Theoretical Frameworks in psychiatric mental health nursing

Mental illness

Freud’s Stages of Psychosexual Development

–    Oral Stage
–    Anal Stage
–    Phallic Stage
–    Latency Stage
–    Genital Stage

Common Defenses

–    Denial. The source of distress is not acknowledged or perceived because it is too threatening.  The person refuses to admit being frightened by an event or action of another individual.
–    Repression. Unacceptable or anxiety-provoking thoughts or feelings are blotted out of consciousness.  People forget threatening occurrences.
–    Displacement. Emotions are transferred from the original person or object to a less formidable, or safer, target.  It is the “kick the cat” defense.
–    Projection.  Rejecting an unacceptable thought or feeling by blaming it on another person.  By attributing it to someone else, the unacceptable thought or feeling is removed from the person.
–    Sublimation. Directing a socially unacceptable desire or activity into a socially acceptable one.  For example, releasing sexual urges though dance.
–    Rationalization.  A socially acceptable reason is given to avoid having to face a non acceptable belief about oneself.
–    Intellectualization. Painful emotions or feelings associated with an event are explained away by the use of a rational explanation.

Six Conditions for Change

–    The client and helper must be in psychological contact. A therapeutic relationship or emotional connection between the helper and client is essential.
–    The client must be in a state of incongruence…If   a client feels no anxiety, she or he is unlikely to be motivated enough to engage in the helping process.
–    The helper must be congruent (genuine) or integrated in the relationship…The helper cannot be phony in the helping relationship.
–    The helper must feel unconditional positive regard for the client…Essentially, a helper is trying to understand a client’s feelings and experience but is not trying to judge whether the person “should” or “should not” have the feelings or whether the feelings are “right” or “wrong.”
–    The helper must experience empathy for the client…We can distinguish empathy from sympathy, in which the helper feels pity for the client and often acts from a one-up power position rather than as an equal.
–    The client must experience the helper’s congruence, unconditional positive regard, and empathy. If the client does not experience the facilitative conditions, for all practical purposes they do not exist for the client and the sessions are not likely to be helpful.

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