Mental Health Ch.7

Devaluation

Attributing exaggerated negative qualities to self or others A boy has been rejected by his long-time girlfriend. He tells his friends that he realizes that she is stupid and ugly.

Idealization

Attributing exaggerated positive qualities to others An adult falls in love and fails to see the negative qualities in the other person.

Sublimation

Channeling potentially maladaptive feelings or impulses into socially acceptable behavior An adolescent boy is very angry with his parents. On the football field, he tackles someone very forcefully.

Splitting

Compartmentalizing opposite affect states and failing to integrate the positive and negative qualities of the self or others into cohesive images Self and object images tend to alternate between polar opposites: exclusively loving, powerful, worthy, nurturing, and kind or exclusively bad, hateful, angry, destructive, rejecting, or worthless. One friend is wonderful and another former friend, who was at one time viewed as being perfect, is now believed to be an evil person.

Help-Rejecting Complaining

Complaining or making repetitious requests for help that disguise covert feelings of hostility or reproach toward others, which are then expressed by rejecting the suggestions, advice, or help that others offer (complaints or requests may involve physical or psychological symptoms or life problems) A college student asks a teacher for help after receiving a bad grade on a test. Every suggestion the teacher has is rejected by the student.

Rationalization

Concealing the true motivations for one's own thoughts, actions, or feelings through the elaboration of reassuring or self-serving but incorrect explanations A man is rejected by his girlfriend but explains to his friends that her leaving was best because she was beneath him socially and would not be liked by his family.

Altruism

Dedicating life to meeting the needs of others (receives gratification either vicariously or from the response of others) After being rejected by her boyfriend, a young girl joins the Peace Corps.

Humor

Emphasizing the amusing or ironic aspects of the conflict or stressor A person makes a joke right after experiencing an embarrassing situation.

Autistic Fantasy

Excessive daydreaming as a substitute for human relationships, more effective action, or problem solving A young man sits in his room all day and dreams about being a rock star instead of attending a baseball game with a friend.

Intellectualization

Excessive use of abstract thinking or the making of generalizations to control or minimize disturbing feelings After rejection in a romantic relationship, the rejected explains the relationship dynamics to a friend.

Repression

Expelling disturbing wishes, thoughts, or experiences from conscious awareness (the feeling component may remain conscious, detached from its associated ideas) A woman does not remember the experience of being raped in the basement but does feel anxious when going into that house.

Dissociation

Experiencing a breakdown in the usually integrated functions of consciousness, memory, perception of self or the environment, or sensory and motor behavior An adult relates severe sexual abuse experienced as a child but does it without feeling. She says that the experience was as if she were outside her body watching the abuse.

Anticipation

Experiencing emotional reactions in advance or anticipating consequences of possible future events and considering realistic, alternative responses or solutions A parent cries for 3 weeks before her last child leaves for college. On the day of the separation, the parent spends the day with friends.

self-assertion

Expressing feelings and thoughts directly in a way that is not coercive or manipulative An individual reaffirms that going to a ball game is not what she wants to do.

Projection

Falsely attributing to another one's own unacceptable feelings, impulses, or thoughts A child is very angry at a parent but accuses the parent of being angry.

Projective identification

Falsely attributing to another one's own unacceptable feelings, impulses, or thoughts. Unlike simple projection, the individual does not fully disavow what is projected. Instead, the individual remains aware of his or her own affect or impulses but misattributes them as justifiable reactions to the other person. Frequently, the individual induces the very feelings in others that were first mistakenly believed to be there, making it difficult to clarify who did what to whom first. A child is mad at a parent, who in turn becomes angry at the child but may be unsure of why. The child then feels justified at being angry with the parent.

Omnipotence

Feeling or acting as if one possesses special powers or abilities and is superior to others An individual tells a friend about personal expertise in the stock market and the ability to predict the best stocks.

passive aggressive

Indirectly and unassertively expressing aggression toward others. There is a facade of overt compliance masking covert resistance, resentment, or hostility. One employee doesn't like another, so he secretly steals her milk from the office refrigerator. She is unaware of his hostile feelings.

supression

Intentionally avoiding thinking about disturbing problems, wishes, feelings, or experiences A student is anxiously awaiting test results but goes to a movie to stop thinking about it.

Self observation

Reflecting feelings, thoughts, motivation, and behavior and responding to them appropriately An individual notices an irritation at his friend's late arrival and decides to tell the friend of the irritation.

Denial

Refusing to acknowledge some painful aspect of external reality or subjective experience that would be apparent to others (psychotic denial used when there is gross impairment in reality testing) A teenager's best friend moves away, but the adolescent says he does not feel sad.

Isolation of affect

Separation of ideas from the feelings originally associated with them The individual loses touch with the feelings associated with a rape while remaining aware of the details.

Reaction formation

Substituting behavior, thoughts, or feelings that are diametrically opposed to one's own unacceptable thoughts or feelings (this usually occurs in conjunction with their repression) A wife finds out about her husband's extramarital affairs and tells her friends that she thinks his affairs are perfectly appropriate. She truly does not feel, on a conscious level, any anger or hurt.

nonjudgmental attitude

The development of self-awareness will enhance the nurse's objectivity and foster a nonjudgmental attitude, which is so important for building and maintaining trust throughout the nurse-patient interaction.

