Mental Health Chapter 5-6

8/14/2019 Mental Health Chapter 5-6

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ClazreG. WaughJic


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This book is dedicated to ny ehildre~Evfick-Anne,Malik, andJan@.

I Fifth Edition.'; 7Mental


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DesensitizationImpIosive Therapy

Problem SolvingRchiques forChangingBehavior

ModelingBole-PlayingConfbntationBehavior MoMsationAssertlvmessTr-

$teti&& , , , ranfrontaeionb&&m modBcarion

@Q o p e r a mnditioning&cematie d a x a t i ~ n negative condit~onlngdmemitization positiw conditioningimplosive therapy %@wivemodebg passiverol~-p1ayin& assertive

a Differentiaethe&aracteristim d ay, fear,pwi~ daggression

II& seven symptoms of seaae anxiety.D Statefourwp ofredudng anxiety

Discuss urnsing actionslinterventi~mor @eanxious clientD Zxplajn modeltng, role-pIayiq,confrontation,and behaviormodBcation as techniquesfor changingbebaviars,D List three elements afpassive,aggressive, and assertive behav-

ior.S t r a is a nonspe&c response to any demand made on th e body,These demandisw 4 e d stressors.People are constantly affmed byph@cal and psTfch~10gical ~ S O ~ S .daptation urmally goes unno-ticed rmless the stressors are severe or prolonged. How strew is per-ceived by the person detesmineswhether the stpess produces anxietyin that individuaL It also determines the degree of atMdety psoducedWe bave become a harried people with stmsors apidly acceleratingwd eontrjbuting10bincreased anxi* in our environment and dailylife.Anxiev&ts thm constant To live s to experienceanx-ious moments,but @ety C a n stimu1atepersonal$ravtk


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ANXIETY: MILD, MODERATE, SEVEREAmd- is a vague, uneasy f e w f discomfbrt It is a term used todescribe reaction to s~ess hen the source isWeved to be threaten-ing but isnot obviow.Thesource of anxiety s usuallywithin the per-son's intend environment &ety isdiffaentfrom fear in that fear isthe reaction to a knownand usuaUy ex te t d threat E w ~ ~ I L ~xperi-ences anxiety at somepoint in their lives. In fact some W t y s neeessary.Withogt it,people would be apathetic and disinttxstedin heirs u r r o u n ~Anxiety magoccur atmy time during the life cycle. It may betheresrilt of a de~el6~mentalr situational saessor. S i t i o n a l strossorsslre cfismptiirechangesinow's lifesuch as divorce, serious i l l na thedeath of a loved one, or lass of a job. Although anxi* is often acuteand ofsbortduration, therearepeoplewtmconsistentlyh witha cer-tain levelofanxi* This iscalled chronic, r long-term,&a. eoplewith cbmnic anxiety may additionally experience acute episodes ofanxiety.

Amietycanbemild,&te, or severe Mild anxiety warns thebody tom o m ts form tohandle an impendingthreat It increasesthe energy level a8d alertness. The irtdiidnal is then better rrble toauk, analyze,draw condusions, and solveproblans Cable5-11.Moderate de +g decrea~es erceptim The p o n onnesatren-tion on the particular task or problem This 3s called selective inatten-fion 0th- oices or events witbin the room may not be miiced

Severe anxiety decreases pemption to an even greater extentThepersonselectsonlyp f an experienceand focuses a11attentionon ?t.Abstract thinking js lost Some concrete directions nury be fol-

pulse and m&ations; a rise in blood pressure;dry mouth. s p e d 1

LNXIETY PERCEPTION PHYSIOLOGICAL BEHAVIORCHANGES

ences intolerable seess. The physiological changes caused by M e Vare inmased. Attention is focusad em a miaute detail that is oftenb 1 0 ~ t ofproportion Speech is wuaIly incoherent and u~mnuni:


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selected Rapidpulsefocus ofattention\ I// Increasedtensemuscles\ bioodpreswve Iposture Irespiration

SpeechFIGURE 5-1 Physicaland mental responses to sBvere anxfety.

Anxiety-pmdueingsituationsare not the same for all people A situs-tion that is unimportantto m e person may cause andety in another(EguE 543.A situationthat is seen as a chanage to oneperson maycause panicin anotherperson Thefollowfngare emmplee of anxi*-producing situations.

Joycewasbroqht up in a family that considered time veryimportmt Shewasmntinually admanshed ts,h w ndwas punished forbeing late. Sheinternalizedthi?.value !~fbeing on time and coatinued to functionunder ts shess.l o p coped with&& stress by being M y aware of tim%organizing h a activkb by the clock,and allovving added -W e or possible delays.One morning Joyce overslept She handled this added ,~treSsor hunying.At the last minute, she discovered hercar kevsweremiss&. Shefelt omwhelmed and no fozxgera b ~ e relyon her usual copingme-sms Hermuscles

RelievfnsAnxiety PIfl--- A

copingMei?RanMm I

Mod'crate anxietp: aWentibnfocwed on getting to work on tlme

Severe anxiety: loss of control.no coping mechanismsFlOURE 5-2 A seemingly insignfmant sttuation can eadm evereanxiew Tfthepersonviews the situation asa severeMlreat,

b e a e e wher thinIeingwas disorgmhed,and she eIphelplas.I-lavingexcwen-& norlolowingwhat to do,shemovedfrom placeto place, becornin$bs awareofhere n k o m t ShekltEkesmeambg or crying. SSh lookedat her keysmvefztltimes bm did notwe them. s h a m-ieygrew, theew;rsagreaterdispuptieninprocestngstim-tdi firom hei senses. When samepne eIse fotad the k mp 3 ai~ded h m tc,4% the severam&e%gnded.Exthis


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c h am 5

time, Joycehad already spent a @at deal O ad@% en=-&y.

IKaren a straight 4 studwt,was known as a "brainPHerdmmates b e l i d amde6wera.easy fi3.rher.They didnotm a k the high En'en paid fm her achievementKaren m e mm family that p?tized sac- Rer fatherw a p&du@t aml Lter mother a c o w @sar.When other ch3dren praised for goodwark she Saitidmd fm not dQTxgmom Notlntng lessl than the bestm toleratad. She began to&eI inferiw To&a ut w as$tillmder the ufcomtanflyhaving toacbieya Earen&me$hemuId makegmdgr& by re* lemmowa nd Corneq'uentl~hespmtmmyextmh o w instudp and many dety-f?Dddays bt&e each examina-fion. Wahm time ar &ends a d ofher aeb i t i , %enw a I& alone.Tb prom her &-esteem an8 ompematefor her laek affkknnds,IZ;aren achievedh%ghrades.

& r d s d e s anm p k f dominz~tiun. y imedomimition s a fa~de;he pemn using it is insecureThe d person mu&project an km@ ofmd m n y ~ e t aaren @mdmedm the &roonlt butothers may project dm&am% in gener;il The dominantperson mmtmakedlofthe e 6 . Depensency-msesemietybeeuse-in o h m hasmer davetop,edForced nroa dep&q position,the dominantp"smmy def3ttherules, c o m p l d m a b a u t i n c o ~ ,nd&saditothersinor& fn emain supt3ia.

. I .Iahn, tool kd ioned under stress. B e m e of his back-ground,he viewed all &en& with mentalillnwsnot asfheywere but as be @ a d &em to be.Re reartea to thee x p a t i om &at had been e8zabMhed in hisyoutk &omthe timeJohnauldmember, hi6&milyftetpent].yt-tlkedaboutWa$ Aunt Suzy:%heshouldbe locked up. Shecannot be nrsted You never how what she is goin$ to do:Even though John nwer met his Armt Swy or ilny other -person wi& mentalm, e formed opihm9 about -t h ~ mhese spinons lay aonnantb e n r k his awaWses.9.fohn%ventintonmsing ftomhighschool HewaswellWby his okssmate4aria &cult$Dming the fbt emww, Johnd&ved sbhoWc stlecesswtthsut&cnl& IJurfng he8econd semetenhewas


