Chapter 3: Psychosocial Theories and Therapy
A client was supposed to meet a friend at a local theater to see a movie. The friend never showed up. The client's initial thought was, "My friend didn't come because my friend doesn't like me." This automatic thought was most likely inferred from which irrational belief?
"I'm worthless, so no one could really want to be my friend"
The nurse is working with a family that has indicated a desire to learn better communication skills. The nurse role-plays assertive communication techniques with each family member. The role-play is an example of which type of family intervention?
Behavioral
Which statement is inconsistent with the concept of milieu therapy, originally developed by Henry Stack Sullivan?
Clients work independently to solve day-to-day problems
A nurse working on a psychiatric unit is helping clients to understand how individual perceptions determine a person's response or behavior in stressful situations. Which therapeutic approach is the nurse employing?
Cognitive therapy
A nurse therapist feels sad after sessions with a client. The client's passiveness reminds the nurse of a family member who led a very unhappy life. What is the term for this emotional dynamic?
Countertransference
For Freud, the therapist's emotional reactions to the client based on personal unconscious needs and conflicts is termed ...
Countertransference
The nurse has a client who reminds the nurse of the nurse's sister, with whom the nurse has a close and positive relationship. This phenomenon is best characterized by which term?
Countertransference
Which concept(s) can the nurse utilize in development of a positive nurse-client relationship?
Empathic linkage Caritas processes Unconditional positive regard
The nurse is working with a client who is grieving over the death of a parent. Which concept is the nurse demonstrating when stating to the client, "I know how sad I was when I lost my parent"?
Empathy
Which action by the group leader demonstrates effective leadership?
Encouraging participation by all members
When the psychiatric nurse is aware of the cultural beliefs of a client diagnosed with bipolar disorder, the therapeutic process is most enhanced by what?
Facilitating the nurse's understanding of how these beliefs affect the client's perception of the disorder
The nurse is aware of the changing demographics and growth of ethnic subcultures of the community and is trying to ensure that the needs for psychotherapy are effectively met. How should the nurse best work toward this goal?
Foster cultural competency among those caregivers who perform psychotherapy and counseling
A 35-year old client states to the nurse "I need to get better so I can go back to work and take care of my family." The nurse recognizes that the client is in which stage of Erickson's development?
Generativity versus stagnation
Which therapeutic factor refers to the group members' relationships to the therapist and other group members?
Group Cohesion
When focusing on the primary goal of crisis therapy, a psychiatric nurse counsels a single mother who is recovering from a suicide attempt to help her achieve which goal?
Help regain confidence in her previous ability to cope with the stress of being a single parent
Which nursing theorist was opposed to the idea that the client passively receives treatment?
Hildegard Peplau
One of the most valuable applications of group therapy is to allow group members to gain an understanding concerning what personal aspect?
Interacting with others and receiving feedback on how others perceive and react to the client
When describing the influence of Harry Stack Sullivan on psychiatric-mental health nursing, which would an instructor address as a major concept?
Interpersonal relations
Which nursing theory focuses on the nurse-client relationship and development of problem-solving skills?
Interpersonal theory
Which phase of individual psychotherapy involves establishing mutual boundaries of the relationship between the client and the mental health nurse?
Introductory
The nurse is caring for a client postoperatively who has recently experienced a family member's death. The nurse is demonstrating empathetic linkage with the client with which action?
Telling the client that it is normal to feel sad when someone has died
The nurse is caring for a 4-year-old child during a well-child visit. According to the Sullivan's stages of development, which behavior would the nurse expect to find in this child?
The child performs actions to earn praise from parents
For a client who has anxiety, the individual psychotherapy process moves into the working phase when which occurs?
The client expresses a willingness to discuss what the client thinks is the cause of the anxiety
The nurse is considering a client's hierarchy of needs according to Maslow's theory. Place the needs of a client in order from basic to higher level.
The client's need for food, sleep, and exercise The client's need to feel safe in the environment The client's need for family involvement The client's need for a positive self-image
Which concept should the nurse consider prior to a formal client referral to a therapeutic group?
