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Strategies and Techniques in
Psychiatric Nursing Practice
Elaboration of the Provided Text
Dynamic Supportive Therapy
The advanced practice psychiatric nurse may intervene as appropriate with agencies or persons in order to advocate for the patient, and do for the patient what they cannot do for themselves. This is done with the aim of maximizing the patient's independence and growth, which is consistent with the basic strategy of dynamic supportive therapy.
Suicide Assessment
Assessing the patient is of paramount importance for the advanced practice psychiatric nurse during the initial patient contact. Suicidality can be assessed by using reliable and valid self-report questionnaires.
Ethnicity
Common ancestry through which individuals have evolved shared values and customs is known as ethnicity.
Cognitive Behavioral Therapy (CBT)
In a CBT approach, the therapist encourages the patient to investigate whether their thoughts are based on facts or assumptions. This is known as "Questioning the Evidence".
Psychodynamic Psychotherapy
Psychodynamic psychotherapy does not assume that what happened in the past determines what we do today. This is not consistent with the underlying assumptions of this approach.
Suicide Risk and Intervention
When a patient is in the process of an unwanted divorce, endorses persistent suicidal ideations with strong intent, the advanced practice psychiatric nurse recognizes the patient is at high suicide risk and recommends hospital psychiatric admission and suicide precautions.
Cultural Influences in Families
The cultural context of families is complicated by the fact that most families are influenced by multiple contexts. The therapist should be safe in making this assumption about cultural influences in a family.
Socratic Dialogue in CBT
The CBT therapist asking the patient to rate their depression on a scale of 0-10 and compare it to 2 months ago would not be a question consistent with Socratic Dialogue.
Standards of Care vs. Practice Guidelines
Standards of care are legally binding, while practice guidelines are not.
Anxiety Management Strategies in Therapy
Restructuring is a strategy for working with anxiety that would be consistent with a behavioral therapy approach.
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is consistent with the following: A) Identifying and modifying maladaptive thoughts and beliefs, and B) Behavioral experiments to test the validity of thoughts.
Structural Family Therapy
In the Structural Family Therapy model, family structure refers to the way families are organized into subsystems separated by emotional boundaries.
Cognitive Distortions
"They probably think I am stupid" is an example of the cognitive distortion known as "Mind reading".
Therapeutic Benefits in Group Therapy
In therapy groups where group members gain through receiving help from group members and giving help to group members, the therapeutic benefit of Altruism is being realized.
Group Therapy Dynamics
When a group member becomes angry with the group leader, accusing the leader of being too controlling and showing favoritism, this behavior is consistent with the therapeutic factor of Catharsis.
Psychosexual Development
According to Freud's Psychosexual stages, the development of sexual identity occurs during the age range of 3 years to 6 years.
Therapeutic Factors in Group Therapy
Yalom's therapeutic benefit of imitative behavior includes the following: A) Observing and imitating the behavior of others, B) Finding out what we are not, and C) Progress toward finding out.
Psychodynamic Therapy
In classical psychodynamic therapy, the therapist's role is that of a participant-observer, encouraging the client to talk about their emotions and helping them identify recurring patterns in their thoughts, emotions, and behaviors.
Cognitive Distortions in Couples Therapy
When a wife states that her husband must be having an affair because he comes home late from work, the advanced practice nurse recognizes this as the cognitive distortion of Arbitrary Inference.
Peplau's Interpersonal Relations Model
According to Peplau's Interpersonal Relations Model for nursing, a cornerstone for the psychotherapeutic process is understanding, assessing, and managing anxiety.
Psychodynamic Therapy and Psychosocial
Stages
Relational Psychodynamic Therapy
The aim in relational psychodynamic therapy is to make the unconscious conscious. This approach focuses on resolving ruptures in the therapeutic alliance and providing interpretation based on the client's past experiences, rather than solely interpreting wish/defense conflicts.
Group Therapy and the Therapeutic Relationship
According to Yalom, the group therapy analogue to the relationship in individual therapy is the social microcosm. This refers to the idea that the group setting provides a miniature representation of the client's interpersonal world, allowing for the exploration and understanding of their relational patterns.
Relationship Triangles
Diverting conflict between two people by involving a third is known as the concept of relationship triangles. This dynamic can be observed in various interpersonal contexts and is an important consideration in understanding and addressing relational issues.
Erikson's Psychosocial Stages
According to Erikson's Psychosocial stages, failure to successfully resolve the trust vs. mistrust conflict is associated with the pathological outcome of inertia and creative inhibition. This stage is typically experienced during the first year of life and lays the foundation for the individual's sense of trust in the world and their ability to engage in creative and productive activities.