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RelievingAnxietv "121

. mmOne evening, Jack was cWViq car doslg a da"Bmwmountain road. eight-mold son was sittinghim.m e as:hmvy in tbe opposite direction and mostof &led to dim heir h&gh&. JaOk WaS driv-@1dy ,ut the dnvm bebind him semed to be in ah m . mey f~uowedclosely behind and honkedhorn. Jack began calJbg tbeother He Pmposefuny turned on his bright lights whenever aappIm&ed when bit: Yaung SOn BZXRaPkd that his dadseemed awfully tense, the father responded by shuin&~~~~tgau $laremy a w a d If twas not for gou, w d dnot be onthmad, soyon jm k e ~*mnaysinwhich people tend to hmdk a stres$ful6kua- Desensitiiation

tion and lessen anxiety include dependenmt domhtioniwithdrawid, hother method usedbytherapisrs to r&me a r ~ d * is&& des--and a m a & n ~o y cegas dependent mrMeMore w d l g , ne thf lonDesensitization is a way of conditioning a tobe non.depends on omer people In a time of isMpfuL but It. re@Ponsiveoa stimulus.This echnique isusuaIly doneby counselors,beeom a pmblem when the dependence P s i s @and ismane. I nurse w-, and psy~hologists,but other health w e tyopkersDependent perrple areinseaup. nd C ~ X K J ~ce* that hyhaw should be kmjliaxwith the method Cliem arefirsttrained musclebilitia, mey are mhly ~et&tive ~~%idsm,w& Or *tion They are then asked t6 identi& (13 the &etpprodueingmily bev i m d iqection For this reason dependantpea~lefmad- *itaatio21;2) a place iusuallyhome) inwhich theg eel safea d eem;1~ o l l ~he d-ds of othd, men if those denan& canflict with and 13) another place or situationthat is rekxing, such lyingon thetheirmwishes. , b e d C k n t ~ then asked to imagine the &ey-pmdudng

j i~p,ohn Jack were in a crisis,A crisis OClXJ3 when fie fion while tbe therapist desixibes it in some detail ments feelp r o w hat produced the M e t @ and@ * d m p the16wts@ of w e % a pmmmged signal, uchas mov$lging m e h e pe not effecave,Helping a person a a The description of the stressful eveneis stopped and the am-helpin$ the- olve problems, Par PIVblm sol*g to aPist be@ d e ~ ~ 1 i i n gbg safe haven When clients fed seme theyOCCw,m e t y be latvered to a l e d at which learning are aken, thmugh imagination,to tbe re- situ&on m e n dentsp r a ~&~pt ing o help Joyce, John or Jack p r o a m in their WY&e& the entireprocess r e p e a estate ofsevere a m uld ha% beenWtl-3. Su~poseb ndergoes desensitization. The therapst mightask Karen to * hemeIf in a specific s i t u a t i ~s hee.~%ht begin saying You are now sittingm the ~ s r o o m .ow deskRELIEVING ANXIETY is chred. Your p m d is out You are ready to take the exam. he pro-Systematic Relaxation fessorwalks in the room. Hehas papers under his a m HeOm to clear their desks. The test papeas are passed out you reeive~ystemaflctian is onemethod fodopsd by hehwioral psZT- Papa and look it over. There are some questiom ym do nota01*ts to relieve d e t y . It is based on the faa that M e V and remember ever d i s e u a . You are trplng to thinkoffheansrnrerut ft-tiOn ea&ate~axationxercises stem fromthe *thatawareness of a tense mvde wables one to that musch is Fh?n might& ~ frogerat thispoint The therapht immd-not easy to do and consums &art mustbe used afiou$h the ate l~ with, "OX,YOII ant now out ofthe-classroom you areof -ety begin to ltnuer immdiatdy, totalrelaxation take @ h-e with YO^MY.ou are sittingat the p* your iss ev edw e . gwndYoW fatheris smokioghis favorlte pipe. m e doglies near-.-


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@Thereis a ~ i n t h e f h p l a c e a n d t h e ~ f i . a m % f e &oodYnurfatherd i e s as he lrstens ro gou play:*When Karen app- moremlaxed, the thempist&t continue~"N~wyoua r e l y i ng~ thebea ch .Thewf i iCes and i swa rm~ tyour skin You eanhew the quiet q~kshhgfthewaves a m he*The sun swarm. YOUean eelyoupmdes rek&g asthesa$s umlm ea& p a +The therapist d e ntakes baok o tbedibssmornwh84sh@appears relaxedMTauhave nsw handed n the testpap&.YOUhimst0wait* the grade.Ypn have no idea haw ou did,but you arewcirzkdabout thequestiomyoudidnotr e m e !The entire proms is repeated averd ver,mtflhtaren n@lower elrperiendes amiety&tt,?hbk&% abouttbme6sful-t

Implio&e therapy is in direct c0mt.t to desemifid-ion B s @ ~ s ktherapy attempts to arouse asmuch anxiety in theindmidual possi-ble. Relaxationis srnetimesused butonlyatthew end ofthes w i o ~ ,Ca l r t i o ~This technique re@m a prof&onanp uaiaedU1mpIst

RelamiionAnd desensitizationarenot the onlymeam af&uc-ingarude , InworlrtngwEeh 0th- thenursewill ikd&ata& tti-mdeand quiet music can have a soothing $fmtWarm bathS or hotdrinks s~m&rieaelp. k s i o n a l actkith have alsobeen used suc.cessfdly to relieve anxiety.Qnce anxiety ia lm r e d to a manageablelevel, th~problemhatcaused the anxietymu@be sobed.PROBLEM SOLVINGSolving a problem may involve se@&% other aptions, cchaneSlngb&& about an event,&m@rng ehaviot orkdQ' more e$e*copingm e w % Problem solvinginvolvesa change.Before apmb-lacanbe solved,the personmutit remgniag theneedfar c ~ X @ndknowthat he or shehas the &abili$y toVeryfewproblemshavedearcut solutiom In-g a deckionit isnecessary toweigh possible $a&f&ctioma g e t padBible andcorn. its.imea l l ihat aftkt an action cannot he conuoUeck it isimgossibleto knowwhetherthe c$osen ecisiond a y d u c ethe plwned result However, a M i o n must be made ItMlillbe amore&e& solution if he entirehealth team, aswell as the client ishvi&$& tlzeprocess.step pblem. salws to problem.

k mt.sshesi'roa*his w., m.me EAL ~sob&ms hiddm.

from avmeneh. Time .ismated on srrper6.M W w hile thereal probLem gQ%. W:c&wdIfJ Q ~en:&& her pB1mvm, she prokwywould .wm&, UI axmotfind ,mykepacor.UIfIwdd

L findmykeys, Iw@ddoth a mblem? mnld noWbtgayPr-havetamake anAnn-@&est' &en ifshe ould not *lain why.,J e h muldbe qe.et@to rampkin ofphysical d i m en ifI&&ds k@, EU%Jets M.& nd J ob5 abd&I &em&m isf e l i e ~dhe undefllying problems-the o m h.a amthed e t ythe firstplaceiaresrilldm. heseamupbrl$ng probIw thatneed

Thef6h.~~shformati011boutKaren rmghthdprbe.team&.W? pmlem andassess he sbatim

Has ICaren f@ wemh&ed & ~I&cIc$did,what the sttuarien? What q i n g mms ,ad ide

t heaTWwe they &ediv&' What we ken!s R~tmmgoaIs?

Wbat ishw elatiamhipvvith hexf d y ?, H C hwhom docs she callforhelp? Ma sheaskW wo n ' shelp at:the- of fkpblem? Did the p~t im b n d ?

Inwhm doesKaren confide?'PhatisKaren's dmbpmcntal level?

~ S W W-o these questionsvviU hdp the fwm ac h somemdqions& O ~ U T ; ~ ~ ~ ,araeof the anduBiom thqmigbtwchareS k m s aspmr s ~EGQ - ~ ~

, S k a,spoorp r d b l e m ~ o l ~W.m' SXtedoes not use adapti*@*dm.


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I Nursing Care Plan: 'The Client with Anxiety and Stress

give direction to the nursingcarem e n wi l l receive.PmsibIeggoals for43 Help Karen become mare a w e of her situation..iQach Karen prablem-solvinp~kill.9.I& Teach her more adaptiee coping ra$asures.,a&&t her in setthg more reabtic goals fof herself._ Tea& her assertlw skills. Nursing Intewentlon6

1% Fl&.de a stlpporflvem e - la Protliddg asupprnfived k t eTatiomhip inwM& t loWp gives Chris theChriswiIIfdfrrl:tcwenf sense a f ~ ~ t y t oh

lifeSituatiomand stwsm*

a thiq-rrineytx~~ldawI ram@inm m a C y headaches,deaeaaedconsen*m&icd fkWy stawg fhat be b4ls b e l o m4 tratfon,e p l g e p a i n , and=II&blood flx he~astewdays.Her&tes to the n mse one^bathe hasbeenq&* wmptcm ofhem- c0bum and epig&~ pain f a the pas^ ma* vial si&ware when symptom develop.m p w a ~ e8& puke 9D, wpiratr,q rate and U m dm~ # S D . Dtnimg theW asswrnent interyiewu;, be comV=hg session@ i wTATS thathjg vvife ~ k % dora dieorce&m&s agobecame Cbrb anoppo* tcl a gm-hours andtime a ~ a yiamtheWYe pnxess sbessffil&mti~m.st&s mthe also is in the M 1 e of a d & d t & X k & dsuit He& ~~& x e a l t q f~thmaricttack. Zie wiuhave an oppo&~~-

A complete blaod m t nd an uppet g- ed e e d for he nextmorning.Themm p d t f m -a x o m & W s ee a clinfcaI s p d s t in ps)rchi-n ~ i n gb &CUBS the S~XSWS in his Me The initial 2b-~ p ~ b 1 ~ m - ~ o I v i n $- Zb.LeamLFle,~mbIan.go~vinge g i~aalshathe isexpepieneingsymptome ofm 0 h - +-%Iqllesencpurageu Chrisateto 8 anxiety.ws ha greed toan extendedd m - W seepofBibleopticm~ndtion &er the inttial fntemie~ hris elates that heb de-esap&en&g fkquent headaches and is fmdbg it@cult toc o n e a t e onhis cornWed 2c Qlris o keep a 2c. J g dwringprovih and * ~ o ~ o f ~ ~omnritpf"orCMstlNURSING MOM-8 1 methods of so* m& pooeess I@ situations.

