Theories for Mental Theories for Mental Health PracticeHealth Practice

Adrianne Maltese, MN, APRN, Adrianne Maltese, MN, APRN, BC, BC, CNSCNS

Psychological Psychological TheoristsTheorists FreudFreud EriksonErikson SullivanSullivan MaslowMaslow RogersRogers SkinnerSkinner

Nursing TheoristsNursing Theorists

PeplauPeplau Watson Watson LeningerLeninger

FreudFreud

Theory of psychosexual developmentTheory of psychosexual development All human behavior can be explainedAll human behavior can be explained Behavior motivated by subconscious Behavior motivated by subconscious

thoughts and feelingsthoughts and feelings treatment involves analysis of dreams treatment involves analysis of dreams

and free association to “get at” and free association to “get at” subconscious materialsubconscious material

Important Important contributions of contributions of Freudian theoryFreudian theory Personality components: Id, Ego, Personality components: Id, Ego,

SuperegoSuperego Concept of Concept of

transference/countertransferencetransference/countertransference Ego defense mechanismsEgo defense mechanisms

Most frequently seen Most frequently seen defense mechanismsdefense mechanisms DenialDenial DisplacementDisplacement FixationFixation ProjectionProjection RationalizationRationalization Reaction formationReaction formation

EriksonErikson

Eight stages of psychosocial Eight stages of psychosocial developmentdevelopment

Biological maturation and social Biological maturation and social forces compel individual to go forces compel individual to go through all stages, each of which may through all stages, each of which may or may not be successfully or may not be successfully negotiatednegotiated

Failure to resolve a stage may lead to Failure to resolve a stage may lead to psychological symptomspsychological symptoms

Developmental Theories - Developmental Theories - EriksonErikson

1. 0-1yr1. 0-1yr trust vs. mistrusttrust vs. mistrust

2. 1-3yr2. 1-3yr autonomy vs. shame and autonomy vs. shame and doubtdoubt

3. 3-6yr3. 3-6yr initiative vs. guiltinitiative vs. guilt

4. 6-11yr4. 6-11yr industry vs. inferiorityindustry vs. inferiority

5. Puberty5. Puberty identity vs. role confusionidentity vs. role confusion

6. Young adult6. Young adult intimacy vs. isolationintimacy vs. isolation

7. Middle age7. Middle age generativity vs. self generativity vs. self absorptionabsorption

8. Old age8. Old age integrity vs. despairintegrity vs. despair

Harry Stack SullivanHarry Stack Sullivan

Described personality development Described personality development impacted by environment and impacted by environment and interpersonal relationshipsinterpersonal relationships

Humans are essentially social beings Humans are essentially social beings Unsatisfying relationships are the Unsatisfying relationships are the

basis for all emotional problemsbasis for all emotional problems contributed the concept of milieu contributed the concept of milieu

therapy and therapeutic communitytherapy and therapeutic community

Abraham MaslowAbraham Maslow

Theorist focused on wellness and Theorist focused on wellness and factors contributing to mental health factors contributing to mental health rather than focusing on factors rather than focusing on factors contributing to mental illnesscontributing to mental illness

The self actualized person is tolerant The self actualized person is tolerant or welcoming of uncertainty, self or welcoming of uncertainty, self accepting, inner directed, accepting, inner directed, spontaneous, creative, caring, open, spontaneous, creative, caring, open, with a good sense of humorwith a good sense of humor

Maslow’s Basic Human Maslow’s Basic Human Needs ModelNeeds Model

Carl RogersCarl Rogers

Client centered theoryClient centered theory If a client receives unconditional If a client receives unconditional

positive regard and empathic positive regard and empathic understanding from a genuine understanding from a genuine and congruent therapist, then the and congruent therapist, then the client will grow as an individual client will grow as an individual

BF Skinner and BF Skinner and behavioristsbehaviorists

All behavior is learnedAll behavior is learned behavior has consequences (+ or -)behavior has consequences (+ or -) rewarded behavior tends to reoccurrewarded behavior tends to reoccur positive reinforcement increases the positive reinforcement increases the

frequency of behavior, as does removal frequency of behavior, as does removal of negative reinforcersof negative reinforcers

treatment modalities based on this treatment modalities based on this theory include behavior modification, theory include behavior modification, token economy, and systematic token economy, and systematic desensitizationdesensitization

