04 & 05 defense mechanisms and therapeutic comm

8/2/2019 04 & 05 Defense Mechanisms and Therapeutic Comm

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COMMUNICATIONTECHNIQUES


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Communicationreciprocal exchange of ideas

between or among persons


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Modes:

Verbal - written/spoken

Non-verbal - posture,tone of voice, facialexpression
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Types of Non-verbal communication:

Kinesis

body movement

eye contact

gestures Paralanguage

voice quality

non-language vocalization (crying,

sobbing, moaning)

Proxemics law of space

relationship


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CONSIDERATIONS INTHERAPEUTIC

COMMUNICATION PRIVACY

RESPECTING BOUNDARIES

PROXEMICSscience of properspacing


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Distance Zones: 1. INTIMATE ZONE- 0-18 inches between

people; comfortable for parents with youngchildren, lovers or people whispering.

2. PERSONAL ZONE - 18-36 inches; distancebetween family and friends when talking

3. SOCIAL ZONE - 4-12 feet; acceptabledistance for communication in social, work &

business settings. 4. PUBLIC ZONE- 12 to 25 feet; acceptable

distance b/w speaker and audience, smallgroups, and informational functions.


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Touch physical act

Cultural artifacts eye glasses

uniform

beard

Meta communication

based on role expectations hidden meaning of words


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5 TYPES OF TOUCH: 1. FUNCTIONAL-PROFESSIONAL TOUCH- used in

examinations or procedures

2. SOCIAL-POLITE TOUCHused in greetings,handshake & air kisses, guiding someone for

direction 3. FRIENDSHIP-WARMTH TOUCH a hug in

greeting, an arm around a shoulder of a good friend orback slapping some men use to greet friends &

relatives.

4. LOVE-INTIMACY TOUCH involves tight hugs andkisses b/w lovers or close relatives.

5. SEXUAL AROUSAL TOUCHused by lovers.


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Always develop

ACTIVE LISTENINGmeans refrainingfrom other internal mental activities and

concentrating exclusively on what theclient says.

ACTIVE OBSERVATION means

watching the speakers nonverbal actionsas he/she communicates.


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Therapeutic Communication

A way of interacting in a purposefulmanner to promote the clients ability

to express his thoughts and feelingsopenly.


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ELEMENTS OF

COMMUNICATION SENDER originator of information

MESSAGE information being transmitted RECEIVER - recipient of information

CHANNEL - mode of communication

FEEDBACK - return response

CONTEXT - the setting of communication


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(Channel)

(Context)

Message

F E E D B A C K

Elements:


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Essentials for a Therapeutic

CommunicationGenuineness

RespectEmpathy

Attentive listening

Trust (rapport)

G RE A T


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Barriers to Therapeutic Communication

BelittlingInterrupting / ignoring

Giving advice

Social response

Changing the subject

Approving / disapproving

Moralizing

B

I

G

S

C

AM


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TYPES OF RELATIONSHIP:

SOCIAL RELATIONSHIP - initiated for thepurpose of friendship, socialization, companionshipor accomplishment of task

INTIMATE RELATIONSHIP involves two people

who are emotionally committed to each other. Mayinclude sexual or emotional intimacy and sharing ofmutual goals.

THERAPEUTIC RELATIONSHIP focuses on theneeds, experiences, feelings and ideas of theclient only. The nurse uses communication skills,personal strengths and understanding of human

behavior to interact with the client.


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Observe these in a Nurse-Patient

Relationship CONFIDENTIALITYmeans respecting the clients right

to keep private any information about his/her mental andphysical health and related care.

Note: if a patient tells a secret about harming oneself orothers, avoid keeping a promise not to tell the revealedinformation by the client.

DUTY TO WARN requires the nurse to notify

physicians, authorities, intended victims of a threat SELF-DISCLOSURE nurses disclosing personal

information to the patient which the nurse think can helpin establishing rapport.


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Accepting

E.g. Yes, that must have been difficult for you.

Acknowledging or giving recognition

E.g. I noticed that you've fixed your bed.

Asking direct questions

E.g. How does your wife feel about yourhospitalization?

Clarifying

E.g. I'm not sure that I understand what youare trying to say.

Confronting or presenting reality

E.g. I see no bats flying in this room.


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Giving broad openings or asking open-ended

questionsE.g. Is there something you'd like to do?