28.~eardhmetho& ofrelie* $tress.rn- m4wSEWS f.%, -dse, y@orfeIaxa,tianante.&q@e@.


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, I ~va~uation II Chris iswmd&g three timesaweek @,ndpfactiices~ h -I ation teehnquea wheA he h c omm twe . He fs BPI*amepmble5ns&ving dmiqrres in iAs dailyBfkII

D e & d @ a d lated to &%kof osing at theq e w e d f o c c u p ~ t i p n d m p ~ e gewndaa f top m i -bfemnz as znmifwted by m- afwifedivare due m C W : a . ~ p a t i o M e s p o ~ b s i b ~ndmedical sppttxm (@eat headachess,inr- ma-cehrn& and epga@tPic).

1 1 outcome IdentificationI I paziuaal mpoetiea and prlo~ize esults uuithin one Iz& will&ate pafehtldl oEtcameg of divorct?aEtdOCOU-N u Y S I ~ ~nterventions ati ion alesDlrmsChrlfi'SexgeECatioliti Dwssing~ e m o dofmagiage and cmhp~t i i ~~ ,nd o&upatjId -a-tiam asgIsrSin- d-nee andmim.RoIe-pIs\yinmctiomwith &Itrplayingprcwide~ppoP-f i d y d ork modatea Wty to identifywith otheri+.fee- &nd bo~gb .I7iscuw possible behavior&ages asneeded.

.Modeling is amethodused to imp~.oventerpersonalwmmunicationskills.The nurse, acting a.9 the teacher, dc~nonstnrtes owK m nmight


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I $ Chapter 5

confrontatlon 'wdeatiswham &cam& $& awnaveryrewar&Wbix th e began wring $ i q s gctian,andC0mn-n is amethod of e~mmunicationhat fo- the client m A n n i e i i u t t o t h e d&* her, Wys-*to bok at inconsweneie~ b.eehg md vo&atiom. Itt means of bzh&&I ,fitappe&helping the p W n validate reality. The nurse might wnfront Karenwith the following: Tou told meyour fatherq e c t s you to geta&. '~om&es a u?ittenmet@ in b m,diftca.tioacan y.ou elateoneincidencem whichyour father told YOU this?" 'i" lientand n m e R@W iaw~itinga he dew,^mirw erher d o lae'recehd d e n isa&&. ne&&W 8 dated and sighed by Bo&~ and& e [m-~].BenaviorModiflcatlonBeha* rn~dtfications a technique batd on &e hetheory b t Assertivenesswarningb W r must be rewarded or reinfed to mntinueThis t a m ebas been used kquently with children but i s d d v e with age ?mPle m y espond to situations in an orgroups. Behaoior iS determinedby thereinforment patternthein&- t @ ~ e r t i ~ eanner.&pssion impliesmeeting &S - *a-ddual& earned throughout his hi h a er'fe.is knbnown aS o p e out egard otherg. The passive pasm S U P P ~ ~ Sr her avn, &wad@ anundesirable behavior is known as desires inh r f others.~ssertiw ehavior implie -~ing on&s-monfng; reinfarein$ a desirable G W m s called Ownneeds,but unlikem a n , t & ~ . m ~ l ~ ~~~ides ing,heotherconmoning.~ehavibr, hether sodallyacceptableor notis continued for a reason. The individual thebbehavior sees S d y , women were wnaoned to be p&ve 'J-)&reason as g o d , nomatter howdbtwdng t may seemto 0tha8. were aughtto s y p r a heir needs.The pawiye person ischangean undesirablebehavior, the reward for the behavior often aken ah- of ~ & e eopleembe counted on o do w&tis - ~ d . ~o a-engthenan acceptable behavior, the behavior isrewarded. It souads simple,but inactualpractice it isnot easy.Not allbeh&~Ts re wntinued by the samereinfarc-t and not aILpeoplerespond to the same rewardTfabehavior is to be ehnged, mustbe speci6edly denti-fiedThebeh~xiormust e stated inconmte t m . A baseline isthenestabIishedby obsmingthebhvior to be changedand rec~rdinghen w e r of times it ouws .This provides a basis for d e t w heeffectivenessofmodifiealtionattempts.~ n efthemostd@I&t aspectsofbehavior modificationiS o dis-mvtr the rewanl the individual ismxiving &m thebehavior.DDuringthe baseline observations, events before and after their behavior

This nay give a clue to tfie reward the individtd ismitrjngfrom theWOI.n the htillowhg examfle, it is evident that thean&&i&Jewives from abehavior is not alway~ bhllS.On sL*(ieTBIoccasioas,M y hit Annie Mthile playing in the


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4 Chanter 5

is asked of them but t h e y q aent i t They canbemnie veryw,but ange~s seldom - W e d openly. Ifthey do express an$,&,they fed g d Q and mu@make arnends. Passive people hawe d greatneed a be liked Their self-mnqt is vulnerable to the comments ofothars, GomsequeatIp &q are not seI-dbctin$ and have & c d ~feel@ p o d aboutthemsek.

Men in our sodetg.have EaaifiomIIy b&n fa@t 0be openiyaggresm. Tomen have been encow-d to be wewive anly in amsaiwe sense.Passive-oarafa to amanip&tive typeofbehau-lor. The mmlipuhtor%mpts tn get his or her b a y by inflicting guilton the receiver. 'The following is an example of manipulative lxhavinr.It isall right if you want to go t~your party a d eavemeal l done. Enjoypo!melf and not@vea thon@Lt to yoafpaormoher in this big housewfth n&hg to da. I stapdhomeMthyou whw youwae smallbecause I lavedyou,butI do .atwantyouto fdahligated.Yougotojrowrpartyand hve aacod t h e .

Thiskind of statements&e&ve for gettingwhatis desiredby nfl ict-ing;guilt fdirlgs.Asse&m requasts .wemade in a n ~ doneofmiee.Theyafespefftic md reasonr;bleandhcludc threeelements:

Q~sbdetationofthe otherpezwn9sk e h g s0 nderstand how you feel)

11I A stawnent of one'sown eelingsI W s the wayied,)Therequest itselfEhis iawhae f would W.3

The following emmpte 8Iustratx-x the dB3ence bemeen ggraske,passim and l~ssertive espoflse~.Sitaatiatt: Jane is a nurseworkjag in a twaty-bed corn-

p 1 e t e ~ ~ tk r e i s a k e a d n mRN,and an aideJanehirs been a s w e d &$itcIienb, the RP6 has five clients,a d Phe aidebas s ew4 Jane f& shecannot give adequate~ t 0 ~ a a d t h i t t ~ tisuidw&ee ;;he has taka &z? =*atdIweekSlxedecidesto t ak ta thehead nursea b u t the&wtPDnThe headamst ~esponds,*Im omy Them i9 nothing I can do. The

I , . . . , .PASSIVE ..-i: .~A:- ASSERTIVEBEHAVIOR i 'Lw-@ $+ BEHAVIOR AGGRESSIVEBEHAVIOR


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EelieuingAnxiety~

SUGGESTED ACTIVITIESConsider he d undwwhi&yo~ ecome d o u s .Do yo8 usuallyrespand byh"oz&g dependentwitMraw@gcessive, or&mt?T q ~dhe feeling9 evoked inyouwhen you are a r o dsomeoneuiho sexp&moderate orsevere anxietytyPmctb fhe relaxation ezergsw dwded n this chapter fortwmly to thkgrminutesa day.

a m e crtmdous&-to Mm b&r&your next~sni&[email protected] be. nam, r ~ a d m w &eUnp;g. qm &q d i f ?h - w mw& ,duringanw t s o n y. ,

)REV1EW- -mowAND C O M ~ P R E H ~& MuMpk &ice* 6el@ the oneBpstx~ ~ p & , ~ ~ ~ * . g ~n~t -3Q lZPa*ans.res~tBtBfrsm&$&,J0 B . .~~ h $ d l ; s . i S .mF

~ , A , .p C,,% @\@ > eU S , . & ;& kp D.,>Z~* :$$?= or g w.-2.;.J$tw@&:w= e I &.&&,&p&@ge~,&@~~b~~0 B. fdkge~~tj$f@~Q Q ~Q a : ,mrn~-;,

"a. A , & & $ p . * ~ @a A.mm& , o m . & & ,$dprnm&@.$hi


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183E Chapter 5

i! The b-or digplayed by a buspitalkeddentwhomnstantlycompkin! and defies rules IsR dependence.Lt B.withdrawal

Q C, donina'tionon.ssion.

r n L Y YOURLEARiumaA. MuEtiple choice.Sdeetthe one bedt ansnier.

