; the id is the source of all drives, *instincts*, reflexes, needs, genetic inheritance and capacity to respond, as well as the wishes that motivate us; lacks the ability to problem solve, is not logical and *operates according to the pleasure principle*; cannot tolerate frustration and seeks to discharge tension and return to more comfort level of energy, *only needs that count are it's own*; *example*: a hungry, screaming infant

Pavlov's Classical Conditioning

-hypothesized that the psychic component was a *learned association between two events*. Found that when a neutral stimulus (a bell) was repeatedly paired with another stimulus (food that triggered salivation), eventually the sound of the bell alone could elicit salivation in the dogs.

Unconscious (levels of conscious) (Freud)

-includes all repressed memories, passions, and unacceptable urges lying deep below the surface; memories and emotions associated with trauma are placed here because they are too difficult to deal with; the unconscious exerts a powerful unseen effect on the conscious thoughts and feelings of the pt -Usually unable to retrieve this material without the assistance of a trained therapist

Preconscious (levels of conscious) (Freud)

-just below the surface of awareness; contains material that can be retrieved rather easily through conscious effort

*Superego* (personality systems) (Freud)

-the last portion of the personality to develop; *represents the moral component*. Consists of the *conscience* ("should nots" internalized from parents) and the *ego ideal* ("shoulds" internalized from parents). represents the ideal rather than the real and opposed to seeking pleasure and reason; *Seeks perfection*.

Mature and Well-adjusted Individual (Freud)

-the three systems of personality--the id, ego, and superego--work together as a team under the *administrative leadership of the ego* -if the id is too powerful, the person lacks control over impulses; if the superego is too powerful, the person is self-critical and suffers from feelings of inferiority

Defense Mechanisms (Freud)

-used to ward off anxiety by preventing conscious awareness of threatening feelings -defense mechs are *developed from the ego* ; *all operate on an unconscious level (except suppression) and they deny, falsify, or distort reality to make it less threatening* -we cannot live without them, but its possible for def mech to distort reality to such a adegree that we exp difficulty with healthy adjustment and personal growth

Erikson

-was a follower of freud but believed his theory was too restrictive and negative; thought *culture and society* also exert significant influence on personality and it develops throughout the life span -described development as occurring in 8 Stages of Development, with each having 2 possible outcomes

*Ego* (personality systems) (Freud)

-within the 1st few yrs of life as the child begins to interact, the ego develops; ego is the problem solver and reality tester; able to differentiate subjective experiences, memory images and objective reality; attempts to negotiate with the outside world; *follows the reality principle* which says "you have to delay gratification for right now; example: a hungry man feels tension arising from the id that wants fed, ego allows him to think about the hunger and plan when and where he can eat, this is known as reality testing

4 steps of Systemic Desensitization

1.The patient's fear is broken down into its components by *exploring the particular stimulus cues* to which the patient reacts. For example, certain situations may precipitate a phobic reaction, whereas others do not. Crowds at parties may be problematic, whereas similar numbers of people in other settings do not cause the same distress. 2.The *patient is incrementally exposed to the fear*. For example, a patient who has a fear of flying is introduced to short periods of visual presentations of flying—first with still pictures, then with videos, and finally in a busy airport. The situations are confronted while the patient is in a relaxed state. Gradually, over a period of time, exposure is increased until anxiety about or fear of the object or situation has ceased. 3.The patient is instructed in *how to design a hierarchy of fears*. For fear of flying, a patient might develop a set of statements representing the stages of a flight, order the statements from the most fearful to the least fearful, and use relaxation techniques to reach a state of relaxation as they progress through the list. 4.The patient *practices these techniques every day*.

Identify vs. Role Confusion (12-20yr) Erikson's 8 Stages of Development

Adolescence. Making transition from childhood to adulthood; developing sense of identity. Identity - Sense of personal identity; fidelity Role Confusion - Confusion about who one is; weak sense of self

Catastrophizing

An extreme form of magnification in which the very worst is assumed to be a probable outcome.

Personalization

Assuming responsibility for an external event or situation that was likely outside personal control.