Nurse psychological state

The nurse's psychological state also influences how he or she analyzes patient information and selects treatment interventions.

Nurse social bias

The nurse's social biases can be particularly problematic for the nurse-patient interaction. Before a nurse can therapeutically care for a patient, he/she must examine their own feelings regarding the patient and their illness. For example, a nurse with very strong feelings about substance abuse may not be able to put aside his/her own feelings in order to objectly care for the patient. NURSE, KNOW THYSELF FIRST!

Personal zone

The patient usually will allow the nurse to enter the personal zone but will express discomfort if the nurse breaches the intimate zone. For the nurse, the difficulty lies in differentiating the personal zone from the intimate zone for each patient. 18inches to 4 feet

Patient communication influencers

The patient's communication is immediately influenced by the nurse's physical characteristics: age, gender, body weight, height, ethnic or racial background, and any other observed physical characteristics.

Displacement

Transferring a feeling about, or a response to, one object onto another (usually less threatening), substitute object A child is mad at her mother for leaving for the day but says she is really mad at the sitter for serving her food she does not like.

Affiliation

Turning to others for help or support (sharing problems with others without implying that someone else is responsible for them) An individual has a fight with her spouse and turns to her best friend for emotional support.

Acting out

Using actions rather than reflections or feelings during periods of emotional conflict A teenager gets mad at his parents and begins staying out late at night.

Undoing

Words or behavior designed to negate or to make amends symbolically for unacceptable thoughts, feelings, or actions A man has sexual fantasies about his wife's sister. He takes his wife away for a romantic weekend.

Defense mechanisms

also known as coping styles. help an individual respond to and cope with difficult situations, emotional conflicts and external stressors. The use of defense mechanisms becomes maladaptive when its persistent use interferes with the person's ability to function and quality of life

nonverbal communication

includes gestures, expressions, and body language. Both the patient and the nurse use verbal and nonverbal communication. To respond therapeutically, the nurse assesses and interprets all forms of patient communication. Non verbal communication may be visible by body language, tattoos, piercings, inability to make eye contact or staring. People with psychiatric problems often have difficulty verbally expressing themselves and interpreting the emotions of others. Because of this, nurses need to continually assess the nonverbal communication needs of patients.

Passive listening

involves sitting quietly and letting the patient talk. A passive listener allows the patient to ramble and does not focus or guide the thought process. This form of listening does not foster a therapeutic relationship. Body language during passive listening usually communicates boredom, indifference, or hostility (

Professional Boundaries

professional boundaries are also essential to consider in the context of the nurse-patient interaction.For example, in a friendship, there is a two-way sharing of personal information and feelings, but in nurse-patient relationship interactions, the focus is on the patient's needs, and the nurse generally does not share personal information or attempt to meet his or her own needs through the relationship.

When to refer the patient

sometimes a nurse realizes that some attitudes are too ingrained to support an effective interaction with a patient with different beliefs. In such cases, the nurse should refer the patient to someone with whom the patient is more likely to develop a successful therapeutic relationship.

Self-disclosure

telling the patient personal information, generally is not a good idea.If a patient asks the nurse personal questions, the nurse should elicit the underlying reason for the request. The nurse can then determine how much personal information to disclose, if any. In revealing personal information, the nurse should be purposeful and have identified therapeutic outcomes. As appropriate, redirecting the patient, giving a neutral or vague answer, or saying, "Let's talk about you," may be all that is necessary to limit self-disclosure. In some instances, nurses may need to tell the patient directly that the nurse will not share personal information.

Boundaries

the defining limits of individuals, objects, or relationships.Psychological boundaries are established in terms of emotional distance from others—how much of our innermost feelings and thoughts we want to share. Social boundaries, such as norms, customs, and roles, help us establish our closeness and place within the family, culture, and community. Boundaries are not fixed but dynamic.

Active listening

the nurse focuses on what the patient is saying interprets the interaction, and responds to the message objectively. While listening, the nurse concentrates only on what the patient says and the underlying meaning. The nurse's verbal and nonverbal behaviors indicate active listening.

Self Awareness

the process of understanding one's own beliefs, thoughts, motivations, biases, and limitations and recognizing how they affect others.Without self-awareness, nurses will find it impossible to establish and maintain therapeutic relationships with patients. "Know thyself" is a basic tenet of psychiatric-mental health nursing (

verbal communication

which is principally achieved by spoken words, includes the underlying emotion, context, and connotation of what is actually said.

Validation

which means explicitly checking one's own thoughts or feelings with another person. To do so, the nurse must own his or her own thoughts or feelings by using "I" statements. The validation generally refers to observation, thoughts, or feelings and seeks explicit feedback. Validation may occur with a statement such as, "I notice you pacing the hallway. I wonder if you are feeling anxious about the family visit?" The patient may agree, "Yes. I keep worrying about what is going to happen!" or disagree, "No. I have been trying to get into the bathroom for the last 30 minutes, but my roommate is still in there!"