1.A nme hasworked a shift fmEorweekends so thatfbepeer could have time ofTfor reamtiowl &ties. Theper says to therurr^je,"Im d ~ o u m&for~nextw&-end, too." Chooseanmeptiveresponse fw thenurse o giveta fbg co-worker,d A , Y ~ ~ d t h a t y ~ u h a v e p ~ f o r t h e ~ e e l r e n & h u t Ilaveplan9 also. SfncePaealreadyWQWhreeweek-ends for you, pleasemk komeoneelsewP B.? had madep h ax the h e n d but realize 2 s mpDx-tant tg help yon Sur& Il lwork nwtwe%kendforpaa0 C,~o~bahiMtysaskingmetoryarkforyo~ouneedg,agkmebody else.{Lt D. m y o you k q skUl;e:me fawork foryou? DodtyouthWTba&lkkT"2. Th e anme gathers data fivm a new client adWtedwithGenera&ed lX8arder. Whichstatement the clientwouId hcfkate theclient uses pasamebeha16m in-tape-sonal lalapimhips74 d 've b e e n mm my&ter domyh o nm r k fmme:Shed o a t have a job andmight as well helpme."D B, "Idwnp putmy Mdrenasandspouse'snee.&firstbutitdytiresmemta,adit'shardmkeegupwithwhatfheywantuD C. JIthink talfegood care dmf*sselE Im proud ofmyprofessiandwork andhawea d g ationskip

with myBenndsPP D.'"L'~&gotto~valcecareafmy6e1Pbearusewb~&~ia$0- to tfa t. I d ~ y @ay, &lve theman nchmdb y ' U ale amile."


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5.fear

D. Briefly answer the fonawing.1. Create a table listingeach letd of anxiety and an exmplle,. eRowyou have e q e r i e ~ dach l e d What ~ y l

n2. %%atarefmways ta relieve anxiety?


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OBJPCTWES--AAee studyin$ this chapter,d e he~denhauldbe ablem.r IdemS.f3ifhetheories of threepqdmtkrapim.nti Ide~tify dmicpmwedby eachwe ofpsych*apistD e h e r am? fteqwntlyused inpsyCh0thmp~

m State the functFon l& of rnm&wness oftke d, ego, and-

E l @lain howseIfdwarenesshelpti to Solvementalproblems.

There are many methods wed to mt mental b e robIenfsenfSM&& wed dIre&y on thebody are called somatic therapies.oVlrea the d o nm e n t is chargd or c@d& them w t sr e f 4 o as&eutherapy. P@&empyum vetbal anaqrea -s& tecbaicpm to hhp clients resolve i~lflepW&C@ and ma*b a r n .

&mi& Rogers, andPerb ark just a few of the peoplewho havedevelop4 psr;.hother@ies. Egch af thetamen has coatribwed infor-matipn us& iade~stamnd trw human behavior pmb-lems.'Be nurse bee& to h v e some howledge of the techniquesemp- thet d o I o& s r d nd thebasicbelie&miler@% eachp&&apy mble 61). Althoq$ tk heN is not apsychothWpWtheLWN inrwam with &enswho arp beirrg treatedby +&empuand therefore,shouldmde&and the prindpb of the p@otherapY

Cllkil't.centeredaherapy

PSYCho.anaksis

Rationalemotivef?eraoyj"-,x

ofOoncUtlpnWre-f!eXeS &Used UYprevlause v e m l t "' an be unlearnedand r e p l a m bynew, moreaDprorDriBteb%hav(gr

fo r ourventbahavr6~h@@psrsan& w eth&Deh;?Yiorby W V h g tlb~ ~ - U I U SE~ewpemon antsto BChwVebBlf-actuatlzatlon andMI6 drwefs theDerson's mottuefop action

" AThe mind conceivesexperiencesas awhole: when anexpefleflce 1sIncomplete,aproblem may r s u R

Abnormal aenavraftsa resultM -encesthat have beranrepfessedInto heperSon's unwn-serous mlnqBehavlorlsdue towhat peoule bellevsaboutan event andno t$heevent itself

Help the


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, ' P S V C ~ O * ~ ~ ~ ~ ~ ~

~-

T p ? aggres~ian n d ~ ~ ~ .heid opmtesat the u n w , m ,evela sruled@ thepleasme prineipIe.W e s no sense of right orwon i$the id,On?ythe seekingpr dem@ding dEdEimmedizt&atisfacfion,Theego S thew3nsdousse E t is through theego thatthoqhts,fe~,.atians, an d compxomirrsa.amed. The ego sw& tocontrol the pleasure prindpie of the idby substitutingther d t y pjm-+lee Thismeans t h s he ego seeksu,delay the drim &the id untilthey ran bereleaged throughappmpriate bebvicu,The egoWWSo Control and to guide the actionsof an indlvid?U@. It is a mediator between the &cfw &vm of the id and th@

afsearie& It develops through nternebionWith the enuimn-~faent, eveIopmmt of the ego begins during the six to eightmonth ,oflife.~t aboutrheage of two lt ism^ fairlydm10pedThe.aperegodwelop later, usuallgaround the age of threeorfm. t eS genmally fairlywell dewdoped at the age often years.m eSaptTego i6 the i n t eWe d parental value system &d the con-s c i w t i s concernedwiththe demands.of societyanda d o r e con-

I trob i m ~ u khatwould mdager st ie ie~t is responsible for helping; the individual to d i g n i s h rtght &ommng.The supeEgowbrh iitboth them&nsmdu n c ~ m ~ i ~ ~ sev& but p atthe uncc~nscious&~SYCHOII.NALVSIS,

Q#&erndhril@m -dilt&,h~a STAGESOF P sY cHBS ~ $Lb@JgLop~&q~*& v:-m*2.hieve-@@ miad g mYimg '* Libido refas to the sexual dIf'vp. P i e d pz-opr~sedb\the lib$&,

,&t@%.mp& ts,@ '-&US %&it%i.:aR! be$ins ta deoelapat birth imd &DU@ & &@ ~ ! ~ ~ ~ t a g m i hheg&@pa&& h W OD,*w& ,d life of the ndividual rable 6-31.The~ h ttage of libido devilop-tis from birth to e i p ; h months. This is &om m the stast3@mt&m,, ,I*hknri$*f&~ @ $ ~ t a W , , - & g b%mB&- ,&2 @&tFy because the idint recziva all of his or her pleas- h u g h the,% *a&,W @+@@ma @r-;f,i.i@ ' e rm a 8 8& mouth The second stage is the analwe,whi& oecm Between the,a*, &m&*- -$ rn 8ab%o*% W m of one andThree. It is in this period that toilet V q ecomenot tare w g e n t iWHSs,l-j very ~bportantThe third stage is^ the phac %a$e. &e child4 9wmw&e &wm&yd;anytw" be@ to develop a wxwd idenBty and becomes aware ofhis or her

Mris ail ea tpe , t s a a ab ,d&w. body, espealIygenitalia* &* a m *@& aim~ f m & w q [email protected] n a g heW d tage, the child developsstsong eelings towadIncwe,g-Mee&ne~w-:@,'@g WQla"iQup PSrenf ofthe opposite sex Theboy 6Us n love'with~motherand becomes jealouiofhis f&m. The$irl growsdoser 0 er father+* @g:w*adbred,w -@& +w, &e,-~ a d kames ealoou8ofher mother. This behavior, n e c p s s ~a or-,& d e@$$l,;tnd;tndInS'mM&&a&&@ Tfre dweIopment is mned me Oedipus conplw x_ inmales andid @&@@&.-,bP1'&,&m'tp@ &&e @@&qi$y ~ 3 ~ s&@ ax?:@ e @ a complex in females. The Oedipus: comple m d m the&gidla&"*. m*. as.& : w*" mythical 1%~ ~ ~ p Wwho ldlled h@ Gther andw e d is~ ~ + ~ w ~ g ~ o ~ ~ , & evea; i%@,,~d@% mother:


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-- I .anrc stage %ma1~r&ntlty bwln s to develop. he Plea- :5 zone 1s the genT&l area. The rdVld

rirr~lalnnsm w n s eeLlhss forthe parentW ,i7vy"-,-.'--- - - - - ~ ~~ , .-; ,he opposite sexand w&ts:that p e w ll t@ J: hrmself.~ t wtweends w h m m e c ~ i l d t a ~' ,to Identlfy wi&.ttwparentof m e same sex. 1 '

&ency stage netween the qges OF six and eleven, sexual U@ings are gomant.The child paitlclpatesm ,more soclallv approved actlvmes.OrOUP tnt*I , .Iaction IS very Important.

oenttal stage mi . IS t h e m 1 phase and I a reawakening o wsexual urges. The stage begins with adoles. ;cence and moves toward sexual maturanon~ 1$and sexual relatlonshtPS. - .It should be noted that same experts do not believe that all children experience Ereud's swes of libjdo development krtheraore,these stages arenot accepted by all a u t h m a .Accalding to Freud, psychologid pmblem may occurbecause

of anrested d d o p n e n t of the libido. The therapist attempts to disrnwhere the libido stopped developing and why It is beIieved thajthis information is in the unconscious. Through psychoanalysis, tbicidormation israised to wnseious levelwhere it canbe dealtwithFree association,caWis ,hypnosis,anddream analysisare echdques used in psychodysis. Free associattond e r s to a promsof counselinginwhichtheperson says aloudwhatever c o r n o mindThe t h q i s t listens and interprets the person's statemenu&thmia is a method of fecaUing to memory an experience that icaw a problem andhelping the personto eqresv it Hypnosis ian w y nduced statein which there is maeased responsimesto swaestion In dream analysis, the therapist interpreB thimagerythat occurs dming sleep.Witance and transference are a h erms frequently used ipsychoanalysis.Resistanceocnus when the person tdes to p Mthe movlng of infarmation from the unconscious to the consdo1level. UnIess the w o n s able to work through this fesistanc