The client's social skills
The nurse conducts a family assessment. Which question assesses the use of informal networks?
"Are there any extended family members in the area who can assist your parents?"
Which statement would indicate that the group is in the working phase of development?
"I don't understand why Mary doesn't see my point of view, and frankly it really irritates me when she does that!"
The nurse is discussing a client's plan of care with the client. Which statement by the nurse demonstrates conditioning as a form of learning?
"If you can attend all group sessions, you will be able to be the group leader soon."
Individual psychotherapy consists of three phases. Which statement by the group therapist would reflect that the group is in the working phase of therapy?
"James, when Shane speaks, it seems you become angry and tend to withdraw"
An instructor is teaching a class about the use of cognitive therapies in psychiatric nursing. Which statement made by a student identifies a need for further instruction?
"Lengths of stay for clients in inpatient settings are becoming longer each year"
A psychiatric-mental health nurse is providing care for a client who lives in the community. Which precondition is necessary before Peplau's interpersonal theory becomes an accurate framework for the nurse's practice?
Prolonged contact between the nurse and the client
Of the following, which is NOT typically applied to individual therapy?
Promoting cohesion
A client has entered treatment for substance abuse and psychotherapy. The client asks about what to expect from individual psychotherapy sessions if the client "works really hard at it." The nurse can answer the question most effectively with which response?
"Psychotherapy will help you adapt healthy coping mechanisms"
A client with a history of trauma has told the nurse that he is pursuing psychoanalysis with an independent therapist. What statement by the client would be most consistent with a Freudian approach to psychoanalysis?
"We're spending quite a bit of time exploring the themes in my dreams"
When using solution-focused behavior therapy (SFBT), which question is appropriate for the nurse to include in the initial session for a client who is experiencing anxiety?
"What is going on that made you choose to seek help for your anxiety?"
Which cognitive theorist conceptualized distorted cognitions as a basis for depression?
Aaron Beck
Who developed cognitive therapy for persons with depression?
Aaron Beck
Degree of agreement between the leader's norms and the group's norms, ability to deal with members' infractions, and conformity to group norms are characteristics of what kind of groups?
All groups
According to Yalom (2005), there are 11 therapeutic factors through which changes occur in group psychotherapy. Which factor correlates with learning to give to others?
Altruism
Some behavioral therapists believe that seclusion and restraint are forms of punishment. It may be assumed that these therapists view seclusion and restraint as:
An unpleasant stimulus that happens after a certain unwanted behavior.
Which developmental conflict correlates with the toddler, according to Erikson's eight stages of man?
Autonomy vs. shame and doubt
Cognitive techniques focus on the client's patterns of which type of thinking?
Automatic
What best describes the use of psychotherapy as a mental health intervention?
Bringing about a change in feelings, attitudes, thinking, and behavior
The nurse explains to the client that extra television time will be awarded based on appropriate behavior during group therapy. Which theorist's concepts is the nurse utilizing?
B. F. Skinner's operant conditioning
A nurse is leading a group. During the session, the nurse observes the members testing each other to see if they can trust each other. The nurse leader also notes that the members are testing the nurse, too. The nurse interprets this behavior as characteristic of which phase?
Beginning
The client's parents have begun a program of therapy that includes giving the client a token each time the client follows directions. Which theoretical framework provides the background for such a program?
Behavioral theory
A nurse demonstrates a sound understanding of the use of ego defense mechanisms by providing which explanation?
Can be either a therapeutic or a pathological way to manage stress
The nurse is working with a client seeking treatment for bulimia and determines that cognitive restructuring will help build the client's self-esteem. Which best describes the goals of cognitive restructuring?
Change distorted thinking and the subsequent behaviors
Aaron T. Beck is associated with ...
Cognitive therapy
Which group role is best reflected by the client who consistently validates members' contributions, tries to be the "mediator" between members, and interprets the group's procedures?