Behavior theory

Based on the assumption that *changes in maladaptive behavior can occur without insight into the underlying cause*. This approach works best when it is directed at specific problems and the goals are well defined. *Behavior therapy is effective in treating people with phobias, alcoholism, schizophrenia, and many other conditions.*

Psychodynamic Therapy

Follows the psychoanalytic model by using many of the tools of psychoanalysis, such as free association, dream analysis, transference, and countertransference; however, the therapist has increased involvement and interacts with the patient more freely than in traditional psychoanalysis. -The therapy is oriented more to the here and now and makes less of an attempt to reconstruct the developmental origins of conflicts -lasts longer than other therapies, can extend to 20+ sessions; best candidates are the "worried well" -pts w/psychosis, severe depression, bipolar, etc. are not approp candidates for this treatment - supportive therapies are more appropriate for pts with these disorders

Negative Reinforcement

Increasing the probability of a behavior by *removing unpleasant consequences*

Trust vs. Mistrust (0-1.5yr) Erikson's 8 Stages of Development

Infancy. Forming attachment to mother, which lays foundations for later trust in others. Trust - Sound basis for relating to other people; trust in people; faith and hope about environment and future Mistrust - General difficulties relating to people effectively; suspicion; trust-fear conflict; fear of future

Punishment

Involves applying a stimulus after a behavior in order to reduce likelihood that the behavior will occur again in the future.

Watson's Behaviorism Theory

Personality traits and responses-adaptive and maladaptive-were socially learned through *classical conditioning*. Thought that *controlling the environment could mold behavior* and that anyone could be trained to be anything, from a beggar man to a merchant.

Milieu Therapy

Philosophy of care in which all parts of the environment are considered to be therapeutic opportunities for growth and healing. Includes the people (patients and staff), setting, structure, and emotional climate.

Positive Reinforcement

The presentation of a reward immediately following a behavior, making the behavior more likely to occur in the future.

Initiative vs. Guilt (3-6yr) Erikson's 8 Stages of Development

Preschool. Becoming purposeful and directive. Initiative - Ability to initiate one's own activities; sense of purpose Guilt - Aggression/fear conflict; sense of inadequacy or guilt

Industry vs. Inferiority (6-12yr) Erikson's 8 Stages of Development

School age. Developing social, physical, and school skills. Industry - Competence; ability to work Inferiority - Sense of inferiority; difficulty learning and working

2. Maslow's theory of humanistic psychology has provided nursing with a framework for A. holistic assessment. B. determining moral development. C. identifying the potential for success in therapy. D. conducting nurse-client interpersonal interactions.

ans A - Central to Maslow's theory is the assumption that human beings are active rather than passive participants in life, striving for self-actualization. Maslow (1968) focuses on human need fulfillment, which he describes in six incremental stages, beginning with physiological survival needs and culminating in self-transcendent needs (see Figure 2-5 in the text). Although these needs are present in all human beings, the behaviors that emanate from them differ according to a person's individual biological makeup and environmental factors. This picture is broader and more holistic. Maslow does not address moral development, the potential for success, or interactions directed toward interpersonal relationships. Reference: pp. 31-32

8. A cognitive therapist would help a client restructure the thought "I am stupid!" to A. "What I did was stupid." B. "I am not as smart as others." C. "Things usually go wrong for me." D. "Things like this should not happen to anyone."

ans A - Cognitive therapists help clients identify, reality test, and correct distorted conceptualizations and dysfunctional beliefs, such as realizing that doing a stupid thing does not mean the person is stupid.

1. One implication of Freud's theory of the unconscious on psychiatric mental health nursing is related to the consideration that conscious and unconscious influences can help nurses better understand A. the root causes of client suffering. B. the client's immature behavior. C. the client's interpersonal interactions. D. the client's psychological ability to reason.

ans A - Freud's theory of the unconscious is particularly valuable as a baseline for considering the complexity of human behavior. By considering conscious and unconscious influences, a nurse can develop and begin to think about the root causes of client suffering. Reference: pp. 21-22`

3. The premise underlying behavioral therapy is A. Behavior is learned and can be modified. B. Behavior is a product of unconscious drives. C. Motives must change before behavior changes. D. Behavior is determined by cognitions; change in cognitions produces new behavior.

ans A - The premise underlying behavior therapy is that behavior is learned and can be modified. Behaviorists agree that behavior can be changed without insight into the underlying cause. Reference: p. 27

6. Which statement best clarifies the difference between the art and the science of nursing? A. The art is the care, compassion, and advocacy component, and the science is the applied knowledge base. B. The art is the way in which knowledge is applied, and the science is the technological aspects of caregiving. C. The art is the applied technology of practice, and the science is the problem-solving and teaching aspects of caregiving. D. The art is the assessing and planning phases of the nursing process, and the science lies in implementing and evaluating.

ans A - This statement reflects the larger thinking of the profession. Reference: p. 24