pmgress wiU not confinue. Transferenre occrrrnt when t h e persangm% the tlierapist characbisties of signi6cant orhem in the person'spast lifo. Thi&process is thought tobe n e w q ormwmqPsycbmnalysis isa very sl~~process.eCovexy m y equire fmmom tomanyyeam of intensfivetreatmentCLIENWCEMERED THERAPYElient-centeredornondirectivetherapyww developed by Carl Rogers,a wntemperarypsychologist Accordfag toRogen, the actuakhg ten-dencg i# the person's motive for action. He b&eves that under thepropet cDndifiow, people have a natural tendency to progress to self-actualimtion.Rogers doesnot Geeterms uchas~ c omd ou sr libida.Hedoesnot beliem iE is helpful to interpret past experiences. Instead he usesterms such 49 8 e l ; F - a wm and achdimdon temlardes. Rogersbekern that anention sbould be centered on the person3 pf%6on&tyandfeelingsat the presentA poor seEmcept can prevent seIf-a&dization. When peoplesee themdives as Merent b m what they are actually experiendng,they become incongruent bc- intemal harmony). Theydistortand deny anything that is not consistent with their self-conceptincongruence causes them to become anxious. Thepurpose of client-eenrered therapy fs to help people i n w e && selfawareness andthm Improve their seIf-wncept By beeomiag self-me, people canview their problems more re&tidy Tbis enables themTo begin toaccept themeIves and their enwonmentts.%chiques med by the thempist are based on thebelief that theperson has a s t r a n g drive for serf-achldizarionThe therapist@laohelp thepepson reduceanxie9 tension, and defensiveness that blockthis drive by pmviBmg a nonjudgmentaI e n v i r o m t in which thepewen actadp heIps himself or he- A noniudgmental envkon-merithelps theperson tafeel safeandnnderstoodWheh d&enses areEelaxed,amore redistic conceptofselfandthe environmentcan dewl-5p. The therapist acceptsthe person ashe or she is and doesnot try o%e him or her.The therapist promotes an e~lvjronmentn whichthe person can changehimself or hersel The client is encouraged to-1:~s his or her feelings. The theraptst listens, tries to understand,then restates the person's thonghts and feelings. In this way, theperson is able to hear his or her own Teelings expressed This leads toincreased self-awarenessDnceaperson isawareof-howhe osshefeelsand what makes the person feel that w a ~e or she can begin to*rove the behavior Rogers' a ~ r o a c ho psychology is humanisticandhop&.


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7& Chapter 6 .- ITbe zttinule of b e therap?& is af primary concern to hgk+.Rogers b b v m rhat the therapbt mmt have th ee basic qnatitim tobring aboutbehavioral change T&path~,mitive regard,d enuine-ness. The meet i m p m t Ofthwe13m g . knpathg is the quali-ty df ur$ undersyandhg Zbe person b o q & orher ex@eriences,and tqing to &eehe world as the client $m i t Empathy is under-stmding the person's fediap, even h s e b e h awareness Thesw-ond,quay positive regar&mwns that the thempist must accept thepmon as he or she S,Thetherapistw%erjudge% nterprets,aprobes.The cIientismtsted o ma-kathechangemssaty ar m e I f ~rhW-self. -eness is the hird qd i@Forchage to o m hetheraipistmust w m a @ t e i n c e r i t y .tothe pwon.

Behawinpism is a type of therapy that examine RarZnal anda b w ~malhehadior a8a result of mdiri[~nedreflexesti$pNarily used fwp q i e in anxiety states or vvitb&eah disodpps. It ts Geldom risedwith a thaught-d.isoderedperso% Joseph%1pe hits d mmuebworkIIIbeha4orism.Behaviolism is based an the bewthat a11 aaion { r a p m l ismused by a p d o u s m t s h ~ l .p o n s a are learned durjnglifemm .%%en a stindm o'ccnps, a pasgn wponds in a m y.Wt @wes plea8um orpnts hurf. Tor exdmplle, each time aW$a= neara glassw e , he mother sapM with it@at O f purdshmentThis is the thetsndm. The cbild stops to save or hm1P fromh e his isthe spnnw When the child Iearns that stoppin$ is thesafestbebvior, this behavier continues6 e hes thuh mcm'9.BvenfuaDythe response becomea automatic Thechild is &en safd tobe c~di tbned ll rwonsm M e both pnsitiw and negative aspects.The childls respoasesaves him qr her&omp i i s h e n & ut itdenisthe plmwe of twi%ng thewas& If arespomehas more positim tbanne&tiveaspects, it is said to be nrlaptive.childtenm y espond to&muluswith temper tan- Efhe-.tanmm estrlt &them getting what thepwsnt Gin this we, han-thevilse3,tl~ey;o\Fi2tmiauausingthisbehavior H ~ F ,an- isws& in terms ofen=, so&isconsidereda maladaptivermpme.Once abeha8ior h;?sbeen learned, itmay result ruma s tbdussimilar oa associatedwi& the orlghd one.Tbis iS calledgetlemliaa-&sf For axample, aamandev8Iops a fear &plane tdps bea we of anacdaeht. EarentuaIly, this faarmay p m l i a e o otherw.he I T Smag feel anxierywhenhe goesto rheairport tomea afriend.72ssmfand s m d ofa pl&e msy b q istress.Eoen t%llddings ma$"cawhim 0&eluneasy

Some terms mmmn in belraviorlsm are eztinctiolr,displace-me- r e i $ m m andconflid E3tinrrion occurswhen a conditionedresponse is stopped.ToFrend, displacanentmmeant taking our hostili-ty on someaneorher than the one for whom it is intended?t,beha*-i o m , dispkmmmt is the act of engaging in%&stitUtebehavimReir&ormrwt is&e saiefactiononegets from a@d a r respon9e. Itis why the behabehavior continues. Con$& as wed by the behaviorist,re& to a situationin which two conditioned respomes oppose eacho*hetPor example,Jane's boyfriendhas requested that shewe= a par-ti& dress on a spedal date. Unf o r t~~~ t+ ,anehih(i gllinedweightand the dress no longer firs. anehas been cqditbned to please herboytitend so shegoes an a dlet Shealsohasbeen conditioned .to sat-isfy frustration& eating. f Jane becomes Eutratexl while diettag?sheis faced with c&ct bemuse she must give up one conditionedrespame to satispYanother.Maladaptive wonses mult fmm e a r h wents, but the behav-ioral there 'st& net interested inexploring the cIienfs prast It is thecurrent b avior and its eurreut stimulus that interest fhe thefapi&rBehavior conrinues only as 104% as it js reh%orcedcedhe stimulus orrein%ommust be determhed and stopped, an avmive comequmceadded, or a difkentb e h a w reinfor~dor change PO o c mDm@ the firstsea$iOn,the them@& akes a derailed his,tory,Thebrstory ncludessuchhhemsw he client's age, maritalstatus, edueat~n,and occupation as well as&a her relations@s with athers,U dbehavion, activities, and hkes and dis- also ar e & ~ s e d t thistim% The focus is on the hehavior the de n t wishes to chan$;e Thek a p f s tmay ask the client tokeep a The&'tory and d i q helpthe therapist determine the maladaptive behavior, the extent of thebehaPior,and the stimulusforand consequences o f debehavior.

Thebehiorisst is primarily a teacher of newbehavia=. Ar t i~ ixare orientedtotvcirda goal fh;lt is stated in specific,m u r a b l e tams.Helping a permn to impme his or her personality isnot a measura-I ble go d because it is toovague Successof the herapy cannotbe deter-mined bya vaguegoal,GodsmusfbespecificAn exampleof a sp&cgoal is Teach the client musele relamion exercim .she can use ro'i relieve a m i q r before examhatiom:The technique used by the behaviorist depends on the sitllrrtionand the consent of theclient. Tkchaiqaes include" Modeling to demonstrate appropriate behavior.Q Desensitization.': Maselerelaxation13 Assertiveness training.Role pb@ngqBehawirk modification.


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I'M-, hapter 6

RATIONAL EMOTIVE THERAPYRational emotive therapy, known as RET, is related to behauiorismWonal refers to the person's abBy to think; to emote is to expressfeelings.Its founder,Albert EUis,was convinced that aperson's behav-ior is dne to his or her avn hinking,Problems are not caused by spe-cificeventsbut area directm u k ofwhattheperson belimes abouttheevents.Por example,Karen expects allA@ut receives aE on a test Asaresult, Karen becomes depressed and leaves schooI. Sup&%dy, itseems that the grade causedthedepression.Ellis, however,would takethe pasitionthat it- not the grade but how W en viewed the wentthat cansedthe depression. To Karen, theBmeant failwe Shetellsher-self that she is an awful person because she did not get an A. Thismakes the event a disaster that Karen cannot handle If the p d e adnot been al-important, the depression would not have occnrred Elliscalls this type of thinkingmas&* and says it is the cause of allmentalhealth problems.InRET thereare nom C s or shaulds.There is only the reality ofthe situatian Oae shouId not demand hut oirly desire. It is not sation-a1 tobelieve that onemust get allAs. Itis irrational to demand that0th- - ~crs respond in a certain wvay.Some ~!~entsr c impc~rtant,u t none areimportant, Some events ?re unrlcsirill~lt. jr ~ncc~nvellierlt.ut noneareb t r o u s .To Ellis,whep a person sees an went as awful or tenible, he orshe is aa@IizinJ; or c a t a s f m pw . Catastrophizing results in alass of caanol over behavior. 'W~thoutonboL there is no problemsolving. The consequen- may be s&-defeating or maladaptit-e.Thephilosophy of rational emowe therapy is expressed in the phrase%'the world gives you almon, make lanowdcN t is notwhat happensto a petson but what theperson does about the event that counts.Since problems are a result of masturbatory rhinking, the thera-pbt wbally attacks the &leafs thinkjng ~r belief system Thoughothertechniques areused, this wnfsontationor attack is the 6nem e ,basic RET technique. The therapist might say something such asWhere is the law that says you must always getanA?""%ow me Theproof thatyouarean awfd stdent' Throuph this echnique,thedm-apist tea- thepersontothmk ealistfcally.Realisticthinking leadstoproblem solving or to the ability to copeuithsituations that cannot bechanffed.ManyRET thefipists ehfflurageheir clients to live bythe fol-