Hildegard PeplauHildegard Peplau Peplau describes nursing as a therapeutic Peplau describes nursing as a therapeutic

interpersonal relationship that provides a interpersonal relationship that provides a growth opportunity for both nurse and growth opportunity for both nurse and patientpatient

identified the phases of a therapeutic identified the phases of a therapeutic relationshiprelationship

identified the roles of a nurse: identified the roles of a nurse: counselor, counselor, teacher, resource person, surrogate, leaderteacher, resource person, surrogate, leader

identified levels of anxiety: identified levels of anxiety: mild, moderate, mild, moderate, severe, panicsevere, panic

Psychological Model Psychological Model (Crisis (Crisis

Intervention Model)-Intervention Model)- AguileraAguilera

Human organismHuman organism↓↓

State of equilibriumState of equilibrium↓↓

State of disequilibriumState of disequilibrium↓↓

Need to restore equilibriumNeed to restore equilibrium

Crisis Intervention Model- AguileraCrisis Intervention Model- AguileraNeed to restore equilibriumNeed to restore equilibrium↓ ↓↓ ↓

Balancing factors presentBalancing factors present++

Realistic perceptionRealistic perception++

Adequate coping Adequate coping mechanismsmechanisms

Result inResult in

Resolution of problem Resolution of problem ↓↓

Equilibrium regained Equilibrium regained ↓↓

No crisisNo crisis

1 or> Balancing 1 or> Balancing factors absentfactors absent

And/OrAnd/Or Distorted perceptionDistorted perception

And/OrAnd/Or Inadequate supportInadequate support

Results inResults in Inadequate coping Inadequate coping

mechanismsmechanisms↓↓

Problem unresolved Problem unresolved ↓↓

CRISISCRISIS

Psychological Influences Psychological Influences on stress responseon stress response ControlControl PredictabilityPredictability PerceptionPerception Coping responsesCoping responses

Ego Defense MechanismsEgo Defense Mechanisms

Defense mechanisms are Defense mechanisms are unconscious behaviors that offer unconscious behaviors that offer psychological protection from psychological protection from stressors. stressors.

Defense mechanisms are used by Defense mechanisms are used by everyone from time to time everyone from time to time

Defense mechanisms do not Defense mechanisms do not eliminate the root cause of stress eliminate the root cause of stress - they treat the symptoms- they treat the symptoms

Coping mechanismsCoping mechanisms

Contrary to defense mechanisms, Contrary to defense mechanisms, coping mechanisms are conscious coping mechanisms are conscious attempts to deal with or mitigate attempts to deal with or mitigate stressors.stressors.

Some coping mechanisms may get at Some coping mechanisms may get at the root cause of the stress, while the root cause of the stress, while some, like defense mechanisms may some, like defense mechanisms may alleviate symptoms without addressing alleviate symptoms without addressing the root causethe root cause

Assessment: Assessment: select select indicators of stressindicators of stress

IrritabilityIrritability

CryingCrying

LethargyLethargy

Loss of interestLoss of interest

BurnoutBurnout

BlockingBlocking

preoccupationpreoccupation

Emotional Emotional outburstsoutbursts

SighingSighing

Making mistakesMaking mistakes

Mental exhaustionMental exhaustion

ForgetfulnessForgetfulness

depressiondepression

Assessment: Assessment: select select indicators of stressindicators of stress

absenteeism absenteeism

inability to concentrateinability to concentrate

decreased productivitydecreased productivity

proneness to accidentsproneness to accidents

loss of motivationloss of motivation

substance abusesubstance abuse

Select interventions for Select interventions for clients with stressclients with stress offer client unconditional positive regardoffer client unconditional positive regard help establish simple routinehelp establish simple routine encourage rest, exercise, and diet as encourage rest, exercise, and diet as

appropriateappropriate encourage use of available supportsencourage use of available supports decrease # of new stressorsdecrease # of new stressors use therapeutic communication skills use therapeutic communication skills encourage verbalizationencourage verbalization explore coping skillsexplore coping skills teach progressive relaxation techniquesteach progressive relaxation techniques mutually identify areas of strengthmutually identify areas of strength