4. The nurse planning care for a 14-year-old needs to take into account that the developmental task of adolescence is to A. establish trust. B. gain autonomy. C. achieve identity. D. develop a sense of industry.

ans C - According to Erikson, the task of adolescence is to achieve identity rather than to be left in role confusion. A sense of identity is essential to making the transition into adulthood. Reference: p. 23; Table 2-2

5. Sullivan viewed anxiety as A. emotional experience felt after the age of 5 years. B. a sign of guilt in adults. C. any painful feeling or emotion arising from social insecurity. D. adults trying to go beyond experiences of guilt and pain.

ans C - According to Sullivan, the purpose of all behavior is to get needs met through interpersonal interactions and decrease or avoid anxiety. He viewed anxiety as a key concept and defined it as any painful feeling or emotion arising from social insecurity or blocks to getting biological needs satisfied. Reference: p. 24

1. An important difference between the developmental theories of Freud and Erikson is A. Freud considers the entire life span from birth to old age. B. Freud focuses to a greater extent on cognitive development. C. Erikson viewed individual growth in terms of social setting. D. Erikson focuses on the development of individual moral thinking.

ans C - Erikson placed greater emphasis on the role of the ego. He also stressed that an individual's development is influenced by more than the restricted mother-child-father triangle and that culture and society exert significant influence on personality. Sigmund Freud advanced the first theory of personality development and articulated levels of awareness (unconscious, preconscious, conscious) and demonstrated the influence of our unconscious behavior on everyday life, as evidenced by the use of defense mechanisms. Freud identified three psychological processes of personality (id, ego, superego) and described how they operate and develop and articulated one of the first modern developmental theories of personality, based on five psychosexual stages. Reference: pp. 22-23

9. The nurse providing anticipatory guidance to the mother of a toddler should advise that childhood temper tantrums are best handled by A. giving the child what he is asking for. B. scolding the child when he displays tantrum behaviors. C. spanking the child at the onset of the tantrum behaviors. D. ignoring the tantrum and giving attention when the child acts appropriately.

ans D - Ignoring the tantrum provides no reinforcement of the undesirable behavior. Instead, approval and reinforcement are given when the child is behaving in the desired way. This is an example of absence of reinforcement, or extinction. Reference: pp. 24-25

1. Which contribution to modern psychiatric mental health nursing practice was made by Freud? a.The theory of personality structure and levels of awareness b.The concept of a "self-actualized personality" c.The thesis that culture and society exert significant influence on personality d.Provision of a developmental model that includes the entire life span

answer A

3. The concepts at the heart of Sullivan's theory of personality are: a.needs and anxiety. b.basic needs and meta-needs. c.schemas, assimilation, and accommodation. d.developmental tasks and psychosocial crises.

answer A

5. Providing a safe environment for patients with impaired cognition, planning unit activities to stimulate thinking, and including patients and staff in unit meetings are all part of: a.milieu therapy. b.cognitive-behavioral therapy. c.behavior therapy. dinterpersonal psychotherapy.

answer A

5. The nurse is working with a client experiencing both post-partum depression and very low self-esteem. The client is distrustful of unit staff and "just wants to go home." Initially the nurse's priority is to A. establish trust with the client. B. teach the client effective mothering skills. C. identify positive traits the client possesses. D. focus on preparing for a speedy discharge.

answer A - Maslow describes safety as a basic need, meaning that it is so basic to existence that it must be resolved to reduce the tension associated with it. These needs have the greatest strength and must be satisfied before a person turns his attention to higher-level needs. Reference: p. 31

When asked, the nurse explains that a client's id is A. the control over the emotional frustration he feels over the loss of his job. B. the source of his instincts to save himself from hurting himself. C. not in place since he was abused after the age of 5 months. D. able to differentiate his believed experiences and reality.

answer B - At birth we are all id. The id is the source of all drives, instincts, reflexes, needs, genetic inheritance, and capacity to respond as well as all the wishes that motivate us. Reference: pp. 20-21

10. Which of the following is considered a primary behavioral theorist? A. Freud B. Skinner C. Sullivan D. Peplau

answer B - B. F. Skinner (1904-1990) represented the second wave of behavioral theorists and is recognized as one of the prime movers behind the behavioral movement. Reference: p. 26

9. Role-playing is associated with which type of therapy? A. Psychoanalysis B. Modeling C. Operant conditioning D. Systematic desensitization

answer B - In modeling, the therapist provides a role model for specific identified behaviors, and the client learns through imitation. The therapist may do the modeling, provide another person to model the behaviors, or present a video for the purpose. Some behavior therapists use role-playing in the consulting room for modeling therapy. Reference: p. 27