God grant me the serenity to accept the things I cannotchange, the muage to c h q e he W g s I can, andthewis-dom to h o w he difference

COONltIVE-BEHAVIORAL THERAPYToday, eognitivebehaviod therapy CCBTI, adaptedEmm thewark of A;aon Be& is a current, sucwsful fm f' psy&other"py,espeoiallyin outpatients Eorboth indivldual andgrouptIn GET, the dient is cmfhnted with inationaL negafive beliefsandattitudesthat drivefaulty,negafive and emotiom. The goal isto recognize the mnnection between predpitxting even@, tbaugh~,m d actions. The "IshaWwuld/woulAiought toirnghtW f'onkfthou@ts are reframed intoTWPa positive tho@% producing apasitionastiori).Themdt is an inneased abatyTOadjust and func~eion eEecridy,whish I=& to m9re m-firfactbnwithlifeStyle of disordeMm g ncluda eatastraphizing,ovwgene~abat io~ ,nd a l l o t - n w hinlang.1 Catastrophizing: exaggerating the importance of negativeaspects and pla.ving donm the jtnportance of positive things.-?eg& 'thought:Iam done in theworld

r: Positme thought: I knaw ndlovemanypeople.t Ooergmerdzation:maP;ing a gemalnrlefmm one idstance.- Negative rbo&t:: 1am a &taI B.otat math*- Positiw thonght: I'mhaw a W d t ime r4gat how-eve?, II mpr- mymsth scornnow fhat I bat% a tutor.3 All-o~mthhghmk.ing' thingsareblack or white, good or b9d,oh m is no midTEle ground.- Nqdve thought: I am notperf- I an a rmalW mPosirhte thought I have imperfections,sa dodoes eoerJrone I

am making an effort o feel good about myself&lapfed $om Buras, J3. i98D). Feelingped.Mew%irk ignet.

GESTALT THERAPYGest;llt therapyw a developd by PritzMIS. Itt my cornplattern based on the theory that themind conceives Brperiences as awhole Whenancqmime is inmmpl&e, a pmblem mayrmIt Thegoal of the Gestalt thm@$t.s tohelp thepe mn completerha xperi-ence an d incrwe au\mreness. A wmpleted eqedenee is &d a

Zb the Gestalt themprst homfflsktiiebalanOebetween thepersona d tis or hez imimmentis inrponmttahealth.Theh d y ersonis in b h e e w id be enairarmern and rnathtedby an awareness ofneeds,~ ~ u r c e s ,d e&&ans Thisavwenes8 makes choiw avail-able andallm the pason o take fflnml ofhis or herMe. roblem


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- - ~~ -I

3s;~-Chapter 6- 1result from a disturbance in homeostasis+Symptoms anseas a resultof the body's attempt to maintain thestam quo.Fqmknce andawareness are thetwo most important.aspem ofWtalt ~ P J " .nly thepreswt r t m because only tIuc present canbe experienced. C d f s hat were inmxnplete in the past mwt bebrought to the present in order to be completed.Each person has theabilityto complete his or her etlperience and relieve the prqblem. Thethempbt acts as a guidein helping-thep m ecamem m ~wareGestaIt therapy isused to treatpeoplein anxietystatesand ho*with somaticand affectivedisorders.It can alsahe used to enhanceliv-ing Eor the mentally heal* person. Three common techniques inGestalt therapy areexaggeration, f a n t q ndppesentiEin$.Ezgp&n i5 a technique used to help the persat becomeaware of his or her body hguageIverbal language, or frEa6ine;s.Forexampl~he student vstbaught herself anew dress.Shespent a greatdeal of money onit,but now shedoes not like it Theproblem isthatshe dues not know why. The qtudent ismld to Iaok at thedress andtdlthe ress shedoesaotlikeit Shemaybeagkedta rep& the wardsseveraltimes, mehtime sayingtbem wder andmore fodu l$ Soonwill o e m f the studentis listening to her feelings insteadofjusther wards.Ettggeratian is &o used when a person isunawareofhis or he2body lang~~+$effhe dientwwmhis h a d while talking, he therapistmight ask him fo waggerate the movement by waving his atm inanever-wideningarc.Since fhe movement is cxagpated, awaxenesofthe m o m e n t increases. When a person is aware of behaviorr be orshecan control itWhen ;Fan&ng, the &eat is asked to b d g the futufe to &ehere and now. The studentwan@ o buy a na y car andhas tQ choosehemeen twopossib&ies. Oae is a baghfly eolored sportycaf and theothef is a much less q x p e n s i a e wmpact She conTindy uaciIlatesbetareen the two md just m o t make up hermind. Ta help her, thetbarapistagks the studentto fantasizethat shehaseachofthew,obeat a time She is ask& to pretend that she is 8g in them, dslYingthem and meetingherfrienh,Then shetrm on each situationsheisasked to concentrateon how each fek,Presentkingis a means o f b r h g i i a past went into tbe pmentas &own in the follomg example.

A student come8 to the M p b t bemuse she f& @lty.She bad been invited to yisit her great aunt but went 8utwith her Bends. The avnt djnd suddenlyand the student:cannotforgiveW he therapistencowages a dialoguebemen the auntand he student A n empty chair s plat&

in&wtof the h e E he stadeat pretends -rt.leaunt ise a t e l inthe chair. She is thenasked to conversewfth themtThestudentalternawiakm tM part ofher asmiandhers* dxqing chairs whea appmpriate. $be is enegm-aged to sayw&Ww c m s oher whilepkBrng eachpart, She is ah0 encouraged to be aware of her fadingswhile playing each This d i a l m e is a fmtasy, but ithelps to inwease awaenms. Throughthe p l eexce , sheisable to b a m e amreofher fedhgs toward hergreatanntAmmess is usually sudden as if a 14ghthas been fumedonw& m e a s omas wnW. The studentLsthen bleto rid hm@ofhff gt&"[email protected] Gestalt thempgrto be effective9 tbeperma m m ~ think d wfn$-presentizinp,hPasiz&g, ar ~ ~ t i o ~ ,e or h e s jusr to ape-rienee &dingis. Peehgs amthe matarTancern.Forthe person toriencefdhgss, t is neeessuy to be selfdware.A great d d ftime m yhe qent bya e thaapist inhdping tb .~ecfteat increasehis ox hw selP-awapqnessThe therapist map dracyamtionto the &en& pasture o?toneofvoice, 13rether%pWsawn ee&@+ doubts,fadatasld&en*also be expressed.D r m re a dfmmttmtionof an ?.xompl& eqmr im~~,&Freud, the G e s W t daes wt attempt to d e m a n d or malyedreams The &erapi& helps the &eat expalent%the &am andincrease awmeness. &perienceesare taken at fa&vaIue. The Gestalttherapist feels &atmeanings emerge by tbemsdves with time. TIE&.era@t uses &ed and p w o m &qua. AU te&miqnes aregeared to hdp the person in-e his isher self-a-m, qai-enee *s am3 complere previouS2gii~~mgletexperiences.

REALITY THERAPYWlEiam Glaasef8wabythesapy s one of the newresf psychotherapies.