Group building and maintenance
Two staff nurses in a psychiatric emergency department are being considered for a promotion that will be announced via memo on a unit bulletin board. They work in a collaborative team environment, have been colleagues for 15 years, and socialize outside work. Nurse A hears from a third colleague that Nurse B was promoted. Nurse A goes into the staff coffee room and slams several cupboard doors. A custodian enters and remarks, "You seem pretty upset." Nurse A replies, "I am not at all upset." In this instance, Nurse A is probably using:
Denial
Which is one common mistake that people working in the helping professions do when applying theory to the therapeutic process?
Develop an overzealous commitment to one form of therapy, ignoring the benefits that other types of therapies may have for a given individual
The nurse leads a small group that is discussing the impact of eating disorders on everyday life. Which action does the nurse implement as the group recorder?
Documenting group suggestions
An 81-year-old resident of a long-term care facility has confided in the nurse that the client is profoundly fearful of death. Within Erikson's psychosocial theory, this statement may suggest a failure to resolve which developmental conflict?
Ego integrity vs. despair
A client describes feeling sad and hopeless during the admission assessment. After the assessment, the nurse feels disheartened. Which concept can explain the feelings the nurse is experiencing?
Empathic linkage
The nurse leader of a group observes a group member attempting to stimulate the group to action or decision. The nurse interprets this member as fulfilling which role?
Energizer
Which is an overarching treatment goal for the client who is prescribed cognitive behavioral therapy (CBT) for the treatment of depression?
Engaging in self-care
A nurse is performing discharge planning for a client who will be returning home to live with family members. Which concept will be most important for the nurse in considering client needs?
Family dynamics
Several members of a self-help group are making T-shirts for the group to wear in a parade. This is an example of which element of group therapy?
Group cohesiveness
Which group characteristic is lacking in the following statement: "Our group never talks about really emotional issues. I mean, no one ever cries."
Group cohesiveness
Within a group, facilitating verbal and nonverbal communication to meet treatment goals individually and with the entire group refers to the ..
Group leader
Within a group, facilitating verbal and nonverbal communication to meet treatment goals individually and with the entire group refers to the ...
Group leader
Which psychotherapy pioneer introduced the term parataxis?
Harry Stack Sullivan
Which theorist viewed interpersonal relations as a basis of human development and behavior?
Harry Stack Sullivan
From the standpoint of cognitive therapy, the term cognition refers to what?
How clients think about themselves and their world
A nurse is reading a journal article that reviews the various theories of human behavior and mental illness. One of the theories described states that all human beings have the potential for goodness and that therapy helps clients explore their own ability to develop self-worth. The nurse is reading about which theory?
Humanistic Theory
A nurse is planning an educational program for families with a mentally ill relative. Which goal is consistent with the current objectives of family education?
Improved family quality of life
To facilitate the understanding of a crisis, which intervention should the nurse employ?
Listen and assist the client to articulate his or her feelings
One particular member of a medication group always seeks out the nurse for one-on-one conversation before each meeting and during scheduled breaks during meetings. What should be the nurse's initial response?
Make a point of engaging with other group members before and after meetings and during breaks
A 55-year-old client is being treated for narcissistic personality disorder. The therapist shows caring and appropriate regard for the client. The therapist's behavior is an example of which concept of behavior theory?
Modeling
What action by the psychiatric mental health nurse best demonstrates the behaviorist theories of B. F. Skinner?
Offering to take a client for an outside smoke break if the client agrees to eat a nutritious meal at the scheduled meal time
Which concept states that if a certain behavior is rewarded with praise, the behavior will probably be repeated?
Operant conditioning
What is the most basic need, according to Maslow's hierarchy of needs?
Physiological
The nurse is planning a social skills training group for clients with schizophrenia. Which techniques should be used to help the clients gain social skills?
Provide rewards for small approximations of the desired behaviors
A therapist is planning care for an adult client with past trauma and neglect. The therapeutic approach will be accessing the client's unconscious conflicts from their past and resolving the issues with the mature adult mind. Which therapy is the therapist utilizing?