Holistic Paradigm
In a holistic paradigm, the goal is to minimize symptoms , rather than solely curing or eliminating them with medication. This approach emphasizes the importance of addressing the whole person, including their physical, emotional, and social well-being, in the process of promoting healing and growth.
Addressing Universality in Multi-Cultural
Groups
In multi-cultural therapy groups, therapists must address the clinical factor of universality by:
Assisting Group Members in Learning About Cultural
Differences
Therapists should help group members learn about and understand the cultural differences within the group. This allows members to recognize their shared experiences and responses, despite their diverse cultural backgrounds.
Helping the Group Move Past Concrete Cultural
Differences
The therapist should guide the group to transcend a focus on specific cultural differences and instead explore the common human responses and experiences that group members share.
Group Cohesion and Solidarity
Groups with a greater sense of solidarity exhibit the following characteristics:
The Good Enough Mother
The "good enough mother" creates a dynamic in which the person feels accepted and valued, rather than never feeling "good enough" in relationships.
Social Constructionism
Social constructionism is the concept that reminds us that families are open systems, and our interpretations are shaped by the assumptions we absorb from the surrounding culture.
Benner's Role Acquisition Model
According to Benner's model, the advanced practice psychiatric nurse with 2-5 years of experience who coordinates complex care and sees situations as wholes with long-term solutions is functioning at the Expert level of competency.
Supportive Psychotherapy Considerations
The decision to use supportive psychotherapy should be based on the following factors:
Recent Losses
The patient's experience of recent losses or life events that may require additional support.
Present Coping Skills
The patient's current coping skills and ability to manage their concerns.
Ego Strength and Weaknesses
An assessment of the patient's overall ego strength and areas of vulnerability.
Highest Level of Functioning
Consideration of the patient's previously achieved highest level of functioning.
Evidenced-Based Guidelines and Therapeutic
Approaches in Psychiatric Nursing
Evidenced-Based Guidelines for Patient Treatment
Evidenced-based guidelines for patient treatment are based on the consensus of an expert panel. These guidelines provide a framework for clinical decision-making and are designed to improve the quality of care.
Cognitive-Behavioral Therapy (CBT) Processes
In CBT, primary thinking recognizes the indeterminate, negative, and irrational thinking as part of human action. Secondary thinking involves the conscious, rational, and logical processes that can challenge and modify primary thinking.
Internal Resources
Internal resources include the person's ability to self-soothe, demonstrate adequate impulse control, and regulate moods. These internal resources are important for effective coping and functioning.
Benner's Role Acquisition Model
According to Benner's role acquisition model, the advanced practice psychiatric nurse with 2-5 years of experience, who coordinates complex care and sees situations as wholes with long-term solutions, is functioning at the competency/proficiency level of competency.
Self-Awareness for the Advanced Practice Psychiatric
Nurse
According to H. Peplau (1991), self-awareness for the advanced practice psychiatric nurse is key to understanding others. This self-awareness helps the nurse develop a therapeutic relationship and provide effective care.
Psychotherapeutic Process for the New Nurse
Psychotherapist
It is important for the new nurse psychotherapist to become comfortable with letting the psychotherapeutic process unfold over time, rather than trying to quickly "fix" the patient's problems.
Therapist's Role in Classical Psychodynamic Therapy
In classical psychodynamic therapy, the therapist's role is that of a participant-observer. The therapist actively engages with the patient while maintaining a degree of objectivity.
Maslow's Hierarchy of Needs and Therapist Involvement
In general, the lower the patient is on Maslow's hierarchy of needs, the more active the therapist must be in providing support and guidance.
Biomedical and Holistic Models of Care
A descriptive/biological approach that treats individuals as members of a diagnostic group is based on a biomedical model, while a holistic model considers the whole person and their unique circumstances.
Mahler's Stages of Separation-Individuation
According to Mahler's stages of separation-individuation, the phase of "normal autism" occurs during the 24 to 36 month age range.
Focus of Psychodynamic Psychotherapy Interventions
Psychodynamic psychotherapy interventions focus on the person's emotions and thoughts, deepening the understanding of triggers from the past that are played out in the present.
Assessing Relationship Dynamics in Couples Therapy
When working with a couple, the advanced practice psychiatric nurse should not make assumptions about the couple's relationship dynamics based on their cultural background. Instead, the nurse should further assess the roles and power dynamics within the relationship.
Factors Influencing the Decision to Use Supportive
Psychotherapy
The decision to use supportive psychotherapy should be based on the patient's recent losses, present coping skills, and ego strength and weaknesses, as well as the highest level of functioning previously achieved.