I Itsp q s e s to M p people gee hemselves aamatel. 6ce e&$, andI fhEU their q ~ needs. lasser beliweg that each pawn fias ampm-sibilityforhismher owm W r . A pason's prmmt behaoior mmotI beblamed oarwhat wcumd in t k p m RediQtherapyhas been usedWensiveipinthe rehabilitatfon o f j u v a e delinquentsandwithW-who h&ie&led in ~ a o i .t has &o succmfdy berrn used tu@duncehe ives ofpegpieduringm&d eonnicts,&es, andin treat-ment for chemical d q e n h eality therap has been sukwWpapplied byparents, teachers, andnder Ia~tpeopLeThexed+@ dmm@t must be a warm, conceined person who jsreal andgenuim%%en sppmpriate,thmapIstsdismss theiranmape


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13enm,achnitpezmd faults, an$ rewiQn&Wm&%ewS M-lm@dMost impwtmtl$ the th!m@t truly $y~mhe 32entThe reakfy therapst is soneemed a b m b e W r , r&w tb*urfeeIingsar b.&ghts,G ~ M Zelie= thatpeople h&e Emkd -1~wtErej,fe&@ dthaZon&beba~canbechaqkd.Ifrhepon~ p h i mf@t kelings, the thefapi6tmjgbt ask theperuj@nsdoing to ma?& himself or herselffed &?"; This &w%@ ehe cum-pM t b m feelingraabehauio~t also f6euses zesponsibj%@&r theguilton thep m . Mgthepresent s impmE4nI;~east s$one andm e . t be changed. Ethe past & d&emsed at allr it is o &cover thep.s@onlsmm$u. The strm$ths 81% zhen datedmmmmtbehavior.Each pmm has a respomiblitg to e Y a I W his or her awnbeh&r, This ~aalmttwn s essential bewnse behavior mn ~mechangedunlessthepersonis comrmeed4batthebebaaimi-~harrnfvltohiin or bee The &&pist m y xp~e 8 s m a l vdae.9 bat daw notattanpi to m p g3m.1on behew pemonbehavier is eduated and a d&im sS nliiae to change asp&c behavlm?apLBn is daielopd Eor chn@%hatbehaylor.Mu&ofthe therapist's time Ss spent in helping?heperson make p h ~orW change. fienext step isk r Ore clientto eomaithims&ar herselfto eaqylng out tEIE plBn EsSentid to d t y h q p he cofmnim%entmaybe verbal or in theform ofa &%ea c~ntiati. t is u s e a&to sweane @herthan he dfent Glassmb&eoesm1$.dilbec~metheycmn&makecagp&mxits to hemelm,

Tf a plan &hno excuse is accept& S a m d m a the p m n sasked whether be er ,she ininrendad to Tu16I1 f.h ommitmentgometimes &atmay be wked&en he or sheintends t@ o w b twa x0mif.dAt other rimes,the&nmaprtlqui*.e m 5 o n Abmluttely~is~ptable,memadismt~Thisis&em~importtantto d t y herapy. AnAn alcst ~srespansfbiliqrorcl the pet%&arrdetnpha&zesfailure thaapy duag atprwiding suaf%Verbalarphysioslptmishenf is never medbyth& -tdky t h e -pi& I;lasser aq1oysrw& he terms the~~ O ~ ~ ~fma&. Por exampIe, a a d y ammi$ imSe!for hw& to pmottQthe d m veryday in exhn@ orpI@~xafttu:child f& tQpxac-ticeche or she does not get ta play Thi6 is the B B W ~q u en C eb m m e it w;ls mntually agreed on b&m the act Wty therapistsbelie vet hi^ rmp&mis the ssameas mmtiil hdfh. Ifpeople aetina responsibleway, they atlain @& happiness,a d ueass.fRANGACtIONAL ANALYSIS'Itansactional ilnalysiswas dnzlloped by Fkc Rcrne in the 1950s. 'meatmof tzansactionalanalysis is to help people impme their 1h.e.s. t has

m e mmm!yb&&ypeopk .a& s &o$e& &~~ i 4 ~ m + m & & & e d i m & & & , ~ ~ & ee p ~ w i e s ,w-a @ . ; w i ~ p w i l p ~11-d g r ~ q s ~&me beii- that each persen am&& ta .a &pt orqtnjtesuipt mnntfmaipt t h e s k n parental S a m w .ThesCr& is-Wenby the individualat .avefyesu1~tge and sbas4 5n adeisiop. fhehedbidgd makw &om self and othem. AemnIime; totran$8crlanalanalJsis, a &soA mice'meof four d e o a :a y$n O.K., yotrtre Q.KUT m O.K, yodre no tOKP,I "I'm noOE,pu'm O.K*H T rn notQX,yunOU'leot 0.ETheaachlalricLipt i~atlelped r5n he We ofa s i ~ c a t ~ther.Atflm, it is an outhe, hut @add& it is m&ed md detailed.Even~aL1-p;tlmwmes the s d p t hatM u e n wth awn's life.A pason ensum the oatsome ofhis or her script tbroup;hgarncpky*. Agame s a sedw t~ fn w o n a l e l a ' t i a w& && todesired resultsfar game player A scriptbased on "I'm nat.O,Krm r r ~ iall forfhe h e d u r i l to gethurtV pmple donota~tamatiCanyhurt him or her, the person engages in behmim &at will Eerm fhm

to do80. Thisbehaviar iswharkme c;rllsg p r ~la)riw The errdremlt&a game i s the cement ofthe person'$ %sling aboutself:Tkmwtiodanalysisrecogaizesthree egastatepi:the pawat thechild,and he adult Thesethree ego stares &st simdtaneouslyin aRpeople;M e a n&one is dombmtat a time.Behmlasbeloqg&gto the tb w ego states rn earned by chWm $-om th& a'@~Bcultothelis. Pam& contain all the rules and adnxooiti~whildren haveh e ~ d ihe look#o f h nd the dmpp f ~ v d eenon themother's%a,t-he Ieflder hug8 and th e severe pw&n@ fhe &Id has receivedP,nIscanbeeithernuzturbg~rcritimL

wdrenhold alltkefeekngsandma pbe mt~mlr adaptive, oysad, or miscbievo~s.zaattd childrenbehaveby ku@&g, smik~@P dw.% re f m p d * aild sporrtaneous. They fee1i%a m w guilC anda.atural dbildra are ~reatme,Whaeas dapW dddrs n me hvdved with rihmband coafxmitr:Theadultprocesses and andpea arimut'i Itis the adultwkoaskscluestion?,mans,plans, and make$ dedsiolls (Table 6-31.Feople mlip~nd n my iraeraction through one of these egoStates. A husband coma home from work and asks in his %ddY* m e nwiU dinner be ready? Iliswife may respond by saying "Is k t~yauthInkIhavetodo? ' o u m n I d d o s o m e ~ s ~ m d h e r e ~help.Thenmybe yon muld have your dinner on tfmpt" Ehe wouldbe responaing in her"&Hcal p m t e Had she %lie& CIt uriUbe rmdy


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in a few minutps. You fust sit dowa thee and put your eet up. Geehoney,you look SO tired,"shewould be responding in her " u d n gparentn Her 'child e g mmight have s&d"kfsgo out and eat to-hpnr 4* that vou fc:amme y Ha adulf would have simply said-'Dinnetd re reah in a half hour."

Jn any tl:a.nsaction one m o t predict the ego state in whi&another p e r s o n d respand. Iftheresponseis in the sameego statea6

EIlo stateOf

husband

"Wllenwitdinnep Beready?" *4

"Inon e hour"

Eao stateO f

flCURe 6-1 A slmple uncrossed tran9action. Three ego statesexist in all People simultaneously. Peaple respond in any interaction through one of these eg o states. If th e resDonss 1s In thesame eg o state as addressed, a simple uncrossed transactionoccurs and communscation conffnues.


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go stateofhusband

sgm stateOfwife

"whenwUl Tranbfemddinner be - to parentready?" fo rresponseParentE l

"IF you W O U I ~ em . ...me, you mighthave dinneron t h e . " ChiId

FII;URE&2 Crossed transaction. The husband asks a question inhis adult ego state, bu t tne wlfe responds in her ctltEal parent.The critical parent directs her statementto he child;thus, thetransaction is crossed. CrQssea ransactions are often destructive.Others, though, feel thatthevanous schools ofp~ychologyavesamethig to offer, but none has the entire an?.= Thwe therapbtsare known as eclectics. They pick and chow techniwes from anyschoolthat seem to fitthe siD1ation Theymight d y z e elationshipswith one client and use fantasy with anoher. Theymay confront one

client and use the word assouation with another. Mmy times thesetherapists havetwo orthree avoriretherapies that they usemost oftwbut theyusenone exclusive&.SUMMARY ------: ----Psychotherapy is amethod of trea?ingmental illness inwhich ver-bal ana expressive techniques are used W help the person resolveinner c&cts and mode behavior. Mmy techniques are used,including psychodysis, client-centered therapy, behavio&m,rational emotivetherapy, Gat& thepapy, andtransactid mdpis.Psyhoanaly~iss based on the work of Siptmd Freud Thethempist obtains hformation about past and present eacpefa~esthat have been repressed in the client's subcomkious mind By