Psychoanalysis
The psychiatrist states that repressed memories in the client's unconscious are causing depression. This reasoning implies that the psychiatrist uses which theory?
Psychoanalytic theory
The primary purpose for generalist nurses to develop skills with psychosocial interventions is:
Psychosocial interventions are needed in all nursing practice settings
The concept that irrational beliefs lead to negative emotions underlies which psychotherapeutic approach?
Rational emotive behavior therapy
The nurse is providing hygiene care for a 70-year-old client in a nursing home who states that the client does not like the physician. Later, when the physician enters the room, the nurse notes that the client is very friendly with the physician, complimenting the physician's care. Which defense mechanism is this client displaying?
Reaction-formation
A nurse working in a psychiatric facility identifies the goal of cognitive therapy (CT) to be what?
Restructure how a person perceives events
According to Maslow, an individual who has developed to the individual's fullest potential has achieved what level of his hierarchy?
Self-actualization
A group of psychiatric-mental health nurses are reviewing information about different theorists who have played a role in shaping pyschiatric-mental health nursing practice. The group demonstrates understanding of the information when they identify which theorist as proposing that adult sexuality is an end product of a complex process of development that begins in early childhood and involves a variety of body functions or areas that correspond to stages of relationships, especially with parents?
Sigmund Freud
Which theorist developed the psychoanalytic theory?
Sigmund Freud
A client has lost a job of 20 years. This is an example of which type of crisis?
Situational
Which defense mechanism is being used when a student decides not to think about a parent's illness but to rather concentrate on studying for an upcoming test?
Supression
Health promotion and health maintenance interventions related to psychiatric-mental health nursing include what?
Teaching stress-reduction techniques
When assessing a client from a Freudian developmental perspective, the nurse determines that the client is functioning in the latency stage based on which behavior?
The client is beginning to develop inner control over aggressive impulses
While assessing a client, the nurse notes the client is functioning at the fourth level according to Maslow's hierarchy of needs. Which observation of the client led the nurse to conclude this?
The client longs to have validation for success and accomplishments
The nurse determines that Pavlov's theory of classical conditioning is demonstrated with which client behavior?
The client states "My stomach is growling" with the sound of the food cart in the hallway
The significance of the use of praise in the therapeutic relationship between the psychiatric nurse and the school-aged client is particularly important for which reason?
The client takes pleasure in individual accomplishments and develops confidence
The nursing theorist Peplau identified which as the essence of psychiatric-mental health nursing?
The nurse-client relationship
The nurse provides care for a client who is hospitalized in an acute inpatient psychiatric setting. The client experiences hallucinations. Which is the best approach to include in this client's plan of care?
The use of solution-focused energy
Which explains why theories are important to psychiatric-mental health nursing?
Theories lead to the expansion of knowledge.
Which is accurate regarding growth inhibiting individual roles of group members?
They detract from group functioning
Why are the developmental theories important to nursing practice?
They outline the process of human growth and development
An adult client is receiving psychoanalysis with a therapist and realizes that they feel angry toward their parents for past emotional neglect. The client begins to feel angry toward the therapist. Which term describes this phenomenon?
Transference
When a therapist is interviewing a client diagnosed with depression, the client's feelings toward the client's parents as a child are being directed at the therapist. This is an example of:
Transference
The following statements are heard in a group: "You can't say that because you don't really know me." "I wonder if the therapist is going to leave?" and "I'm not sure whether or not I can really talk freely." These best reflect which group theme?
Trust and belonging
A client is being discharged from the psychiatric unit this afternoon, and a nurse needs to teach the client about discharge medications. The client is exhibiting signs of moderate anxiety about the upcoming discharge. Based on Peplau's views regarding anxiety, the nurse would expect to implement the education plan at which time?
When the client's anxiety decreases to a mild level
A group is trying to handle issues related to dominance, control, and power within the group. In what stage of group development is this group?
Working