6. Using Maslow's model of needs, the nurse providing care for an anxious client identifies the priority intervention to be A. assessing the client's success at fulfilling her appropriate developmental level tasks. B. assessing the client for her strengths upon which a nurse-client relationship can be based. C. planning one-on-one time with the client to assist in identifying the fears behind her anxiety. D. evaluating the client's ability to learn and retain essential information regarding her condition.

answer B - The value of Maslow's model in nursing practice is twofold. First, the emphasis on human potential and the client's strengths is key to successful nurse-client relationships. The second value lies in establishing what is most important in sequencing of nursing actions in the nurse-client relationship. Reference: pp. 31-32

2. The theory of interpersonal relationships developed by Hildegard Peplau is based on the foundation provided by which early theorist? a.Freud b.Piaget c.Sullivan d.Maslow

answer C

4. The premise that an individual's behavior and affect are largely determined by his or her attitudes and assumptions about the world underlies: a.modeling. b.milieu therapy. c.cognitive-behavioral therapy. d.psychoanalytic psychotherapy.

answer C

7. A suspicious client who smokes several packs of cigarettes daily and drinks large quantities of coffee and soda as he is able to afford reacts to every nursing intervention with sarcasm. When asking for advice, the nurse manager's most helpful response is A. "You are dealing with a very difficult and resistant client; just keep with your plan." B. "If you haven't been able to establish client trust by now, ask for a change of assignment." C. "Remember that sarcasm represents the oral-stage fixation of development." D. "You are attempting to work with a client who likes to keep others off-balance."

answer C - According to Freud's psychosexual stages of development, this client is exhibiting the oral (0-1 year) personality traits: fixation at the oral stage is associated with passivity, gullibility, and dependence; the use of sarcasm; and the development of orally focused habits (e.g., smoking, nail biting). Reference: p. 21

2. According to Freud, the nurse recognizes that a client experiencing dysfunction of the conscious as part of the mind will have problems with A. only recent memory. B. both recent and long-term memory. C. all material that the person is aware of at any one time. D. only material that should be easily retrieved.

answer C - Freud described the conscious part of the mind as the tip of the iceberg. It contains all of the material that the person is aware of at any one time. Reference: pp. 20-21

8. A client with a history of three failed engagements is concerned about being "too possessive." This concern supports a need for which type of therapy? A. Psychodynamic B. Cognitive C. Behavioral D. Interpersonal.

answer D - Interpersonal psychotherapy is considered to be effective in resolving problems of grief, role disputes, role transition, and interpersonal deficit. Reference: pp. 24-25

4. As a result of Harry Stack Sullivan's work, the mental health nurse is involved in providing clients with A. security operations. B. psychoanalysis. C. analysis of behavior patterns. D. a psychotherapeutic environment.

answer D - Sullivan demonstrated that a psychotherapeutic environment, revolving around an accepting atmosphere that provides numerous opportunities for practicing interpersonal skills and developing relationships, is an invaluable treatment tool. This method is used today in virtually all residential and day hospital settings. Reference: pp. 24-25

Key points

• Sigmund Freud advanced the first theory of personality development. • Freud articulated levels of awareness (unconscious, preconscious, conscious) and demonstrated the influence of our unconscious behavior on everyday life, as evidenced by the use of defense mechanisms. • Freud identified three psychological processes of personality (id, ego, superego) and described how they operate and develop. • Freud articulated one of the first modern developmental theories of personality, based on five psychosexual stages. • Various psychoanalytic therapies have been used over the years. Currently, a short-term, time-limited version of psychotherapy is common. • Erik Erikson expanded on Freud's developmental stages to include middle age through old age. Erikson called his stages psychosocial stages and emphasized the social aspect of personality development. • Harry Stack Sullivan proposed the interpersonal theory of personality development, which focuses on interpersonal processes that can be observed in a social framework. 3435 • Hildegard Peplau, a nursing theorist, developed an interpersonal theoretical framework that has become the foundation of psychiatric mental health nursing practice. • Abraham Maslow, the founder of humanistic psychology, offered the theory of self-actualization and human motivation that is basic to all nursing education today. • Cognitive-behavioral therapy is the most commonly used, accepted, and empirically validated psychotherapeutic approach. • A biological model of mental illness and treatment dominates care for psychiatric disorders. • Milieu therapy is a philosophy of care in which all parts of the environment are considered to be therapeutic opportunities for growth and healing. The milieu includes the people (patients and staff), setting, structure, and emotional climate