1-1 IWE bf peppwm ipsp r~b l k~aanbe h m e t othe ebmtioua migm Wile@, itw be d d t w%&The id,w, andsup&zB;o balance eaCh oibw to check behavior.P~yehoanalysks aaery langpmw , some- taKing-y yeare.CIientcenteedthff~apys based on the belief thatpeoplenat-m a y ww t uwdseEa~twht%onnder the riglacanditiuns.It isthe p p s e aftheh a @ to praide these conditfons.The@ax-pist provides an accqTtng, nonnjagmmtal environment aimed atreducftlg the client%m$iety and cefemsea that block ?his driwe.Client9 are muraged to ~ r e z sheir f-ge and i n m heirself-awamaesaWhen people are amre of howthey feel an6whatmakes them feel f iat way, they ca n wowork on improxdng behaxioeEmpathy, positive regard and g a u h m w are dhmctedstirs thatthe client-oriented therapistmwt show the clientkh;wjorism is a school of therap that believes actioIbgmcaused bypast even- Behadommnthue only if theyareaceampa-nied by a ward m e n a learned response becomes a m &peopleamM d obe canditionedto tlre response-ThaapWmeptlrm y eachem of newbehaviomm u s e d y f te&niquet~ eliminaterewards for und&ble Behavior or in- m i l sEw d&able behavior.Ra?iorlal emotive therapy is related to b&vimism Its fmder,&rt Ellis, w u wvinced tbata person's behwkr is due to his orher her tbhkmg.Prabierns are not caused by evenfa .that happenbut are a result ofwha B e a o n b e b s about the eyents.Therapyis aimed at h @ p g the pwon's belief s g a k and e d -~ ~ e p e r s o n t h a t h e o r s h e h a s ' t h e a b ~ t o c ~ p e ~ a n y e ~ e n fCogniGive-behawid therapy is a+ted ftom the work ofAaronBeck It is a cum&zt and successfulform oftherapy in ouLpa-b t ettings. a i m tewnf5ontedwith hatio~lgLegativebeli&end a W e 8 and learn howtheir belie%influencethefr thongbts,iWin@,d a c t b m .Gestalt theram ishued onrhe theoryBat themind conceivese?rperiences a whole.When an experience is hwmplete, a pmb-Iemmaymirlt Tl?egml oftheGestalttke~tpistiso help tke clientmple t e the expaknce though awareness. ExpMendng andawweness am the two =st irtlpmant aspem of k a p y .mawmes9, heperson can hangehisorher a o ~ nehavim The t h eapkt~pendsmuch tjmehelp* people hacomemore anrafe.ReaEQ Therapyahas o wsiat people 0 see themseha accu-rately, ro fam reaIi@,and to bXlll peFsanal nee&. Individuals arempomible far t b k own behior; present behavior cannot beb k e d on past events. The r e w aerapbt is concerned wiih


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b&+r, r&@ ;@Qfw*.@ tp re @ % a g e d @@uate>&& b k v i ~ r o m 13@&g?qnahtdap!@eb-@cr: Thewrq&telps @ &&e,pI@mor fhat &~&t$r@@a*p* h&epp. &;lt rwm$$ig &, M e @mend ealrh,pmP&d i s g . 9 ~ ~h~~py~@@hudfhelpspe~--&+-&&.* agd ;@d@ maitg*:w u s i p n , o,X,, m9te-QXK& &tapBt wegg&Biqgea from mme than onesch00I &pq&oiO@ a & ~ d e r&tpn&$ &Q%@8oa a t & ~ew& f&e &.en@ may .red&@ Thea e cwnmonllynsed d . & e g& Qf

therherapiesmimes migilt rn.WUDlW.-..,8- =J . , . * L.x , ;~I .

SUGGESTED ACTIVlTlESm W th a smallgrouprmake and play word b i o . M e everalbingo car& with d W m fpyehuthmpji terms,A d e r

caIks Qttt the thnns.Ea& playeralea o &d the ddW%on nh&orhmd h irstplayer tomer the definitions m e t -&*,hhkv a4 k fm the yadoug p6ychOthmapie8.Lrst hepwchoth.ewpy,itsintended goal,andthe techntgaes used toaamnpbhthisgad

REVIEWKNOWrn O ~ m mk Maltiple choice,Select the one b& answer.

1. C o n d i W r@m f~ a term aswciatedwithwhi& ofthem n h g psychoherapiie9?ok &Wwmo .Getitdt*ob@0 C, Z c e n ~D. reality the r m

a.According toPreudwhit&ofthe f oUoW controls andguides the actions af a p w a dP tl ego Q C, libidoQ B.id 0 D. superego

3.A Gestalttherapistassistss lient in acting out a manary afa tra-atic childhood experiencevvfthm abusivefamilymember. Which echnique'is tbe rhmpist using?tl A. fantasizingtl B. presentizingD G resistanceLl D. awareness

B. Erwd d&ed the O&pm avnpleaaswhich ofthe foUmving?O A. an abnormalhahador in developinggii-IBo 3. a f e e k g of inferior+tyassociatedwith familg.relation-Q C. a strong;f w f doseness a child has for the p w n t

of the appasitesaQ D. a smng feeling of doseness a child has for thep p n tof the same sex5.The erm Ebidu refers towhich afthe following?Q A. canseienceo B. setf-conoeptQ C.availablesexual enexgy0 D. m d t i o ~eapme

6. Which phrase cmCt ly defhe8 tO A moving wwmcious thmgha to the consworn levelQ B. anributing b c f M e S f a sigmEcant other to theP C.substituting one behavior formder0 D. verb- fPelin$saf@ and anxiety

9 Whkh situation accuratelyidentifies incongruencs?Clients:Q k ee themselvesasdifferent &amwhat thegmearperienefng.0 B,playm a n i pW Y e gslnes to aadsfy internd drives.12 . respond t6 a message n a cbild-Wnemarmer.CI D. change their behavior in esponse to a repeatedstimuIus.

3. Which herapistW d sedwensitimtion and r~laxationte~hniques?D A behaviorietQ B. client-entered therapistP c.psy&oan*t0 D, reality therapist


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niques?D A, dient-ceateredtherapist a . .P B. Gestalt therapist .Im t .0 C. transactional analyst I .U D.behado&

10.Accarding to Freud's Stag'& of libido developx~nt hichstage developsfist?U k nala B. phallic0 C superegoO D. osal

APPLY YOUR LEARNINGB.Multiple cbo i e Seled the onebest answer.

1.The nurse is assigned to care for a nwly admitted adultcEwon he ps'ychiatricunit The n&s physical features andmane@rns are similar to those ofthe client'smotha,whowasphysically abusive during the client's childhood. Whichfactor below is most likely t~ affect the nurse-client relation-ship?O A. transferenwO B. disphcementCJ C,game playinga D. ca6amis

2.A client diagnosed with an anxiev disorder is involved*Gestalt psychotherapy. 73% client attends sessionstwi-week with the psychotherapist In w W f the followingways would the practical nurse most appropmte1y suppmthe pyehatherapy?Q A. Have the client describe the dis&on from each a=-sionwith he psychotherapistD B. Use exaggeration, fantrtsiz'i and presentiang tech-niques in the nurse-client interactions.01 C. Ask the client to deswibe dreams and hdp the clientinterpret the dreams' meanings.u D. Assist the client to attend the psydmthempy sessionsregularlyand o be on time.

mend gsychothwpysessIcms trs helpmewith my problemsjbut I'm n agoing. I've s m xamplea of paychoan&ysfs ne e s d th&s nat fosme? Whtch responseby the nursewould bemost apEnapPiate?C;I k Tsychoanalysiswouldbe y a y efferpiveforpour prob-lems You should follawyour doctor's r e m d -tion"!2 a T9ychoanalysisis j ~ m t ne type ofpayeho&erap~

"Iclyour therapistcandedldeWMch approach i s bem foryau?U C.%a have he right to d&de w h a e r or not to followyour doctor'sr e c c n n m d a t i ~ ~ . "R D. '"Itdoes% 5 m d &e yanr doam s o~eringelpful rec-mmendatim. Terhap9you s h d d w e octo&

4. Thg nurse assists a client daring an acts and cr& group. Theclient sagis,Tm lSst no gomi at fhisstuff I don" t o w why Ikeep coming to rh- $roupkVThe clients plan of m e lsoindudes c o ~ ~ h e h a v i o r a lhaw swsionsWee il weekFhi& wsnmentby the n m e would be qprckre of theplanofwe7O A /? notieed yoa rayedfor the entirearb anti craftsgroupandwere encoxmgbg toD B. "Whattypm of activitiesd d ppeal to you more tbana m and cr&TO C. Tou &odd uy hanler to &b thea& projects youstart You give up tooU D. "GOeasiex on pornelf: Aas and6 s just a 6implewm- a e i i w

5. A &entin a psy.chiatricunit who i s also a suctressfulinmt-mentdm%,ap te henurseY'm nmr going ro bemmt:apartnerat my wmpans I jm can't predict ibanda]. rendsEke other&[email protected] The hoqital uses problem-ariatedprogress notes, Beside which ofthcfdnowing problem state-ments would the n m e oeamentthe &e&s dmnmn t ?Ci A, defmkvecopinga . impaired adjmtmentU c.altered role petfonnanceR D. self-esteemdistwban-ce


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1.Bsinging exp&*ncas repreraed is a. Behaxiorismd e a c w d o mo the mnscious C&ntcenteredlevel therapy

2. Baviding an acrepting,nonjudgmmtdenxdronmmt kfmedat redwing the &&'P m e t $and def- tha*block self-acmaI&aernendencies

3. Kmoving or inmming a rewardto cbxilgemnditioned r a p e s4. frrarional beliefs arerefrmedinto apost& thaughtproducing

a p o w e action5. TherapyM on the b M ~ a tproBbs are c a i e d by whataperson belie- about an eventand nottheevent itself

c @sM t therapy

6. Iiclping the dient to completean incompleteexperience7 Helping the &nf m seehimselfor herself acwadpI D face reali$,

andtomatGepbt0-emaladaptivebdavior5. &@up therapy inwbichCHentsm Mped to a d p heirmnsamonswith others

D, Brief* mwt~he finowinsI- Define psychotherapy

3. Name three essenW awbute s of the dient-ed therapist,

4. Howdoes selfawaremahelp a person to solvea meatalproblem?

3. rk-xribe the PcTicalivocatianalnurses role keg*P.%cMtberapy.

2, State the function ofthe id, ego, aad superego, Indicate thel e d of Cansdousne8s atwHch each opera*.


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