Informing giving needed facts

E.g. I'll be your nurse for today, from 7:00 until

3:00 this afternoon. Making observations

E.g. You appear to be angry. / I noticed thatyou're trembling.

Offering general leads

E.g. Go on. / You were saying


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Restating

E.g. Client: I can't sleep, I stay awake all

night. Nurse: You can't sleep at night,(restating)

Summarizing

E.g. During the past hour, we talked aboutyour plans for the future, they include...

Using silence- to induce thought, pacing,acceptance

Validating- confirming one's observation

E.g. So you mean . . .

Voicing doubt

E.g. I find that hard to believe.


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Non-therapeutic

and IneffectiveCommunication


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Agreeing and disagreeing

E.g. I think you did the right thing. Advice

E.g. You should..

Belittling

E.g. "Don't be concerned, evervonefeels like that".

Defending

E.g. "All doctors here are simply great".


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False reassuranceE.g. "Don't worry, everything will be all

right".

Focus on caregivers feelingE.g. I feel that way too.

Judging

E.g. "It's your own mistake".


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DEFENSE

MECHANISMS


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These are automatic and usually

unconscious processes or act by theindividuals to:

reduce or cope anxiety or fear

resolve emotional or mental conflictprotect one's self-esteem

protect one's sense of security

Becomes pathologic when overused. Used by both mentally healthy and

mentally ill individuals


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Common Defense

Mechanisms Used


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Compensation

An attempt to overcome a real or imagined

short coming, inferiority, inabilities andweaknesses.

A blind woman becomes proficient in playingpiano.

Conversion

Emotional problems are converted to physicalsymptoms

A student unprepared for a report sufferedheadache the day she is supposed to deliverher report.


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DenialFailure to acknowledge an intolerable thought,

feeling, experience or realityA middle-aged man after being admitted to

the CCU because of an AMI, insists that he isin the hospital for just a diagnostic work-up.

Displacement the redirection of feelings to a less threatening

objectAn adolescent boy, after an argument with his

father, goes to the room and kicked hisrooms door.


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Introjection

Symbolic assimilation or taking into oneself a

love/hatred object. Derived from the word"introject" which literally means to take into oringest.

Common to depressed clients.

Identification

An individual integrates certain aspects of

someone else's personality into one's own.A young school teacher adopts his former

mentor's teaching style when conductingclass sessions.


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Intellectualization

An overuse of intellectual concepts by anindividual to avoid expression of feelings

A man who was asked to share a memorableexperience about his grandmother who dieddiscussed the stages of death and dying byElizabeth Kubler Ross.

Projection

Attributing to others one's unconsciouswishes/fear.

Literally, this means to "throw off.

A student who failed a subject blames his failureon poor teaching.


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Reaction Formation

Expression of feeling that is the directopposite of one's real feeling.

Also referred to as overcompensation.

A student who dislikes one of her classmates

may act or show concern toward her.


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Rationalization

An individual finds a justifiable cause and acceptablereasons just to be saved from an embarrassing andanxiety producing thoughts or situations.

A basketball player claims that he missed the shotand lost the game because of the distractions madeby the audience.

Regression

Is the turning back to earlier patterns of behavior insolving personal conflicts.

Commonly seen to schizophrenic patients A person who becomes ill in the face of

disappointment has regressed to a form of childishbehavior.


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Repression

It is the involuntary or unconscious forgetting

of an unpleasant ideas or impulses.During the nurse-patient relationships,

patients often unconsciously avoid discussingthose experiences producing anxiety whichare emotionally difficult to verbalize.


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Suppression

Permits the individual to store away or

consciously forget the unpleasant, painful andunacceptable thoughts, desires, experiencesand impulses.

"I'll think it about tomorrow", "I'd rather gonow", "Can we change the topic?"

A boy walked out from the group and said "Ihave to go now", when he was asked what

was happened to their relationship with hisgirlfriend.


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Substitution

Replacing the desired unattainable goal withone that is attainable

A woman who failed the nursing board exam3 times, worked as a nursing aide just to be in

the hospital.

Sublimation

The redirection of unacceptable instinctualdrive with one that is socially acceptable

Instead of harming his mother, a manexpressed his anger by composing a song.


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SymbolizationLess threatening object is used to represent

anotherA woman, missing her husband finds comfort

in hugging her son who looks like his father.

UndoingAn attempt to erase an act, thought, feeling,

guilt or desire

A man gives her wife a bunch of roses aftertheir argument last night.

04 & 05 defense mechanisms and therapeutic comm

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